Retropupillary iris-claw aphakic intraocular lens implantation in children

Session Details

Session Title: Congenital Cataract Surgery

Session Date/Time: Sunday 14/09/2014 | 16:30-18:30

Paper Time: 17:57

Venue: Boulevard A

First Author: : D.Hildebrand UK

Co Author(s): :    K. Xue              

Abstract Details

Purpose:

We report the efficacy of retropupillary implantation of the iris-claw intraocular lens (Artisan IOL, Ophtec, the Netherlands) in the correction of aphakia with inadequate capsular support in the youngest and largest pediatric series to date.

Setting:

Royal Berkshire Hospital, Reading, and Prince Charles Eye Unit, Windsor, United Kingdom

Methods:

A consecutive series of 8 children with a mean age of 4.9 years ± 3.5 (SD) (range 1.1 to 11.9 years) underwent retropupillary Artisan IOL implantation for aphakia with inadequate capsular support by one surgeon (GDH) between 2011 and 2013. All children underwent regular comprehensive eye examinations, including visual acuity assessment, dilated fundoscopy and cycloplegic refraction. The mean follow-up period was 12.9 months ± 6.3 (range 8 to 27 months).

Results:

All children showed improvement in visual acuity postoperatively with pre-existing amblyopia being the limiting factor. Four children who received retropupillary Artisan IOL after penetrating injury achieved postoperative best-corrected visual acuity (BCVA) of 0.00 to 0.10 logMAR. The postoperative VA of four other children, who had pre-existing dense amblyopia due to congenital or developmental cataracts, ranged from 0.78 logMAR unaided to light perception (with resolution of nystagmus). The mean final spherical equivalent (SE) was -1.66 D ± 0.64, which represents a mean myopic shift of 1.46 D ± 0.48 from target SE. Complications include transient mild vitreous hemorrhage in 2 eyes and transient uveitis in 2 eyes. A two year old who received primary IOL implantation following penetrating injury required pars plana membranectomy to remove fibrin deposits behind the IOL due to poor compliance with drops, and obtained a final BCVA of 0.00 logMAR. Traumatic IOL dislocation occurred in one eye, which was re-enclavated uneventfully. One eye with dislocation of a prepupillary Artisan IOL implanted elsewhere underwent IOL re-enclavated behind the iris. Subsequently, it was found to have an area of stable retinal elevation (without retinal break). The origin and chronicity of this lesion is uncertain but no treatment was required.

Conclusions:

Retropupillary Artisan IOL implantation is an effective alternative approach for the visual rehabilitation of aphakia with inadequate capsular support in young children. The technique is versatile and applicable in a variety of settings, including penetrating eye injury, pediatric cataract extraction, or lens dislocation.

Financial Interest:

NONE