Primary scleral-fixated posterior chamber intraocular lenses in patients with congenital lens subluxation

Anjian Wang,Qi Fan,Yi Lu,Yongxiang Jiang

doi:10.1186/s12886-021-02182-0

Abstract

ObjectiveWe investigated the long-term visual outcomes and ocular complications of primary scleral-fixated posterior chamber intraocular lenses (SF-PC-IOLs) in patients with congenital lens subluxation.MethodsWe enrolled 53 patients (77 eyes) with congenital lens subluxation caused by ectopia lentis, Marfan syndrome, and Weill–Marchesani syndrome who underwent primary implantation of a SF-PC-IOL. All patients underwent a complete ophthalmic examination include visual acuity (VA), intraocular pressure (IOP), intraocular lenses (IOL) position, intraoperative complications and postoperative complications. Cox regression analysis and survival analysis were used to evaluate the risk factors for postoperative complications.ResultsSeventy seven eyes from 53 patients were included. Mean age at surgery was 23 ± 20 years (5 to 67 years), with a mean follow-up of 39 ± 27 months (12 to 130 months). The best-corrected VA improved from 0.84 ± 0.55 to 0.26 ± 0.43 logarithms of the minimum angle of resolution (p < 0.001). Best-corrected VA improved postoperatively in 73 eyes (94%). The main causes of reduced vision after surgery were retinal pathologies and amblyopia. Complications included transient intraocular haemorrhage (2 eyes, 2.6%), early vitreous incarceration (2 eyes, 2.6%), retinal detachment (6 eyes, 7.8%) and IOL dislocation (3 eyes, 3.9%). Cox regression showed that postoperative eye trauma was a risk factor for long-term postoperative complications.ConclusionSF-PC-IOLs provide good visual outcomes in patients with congenital lens subluxation. The SF-PC-IOLs showed good stability, except in patients suffering from postsurgical eye trauma.

Highlights

Congenital lens subluxation is a relatively rare disease that may present in isolation or in combination with a systemic disease
Subjects We performed a retrospective review of the medical records of 77 eyes in 53 patients (31 males and 22 females) who underwent SF-PC-intraocular lenses (IOL) implantation between January 2005 and June 2014 at the Eye & ENT Hospital of Fudan University, Shanghai, China
The best-corrected visual acuity (BCVA) improved after surgery in 73 eyes (94%) compared with the BCVA before surgery

Summary

Introduction

Congenital lens subluxation is a relatively rare disease that may present in isolation (e.g. sporadic or familial ectopia lentis, ectopia lentis et pupillae, and aniridia) or in combination with a systemic disease (e.g. Marfan syndrome, homocystinuria, Weill–Marchesani syndrome, Ehlers–Danlos syndrome, sulphite oxidase deficiency, Patients with mild lens subluxation or lens edge dislocation out of the visual axis can often be treated via optical correction (glasses or contact lenses) [3]. Wang et al BMC Ophthalmology (2021) 21:411 or progressive lens displacement and patients with complications may require surgical intervention. The surgical procedure is complicated and carries a high risk of complications. Sutured Scleral-fixated PC-IOLs (SF-PC-IOL) have been used to treat lens subluxation for many years. Complex surgical techniques and mCTR (modified CTR = Cionni CTR) as a special implanting device makes a difficult access to the hospitals in grassroots areas and areas where modified CTR are not available. Under these circumstances, primary SF-PC-IOL implantation remains a major surgical intervention in the correction of aphakic eyes without sufficient capsular support

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