group one received artisan iris - claw iol ( ophtec , groningen , the netherlands ) implantation over the iris , and group 2 received retropupillary artisan iol implantation .
this study protocol was approved by the local ethics committee and written informed consent form was obtained from all patients .
patients who were admitted to adana numune training and research hospital with aphakia and no capsular support between november 2013 and april 2014 were included in this study .
inclusion criteria included aphakia which is due to trauma , complicated cataract surgery and lens / iol luxation , integrity of the iris which allows to enclavation of the iol 's claw , normal intraocular pressure ( iop ) limits , anterior chamber depth > 3.2 mm , endothelial cell density > 900/mm , and normal retinal examination .
exclusion criteria were glaucoma , iris defect , uveitis , and any pathology of the retina .
clinical and demographic features ( such as age , gender , and etiology of aphakia ) of the patients were noted .
iop which measured with goldmann applanation tonometry , snellen 's corrected distance visual acuity ( cdva ) , slit - lamp biomicroscopy examination , and fundus examination were evaluated preoperatively and at 24 h , 1 week , 1 , 3 , and 6 month postoperatively by the same examiner .
all the data were analyzed using spss 18.0 package ( ophtec , groningen , the netherlands ) program .
if the data have a normal distribution , paired samples t - test was used to compare the preoperatively and postoperatively cdva and iop values .
iol power was calculated with an a - constant of 115 for group 1 , and 117 for group 2 by ultrasonic biometry ( digital a / b scan 5500 ; sonomed inc . ,
since some patients have iol luxation , lens luxation or luxated nigra cataract , operation was combined with pars plana vitrectomy and iol / lens explantation .
the surgeon performed iris - claw iol implantation with the same standardized technique . in summary , two vertical side - port at 2 and 10 oclock were performed .
artisan iol with a position of convex side up for group 1 , convex side down for group 2 was inserted , rotated the iol such that haptics were positioned at 3 and 9 oclock and centralized .
thereafter , artisan iol 's optic was holded with its special forceps ; for anterior chamber group iris was enclavated between the iol 's claw haptics using special enclavation needles . after repositioning the iol behind the iris and centralized ,
a total of forty eyes ( group 1 : twenty anterior chamber iris - claw fixation , group 2 : twenty retropupillary iris - claw implantation ) of forty different patients ( 24 males , 16 females ) with aphakia of various etiologic reasons were treated with artisan iol .
mean age of the patients was 69.2  7.4 ( min - max : 4582 years ) .
eleven ( 55% ) patients right eyes , 9 ( 45% ) patients left eyes , 12 ( 60% ) patients right eyes , and 8 ( 40% ) patients left eyes were treated in group 1 and 2 , respectively .
when evaluating the age range , in each group , there was an accumulation among 7079 age .
when comparing the each group the most causative etiologic factor was complicated cataract surgery resulted in aphakia ( 65% and 65% for group 1 and 2 , respectively ) .
there was no statistically significance when indications compared between the two groups ( p = 0.434 ) .
the demographic features of the patients surgery indications of group 1 surgery indications of group 2 there was no complication intraoperatively and desired anatomic conclusions were achieved [ fig
no hypotony , uveitis , cystoid macular edema , iol dislocation , hyphema , and vitreous hemorrhage were seen at long - term follow - up ( 1 week - 6 month ) like mentioned about in the other studies .
nevertheless , pupillary distortion was seen in one patient in group 1 and in two patients in group 2 .
since aforementioned detachment was in the inferior retina with a shallow feature , it was just followed with no intervention in a 6 months follow - up .
elevated iop were noted in four patients in group 1 and in five patients in group 2 1 week postoperatively .
these increases were statistically significant for each group at 1 week ( p < 0.05 ) .
all patients increased iop values were controlled adequately with a fix combination of hypotensive drop ( dorzolamide / timolol 2 times / day ) .
when the treatment stopped just a few weeks later , there was no permanent increase of iop .
there was no statistically significance when complications range compared between the two groups ( p = 0.067 ) .
an implanted anterior chamber artisan intraocular lens when evaluating the cdvas in both groups , there was statistically significant increase when compared the preoperatively and for each 1 week , 1 , 3 , and 6 month values ( p < 0.05 ) .
however , these increases were stabilized since 1 month visit . sixteen patients achieved the same final cdva values , four patients achieved poorer cdva values that were measured preoperatively in group 1 . eighteen
patients achieved the same final cdva values , two patients achieved a poorer cdva that was measured preoperatively in group 2 .
mean spherical equivalent ( se ) was 4.98  5.99d in group 1 and 4.87  6.01 in group 2 preoperatively .
when evaluated postoperatively , se decreased to  0.25  1.87/0.25  1.75 in group 1 and 2 , respectively .
p values of the best corrected visual acuity and intraocular pressure values at 6 months follow - up best corrected visual acuity and intraocular pressure values of each group at 6 months follow - up
in this study , we aimed to compare the short - term efficiency and complications of anterior chamber and retropupillary implantation of artisan iol , to the best of our knowledge , it is the first time in data .
there had been many reported studies that evaluated the angle - supported and scleral fixated iols in case of insufficient capsular support .
in contrast to aforementioned surgery procedures ; artisan iol seems to be safer , efficient , and easily applicable way to correct aphakia . in our presented study , we corrected aphakia using artisan iol ( model 205 ) over and behind the iris .
artisan iol for aphakia is a single - piece polymethyl methacrylate iol with its 5.4 mm optic body and 8.5 mm overall length .
there is a large available diopter range ( + 2.0d to + 30.0d with 1.0d increments and + 14.5d to + 24.5d with 0.5d increments ) .
gell et al . reported that artisan iol implantation caused approximately 10.9% endothelial cell loss in the 3 years follow - up .
anbari and lake reported preoperative manual endothelial cell density mean of 2269  611 cells / mm decreased postoperatively to 2002  532 cells / mm at 2 years ( p = 0.0005 ) . in our series ,
reported that anterior chamber implantation results in more endothelial cell loss than the retropupillary implantation . anyway , since the artisan iol 's haptics probable contact is being prevented to the endothelium ; it should be safer to implant it retropupillary .
reported some contraindications for iris - claw lens implantation such as ischemic vitreoretinopathies , such as diabetes or vascular occlusive entities , as well as uveitis .
when compared the amounts of patients whose iop values were increased in each group , there was no statistically significance ( p = 0.543 ) .
pupil distortion was observed in three patients ; however , none of them was permanent . a considerable disadvantage of artisan iol is that it requires a wide corneal incision because of its 5.4 mm width polymethyl methacrylate optic body .
another difficulty of retropupillary implantation is the probability of iol dislocation to vitreous due to enclavation fail .
although anterior implantation has a risk of endothelial touch in shallow anterior chambers , it is easier than retropupillary implantation . in both ways ,
accordingly , this article suggests that both anterior and retropupillary implantation of artisan iol are effective in visual improvement , comfortable applicable , and time - saving surgery technique .
as regards the limitation of this study was its small sample size and not to count the endothelial cell density .
patients could be followed up longer as well . in consideration of our first and preliminary results , both anterior and retropupillary implantation of artisan iol
the surgical procedure is dependent to the experience of the surgeon . to assess the safety and efficacy of these two methods , long - term follow - up is needed .
further studies are required to compare the anterior and posterior implantation of artisan iol taking into account endothelial cells counting with more sample size and long - term follow - up .
 purpose : to compare the outcomes of anterior chamber and retropupillary implantation of iris - claw artisan intraocular lenses ( iol).design : prospective , randomized , single - blinded study.patients and methods : forty eyes of forty aphakic patients were enrolled . 
 patients were randomized into two groups . 
 each group includes twenty patients . 
 group 1 received anterior chamber artisan iol implantation . 
 group 2 received retropupillary artisan iol implantation . 
 preoperative and postoperative corrected distance visual acuity ( cdva ) , intraocular pressure ( iop ) , and all complications were noted and compared at 6 months follow-up.results:each two groups obtained a significant improvement in cdva ( p < 0.05 ) . 
 four patients in group 1 and five patients in group 2 had significant but nonpermanent increase at iop values . 
 there were one and two pupillary irregularity in group 1 and group 2 , respectively . 
 in one patient , a shallow and inferior located retinal detachment were encountered in anterior chamber group.conclusions:the results were not significantly different between the two fixation techniques for iris - claw lens . 
 the surgery procedure is dependent to surgeon experience and eye 's conditions . 
Patients and Methods
Results
Discussion
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