Is an iris claw IOL a good option for correcting surgically induced aphakia in children? A review of the literature and illustrative case study

Refractive correction of aphakia in childhood can be a complex management issue following lensectomy for congenital cataract or ectopia lentis. Some children have inadequate capsular support to allow an ‘in the bag’ or sulcus fixated intra-ocular lens (IOL). In such cases, options for refractive correction include spectacles, contact lenses or surgically fixed IOLs. Many methods of intra-ocular IOLs fixation have been described and none widely adopted in children. In recent years, the iris fixated Artisan Aphakic IOL (Ophtec BV, Groningen, The Netherlands) has gained popularity but there is still significant concern about the rate of corneal endothelial cell loss and IOL de-enclavation. Here, we review the current literature on the use of iris fixated IOLs in children, the published data on endothelial cell loss and deenclavation rates. We present a case illustrating the significant improvements in quality of life which can be seen in selected children but also the rate of endothelial cell loss which can be encountered after initial surgery and a re-enclavation event. We make the case that until more data is available on normal endothelial cell decline in early childhood in addition to age specific rates of endothelial cell loss and deenclavation rates following surgery, the use of iris fixated IOLs in children will continue to be a moot point and is unlikely to be widely adopted