Abstract
Purpose :
Treatment of ametropia in children with Marfan Syndrome due to ectopia lentis entails removal of the dislocated crystalline lens. The ensuing aphakia has been treated by intraocular lens (IOL) implantation using either a trans-scleral sutured, posterior chamber IOL (TSS-IOL) or an iris-enclaved anterior chamber IOL (Ophtec IOL). Here we compare efficacy and safety outcomes after TSS-IOL or Ophtec IOL implantation in a series of Marfan Syndrome children.
Methods :
Outcomes were collated retrospectively (TSS-IOL) and prospectively (Ophtec IOL) for 17 eyes (9 children) implanted with TSS-IOLs and 23 eyes (12 children) implanted with Ophtec IOLs. All children had a history of lensectomy-vitrectomy with complete capsulectomy for ectopia lentis. Age at IOL implantation was comparable (p = .60), an average 6.25 yrs (1 – 19 yrs) for TSS-IOL and 4.92 yrs (1 – 11 yrs) for Ophtec IOL. Average follow-up in the TSS-IOL group was 10.0 yrs (5 – 16 yrs) and in the Ophtec IOL group 3.17 yrs (1 – 7.5 yrs).
Results :
At last follow-up visit, CDVA was better than pre-operative measures in 59% of TSS-IOL implanted eyes and 91% of Ophtec IOL eyes. The major cause of severe visual loss in TSS-IOL eyes was retinal detachment (41%, 7/17 eyes); no cases of retinal detachment occurred in Ophtec IOL eyes (0%, 0/23). Suture breakage-related TSS-IOL dislocation required either re-suturing (35.3%, 6/17 eyes) and/or subsequent IOL exchange with implantation of an anterior chamber IOL (53%, 9/17 eyes). One case of dislocation of an Ophtec IOL occurred after it was exchanged from the TSS-IOL. Iris capture required IOL repositioning in 24% (4/17) of TSS-IOL eyes. Central corneal thickness was greater (p = .35) in TSS-IOL eyes compared to Ophtec IOL eyes.
Conclusions :
Longer term follow-up of children with Marfan Syndrome reveals substantial differences in safety and efficacy for TSS vs Ophtec IOL implanted eyes. IOL dislocation, IOL exchange and/or retinal detachment with loss of CDVA occurred in greater than 40% of TSS-IOL implanted eyes followed an average of 10 years. These complications were not encountered in children implanted with the Ophtec IOL.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.