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Musleh M, Bull A, Linton E, Liu J, Waller S, Hardcastle C, Clayton-Smith J, Sharma V, Black GC, Biswas S, Ashworth JL, Sergouniotis PI. The Role of Genetic Testing in Children Requiring Surgery for Ectopia Lentis. Genes (Basel) 2023; 14:genes14040791. [PMID: 37107549 PMCID: PMC10137664 DOI: 10.3390/genes14040791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Non-traumatic ectopia lentis can be isolated or herald an underlying multisystemic disorder. Technological advances have revolutionized genetic testing for many ophthalmic disorders, and this study aims to provide insights into the clinical utility of genetic analysis in paediatric ectopia lentis. Children that underwent lens extraction for ectopia lentis between 2013 and 2017 were identified, and gene panel testing findings and surgical outcomes were collected. Overall, 10/11 cases received a probable molecular diagnosis. Genetic variants were identified in four genes: FBN1 (associated with Marfan syndrome and cardiovascular complications; n = 6), ADAMTSL4 (associated with non-syndromic ectopia lentis; n = 2), LTBP2 (n = 1) and ASPH (n = 1). Parents appeared unaffected in 6/11 cases; the initial presentation of all six of these children was to an ophthalmologist, and only 2/6 had FBN1 variants. Notably, 4/11 cases required surgery before the age of 4 years, and only one of these children carried an FBN1 variant. In summary, in this retrospective cohort study, panel-based genetic testing pointed to a molecular diagnosis in >90% of paediatric ectopia lentis cases requiring surgery. In a subset of study participants, genetic analysis revealed changes in genes that have not been linked to extraocular manifestations and highlighted that extensive systemic investigations were not required in these individuals. We propose the introduction of genetic testing early in the diagnostic pathway in children with ectopia lentis.
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Affiliation(s)
- Mohammud Musleh
- Eye Department, St. James’s University Hospital, Leeds LS9 7TF, UK
| | - Adam Bull
- Manchester Royal Eye Hospital, Manchester M13 9WL, UK
| | - Emma Linton
- Manchester Royal Eye Hospital, Manchester M13 9WL, UK
| | - Jingshu Liu
- Division of Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Sarah Waller
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester M13 9WL, UK
| | - Claire Hardcastle
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester M13 9WL, UK
| | - Jill Clayton-Smith
- Division of Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester M13 9PL, UK
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester M13 9WL, UK
| | - Vinod Sharma
- Manchester Royal Eye Hospital, Manchester M13 9WL, UK
| | - Graeme C. Black
- Division of Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester M13 9PL, UK
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester M13 9WL, UK
- Correspondence: (G.C.B.); (P.I.S.)
| | - Susmito Biswas
- Manchester Royal Eye Hospital, Manchester M13 9WL, UK
- Division of Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Jane L. Ashworth
- Manchester Royal Eye Hospital, Manchester M13 9WL, UK
- Division of Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Panagiotis I. Sergouniotis
- Manchester Royal Eye Hospital, Manchester M13 9WL, UK
- Division of Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester M13 9PL, UK
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester M13 9WL, UK
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, LJ1000 Ljubljana, Slovenia
- Correspondence: (G.C.B.); (P.I.S.)
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Ucar F. Intraocular lens implantation with flattened flanged intrascleral fixation technique in pediatric aphakia. J AAPOS 2022; 26:8.e1-8.e7. [PMID: 35085759 DOI: 10.1016/j.jaapos.2021.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of flattened flanged intrascleral fixation of the intraocular lens (IOL) in cases of pediatric aphakia without adequate capsular support. METHODS The medical records of children who underwent flattened flanged intrascleral IOL implantation for aphakia with insufficient capsular support, subluxated cataract, ectopia lentis, and dislocated IOL were reviewed retrospectively. Best-corrected visual acuity, astigmatism, corneal endothelial cell loss, IOL tilt, and intra- and postoperative complications were evaluated. RESULTS A total of 21 eyes of 16 patients were included. Mean patient age at time of surgery was 7.1 ± 3.8 years (range, 2-15). Mean follow-up time after surgery was 2.0 years. The mean pre- and postoperative best-corrected visual acuities were 1.03 ± 0.49 logMAR and 0.33 ±0.44 logMAR, respectively (P < 0.001). The mean preoperative astigmatism was 2.2 ± 0.9 D; and the mean postoperative astigmatism, 1.8 ± 0.8 D. The mean IOL tilt was 3.2° ± 3.1° (range, 0°-10°). The mean endothelial loss was 4.8%. Postoperatively, one of the haptics was partially visible in the scleral tunnel in one eye of a patient with Marfan syndrome. CONCLUSIONS In our study cohort, the flattened flanged IOL fixation technique provided good IOL fixation, with firm haptic fixation, without use of sutures or glue.
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Affiliation(s)
- Fikret Ucar
- Konyagoz Eye Hospital, Ophthalmology Department, Konya, Turkey.
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Karasavvidou EM, Wilde C, Zaman A, Orr G, Kumudhan D, Panos GD. Surgical Management of Paediatric Aphakia in the Absence of Sufficient Capsular Support. J Ophthalmol 2021; 2021:2253486. [PMID: 34904056 PMCID: PMC8665890 DOI: 10.1155/2021/2253486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022] Open
Abstract
There are several available options for the demanding surgical correction of paediatric aphakia without sufficient capsular support. The literature suggests the implantation of a transscleral fixated posterior chamber-intraocular lens (PCIOL), an intrascleral fixated PCIOL, an iris-sutured intraocular lens (IOL), or an anterior chamber iris-claw IOL. We searched for reports on the management of paediatric aphakia in case of inadequate capsular support that delineated the diverse surgical approaches and their postoperative results. Analysis demonstrated that different complications can be encountered depending on IOL placement technique, such as suture rupture, IOL dislocation, secondary glaucoma, endophthalmitis, vitreous hemorrhage, and endothelial cell loss. However, it was shown that various IOL designs have similar visual outcomes. Taking into consideration the advantages and disadvantages of each surgical technique, ophthalmic surgeons can determine the safest and most efficient approach for paediatric aphakic patients.
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Affiliation(s)
| | - Craig Wilde
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Anwar Zaman
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gavin Orr
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dharmalingam Kumudhan
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Georgios D. Panos
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Gotzaridis S, Georgalas I, Papakonstantinou E, Spyropoulos D, Kouri A, Kandarakis S, Karamaounas A, Gkiala A, Sideri AM, Droutsas K, Petrou P. Scleral Fixation of Carlevale Intraocular Lens in Children: A Novel Tool in Correcting Aphakia With No Capsular Support. Ophthalmic Surg Lasers Imaging Retina 2021; 52:94-101. [PMID: 33626170 DOI: 10.3928/23258160-20210201-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report the clinical outcomes of the use of a novel, specially designed, scleral-fixated intraocular lens (IOL) for the correction of aphakia in the absence of capsular support of variable etiology in children. PATIENTS AND METHODS This is a retrospective, noncomparative, interventional case series of five eyes of five consecutive patients who underwent three-port pars plana vitrectomy and scleral fixation of the IOL. Inclusion criteria were at least 6 months of follow-up in children who underwent vitrectomy and IOL placement for aphakia and inadequate capsular support. Patients were excluded from the analysis if there was a previous open globe injury or any other ocular comorbidity such as macular pathology or previous surgery for retinal detachment, glaucoma, corneal transplantation, or strabismus. RESULTS The median follow-up period was 9 months (range: 7-13 months). The median age was 8 years (range: 2-10 years), and the male-to-female ratio was 5 to 0. Mean postoperative best-corrected visual acuity (VA) at the last follow-up visit was 20/32 (0.26 ± 0.32 logMAR [mean ± standard deviation]), improving from a mean baseline uncorrected VA of 20/800 (1.6 ± 0.7 logMAR), a statistically significant change (P = .003). The uncorrected postoperative VA was 20/63 (0.54 ± 0.37 logMAR). No significant postoperative complications were noted and all patients had good IOL position at the end of the follow-up without IOL capture. The mean tilt in four eyes (the 2-year-old was excluded from the analysis) was 2.1 ± 1.9 degrees. None of the patients required reoperation. CONLCUSIONS The present study represents the first to date in evaluating the use of a scleral-fixated IOL in patients with aphakia and in pediatric patients with inadequate capsular support. The technique is safe and provides excellent postoperative IOL fixation without IOL capture in any of the patients studied. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:94-101.].
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Cheung CSY, VanderVeen DK. Intraocular Lens Techniques in Pediatric Eyes with Insufficient Capsular Support: Complications and Outcomes. Semin Ophthalmol 2019; 34:293-302. [DOI: 10.1080/08820538.2019.1620809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Crystal SY Cheung
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Byrd JM, Young MP, Liu W, Zhang Y, Tate DB, Crandall AS, Owen LA. Long-term outcomes for pediatric patients having transscleral fixation of the capsular bag with intraocular lens for ectopia lentis. J Cataract Refract Surg 2018; 44:603-609. [PMID: 29752046 DOI: 10.1016/j.jcrs.2018.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the long-term outcomes of transscleral fixation of capsular tension rings (CTR) with intraocular lens (IOL) placement in pediatric patients with ectopia lentis. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Retrospective case series. METHODS Pediatric patients requiring lens extraction with transscleral capsular bag fixation with a CTR and IOL for ectopia lentis between January 2006 and January 2016 were analyzed. RESULTS Thirty-seven patients (67 eyes) who had transscleral fixation of the capsular bag using a CTR fixated with 9-0 or 10-0 polypropylene (Prolene), 8-0 polytetrafluoroethylene (Gore-Tex), or 9-0 nylon were identified. The mean age at time of surgery was 7.25 years (2 to 18 years) and the mean follow-up was 35.3 months (0.25 to 120 months). The proportion of eyes showing improvement in corrected distance visual acuity (CDVA) postoperatively was 78.5%, which demonstrated significance with a 95% confidence interval. In the immediate postoperative period, 1 eye developed a hyphema and 1 eye required IOL repositioning. Long-term complications included posterior capsule opacification in 35 eyes (52%) and uveitis-glaucoma-hyphema syndrome in 1 eye (1.5%). Three eyes (4.4 %) required IOL repositioning for spontaneous delayed IOL dislocation, 2 sutured with 8-0 polytetrafluoroethylene at postoperative month 8 and postoperative year 3 and 1 sutured with 9-0 polypropylene at postoperative year 7. CONCLUSION Transscleral fixation of the capsular bag using a CTR improved CDVA and provided IOL stability in pediatric patients with ectopia lentis.
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Affiliation(s)
- Julia M Byrd
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marielle P Young
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Wei Liu
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Yue Zhang
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David B Tate
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alan S Crandall
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leah A Owen
- From the John A. Moran Eye Center (Byrd, Young, Tate, Crandall, Owen) and the Division of Epidemiology (Liu, Zhang), University of Utah School of Medicine, Salt Lake City, Utah, USA.
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Khokhar S, Aron N, Yadav N, Pillay G, Agarwal E. Modified technique of endocapsular lens aspiration for severely subluxated lenses. Eye (Lond) 2017; 32:128-135. [PMID: 28799565 DOI: 10.1038/eye.2017.160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 06/21/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeSeverely subluxated crystalline lenses pose a difficult situation to anterior segment surgeons and can only be managed surgically by removal of the lens as well as the capsular bag. Several techniques have been described in literature for the management of such cases. We describe a modified technique of endocapsular lens aspiration by the limbal route for lens extraction through small incisions on the cornea.Patients and methodsThirty-two eyes of 16 consecutive patients with severely subluxated crystalline lenses were recruited in the study. All eyes underwent a modified technique of lens aspiration within the capsular bag using a single instrument, vitrectomy cutter, and irrigation cannula, followed by sacrificing of the capsular bag. The patients were either left aphakic or implanted with an open loop anterior chamber intraocular lens (ACIOL Kelman Multiflex) and prospectively followed up for a period of 3 months.ResultsThe mean age of the patients was 9 years 3 months±3 years (range 5-15 yrs). All eyes underwent complete lens aspiration within the capsular bag with no dislocation of the lens matter. ACIOL was inserted in 22 eyes (68.7%) and 10 eyes (31.2%) were left aphakic. All the surgeries were uneventful. The mean best corrected visual acuity (BCVA) at 3 months post surgery was 0.47±0.11 logMAR which was significantly better than pre-operative BCVA (P=0.001). The percentage endothelial cell loss at 3 months was 7.1%. There was no evidence of glaucoma, corneal decompensation, or retinal detachment. The astigmatism which increased from 1.45D±086 preoperatively to 3.76D±2.02 1 week post-operatively due to sutures reduced to 1.97D±0.81 post suture removal at 3 months.ConclusionThe modified technique of endocapsular lens aspiration proves to be a simple and effective method of removal of the lens-capsular bag complex in severely subluxated lenses.
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Affiliation(s)
- S Khokhar
- Department of Ophthalmology, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - N Aron
- Department of Ophthalmology, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - N Yadav
- Department of Ophthalmology, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - G Pillay
- Department of Ophthalmology, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - E Agarwal
- Department of Ophthalmology, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Zhang H, Zhao J, Zhang LJ, Liu J, Liu Y, Song W, Tian QF, Wang Q, Hamilton DR. Comparison of iris-fixated foldable lens and scleral-fixated foldable lens implantation in eyes with insufficient capsular support. Int J Ophthalmol 2016; 9:1608-1613. [PMID: 27990363 DOI: 10.18240/ijo.2016.11.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/25/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the outcomes of vision using two different intraocular lens (IOL) replacement techniques, iris-fixated foldable intraocular lens (IF-IOL) and scleral-fixated foldable intraocular lens (SF-IOL) in patients with insufficient capsular support. METHODS Total 63 eyes (62 patients) with insufficient posterior capsule support underwent replacement of IF-IOL or SF-IOL between January 2008 and August 2011. Outcome measures included changes in visual acuity, slit lamp examination, refractive indices and corneal curvatures. RESULTS The mean improvement of uncorrected visual acuity (UCVA) was greater in IF-IOL group compared to the SF-IOL group (0.43 D±0.19 D vs 0.35 D±0.18 D, P<0.05). Moreover, 12 (38.71%) eyes in IF-IOL group and 4 (12.50%) in SF-IOL group had a higher postoperative UCVA than preoperative best corrected visual acuity (BCVA) while 9 (29.03%) eyes in IF-IOL group and 18 (56.25%) in SF-IOL group had a lower postoperative UCVA than preoperative BCVA. The myopic mean manifest sphere and mean cylinder magnitude were lower in the IF-IOL group than that in the SF-IOL group (-0.47 D±0.58 D vs 0.50 D±0.43 D, P<0.01; 0.84 D±0.53 D vs 1.23 D±0.70 D, P<0.05). No difference of corneal astigmatism and surgically induced astigmatism was found between the two groups. In addition, fewer complications were observed in IF-IOL eyes. CONCLUSION IF-IOL implantation can give a significant improvement in vision with fewer complications than SF-IOL in patients with insufficient capsular support.
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Affiliation(s)
- Han Zhang
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Jun Zhao
- Department of Ophthalmology, General Hospital of Liaohe Oil Field, Panjin 124010, Liaoning Province, China
| | - Li-Jun Zhang
- Refractive Center, Third Hospital Affiliated of Dalian Medical University, Dalian 116033, Liaoning Province, China
| | - Jing Liu
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Yuan Liu
- Department of Ophthalmology, Zibo Kangming Ophthalmology Hospital, Zibo 255025, Shandong Province, China
| | - Wei Song
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Qing-Fen Tian
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Qi Wang
- Department of Ophthalmology, General Hospital of Liaohe Oil Field, Panjin 124010, Liaoning Province, China
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Kavitha V, Balasubramanian P, Heralgi MM. Posterior Iris Fixated Intraocular Lens for Pediatric Traumatic Cataract. Middle East Afr J Ophthalmol 2016; 23:215-8. [PMID: 27162456 PMCID: PMC4845622 DOI: 10.4103/0974-9233.171777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose: To evaluate the postoperative visual outcomes and complications of posterior iris fixated intraocular lens (IFIOL) implantation for pediatric traumatic cataract. Methods: A retrospective clinical audit was performed of all the pediatric traumatic cataract patients who underwent lens removal and iris fixated lens implantation due to inadequate capsular support with or without corneal tear repair between January 2009 and December 2013. Data were collected and analyzed on the preoperative and postoperative visual outcomes and complications. Results: Twenty-five children (25 eyes; 21 males and 4 females) were enrolled with the mean age of 11 ± 4.0 years. There were 72% of eyes that underwent primary cataract removal with IFIOL implantation. Twenty-eight percent of eyes underwent corneal tear repair prior to intraocular lens (IOL) implantation. Preoperative best corrected visual acuity (BCVA) was hand motion in 32% eyes, counting fingers in 24%, and perception of light in 44%. Postoperative BCVA of 0-0.2 logarithm of minimum angle of resolution was reported in the 64% of eyes. One eye developed secondary glaucoma, one eye underwent re-enclavation, and none developed retinal complications. Conclusion: Posterior IFIOL implantation resulted in an improved visual outcome, low incidence of postoperative complications, and is a good alternative to other IOL, in the cases of pediatric traumatic cataract without adequate capsular support.
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Affiliation(s)
- V Kavitha
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
| | - Preethi Balasubramanian
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
| | - Mallikarjun M Heralgi
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
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Shah R, Weikert MP, Grannis C, Hamill MB, Kong L, Yen KG. Long-Term Outcomes of Iris-sutured Posterior Chamber Intraocular Lenses in Children. Am J Ophthalmol 2016; 161:44-9.e1. [PMID: 26429583 DOI: 10.1016/j.ajo.2015.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To report the long-term outcomes and complications of iris-sutured posterior chamber intraocular lenses (PCIOLs) in the pediatric population. DESIGN Retrospective interventional case study. METHODS This study involved 12 consecutive pediatric patients (17 eyes) who underwent placement of foldable iris-sutured PCIOLs between September 2004 and September 2007. Outcome measures included change in visual acuity and complications. RESULTS Of the 17 eyes were reviewed, 6 (35%) had hereditary or idiopathic ectopia lentis, 5 (29%) had Marfan syndrome, 2 (12%) were aphakic after pars plana vitrectomy and 4 (24%) were aphakic after surgical intervention for trauma. Average follow-up was 4.69 ± 3.21 years and mean age of surgery was 7.21 ± 3.78 years. Seven eyes suffered dislocation of the PCIOL an average of 12.11 ± 11.97 months after surgery, with 2 patients undergoing dislocation a second time. There was a higher rate of dislocation in patients with a history of ectopia lentis due to Marfan syndrome, idiopathic causes, or hereditary causes than in patients being treated for aphakia resulting from other causes (71% vs 29%). Mean visual acuity improved in 12 of 17 patients (71%), from 0.80 ± 0.6 logMAR preoperatively to 0.35 ± 0.5 logMAR at most recent visit, P = .009. One eye of a Marfan patient sustained a retinal detachment 8 months after dislocation of the PCIOL, and 1 patient experienced iris capture of the PCIOL after surgery. CONCLUSIONS Iris-sutured intraocular lenses have been used as an alternative to transsclerally sutured intraocular lenses to correct aphakia in pediatric patients. Dislocation of the intraocular lenses can occur frequently, however. The procedure should be considered with caution in pediatric patients.
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Affiliation(s)
- Ravi Shah
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | | | - Charity Grannis
- Department of Ophthalmology and Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Marshall B Hamill
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Lingkun Kong
- Department of Ophthalmology and Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Kimberly G Yen
- Department of Ophthalmology and Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
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Simon MA, Origlieri CA, Dinallo AM, Forbes BJ, Wagner RS, Guo S. New Management Strategies for Ectopia Lentis. J Pediatr Ophthalmol Strabismus 2015; 52:269-81. [PMID: 26181899 DOI: 10.3928/01913913-20150714-02] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 05/05/2015] [Indexed: 11/20/2022]
Abstract
Ectopia lentis refers to displacement of the crystalline lens in the setting of various systemic and metabolic disorders. A literature review was conducted to investigate the management of non-traumatic ectopia lentis in the pediatric population, particularly focusing on surgical intervention. Both limbal and pars plana approaches for lensectomy are well established in the literature. Surgical options for intraocular lens implantation in pediatric eyes with ectopia lentis include anterior chamber intraocular lenses and iris-fixated or scleral-fixated posterior chamber intraocular lenses. Recently, the use of capsular tension rings has also been described with promising results. Visual rehabilitation and treatment of amblyopia are essential for patients within the amblyogenic age group following surgical intervention.
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12
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Kim EJ, Berg JP, Weikert MP, Kong L, Hamill MB, Koch DD, Yen KG. Scleral-fixated capsular tension rings and segments for ectopia lentis in children. Am J Ophthalmol 2014; 158:899-904. [PMID: 25127699 DOI: 10.1016/j.ajo.2014.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/30/2014] [Accepted: 08/01/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the short-term outcomes and complications of implantation of scleral-fixated capsular tension rings and/or capsular tension segments with intraocular lenses (IOL) in pediatric patients with ectopia lentis. DESIGN Retrospective, observational case series. METHODS Thirteen consecutive pediatric patients (19 eyes) underwent placement of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring between January 1, 2009 and March 30, 2013 by 3 anterior segment surgeons at a single academic center. The scleral fixation suture was 9-0 polypropylene in 16 eyes and CV-8 Gore-Tex (expanded polytetrafluoroethylene) in 3 eyes. Outcome measures included change in corrected distance visual acuity (CDVA) and complications. RESULTS The mean age was 10.2 years ± 4.8 (SD) and the median follow-up, 23.4 months. A Cionni modified capsular tension ring was implanted in 5 eyes and a capsular tension segment with an unsutured capsular tension ring was implanted in 12 eyes. In 2 eyes, capsular tension segment alone was placed. The mean CDVA at the final follow-up (0.10 ± 0.11 logMAR, 18 eyes) was significantly better than preoperatively (0.58 ± 0.26 logMAR, 15 eyes) (P < .001). The CDVA at the final follow-up was 20/40 or better in 18 eyes (94.7%). All IOLs were well centered. Posterior capsule opacification developed in 11 eyes (57.9%), 9 eyes (47.4%) required neodymium-yttrium-aluminum-garnet capsulotomy, and 3 eyes (15.8%) required pars plana vitrectomy and posterior capsulotomy. Other complications included broken suture (5.3%) (9-0 polypropylene at CTR eyelet, repaired with CV-8 Gore-Tex), conjunctival dehiscence (5.3%), suture exposure (5.3%) (trans-scleral 9-0 polypropylene), and vitreous strand at inferior paracentesis (5.3%). CONCLUSIONS Implantation of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring appears to be a safe and effective technique for visual rehabilitation in pediatric ectopia lentis.
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Affiliation(s)
- Eric J Kim
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - James P Berg
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Mitchell P Weikert
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Lingkun Kong
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Marshall B Hamill
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Douglas D Koch
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Kimberly G Yen
- Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
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Miraldi Utz V, Coussa RG, Traboulsi EI. Surgical management of lens subluxation in Marfan syndrome. J AAPOS 2014; 18:140-6. [PMID: 24698610 DOI: 10.1016/j.jaapos.2013.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 12/06/2013] [Accepted: 12/22/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To review the literature on the surgical management, describe a simplified surgical technique, and to report the postoperative clinical course of ectopia lentis removal in patients with Marfan syndrome. METHODS The medical records of patients with a clinical diagnosis of Marfan syndrome and clinically significant lens subluxation were retrospectively reviewed. Patients underwent lens extraction by a single surgeon via a simplified anterior segment approach. The pre- and postoperative best-corrected visual acuity, biometric measurements, intraocular pressure, and incidence of surgery-related complications were reviewed. RESULTS A total of 42 eyes of 22 patients were included. Mean postoperative follow-up was 4.9 ± 2.9 years (range, 1-10 years). Average age at surgery was 10.2 ± 9.2 years (range, 2-37 years), with 18 patients (36 eyes) ≤ 18 years of age. The average preoperative best-corrected visual acuity was 20/80, and the average postoperative best-corrected visual acuity at last follow-up was 20/25, with an average improvement of 6 lines on the Snellen chart. All eyes had a best-corrected visual acuity > 20/30 at last follow-up with aphakic correction. One eye of 1 patient developed a retinal detachment following blunt trauma. No other intra- or postoperative complications were reported. CONCLUSIONS Anterior lensectomy and limited vitrectomy with aphakic correction is safe and provides a consistent visual outcome in patients with lens subluxation secondary to Marfan syndrome. This is especially important in pediatric patients, in whom long-term follow-up for iris- and scleral-fixated intraocular lenses is limited.
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Affiliation(s)
- Virginia Miraldi Utz
- Abrahamson Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Elias I Traboulsi
- The Cole Eye Institute, Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
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14
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Gerstmeyer K, Sekundo W. [Iris suture fixation of posterior chamber lenses. New perspectives for an old technique]. Ophthalmologe 2014; 111:210-6. [PMID: 24633459 DOI: 10.1007/s00347-013-2849-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intraocular approaches to correct aphakia in cases of inadequate capsular support include an anterior chamber intraocular lens, fixation of a posterior chamber lens to the sclera or iris by suturing or iris claw, respectively. OBJECTIVES This article reviews the indications and contraindications for iris fixation with sutures and gives an overview of surgical techniques, potential complications and outcomes. METHODS Based on a selective search of pertinent literature in PubMed the information from original articles and reviews are analyzed, summarized and discussed. RESULTS New surgical techniques have imparted an impetus to iris suture fixation with encouraging functional and morphological results offering a new promising alternative to the established options. Improved aspects arise for repositioning of a decentered intraocular lens and for a minimally invasive method for repair of late in-the-bag lens dislocation as seen more frequently by cataract surgeons. CONCLUSION A final evaluation of the proposed techniques is not possible because none has clearly emerged as the optimal method. Precise determination of small differences in visual outcome or complication rates requires a large prospective, randomized clinical trial.
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Affiliation(s)
- K Gerstmeyer
- Augenklinik Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland,
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15
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Salchow DJ, Sinard J. Management of lens dislocation and iris cyst after iris sutured intraocular lens implantation in children with Marfan syndrome. J Pediatr Ophthalmol Strabismus 2013; 50 Online:e8-10. [PMID: 23429576 DOI: 10.3928/01913913-20130219-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/22/2013] [Indexed: 11/20/2022]
Abstract
The authors describe two brothers with Marfan syndrome who developed severe complications after iris-suture fixation of an intraocular lens (IOL). A secondary iris cyst developed in one and the IOL dislocated into the vitreous in the other, requiring pars plana vitrectomy and IOL removal. Although the visual outcome was good in both cases, severe complications of iris-suture fixated IOLs must be considered when surgical correction of aphakia is attempted in children with Marfan syndrome.
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Affiliation(s)
- Daniel J Salchow
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Kara N, Bozkurt E, Yazici AT, Demirok A. Bilateral transient pupil closure after iris supported intraocular lens implantation in a case with Marfan syndrome. Middle East Afr J Ophthalmol 2012; 19:262-4. [PMID: 22623873 PMCID: PMC3353682 DOI: 10.4103/0974-9233.95270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A 16-year-old woman presented with Marfan syndrome and bilateral ectopia lentis. The surgical treatment including removal of the crystalline lens and implantation of an iris-supported intraocular lens in both eyes at a week interval. Postoperatively, the biomicroscopic examination showed total pupil closure bilaterally. After the topical tropicamide treatment, the pupil returned to normal shape.
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Affiliation(s)
- Necip Kara
- Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
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17
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Surgical management of non-traumatic pediatric ectopia lentis: A case series and review of the literature. Saudi J Ophthalmol 2012; 26:315-21. [PMID: 23961012 DOI: 10.1016/j.sjopt.2012.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/28/2012] [Accepted: 05/01/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To report a small series of pediatric patients with ectopia lentis that underwent limbal-approach lensectomy and vitrectomy and scleral-fixated intraocular lens implantation and to review the literature on the topic of surgical management of ectopia lentis. METHOD A retrospective review of 13 eyes of seven patients that underwent lensectomy, vitrectomy, and scleral-fixated intraocular lens implantation and a review of the ophthalmic literature. RESULTS In our series, the average age at surgery was 70.3 ± 13.8 months and the average length of follow-up was 23.8 ± 5.9 months. The mean pre-operative visual acuity was 0.86 ± 0.17 which improved to 0.23 ± 0.09 post-operatively (p < 0.001). No complications were encountered in our series. A review of the literature found that amblyopia was the biggest vision-limiting factor. In general, the literature suggested that a higher percentage of eyes that were left aphakic achieved better vision than those implanted with a scleral-fixated intraocular lens. However, there may be selection bias in that more eyes receiving an intraocular lens may have pre-existing amblyopia. The complication rates for lensectomy or scleral-fixated intraocular lens implantation were low in the literature. In the latter group, suture breakage and resultant intraocular lens dislocation is a worrisome late complication. CONCLUSION Surgical intervention for ectopia lentis via vitrectomy techniques yields good result. In cases of unilateral aphakia or in settings where compliance with aphakic refractive correction is questionable and amblyopia is a constant threat, scleral-fixated intraocular lens implantation is highly encouraged. However, long-term follow-up is required due to the risk of suture breakage and resultant intraocular lens dislocation over time.
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Gimbel HV, Camoriano GD, Aman-Ullah M. Bilateral Implantation of Scleral-Fixated Cionni Endocapsular Rings and Toric Intraocular Lenses in a Pediatric Patient with Marfan's Syndrome. Case Rep Ophthalmol 2012; 3:16-23. [PMID: 22615696 PMCID: PMC3357140 DOI: 10.1159/000335652] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The management of ectopia lentis in Marfan's syndrome is challenging. Multiple disease-associated factors conspire to deprive these patients of adequate vision. While optical correction with glasses and contact lenses is usually advocated early on, the irregular astigmatism and even partial aphakia that accompanies advanced cases generally warrant surgical intervention. Several surgical strategies have been devised to manage these challenging cases, including the combination of endocapsular or pars plana lensectomy and iris or scleral fixation of the intraocular lens (IOL) or IOL-bag complex. All of the reported cases have been implanted with IOLs that correct for myopia only. With toric lenses, it is now possible to correct for corneal astigmatism in these patients as well, provided that the capsular bag is maintained and can be properly centered. We report the combination of scleral-fixated Cionni endocapsular rings and toric IOLs in a pediatric patient with bilateral ectopia lentis secondary to Marfan's syndrome.
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Özer A, Niyaz L. Anterior iris-claw lens implantation with single paracentesis. SURGICAL TECHNIQUES DEVELOPMENT 2011. [DOI: 10.4081/std.2011.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this study, the technique and results of iris-claw intraocular lens (IOL) implantation with corneal incision and single paracentesis were presented. Eighteen eyes of 18 patients who underwent iris-claw implantation surgery with a single paracentesis were included in this prospective study. Iris-claw lens was grasped by its forceps and placed into the anterior chamber through superior corneal opening. While IOL was held by forceps, a blunt enclavation spatula was introduced through inferior paracentesis. Then the spatula was directed toward underneath of iris through pupil and toward sides where iris was entrapped into the claw by gentle push of iris through the slotted center of the lens haptics. Mean age of patients was 54.28±25.21 years (7-76 years). Mean anterior chamber depth was 4.07±0.32 mm and mean keratometric power was 43.01±2.73 D. Preoperative BCVA was 20/63 or better in 8 (44.4%) patients. At the first postoperative month BCVA was 20/63 or better in 14 (77.8%) patients. Preoperative mean spherical refraction was +11.05±2.62 D, preoperative astigmatism was 2.15±0.85. Postoperative mean spherical refraction was - 0.58±0.25 D and mean astigmatism was - 1.92±0.67 D. The most frequent postoperative complication was mild corneal edema seen in three patients that resolved completely during the first week with medical treatment. Irisclaw IOL implantation can be performed easily with corneal incision and single paracentesis. Single paracentesis does not increase surgical time or cause inconvenience during the procedure.
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Sergienko NM, Kondratenko YN, Yakimov AK. Capsule fixation device for cataract surgery. Eur J Ophthalmol 2009; 19:143-6. [PMID: 19123164 DOI: 10.1177/112067210901900123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The authors present a patient with Marfan syndrome who underwent cataract surgery using a novel device for fixation of capsular bag. METHODS The capsule fixation device (CFD) is poly(methyl methacrylate) arch with double-armed bent hook that can be introduced into the anterior chamber through the clear corneal incision, placed with a rest on the capsule equator, and sutured to the sclera without injury of the capsular bag. A 16-year-old patient with Marfan syndrome underwent consecutive phacoemulsification with in-the-bag intraocular lens and CFD implantation on both eyes. RESULTS During the surgery handling the CFD was technically simple with good visualization. The preoperative best-corrected visual acuity was 0.3 and 0.1 and postoperatively 0.6 and 0.8 in the right and left eyes, respectively. The postoperative follow-up was over 9 months. CONCLUSIONS Use of the CFD was successful in a case of lens subluxation with no complications observed during the period of follow-up.
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Affiliation(s)
- N M Sergienko
- Department of Ophthalmology, National Medical Academy of Postgraduate Education, Kiev, Ukraine
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Buckley EG. Pediatric sutured intraocular lenses: trouble waiting to happen. Am J Ophthalmol 2009; 147:3-4. [PMID: 19100350 DOI: 10.1016/j.ajo.2008.08.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 08/22/2008] [Accepted: 08/23/2008] [Indexed: 12/01/2022]
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Iris-fixated posterior chamber intraocular lenses in children. Am J Ophthalmol 2009; 147:121-6. [PMID: 18790471 DOI: 10.1016/j.ajo.2008.07.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 07/22/2008] [Accepted: 07/23/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE To report the short-term outcomes and complications of iris-fixated posterior chamber intraocular lenses (PCIOL) in the pediatric population. DESIGN Retrospective, observational case study. METHODS Twelve consecutive pediatric patients (17 eyes) underwent placement of foldable iris-sutured PCIOLs between September 1, 2004 and September 30, 2007 by two anterior segment surgeons at a single academic center. Outcome measures included change in visual acuity (VA) and complications. RESULTS In our series, there was a higher rate of dislocation of iris-sutured IOLs in patients with a history of ectopia lentis resulting from Marfan syndrome or hereditary or idiopathic causes than in patients being treated for aphakia resulting from other causes (45% vs 0%). Mean final VA improved by 0.23 logarithm of the minimum angle of resolution units from preoperative baseline. One eye of a Marfan patient sustained a retinal detachment eight months after dislocation of the PCIOL, and one patient experienced iris capture of the IOL after surgery. CONCLUSIONS Iris-fixated IOLs are reasonable alternative to transsclerally sutured IOLs to correct aphakia in pediatric patient. Dislocation of the IOLs can occur, however, and there is concern for suture degradation over time. The procedure should be considered with caution in pediatric patients.
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