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

Session Details

Session Title: Paediatric Cataract Surgery

Session Date/Time: Sunday 15/09/2019 | 16:30-18:00

Paper Time: 17:00

Venue: Free Paper Forum: Podium 2

First Author: : J.Català-Mora SPAIN

Co Author(s): :    D. Cuadras   J. Díaz-Cascajosa   M. Castany-Aregall   J. Prat-Bartomeu   J. García-Arumí                 

Abstract Details

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 paediatric patients.

Setting:

Paediatric Ophthalmology 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 63.3 ± 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.

Conclusions:

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.

Financial Disclosure:

None