Abstract
Purpose. To evaluate the short-term postoperative outcomes in endoscopic-assisted sclera fixation intraocular lens (IOL) for the management of secondary aphakia in children. Methods. This is a prospective study, whereas 40 aphakic eyes with absence of a good capsular support were implanted by endoscopy-assisted sclera fixation technique. Results. No major intraoperative complications were recorded. All cases were followed up for 6 months. Only transient ocular hypertension occurred in 10 (25%) eyes. Lens decentration and/or tilting were clinically detected in 2 eyes (5%). Ultrasonic biomicroscopic (UBM) examination revealed lens tilting in 2 (5%) of the operated eyes, despite the proper haptics positioning in the ciliary sulcus. Postoperative vitreous hemorrhage was reported in 5 eyes (12.5%) in the early postoperative period and retinal detachment in one eye. A postoperative refractive astigmatism ranging from 0.75 D to 3.75 D (mean 1.7 D ± 0.79) was recorded, as compared to mean preoperative values of 2.00 D, with no statistically significant differences being recorded (p ≥ 0.05). An improvement of BCVA, 1-2 lines on Snellen chart at the end of the follow-up period, was detected in 23 eyes (57.5%) with a mean of 0.6 ± 0.08 SD, as compared to a preoperative mean values of 0.5 ± 0.07 SD (p ≥ 0.05). Conclusion. Using an endoscope for transscleral suturing of intraocular lenses in aphakic pediatric eyes might be considered as being an effective technique that can reduce surgical complications, especially postoperative lens decentration.
Highlights
Loss of a good capsular support is one of the intraoperative complications that may interfere with the decision of primary intraocular lens implantation at the time of surgery, whereas the decision of secondary implantation might be considered later aiming for proper optical correction of the resultant aniseikonic condition following unilateral postoperative aphakia
The optical correction of aphakia in the pediatric age group has been considered as being a challenging situation, with the option of intraocular lens (IOL) implantation to be considered in the majority of cases
In aphakic eyes with insufficient capsular support, scleral fixation of a posterior chamber intraocular lenses (PCIOLs) has been reported to be more superior than the anterior chamber IOL, being away from the corneal endothelium and being more anatomically placed; being a blind procedure with increasing the risks of intraoperative as well as postoperative complications made the procedure of ab externo scleral fixation PCIOLs in a rear position for many years [11]
Summary
Loss of a good capsular support is one of the intraoperative complications that may interfere with the decision of primary intraocular lens implantation at the time of surgery, whereas the decision of secondary implantation might be considered later aiming for proper optical correction of the resultant aniseikonic condition following unilateral postoperative aphakia.Several alternatives for the surgical correction of aphakia have been suggested (i.e., a posterior chamber intraocular lens (PCIOL) placed in the ciliary sulcus, or preferably in the capsular bag if possible); in the absence of a good capsular support, an anterior chamber IOL, an iris-fixated IOL, or a sutured PCIOL would be suggested [1].the introduction of sutureless (sclera tunnel) fixation of PCIOLs and glued assisted fixation has been proposed for the management of the problem of secondary aphakia in children with lack of a good capsular support [2, 3].Both transscleral suture fixation of posterior chamber lenses (PCLs) or sutureless fixation techniques in the absence of capsular support do provide the placement of the IOL in the posterior compartment being more fit to the anatomical position of the crystalline lens providing a good visual rehabilitation with a minimal long-term alteration of the blood-aqueous barrier [4].Considering the transscleral suture fixation, the suture has to penetrate exactly through the ciliary sulcus, and the PCL haptics have to be directed into the sulcus and secured there in order to provide a proper centration of the implanted IOL [5, 6].Journal of Ophthalmology. The introduction of sutureless (sclera tunnel) fixation of PCIOLs and glued assisted fixation has been proposed for the management of the problem of secondary aphakia in children with lack of a good capsular support [2, 3]. Both transscleral suture fixation of posterior chamber lenses (PCLs) or sutureless fixation techniques in the absence of capsular support do provide the placement of the IOL in the posterior compartment being more fit to the anatomical position of the crystalline lens providing a good visual rehabilitation with a minimal long-term alteration of the blood-aqueous barrier [4].
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