الفهرس 
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Abstract
Summary
C
omplicated cataract surgery without capsular preservation is one of the major etiologies for secondary implantation of IOL.
Several surgical procedures have been described for correction of aphakia, each technique has advantages and disadvantages regarding difficulty and associated complications. There is no established consensus on the indications for and relative safety and efficacy of these alternatives.
In this study, three different secondary IOL implantation procedures were compared to correct the aphakia without sufficient capsular support which are; Angle-supported anterior chamber fixation, Iris fixation, either implanted into the anterior chamber or behind the iris plane (retropupillary IOL), sulcus fixation of IOL and scleral fixation which may be sutured or sutureless.
The characteristics of the included studies; all were published between 2000 and 2022. They were RCTs – 771 participants with lost (781 eyes).
Mean age of subjects in the included studies ranged between 63.125 and 76.2 years. The baseline of the mean BCVA ranged between 0.657 and 0.236 log. MAR, The ECD mean baseline ranged between 1872 to 1717 μm and the IOP mean baseline ranged between 13 and 15.44 mmHg.
This study demonstrated a statistically significant difference in the BCVA improvement in all techniques when comparing the baseline to one and three-months follow up after operation, though with no statistically difference between the three techniques.
At six month follow up all groups showed no significant difference in the BCVA compared to the baseline and along the follow up periods.
There is no significant loss in mean ECD in all groups.
Regarding IOP elevation it was more in scleral fixated and anterior chamber IOL than that in retropupillary IOL, and glaucoma was the second most common complication in secondry IOL implantation after anterior chamber reaction especially in AC-IFIOL group.
The present study showed that each procedure had similar outcomes in terms of visual acuity and complications.
However, many previous studies have reported different advantages for each procedure;
AC-IFIOL is the best option in complicated cases and is recommended in elder patients with healthy endothelium and normal anterior segment anatomy, while the RP-IFIOL technique offers several advantages, including considerable cosmetic benefit, by hiding the IOL haptic and parts of the lens behind the iris and reducing the glare phenomenon, which is characteristic of the lens being implanted in the anterior chamber. Moreover, due to the retropupillar location, which corresponds to that of the natural lens, the aniseikonia risk is lower than that observed with anterior chamber lenses. The mean surgical time in the RP-IFIOL implantation was significantly shorter than that in the SF-PCIOL implantation.
Unlike in SF-PCIOL implantation, the opening of the conjunctiva and sclera is not required in RP-IOL or AC-IFIOL implantation. Although dislocation of the RP-IFIOL and collapse into the vitreous cavity were not observed during the follow-up period in the current study, it is also possible that the iris-claw haptics might release the chronically damaged iris and cause dislocation of the IOL for a long period after the surgery