Ectopia lentis: surgical management and visual outcomes

Session Details

Session Title: Cataract Surgery Special Cases

Session Date/Time: Monday 12/09/2016 | 08:00-10:30

Paper Time: 08:56

Venue: Auditorium C6

First Author: : M.Mota PORTUGAL

Co Author(s): :    D. Silva   C. Pedrosa   P. Pego   C. Vendrell   I. Prieto        

Abstract Details

Purpose:

To present our surgical techniques, visual outcomes and complications during and after crystalline lens surgery with intraocular lens (IOL) implantation in ectopia lentis due to Marfan Syndrome (MFS) or Congenital Isolated Ectopia Lentis (CIEL). All surgical steps are carried out smoothly, in order to avoid subluxation increase and unnecessary tractions in the vitreous base. MFS and CIEL are a progressive pathologic state. Therefore, in most cases, even with mild zonular laxity, a capsular tension ring (CTR)/segment with scleral fixation was placed. The authors show in video different approaches for the management of this condition.

Setting:

Ophthalmology Department, Hospital Prof. Dr. Fernando Fonseca E.P.E., Amadora, Portugal.

Methods:

Retrospective analysis of 34 eyes of 19 patients, with lens subluxation due to MFS (22 eyes) and CIEL (12 eyes), who underwent crystalline lens surgery. The pre- and postoperative corrected distance visual acuity (CDVA), surgical techniques and intra and postoperative complications were reviewed. In most cases, we performed stabilization and centration of the capsular bag, for safe phacoaspiration of the lens, placing capsular hooks associated with CTR and segment with scleral fixation. In other cases, we choose to perform a complete anterior vitrectomy with preservative-free triamcinolone acetonide after phacoaspiration.

Results:

Average age at surgery was 11,44 years and mean postoperative follow-up was 5,56 years. Mean CDVA improved from 20/100 before surgery to 20/30 after surgery (p<0.001). Primary implantation of acrylic hydrophobic posterior chamber IOL was the preferred approach (3-piece: 14; scleral suspension: 3; single-piece: 2). In 13 cases, iris enclavation IOL was implanted. Two eyes were left aphakic (high myopia). Complications included posterior capsule rupture during surgery (1 eye), CTR extrusion (2 eyes), IOL dislocation (5 eyes), posterior capsule opacification (3 eye), suture extrusion (2 eyes) and capsular contraction (1 eye).

Conclusions:

A complete capsulorhexis is a challenging step, facilitated by use of the bimanual micro-incision technique, which avoids the instability of the anterior chamber. Primary posterior capsulotomy is also an important surgical step in very young patients. This surgical approach provides a significant and longstanding improvement in CDVA in patients with ectopia lentis. Our preferred approach is gentle phacoaspiration of the lens with bag preservation in order to be as minimally aggressive as possible, but these surgeries are a major challenge and the surgeon must be prepared to reconsider the approach depending on the surgical complications that may arise.

Financial Disclosure:

NONE