Pupillary capture following sutureless scleral-fixated intraocular lens in children with Marfan syndrome

AIM:To compare the clinical outcomes between two approaches for sutureless scleral-fixated intraocular lens(SFIOL)in children with Marfan syndrome(MFS).METHODS:The study included 15 children(26 eyes)with lens subluxation due to MFS.These children underwent lensectomy,anterior vitrectomy,and sutureless SFIOL.According to the position of placement of intraocular lens(IOL)haptics,two study groups were reviewed for best corrected visual acuity(BCVA)and postoperative complications:group A,14 eyes with haptics fixated at 2.0 mm from the limbus;group B,12 eyes with the haptics fixated at 2.5 mm from the limbus.RESULTS:The mean axial length for all patients was 25.66±2.35 mm.Postoperative BCVA in logMAR were significant improved in both groups(0.77±0.32 to 0.17±0.12 in group A,0.66±0.25 to 0.24±0.12 in group B,both P<0.001)while no significant difference between two groups(P>0.05).Pupillary capture was main postoperative complication,occurring between 3d and 18mo.It occurred in 7 eyes in group A and one eye in group B(P=0.02).CONCLUSION:Sutureless SFIOL is an effective treatment approach for lens subluxation in children with MFS.Pupillary capture is the main postoperative complication.Fixated IOL haptics at 2.5 mm from the limbus can reduce the occurrence of pupillary capture.

Comparison of iris-fixated foldable lens and scleralfixated foldable lens implantation in eyes with insufficient capsular support

AIM： To compare the outcomes of vision using two different intraocular lens（IOL） replacement techniques,iris-fixated foldable intraocular lens（IF-IOL） and scleralfixated foldable intraocular lens（SF-IOL） in patients with insufficient capsular support.METHODS： Total 63 eyes（62 patients） with insufficient posterior capsule support underwent replacement of IF-IOL or SF-IOL between January 2008 and August 2011.Outcome measures included changes in visual acuity, slit lamp examination, refractive indices and corneal curvatures. RESULTS： The mean improvement of uncorrected visual acuity（UCVA） was greater in IF-IOL group compared to the SF-IOL group（0.43 D±0.19 D vs 0.35 D±0.18 D, P 〈0.05）. Moreover, 12（38.71%） eyes in IF-IOL group and 4（12.50%） in SF-IOL group had a higher postoperative UCVA than preoperative best corrected visual acuity（BCVA） while 9（29.03%） eyes in IF-IOLgroup and 18（56.25%） in SF-IOL group had a lower postoperative UCVA than preoperative BCVA. The myopic mean manifest sphere and mean cylinder magnitude were lower in the IF-IOL group than that in the SF-IOL group（-0.47 D±0.58 D vs 0.50 D±0.43 D, P 〈0.01; 0.84 D ±0.53 D vs 1.23 D ±0.70 D, P 〈0.05）. No difference of corneal astigmatism and surgically induced astigmatism was found between the two groups. In addition, fewer complications were observed in IF-IOL eyes. CONCLUSION： IF-IOL implantation can give a significant improvement in vision with fewer complications than SF-IOL in patients with insufficient capsular support.