Glued Intrascleral Fixation of Posterior Chamber Intraocular Lens in Children

We read with great interest the article entitled “Glued intrascleral fixation of posterior chamber intraocular lens in children,” by Kumar and associates. The authors reported the short-term results of glued intrascleral fixation of posterior chamber intraocular lens (glued IOL) in children without adequate capsular support. It is indeed a good alternative in children without adequate capsular support. We are especially interested in the 9 eyes with ectopia lentis in this study. The authors reported excellent result with this technique, with none of the eyes developing retinal detachment, IOL dislocation, endophthalmitis, or glaucoma on follow-up.

We would like to share our small study, which we abandoned in between because of serious complications in 1 group. We prospectively randomized the eyes of 5 Marfan syndrome children with bilateral ectopia lentis into 2 groups. Group A eyes underwent 23-gauge pars plana lensectomy (PPL) with anterior vitrectomy and trans-scleral fixation of polymethyl methacrylate (PMMA) IOL using 10-0 polypropylene suture employing ab externo technique. Group B eyes underwent 23-gauge PPL with anterior vitrectomy and glued intrascleral fixation of foldable 3-piece acrylic IOL (technique described by the authors ). Intraoperative peripheral fundus examination of all these eyes was done after PPL, before inserting the implant, in both groups. The aim of the study was to compare the postoperative outcome and complications between the 2 groups.

There were 5 eyes in group A and 4 eyes in group B at the time of termination of the study. Out of 4 eyes in group B, 2 developed retinal detachment (RD). One eye developed RD at 3 months and the other at 5 months. None of the eyes in group A developed RD. There was no other complication in either group during the follow-up period. Both of these eyes with RD were managed by pars plana vitrectomy and silicone oil tamponade. An important intraoperative finding was the presence of vitreous incarceration at the site of externalization of haptics. Both eyes required iris hooks for better visualization of the posterior segment.

We offer different points of view regarding the use of this technique in these eyes. These eyes are already predisposed to retinal detachment for various reasons, with reported incidence of 8% to 25.6%. This rate further increases with surgical techniques that result in vitreous incarceration and traction. Management options for these eyes include lensectomy without implant or lensectomy with iris/sclera fixation of IOLs using various techniques. Our concern is the possibility of peripheral vitreous incarceration into sclerotomies, which may have occurred in our case, while doing externalization of the haptics. This vitreous incarceration further led to traction and retinal detachment. Anterior vitrectomy limited to the pupillary area in this technique leaves all the vitreous in the periphery intact, thus increasing the chances of vitreous incarceration in these eyes. There is a possibility of surgeon-related complications in these eyes, but we have not encountered such complications with this technique in adults. We suggest that the outcome of glued IOL in ectopia lentis eyes deserves individual attention because of the propensity to retinal detachment.

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Jan 12, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Glued Intrascleral Fixation of Posterior Chamber Intraocular Lens in Children

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