Pars plana technique for removal of congenital subluxated lenses in young patients

Abstract

Lensectomy with the pars plana technique was performed in 16 eyes of 11 patients (2 female, 9 male) with congenital subluxated lenses. Lens subluxation was associated with homocystinuria in 2 patients, Marfan's syndrome in 4, congenital simple ectopia lentis in 2 and without any known heredity in 3 patients. The reason for removal was in all eyes optical disturbances. Five patients were operated on both eyes. All lenses were removed with the Kløti Vitreous Stripper through the pars plana. No complications occurred. Retinal detachment was present pre-operatively in both eyes in one patient with homocystinuria. In the post-operative period, prophylactic photocoagulation and cryotherapy were performed in 7 eyes in 6 patients (6 photocoagulation and 1 cryo). The pars plana technique for removal of clear subluxated lenses in young individuals seems to be the method of choice. Complications are negligible and the method gives excellent optical results.

Iris-sutured intraocular lenses for ectopia lentis in children

“…In all the other series in Table 1, the capsule was removed. [4][5][6][8][9][10][11][12][13][14][15][16][17][18] Thus, although it appears that leaving a narrow rim of capsule may improve the stability of the IOL, the long-term safety of this practice remains to be established; the capsule remnants may contract and cause traction to cortical vitreous, leading to peripheral retinal breaks and/or detachment. A recent report of iris-fixated IOLs in the absence of capsule support in adults 26 had an IOL dislocation rate of 4.3% over a mean follow-up of 24 months.…”

“…3 In recent years, there has been mounting evidence that lensectomy, whether through the limbal or pars plana approach, combined with anterior vitrectomy is safe in the longer term. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Bilaterally aphakic children can be managed with spectacles or contact lenses and unilaterally aphakic children can be managed with contact lenses with excellent visual outcomes; however, aphakic spectacles produce troublesome optical aberrations and a limited visual field, may be considered disfiguring, and may cause the patient to have difficulty integrating into the social environment. 10 Contact lenses, on the other hand, have been associated with intolerance, noncompliance, need for frequent replacement, and relatively high costs.…”