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IOL implantation with "flattened flanged intrascleral fixation technique" in pediatric aphakia

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First Author: F.Ucar TURKEY

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Abstract Details

Purpose:

To evaluate the effectiveness of flattened flanged intrascleral intraocular lens (IOL) fixation technique in pediatric aphakia.

Setting:

Konyagoz Eye Hospital

Methods:

Cases who admitted to our clinic and required secondary IOLimplantation due to different indications were included in this study. We performed "flattened flanged intrascleral IOL fixation", which is our sutureless scleral fixation technique described in adults, also in pediatric cases. Due to the scleral elasticity in children, the flattening process of the flange facilitated our surgery by providing stronger stability. Some steps we applied during IOL implantation allow us to utilize this method much faster. The technique has been elucidated in our article. (Flattened flanged intrascleral intraocular lens fixation technique. Ucar F, Cetinkaya S. Int Ophthalmol. 2020; 40 (6): 1455-1460.)

Results:

12 eyes of 12 patients were included in the study. The mean age was 5.95 ± 2.56 months. Scleral fixation indications were ectopia lentis (secondary to Marfan Syndrome [n = 2]), insufficient capsular support (n = 7) in the patient who underwent lensectomy, traumatic aphakia (n = 3) due to open globe injury. The mean follow-up time was 29 ± 19.28 months. The mean postoperative astigmatism was 2 ± 2 D. No major intraoperative complications were observed. Postoperative IOL decentralization, tilt, suture exposure, hypotonia, choroidal effusion, ocular hypertension, cystoid macular edema and retinal detachment were not observed in any patient.

Conclusions:

Given the life expectancy of children, prolene sutured scleral fixation IOLs carry the risk of late decentralization and dislocation due to late suture breakage and fracture. Therefore, scleral fixation techniques using no sutures or glue have been reported recently. The Yamane technique provides significant advantages over other suture-free techniques. However, because the sclera is more flexible in children, the flange state of the haptics in the sclera is not sufficient for complete stabilization. The flattened process of flanged haptics provides stronger stability. In addition, we perform flattening the haptics in children 20% more than in adults.

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