Sutured Scleral Fixation of Posterior Chamber Intraocular Lens in Children under the Age of 9 with Congenital Ectopia Lentis

Abstract

<b><i>Introduction:</i></b> This study aimed to report the visual acuity outcomes and complications of sutured scleral fixation of posterior chamber intraocular lens (IOL) in children under 9 years old with congenital ectopia lentis. <b><i>Methods:</i></b> Twenty-six children (47 eyes) with congenital ectopia lentis were included in this study. The mean age at surgery was 61.6 ± 22.3 months (range, 32–94). Patients underwent lens extraction, anterior vitrectomy, and sutured scleral fixation of posterior chamber IOL. The implanted IOL included rigid polymethyl methacrylate (PMMA) IOL (CZ70BD, <i>n</i> = 36) and foldable IOL (SA60AT, <i>n</i> = 9, and LI61SE, <i>n</i> = 2). The outcome measures used to assess the benefits were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, intraocular pressure, and any associated complications. Median follow-up was 33.0 months (range, 4–129). <b><i>Results:</i></b> After surgery, the median UCVA (1.30 vs. 0.35 logMAR) and BCVA (0.82 vs. 0.15 logMAR) improved significantly (<i>p</i> < 0.001). The median absolute spherical values decreased considerably (9.00 vs. 0.75 D; <i>p</i> < 0.001). The median astigmatism was lower in foldable IOL compared to rigid PMMA IOL (1.0 vs. 2.5 D; <i>p</i> = 0.026), but neither the UCVA nor BCVA was significantly different. There was no intraoperative complication. Postoperative complications included pupillary capture in 4 eyes (9%), IOL decentration in 4 eyes (9%), choroid edema in 1 eye (2%), and subretinal hemorrhage in 1 eye (2%). The rate of secondary surgery was 9%, caused by IOL decentration of IOL haptics which was broken in 3 eyes and suture degradation in 1 eye. <b><i>Conclusion:</i></b> Sutured scleral fixation of posterior chamber IOL provided good visual outcomes in children under 9 years of age with congenital ectopia lentis. Although there were some risks of secondary surgery, the complications were acceptable.

Ectopia Lentis: Clinical profiles in a large cohort of children from a Tertiary Eye Care network in India

“…studied scleral fixated IOL implantation in their series of ectopia lentis, they reported an improvement of median BCVA of 0.82 logMAR (preoperative) to 0.15 logMAR (postoperative) and an improvement of SE; however, a re-surgery rate of 9% for IOL decenteration was reported. [ 14 ] Cai et al . report in their study of 101 eyes of 57 children under 8 years of age who received a cioni-modified capsular ring tension ring and in the bag IOL placement that in the bag placement offers better stability and the reported improvement in postoperative visual outcomes was significantly better, although re-surgery was needed in a very small number of cases (4/101 eyes) for IOL decentration and anterior capsular contraction.…”

Effect of lens surgery on health-related quality of life in preschool children with congenital ectopia lentis

“…For example, cardiovascular manifestations of Marfan syndrome such as aortic root dilation or aortic dissection may threaten their lives. All surgeries were performed by the same surgeon and conducted using phacoemulsification, which presented better clinical outcomes and fewer complications compared to traditional intracapsular and extracapsular cataract extraction [14] , and implantation of a sclera-fixated intraocular lens (IOL) [15] . All eyes underwent bilateral presenting vision test, best-corrected visual acuity (BCVA) test and slit-lamp examination before and after operation.…”

Sutured scleral fixation of existing subluxated/dislocated acrylic one-piece intraocular lenses

“…Besides, no suture-related complications, including erosion or breakage, were noted during the follow-up period in our series. Late subluxation or dislocation of sutured scleral fixation of IOLs has been documented [21][22][23][24] , especially occurring in young patients [21][22]24] . This may be related to suture erosion, scleral tissue cutting by sutures, suture cutting by IOL haptics, IOL haptics cutting by sutures, suture damage by surgical manipulation, and degradation of the suture material itself.…”

“…A clinicopathological study suggested that the surface properties of the positioning holes of IOLs lead to cutting of sutures, and subsequent subluxation of IOLs [23] . In addition, suture breakage typically occurs after 10y postoperatively and in young patients [21][22]24] . Nevertheless, suture degradation of 10-0 polypropylene cannot be neglected.…”