Anterior iris-claw intraocular lens implantation for the management of nontraumatic ectopia lentis: long-term outcomes in a paediatric cohort.

Abstract

PURPOSE:

To report the feasibility and long-term safety of lensectomy and iris-claw intraocular lens (IOL) implantation to treat children with severe ectopia lentis in a paediatric tertiary hospital.

METHODS:

Prospective cohort study of 21 eyes from 12 patients with severe ectopia lentis and visual acuity <20/63. All eyes underwent 23-gauge pars plana vitrectomy, lensectomy, iridectomy and Artisan IOL implantation in the anterior chamber with iris-claw enclavation via pars plana. Mean age at surgery was 8.0 ± 5.3 yo (range 3-17 years). A full ophthalmologic examination including best-corrected visual acuity (BCVA), biomicroscopy, intraocular pressure (IOP) measurement, fundus evaluation and central endothelial cell count (cECC) was performed pretreatment, at 3 months' postsurgery, and every 6 months thereafter. Ultrasound biomicroscopy (UBM) was performed 12 months after surgery.

RESULTS:

Mean follow-up was 39.3 ± 13.0 months. Best-corrected visual acuity (BCVA) (mean ± SD) improved from 0.91 ± 0.29 logMar preoperatively to 0.18 ± 0.23 logMar at final follow-up (p < 0.0001). Mean distance from the endothelium to the anterior IOL surface after surgery was 3.11 ± 0.61 mm. Postsurgically, cECC loss was 5.04% ± 9.58% with an annual cECC loss rate of 3.16% ± 4.46%. One patient developed IOL dislocation and retinal detachment after severe ocular contusion requiring vitrectomy, IOL refixation and gas tamponade. Another patient developed cystoid macular oedema, managed with intravitreal dexamethasone.

CONCLUSION:

This technique is both feasible and effective to manage severe ectopia lentis in children. Lifetime ophthalmic follow-up including cECC measurement, IOL position monitoring and fundus examination is mandatory in these patients.

• Authors: Jaume Català-Mora, Daniel Cuadras, Jesús Díaz-Cascajosa, Marta Castany-Aregall, Joan Prat-Bartomeu, José García-Arumí
• Journal: Acta ophthalmologica (Acta Ophthalmol) Vol. 95 Issue 2 Pg. 170-174 (Mar 2017) ISSN: 1755-3768 [Electronic] England
• PMID: 27535343 (Publication Type: Journal Article)
• Copyright: © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Topics

• Adolescent
• Child
• Child, Preschool
• Ectopia Lentis (physiopathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Iris (surgery)
• Lens Implantation, Intraocular (methods)
• Lenses, Intraocular
• Male
• Postoperative Complications (epidemiology)
• Prospective Studies
• Prosthesis Design
• Spain (epidemiology)
• Time Factors
• Visual Acuity (physiology)