Abstract
There are several available options for the demanding surgical correction of paediatric aphakia without sufficient capsular support. The literature suggests the implantation of a transscleral fixated posterior chamber-intraocular lens (PCIOL), an intrascleral fixated PCIOL, an iris-sutured intraocular lens (IOL), or an anterior chamber iris-claw IOL. We searched for reports on the management of paediatric aphakia in case of inadequate capsular support that delineated the diverse surgical approaches and their postoperative results. Analysis demonstrated that different complications can be encountered depending on IOL placement technique, such as suture rupture, IOL dislocation, secondary glaucoma, endophthalmitis, vitreous hemorrhage, and endothelial cell loss. However, it was shown that various IOL designs have similar visual outcomes. Taking into consideration the advantages and disadvantages of each surgical technique, ophthalmic surgeons can determine the safest and most efficient approach for paediatric aphakic patients.
Highlights
Paediatric aphakia with the absence of adequate capsular support may occur after lens removal for congenital cataract, after trauma or lens subluxation associated with systemic disorders
The implantation of anterior chamber intraocular lens (IOL) has been related to several postoperative complications, such as corneal endothelial cell loss (ECL), glaucoma, intraocular inflammation, hyphema, and cystoid macular oedema. us, anterior chamber IOLs are not recommended for use in the paediatric population [6]
Another alternative solution for the correction of paediatric aphakia in case of insufficient capsular support has been the implantation of Artisan IOL [27]. e Artisan IOL, invented by Worst in 1986, was originally a biconcave iris-enclavated IOL used in phakic patients with high myopia [28]
Summary
Paediatric aphakia with the absence of adequate capsular support may occur after lens removal for congenital cataract, after trauma or lens subluxation associated with systemic disorders. Refractive error can be temporarily managed with spectacles or contact lenses; secondary implantation of an intraocular lens (IOL) provides better visual outcomes in children with aphakia or lens subluxation [1, 2]. Available options include the use of an anterior chamber IOL, a scleral fixated (SF) sutured posterior chamber IOL (PCIOL), an intrascleral fixated PCIOL, an iris-sutured PCIOL, or iris-claw lens [3]. Is review aims to present the different surgical methods used in cases of paediatric aphakia without adequate capsular support and give a full description of their complications and visual outcomes
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