A Comparison of Lens Fixation Techniques Versus Aphakia in the Treatment of Pediatric Ectopia Lentis
Rohini R. Sigireddi; Zaina N. Al-Mohtaseb; Sarah A. Logan; Mitchell P. Wiekert; M. Bowes Hamill; Li Wang; Kimberly G. Yen
Texas Children’s Hospital & Baylor College of Medicine
Introduction: No standard approach exists for treatment of pediatric ectopia lentis. Individual studies evaluating iris-sutured intraocular lenses (IOL), scleral fixated IOLs, scleral fixated capsular tension segments (CTS)/capsular tension rings (CTR) with IOL, and aphakia exist, but none directly compare these approaches.
Methods: Retrospective study of pediatric ectopia lentis comparing lensectomy and aphakia, iris-sutured IOL, trans-scleral fixation of CTR/CTS with placement of IOL in-the-bag, and scleral-sutured IOL.
Results: 71 eyes were included (43 CTR/CTS, 12 iris-sutured, 11 aphakic, and 5 scleral-sutured). Average follow was 2.0 years for CTR/CTS, 4.4 years for aphakic, 5.4 years for scleral-sutured, and 7.0 years for iris-sutured. Vision improved significantly in all but the iris-sutured group. IOL repositioning was required due to IOL dislocation in 6/12 (50%) iris-sutured, 1/5 (20%) scleral-sutured, and 2/43 (9.3%) CTR/CTS eyes. 24/43 (55.8%) CTR/CTS and 1/5 (20%) scleral-sutured eyes developed visual axis opacification (VAO). Other complications included wound leak in 3/43 (7%) CTR/CTS and 1/5 (20%) scleral-sutured eyes, retinal detachment (RD) in 2/12 (16.7%) iris-sutured eyes, iris capture in 2/5 (40%) scleral-sutured and 1/43 (2.3%) CTR/CTS eyes, corectopia in 3/5 (60%) scleral-sutured and 2/43 (4.6%) CTR/CTS eyes, and vitreous wick in 1/43 (2.3%) CTR/CTS eyes.
Discussion: Clinically, visual outcome was poorest for the iris-sutured eyes since 2 eyes developed RD after IOL dislocation. The CTR/CTS group had the highest rate of VAO.
Conclusion: VAO is the most common complication after CTR/CTS in pediatric ectopia lentis; iris-sutured IOLs are associated with a higher rate of dislocation and RD. Longer follow up is required to assess long-term outcomes of all techniques.
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3 Kim EJ, et al. Scleral-fixated capsular tension rings and segments for ectopia lentis in children. Am J Ophthalmol. 2014 Nov;158(5):899-904.