Abstract
Purpose :
Ectopia lentis poses a challenging decision for surgeons, requiring consideration of whether to operate or watch-and-wait. Up till now there is no standard approach to treat ectopia lentis. In 2021 Tassignon et al. reported an adapted vitrectomy sparing bag-in-the-lens intraocular lens (BIL IOL) implantation technique in children with congenital ectopia lentis. We present the anatomical and functional results of the pediatric patients who were treated with this technique aimed at optimal centration and fixation of the BIL IOL with one year follow up.
Methods :
Seven consecutive pediatric cases (eleven eyes) aged 2-16 years with a diagnosis of ectopia lentis were operated between September 2020 and November 2023 using an adapted vitrectomy sparing BIL IOL implantation technique, which included lens extraction, implantation of the BIL IOL and combination of supporting bean-shaped segments and a sclera fixated 6,0 polypropylene loop (PPL) following the Yamane technique. In all cases a standard ophthalmologic examination was performed before and 1 day, 1, 4 weeks and 1 year after the surgery.
Results :
In 5 patients a Marfan syndrome was diagnosed by molecular genetics. In all cases luxation of the lens was consistently upward, and all eyes exhibited severe subluxation with preserved but stretched ciliary zonulae. Preoperative refraction revealed high astigmatism values for all eyes, with the risk of amblyopia. Surgery was successfully conducted in all eyes without major local or systemic adverse events. In 2 patients (3 eyes) a limited anterior vitrectomy was performed in order to remove vitreous strands located in the anterior chamber preoperatively. In all cases it an optimal centration of the BIL IOL was achieved. In one case a minimal displacement of the PPL was observed without decentration of the IOL. Refraction outcomes demonstrated significant improvements of the visual acuity with reduced degrees of astigmatism and postoperative refractive error.
Conclusions :
This adapted BIL IOL implantation technique with the inclusion of supporting bean-shaped segments and a 6.0 PPL fixated at the sclera, allowed to spare a vitrectomy, demonstrated consistent success in achieving an optimal centration and stability of the implanted IOL, and showed favorable refractive outcomes in all cases. Further studies are required to prove the efficacy of this technique on a large cohort of patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.