Experience of early implantation of retropupillary iris-claw intraocular lens in childhood

Session Details

Session Title: Paediatric Cataract Surgery

Session Date/Time: Tuesday 13/09/2016 | 08:00-10:30

Paper Time: 08:00

Venue: Hall C1

First Author: : G.Hildebrand UK

Co Author(s): :    K. Xue                    

Abstract Details

Purpose:

Aphakia with inadequate capsular support is occasionally encountered in young children following trauma, complicated cataract surgery or lens dislocation, and carries a high risk of amblyopia. Options for visual rehabilitation include aphakic contact lens or intraocular lens (IOL) implantation with fixation either in the anterior chamber, iris or sclera. Retropupillary fixation of the Artisan iris-claw IOL appears safe in adults, but has rarely been used in children. Here, we report outcomes of retropupillary Artisan IOL implantation in the largest and youngest series of children to date.

Setting:

A secondary referral centre for paediatric ophthalmology.

Methods:

A retrospective consecutive cohort study of eight children with mean age 4.9 years ±3.5 SD (range 1.1-11.9) who underwent retropupillary Artisan IOL implantation between 2011 and 2013 by the same surgeon (GDH). Surgical indication was aphakia with inadequate capsular support following complicated lens extraction for congenital or developmental cataract (n=5) or penetrating eye injury (n=3). Six children received IOL implantation as a secondary procedure after failure to tolerate contact lenses. The A-constant for retropupillary Artisan IOL selection was 116.8 as recommended by the manufacturer. Outcome measures include best-corrected visual acuity (BCVA), cycloplegic refraction and any complications.

Results:

Visual improvement over mean followed-up of 20.5 months ±14.0 (range 8-46) varied by the degree, if any, of pre-existing amblyopia. Four eyes with either penetrating injury (n=3) or developmental cataract (n=1) but no pre-existing amblyopia, achieved final BCVA 0.00-0.10 logMAR. Four other eyes with pre-existing amblyopia due to unilateral cataract achieved limited visual improvement (final BCVA 0.50-1.00). Mean final spherical equivalent was -2.02 dioptre ±0.87, representing 1.78 D ±0.84 of myopic shift from target. Transient uveitis occurred in two eyes, one requiring membranectomy (achieving 0.00). Traumatic IOL dislocation occurred in one eye with successful re-enclavation. No long-term complications were encountered.

Conclusions:

The data adds support for retropupillary Artisan IOL as an alternative approach for the correction of aphakia in young children with insufficient capsular support.

Financial Disclosure:

NONE