Yulia Dian Estu, Soeharto Diajeng Ayesha
Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
J Curr Ophthalmol. 2023 Aug 11;35(1):1-10. doi: 10.4103/joco.joco_249_22. eCollection 2023 Jan-Mar.
To review current evidence regarding the use of iris-claw intraocular lens (IOL) in terms of its efficacy and safety in the population of pediatric ectopia lentis.
A comprehensive literature search of six electronic databases (PubMed-NCBI, Medline-OVID, Embase, Cochrane, Scopus, and Wiley) and secondary search through reference lists was conducted using keywords selected a priori. All primary studies on the use of iris-claw in pediatric ectopia lentis that evaluated visual acuity (VA), complications, and endothelial cell density (ECD) were included and critically appraised using the Newcastle-Ottawa Scale.
Ten studies were eligible for inclusion with an overall sample size of 168 eyes of children with ectopia lentis, and the majority of studies evaluated anterior iris-claw IOL. All studies reported improvement in postoperative VA. The most commonly reported complication across studies was IOL decentration. All studies reported decreasing ECD, and this was observed in both anterior and retropupillary iris-claw IOL.
Current evidence shows that iris-claw IOL is effective in terms of improving VA in pediatric ectopia lentis. Due to the lack of long-term evidence of its safety in children, one must remain cautious regarding potential endothelial cell loss. Further high-quality, interventional, long-term studies are needed.
回顾目前关于虹膜爪型人工晶状体（IOL）在小儿晶状体异位患者中的有效性和安全性的证据。
使用预先选定的关键词，对六个电子数据库（PubMed-NCBI、Medline-OVID、Embase、Cochrane、Scopus和Wiley）进行全面的文献检索，并通过参考文献列表进行二次检索。纳入所有评估小儿晶状体异位患者使用虹膜爪型人工晶状体后的视力（VA）、并发症和内皮细胞密度（ECD）的主要研究，并使用纽卡斯尔-渥太华量表进行严格评估。
十项研究符合纳入标准，小儿晶状体异位患者的总体样本量为168只眼，大多数研究评估的是前房虹膜爪型人工晶状体。所有研究均报告术后视力有所改善。各研究中最常报告的并发症是人工晶状体偏心。所有研究均报告内皮细胞密度降低，在前房和瞳孔后虹膜爪型人工晶状体中均观察到这种情况。
目前的证据表明，虹膜爪型人工晶状体在改善小儿晶状体异位患者的视力方面是有效的。由于缺乏其在儿童中安全性的长期证据，对于潜在的内皮细胞丢失必须保持谨慎。需要进一步开展高质量、干预性的长期研究。
