Abstract
Purpose :
To report longer-term safety and efficacy outcomes after implantation of trans-scleral sutured posterior chamber intraocular lenses (TSS-IOLs) in children lacking capsular support. Comparison was made between children with ectopia lentis, congenital cataract, or traumatic cataract as well those implanted using 9-0 vs. 10-0 Prolene sutures.
Methods :
Outcomes were collated retrospectively for 48 children (61 eyes) implanted with TSS-IOLs. All of the children had a history of lensectomy-vitrectomy with primary or secondary extensive or complete capsulectomy. Main outcome variables were final corrected distance visual acuity (CDVA) and occurrence of IOL-related adverse events (AE). The cause of the initial lenticular abnormality was ectopia lentis in 10 children (19 eyes), congenital cataract in 13 children (16 eyes), and traumatic cataract in 16 children (16 eyes). Mean follow-up for the 3 groups was 10.7, 10.6, and 7.5 years respectively. 39 eyes were implanted using 10-0 Prolene and 9 eyes using 9-0 Prolene.
Results :
CDVA (mean 0.4 ± 0.3 logMAR) at last follow-up was best for those with ectopia lentis; mean age at initial surgery 7.8 yrs. CDVA (mean 1.25 ± 0.9) was worst for those with congenital cataract-related deprivation amblyopia; mean age at initial surgery 2.1 ± 0.4 months. The major AE encountered was suture breakage and TSS-IOL dislocation, which occurred in 68% of children with ectopia lentis, 23% with traumatic cataract, and 19% with congenital cataract. The IOL dislocation rate for eyes implanted using the thinner 10-0 Prolene suture was 37%, compared to 0% using the thicker 9-0 Prolene suture.
Conclusions :
The TSS-IOL remains a useful option for correction of aphakia in pediatric eyes lacking capsular support. The major determinants of outcome success are lack of deprivation amblyopia (older age at first surgery) and use of thicker, breakage-resistant suture.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.