Comparative Visual Outcomes and Complications Following Secondary Iris-Claw versus Scleral-Fixated Intraocular Lens Implantation: A Retrospective Comparative Study

Abstract

Background: Aphakia without adequate capsular support, arising from complicated cataract surgery, ocular trauma, or intraocular lens (IOL) dislocation, remains a common reconstructive challenge. Secondary iris-claw IOL and scleral-fixated IOL (SFIOL) implantation are both established techniques for visual rehabilitation in such eyes, but institution-specific comparative data on their outcomes remain limited. Methods: A retrospective comparative study of 82 eyes (41 iris-claw IOL, 41 SFIOL) was conducted at the Department of Ophthalmology, Sri Narayani Hospital and Research Centre (SNHRC) from January 2026 to July 2026. Data on demographics, preoperative and postoperative BCVA (logMAR), operative duration, and intraoperative and postoperative complications were abstracted from case records. Continuous variables were compared using the independent-samples t-test and categorical variables using the chi-square/Fisher's exact test. Multivariable linear regression was used to identify independent predictors of final postoperative BCVA. Results: The two groups were comparable in age, gender, side, duration of aphakia, and follow-up duration, but a history of prior vitrectomy was significantly more common in the SFIOL group (46.3% vs 14.6%; p = 0.004). Preoperative BCVA (1.76 ± 0.63 vs 1.60 ± 0.30 logMAR; p = 0.165), post-operative BCVA (0.35 ± 0.21 vs 0.30 ± 0.17 logMAR; p = 0.224), and mean visual improvement (1.40 ± 0.61 vs 1.30 ± 0.32 logMAR; p = 0.358) did not differ significantly between the iris-claw and SFIOL groups. Mean operative duration was significantly shorter with iris-claw IOL implantation (27.47 ± 4.1 vs 42.93 ± 5.3 minutes; p < 0.001). Conclusion: Secondary iris-claw and scleral-fixated IOL implantation achieved comparable visual rehabilitation in eyes without adequate capsular support, but each technique carried a distinct, technique-specific complication profile, and iris-claw implantation required significantly less operative time. These institution-specific findings may help guide procedure selection and patient counselling.