Long-term outcomes of scleral fixated black diaphragm intraocular lens in eyes with combined aphakia and aniridia.

Purpose: To evaluate long-term anatomical and functional outcomes in eyes undergoing scleral fixation of aniridic black diaphragm intraocular lens (BDIOL).

Methods: Total 38 eyes that underwent scleral fixation of BDIOL for secondary aniridia following ocular trauma with aphakia with absent posterior capsule or primary congenital aniridia with subluxated lens were retrospectively analyzed. Final visual acuity, early and late complications were examined. Correlation analysis was done.

Results: The mean follow-up was 28 months (range 6 to 66 months). The mean preoperative visual acuity of 1.82 ± 0.90 logMAR improved to 0.69 ± 0.61 (p = 0.00). The mean spherical equivalent refractive error of 7.88 ± 4.85 diopters improved to -0.69 ± 1.52(p = 0.00). Complications were seen in 9 eyes (23.6%). Early complications were raised intraocular pressure (IOP) in 2 eyes and one eye with suture site infection which were managed conservatively. Late complications were corneal decompensation 3eyes (7.8%), retinal detachment, hypotonic maculopathy and refractive surprise in 1 eye each (2.6%). None reported IOL tilt or dislocation. The patients noticed a significant reduction in glare disability and photophobia. No significant association was found between pre-operative factors such as prior surgical procedures, history of trauma and length of follow-up with surgical outcomes.

Conclusions: Scleral fixation of BDIOL is an effective option in eyes with aniridia and aphakia without capsular support that have undergone multiple previous surgeries. Despite severe damage, the BDIOL helps reconstruct the anterior segment and give a good quality of vision with minimal complications rate.