Abstract
PURPOSE: To evaluate the surgical outcomes of intraocular lens (IOL) exchange combining pars plana vitrectomy (PPV) with retropupillary iris‑claw IOL (ICIOL) fixation. METHODS: This was a retrospective series of 33 eyes of 32 patients undergoing PPV and secondary retropupillary ICIOL implantation. The primary outcomes included the best‑corrected visual acuity (BCVA), refraction (spherical equivalent [SE], refractive astigmatism), surgically induced astigmatism (SIA) and prediction error. Secondary outcomes included pachymetry, intraocular pressure, surgical time, and complications. RESULTS: The mean BCVA improved from the baseline logarithm of the minimum angle of resolution (logMAR) visual acuity of 0.73 ± 0.55 to 0.18 ± 0.24 at 6 months (p < 0.001). The mean final SE was − 0.40 ± 0.97 diopters (D) (p = 0.001), mean refractive astigmatism 1.36 ± 1.30 D (p = 0.955), mean SIA 1.39 ± 0.93 D, and mean prediction error − 0.28 ± 0.99 D. The mean pachymetry was stable (preoperative 562 ± 35.09 μm; postoperative 558 ± 42.15 μm; p = 0.122). The mean IOP was 15.85 ± 4.89 mmHg preoperatively and 14.72 ± 4.10 mmHg postoperatively (p = 0.563). The mean surgical time was 25.3 ± 4.5 min. Postoperative events included hyphema in 9.1%, cystoid macular edema in 6%, ocular hypertension in 6%, and IOL dislocation in 6%. CONCLUSIONS: IOL exchange with combined PPV and retropupillary ICIOL fixation achieved favorable visual and refractive outcomes with a short operating time and low complication rates, supporting this approach as an efficient option for eyes without capsular support. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40942-025-00791-1.