Abstract
Aim: To study the feasibility and efficacy of removal of the subluxated lens and sclera fixation of a foldable intraocular lens on top of the decentered preserved capsular bag. Patients and methods. Seventeen eyes of 10 patients (9 - 15 years) were done by phacoaspiration followed by trans-scleral fixation of foldable IOL in the sulcus on top of the decentered capsular bag of the subluxated lens. Results: Postoperative refraction spherical equivalent amplitude ranged from 0.25 to 1.38 diopters with a mean of 1.35 ± 1.13 diopters. The final postoperative BCVA ranged from 6/18 to 6/6 with a mean of 6/9 (0.67 ± 0.25 decimal). Intraoperative complications were hyphema in one case and accidental small zonular injury without vitreous prolapsed during needle passage in two cases. Postoperative complications were transient iridocyclitis in one case. Posterior capsular opacification (PCO) occurred in all cases but in thirteen cases the bag gets contracted and the opacity was away from the visual axis and only four cases needed YAG posterior capsulotomy. Conclusion: Combined sulcus and scleral fixation of foldable intraocular is a safe and effective method. This technique of keeping the decentered bag attached to the stretched zonules will prevent IOL tilt and avoid working on the vitreous with its known complications. Scleral fixation of the foldable IOL guarantees the long term stability and gets the benefits of small incision surgery.
Highlights
Marfan’s syndrome is a connective tissue disorder characterized by skeletal, cardiac and ocular abnormalities
Parsplana lensectomy with scleral fixation of either large optic PMMA or foldable intraocular lens (IOL) gave favorable results in comparison with old techniques of ECCE or ICCE
Two point scleral fixation of IOL carries the risk of IOL tilt due to lack of capsular support [5]
Summary
Marfan’s syndrome is a connective tissue disorder characterized by skeletal, cardiac and ocular abnormalities. Lens subluxation occurs in 50-80% of the Marfan cases. It tends to be bilateral, symmetrical and displaced almost always toward the super temporal direction. Lens subluxation induces myopia and irregular astigmatism which are uncorrectable with glasses in most cases [1]. Many surgical techniques for removal of the subluxated lens were described. Parsplana lensectomy with closed system is proven to prevent scleral collapse and vitreous loss. After lens removal aphakia is corrected by glasses, contact lenses, anterior chamber IOL or sutured IOL to the iris or the sclera [3]. The aim of this work was to study the feasibility and efficacy of phaco-extraction of the subluxated lens and scleral fixation of a foldable intraocular lens (IOL) on top of the decentered capsular bag
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