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      Surgical Management of Paediatric Aphakia in the Absence of Sufficient Capsular Support

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          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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          Late dislocation of scleral-sutured posterior chamber intraocular lenses.

          Cecil Berlie, Nick Mamalis, Jacqueline Price … (2005)
          To examine a recent series of late scleral-sutured posterior chamber intraocular lens (PCIOL) dislocations to identify possible causes and preventive measures. Price Vision Group, Indianapolis, Indiana, USA. In this retrospective non-comparative interventional case series, 5 consecutive patients received treatment for dislocated scleral-sutured PCIOLs between July 2002 and March 2004. Dislocated lenses were resutured or replaced with another scleral-sutured PCIOL. Dislocation of scleral-sutured PCIOLs occurred 7 to 14 years after implantation. Four dislocations were spontaneous, and 1 was precipitated by trauma. In each case, the suture affixing 1 or both haptics failed. There was no evidence that the suture had eroded through the tissue or that the knot had untied. Microscopic analysis of an explanted IOL with remnants of the suture attached showed localized degradation and cracking of the polypropylene suture material where it had been embedded in the scleral tissue. Suture-fixated PCIOLs can dislocate due to degradation of the suture material over time. The use of larger diameter (9-0 instead of 10-0) polypropylene suture material and placement of the haptic and sutures in the ciliary sulcus to promote attachment of scar tissue may enhance the long-term stability of scleral-fixated PCIOLs.
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            Long-term results of scleral fixation of posterior chamber intraocular lenses in children.

            Ahmad Kheirkhah, Reza Asadi-Golshan (2007)
            To evaluate the long-term results of transsclerally fixated posterior chamber intraocular lenses (SF-PCIOLs) in children without adequate capsular support. Noncomparative interventional case series. Twenty-five eyes of 23 children who underwent primary (6 eyes) or secondary (19 eyes) implantation of SF-PCIOLs. The primary cases included those undergoing surgery for lens subluxation due to Marfan's syndrome, and secondary cases included those after surgery for congenital cataract (3 eyes) or traumatic cataract (16 eyes). All eyes lacked adequate capsular support and, in secondary cases, manifested contact lens intolerance. Ab externo transscleral fixation of PCIOLs. Visual acuity (VA), IOL position, and postoperative complications. The mean age of patients at the time of SF-PCIOL implantation was 79+/-20.2 months (range, 33-120). The mean duration of follow-up after surgery was 81.1+/-46.2 months (range, 12-144). Best-corrected VA improved postoperatively in 12 eyes (48%) by >1 Snellen line. The main cause of reduced vision was corneal and retinal pathologies and amblyopia. Complications included transient intraocular hemorrhage in 13 eyes (52%), transient choroidal effusion in 2 eyes (8%), late endophthalmitis in 1 eye (4%), retinal detachment in 1 eye (4%), and late IOL dislocation due to breakage of polypropylene sutures after 7 to 10 years in 6 eyes (24%). Scleral fixation of PCIOLs can be visually rewarding in selected cases, but there is a high rate of complications during a long-term follow-up.
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              Posterior iris fixation of the iris-claw intraocular lens implantation through a scleral tunnel incision.

              Özgür Timuçin, Mehmet Baykara, Hikmet Ozcetin … (2007)
              To evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel incision for aphakia correction. Noncomparative, interventional case series. A secondary posterior iris fixation of the Artisan iris-claw IOL (Ophthec BV, Groningen, The Netherlands) was implanted for aphakia correction in the authors' clinical practice. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), astigmatism, manifest refraction, lens position, pigment dispersion, and intraocular pressure (IOP) were evaluated in 32 consecutive eyes of 32 patients. BSCVA was 20/40 or better in 28 eyes (87.50%) during the mean follow-up time (nine months). Mean postoperative spherical equivalent was -0.70 diopters (D; standard deviation [SD], 0.47 D) at six months after surgery. Mean prediction error was -0.13 D (SD, 0.28 D), and mean absolute prediction error was 0.26 D (SD, 0.15 D). Preoperative mean astigmatism was -1.08 D (SD, 0.55 D; range, 0.0 to -2.0 D). At six months after surgery, mean astigmatism was -2.1 D (SD, 0.81 D; range, -0.75 to -3.75 D). There was no significant postoperative IOP increase. Lens position, evaluated by Oculus Pentacam (Pentacam 70700: Oculus, Wetzlar, Germany) and ultrasound biomicroscopy [UBM] (Ophthalmic Technologies Inc, Toronto, Ontario, Canada), was parallel to the iris plane. Posterior iris fixation of the iris-claw IOL implantation through a scleral tunnel incision is a safe procedure and an effective option for aphakic eyes without capsule support.
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                Author and article information

                Contributors
                Georgios D. Panos:
                ORCID: https://orcid.org/0000-0001-8399-7456
                Journal
                Journal ID (nlm-ta): J Ophthalmol
                Journal ID (iso-abbrev): J Ophthalmol
                Journal ID (publisher-id): JOPH
                Title: Journal of Ophthalmology
                Publisher: Hindawi
                ISSN (Print): 2090-004X
                ISSN (Electronic): 2090-0058
                Publication date Collection: 2021
                Publication date (Electronic): 4 December 2021
                Volume: 2021
                Electronic Location Identifier: 2253486
                Affiliations
                1Karasavvidou Eye Centre, Naousa, Greece
                2Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
                Author notes

                Academic Editor: Alessandro Meduri

                Author information
                https://orcid.org/0000-0002-5358-8579
                https://orcid.org/0000-0001-8399-7456
                Article
                DOI: 10.1155/2021/2253486
                PMC ID: 8665890
                PubMed ID: 34904056
                SO-VID: b85728aa-1b74-4ac7-918c-e6815ed2c85d
                Copyright © Copyright © 2021 Evdoxia-Maria Karasavvidou et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 4 November 2021
                Date accepted : 15 November 2021
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Ophthalmology & Optometry
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry

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