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E. Hatef Naimi, P. L. Gehlbach, I. H. Maumenee; Functional and Structural Outcomes of Lens Removal and Insertion of Posterior Chamber Intraocular Lenses in Patients With the Marfan Syndrome. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1445.
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To evaluate functional and structural outcomes resulting from lens removal and insertion of posterior chamber intraocular lenses in patients with Marfan syndrome.
We reviewed clinical charts of 90 patients (146 eyes) with Marfan syndrome who underwent lens removal and intraocular lens (IOL) implantation with scleral fixation with and without anterior vitrectomy performed by a single surgeon (1975-present). Patient data were sorted into two groups determined by size of the implanted lens, with IOLs < 13.5mm length and IOLs ≥ 13.5mm constituting the groups. Functional and structural outcomes and post-operative complications associated with the groups are reported.
The age range at the time of IOL implantation varied from 8.45 to 68.46 years, median 40.57. There were 79 (54.1%) women in the population. 58.0% of eyes had a superior dislocation of the lens; 22.2% were superior nasal and 17.5% were superior temporal. Axial length of operated eyes varied from 20.37 to 30.00 mm, median 25.02. The primary indication for surgery was decreased visual acuity in 96.6% of eyes. The median follow up time, from first IOL implant to death or last contact, was 23.11 months (range: 0.03, 148.95 months). The median visual acuity was 20/50 at preoperative exam and at one week after surgery. It was 20/25 at last visit. The median preoperative IOP was 16.0; while at one week follow up it was 12.0 and at last recorded visit it was 14.0. The median preoperative spherical equivalent was -0.61; at one week postoperatively it was -0.37 and at last visit it was -0.25. At one week follow up 97.9% of IOLs were centered and 90.3% of pupils were round. On last recorded visit 95.2% of IOLs were centered and 91.7% of pupils were round. IOL dislocation (19.9%) was the most common complication in operated eyes. 2.1% of the eyes had more than one IOL dislocation requiring surgical correction. The median time interval from IOL implantation to IOL dislocation was 28.09 months (range: 0.16, 109.90 months). There was no statistically significant difference in the prevalence of IOL dislocation between the two groups studied (P-value: 0.728).
This study provides an opportunity to identify aspects of lens design that may affect clinical outcomes in Marfan patients. The results provide insight into relevant next generation lens design features for the Marfan population. All patients requiring suture fixation of IOLs, including but not limited to Marfan patients, will benefit from more complete knowledge of IOL design features associated with optimal outcomes.
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