Rescue by primary retropupillary iris-claw intraocular lens in complicated cataract surgery: Risk factors, postoperative visual outcomes, and complications

Abstract Purpose: To assess the risk factors, safety, efficacy, and complication profile of primary retropupillary iris-claw intraocular lens (IOL) implantation in eyes with intraoperative posterior capsule rent (PCR) or inadequate sulcus support. Methods: In this prospective cross-sectional study (January–December 2022), 50 eyes sustaining PCR and/or zonular dehiscence during cataract surgery underwent primary retropupillary fixation of a single-piece PMMA iris-claw IOL. Pre- and postoperative evaluations included best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, and documentation of anterior segment complications. Follow-up was done at day 1, 1 week, and 1 month. Results: Mean patient age was 66 ± 8 years. Preoperatively, 64% of eyes had BCVA less than counting fingers at 3 m; mean IOP was 13.5 ± 5 mmHg. Intraoperative findings included PCR in 64%, zonular dehiscence in 18%, and vitreous prolapse in 56%. At 1 month, 72% of eyes achieved BCVA ≥6/12. Transient Descemet’s membrane folds (23%), stromal edema (12%), elevated IOP (11%), and pupil irregularities (16%) were managed medically. No IOL disenclavation or dislocation occurred. Conclusion: Primary retropupillary iris-claw IOL implantation in cataract surgeries complicated by PCR or lack of capsular support provides rapid visual rehabilitation and a low rate of manageable complications. Identifying preexisting risk factors such as small pupil (<6 mm), pseudoexfoliation, hard cataract, mature cataract, posterior polar cataracts, and traumatic subluxated cataract helps proper surgical planning intraoperatively with primary iris-claw lens backup and gives good visual prognosis postoperatively after cataract surgery.