Comparison of Transscleral Sutureless Intraocular Lens and Retropupillary Iris-Claw Lens Fixation for Aphakia without Capsular Support in Children
Asmaa Shuaib, MSc; Ahmed Kamal, MD; Yasmine El Sayed, MD; Zeinab El Senebary, MD; Hala Elhilali, MD
Abo El Rish Hospital- Cairo University
Introduction: Intraocular lens (IOL) implantation in aphakic eyes without capsular support poses a challenge in children.
Methods: Fifteen eyes underwent sutureless transscleral IOL fixation (Group 1) and 15 eyes iris-claw lens fixation (Group 2) with 6 months follow-up. The primary outcome measured was best-corrected visual acuity (BCVA). Secondary outcomes included operative time, postoperative astigmatism, central corneal thickness (CCT), endothelial cell count, IOL decentration and tilt, central foveal thickness (CFT) and intraoperative and postoperative complications.
Results: The mean postoperative BCVA in Group 1 was 0.41±0.28 and in Group 2 was 0.42±0.21 (p=0.21). The iris-claw lens group had significantly shorter operative time (47.86± 4.2 min) than scleral fixation group (61.74±9.13 min) (p=0.0014). The mean decrease in endothelial cell count in Group 1 was 370.14 ± 472.08 cell/mm2 and in Group 2 was 468.43 ± 491.09 cell/mm2 (p=0.48). There was no statistical difference in astigmatism, CCT, IOL tilt and decentration or CFT (p=0.62, p=0.054, p=0.1, p=0.078 and p=0.32, respectively). Postoperative complications in the Group 1 included IOL haptic slippage and IOL capture whereas ovalization of the pupil, IOL disenclavation and retinal detachment occurred in Group 2. Glaucoma and hypotony occurred in both groups.
Discussion: Primary and secondary outcomes show no statistically significant difference in the 2 groups, except for significantly longer operative time in the transscleral sutureless IOL fixation,which is more technically demanding than iris-claw lens implantation.
Conclusion: Retropupillary iris-claw lens fixation procedure is shorter and technically easier. It is the only option in severe iris damage. Modifications in IOL design could facilitate transscleral IOL fixation.
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2-Gonnermann J, Torun N, Klamann MK, Maier AK, von Sonnleithner C, Rieck PW, et al. Posterior irisclaw aphakic intraocular lens implantation in children. Am J Ophthalmol. 2013; 156(2):382-6.
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