Long-term Outcomes for Pediatric Patients Undergoing Trans-Scleral Fixation of the Capsular Bag with Intraocular Lens for Ectopia Lentis

Abstract

Purpose : There is no consensus regarding surgical management of ectopia lentis in children. Trans-scleral fixation techniques are controversial and long-term outcomes unclear. We report a retrospective observational case series demonstrating long term outcomes of trans-scleral fixation of a capsular tension device with IOL placement in pediatric patients with ectopia lentis.

Methods : Pediatric patients were identified who had undergone lens extraction at the John Moran Eye Center between 1/2006 and 1/2016. Patients between the ages of birth to 18 years with atraumatic ectopia lentis who underwent trans-scleral fixation with a capsular tension device and implantation of an intraocular lens (IOL) were analyzed.

Results : We identified 37 patients, 67 eyes, who underwent trans-scleral fixation of the capsular bag with use of a capsular tension device fixated with 9-0 or 10-0 polypropylene, 8-0 Gore-Tex, or 9-0 nylon from 2006-2016. The mean age at time of surgery was 7.25 years (2-18 years) and mean follow-up was 35.3 months (0.25-120 months). The proportion of eyes demonstrating improvement in best-corrected visual acuity post-operatively was 78.5%, which demonstrated significance with a 95% confidence interval. In the immediate post-operative period one eye developed a hyphema and one eye underwent IOL repositioning at post-op month (POM) 3. Long-term complications included posterior capsule opacity in 35 eyes (52%) and uveitis-glaucoma-hyphema syndrome in 1 eye (1.5%); no other patients developed glaucoma. Three eyes (4.4 %) required IOL repositioning for spontaneous delayed IOL dislocation, 2 sutured with 8-0 Gore-Tex at POM8 and POY3 and 1 sutured with 9-0 polypropylene at POY7.

Conclusions : Trans-scleral fixation of the capsular bag using a capsular tension device offers improved vision and IOL stability in pediatric patients with ectopia lentis.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.