儿童人工晶状体二期植入术

目的探讨人工晶状体（IOL）二期植入术矫正儿童无晶状体眼的疗效和手术适应证。方法对37例（57眼）后囊和悬韧带完整或仅中央区后囊缺损的儿童无晶状体眼,二期植入人工晶状体,术后随访3～54个月。结果术后裸眼视力均等于或高于术前矫正视力,其中术后裸眼视力≥0．5者30眼（52．63％）,术后矫正视力≥0．5者45眼（78．95％）。并发症包括虹膜后粘连9眼（15．79％）,前房渗出物7眼（12．28％）,人工品状体偏位2眼（3．51％）。结论对于尚存完整或部分后囊支撑的无晶状体眼进行前后囊软性分离,注吸周边增生的皮质,虹膜粘连分离,后囊切开,前段玻璃体切除,再植入人工晶状体,可改善患儿视功能。     

Secondary intraocular lens implantation in children

PURPOSE: We describe a technique for secondary intraocular lens implantation in the ciliary sulcus in patients with congenital cataract or with primary aphakia. MATERIAL AND METHODS: Secondary intraocular lens implantation was performed in 119 eyes of 74 children. The average age at this procedure was 6.8 (range 22 months to 10 years), whereas the average age at primary cataract surgery was 18 weeks (range 7 weeks to 19 months). The average follow-up was 5.7 years. All eyes received a PMMA IOL. The sites of IOL fixation was ciliary sulcus. All patients had cataract extraction (lensectomy) via the pars plana, leaving in situ peripheral collarette of capsular bag to enable secondary lens implantation. RESULTS: Complications included IOL dislocation in five eyes, visual axis opacification in four, pupillary capture in one eye. CONCLUSIONS: Secondary IOL implantation in the ciliary sulcus is a safe and effective method to correct aphakia in pediatric patients with adequate capsular support. This surgical procedure is associated with a low rate of complications.     

Pediatric transscleral sutured intraocular lenses: efficacy and safety in 43 eyes followed an average of 3 years.

PURPOSE: To report longer term results of transscleral sutured intraocular lens (TSSIOL) implantation in a sizable cohort of aphakic children, who were not suitable for contact lens wear and lacked adequate capsular support for sulcus fixation of an intraocular lens. METHODS: Clinical outcome data were collated by retrospective review after surgery on 43 consecutive eyes in 32 aphakic children (mean age at implantation = 10 years; 33% < or = age 7 years). Outcome measures included visual acuity, postoperative refractive error, postoperative complications, and rate of reoperation. Follow-up averaged 37 months. RESULTS: Visual acuity improved after surgery in 70% (30) of operated eyes (in 69% or 22/32 children). Fifty-one percent (22/43 eyes) improved by two lines or more. No patient suffered a loss of acuity or exacerbation of preexisting amblyopia. Postoperative refraction was within +/-2.0 D of the predicted refraction in 93% (40/43) of eyes. Complications, with the exception of one eye (2%), were minor/transient and resolved in the first week after surgery. Complications included small hyphemas (7%, 3/43 eyes), vitreous hemorrhage (5%, 2/43 eyes), and ocular hypertension or hypotony (5%). Two eyes (5%) exhibited episodes of iris capture of the IOL optic, one of which (2%, 1/43) eventually necessitated reoperation for IOL exchange. No retinal detachments or other retinal complications were encountered. CONCLUSION: TSSIOL implantation appears to be a safe and effective method for correcting aphakia in pediatric eyes that lack adequate capsular support. Safety over a follow-up period longer than the average 3 years reported here remains to be determined. The surgery is more difficult to perform than capsular-bag or sulcus implantation and potentially carries greater risks.     

Single-piece acrylic intraocular lens implantation in children

PURPOSE: To assess the short-term outcomes of single-piece acrylic intraocular lens (IOL) implantation in children by determining the incidence of postoperative visual axis opacification and the need for a second procedure to clear the axis, cell deposits on the IOL optic, posterior synechias, and IOL decentration. SETTING: Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: This retrospective case review comprised 43 consecutive implantations (33 patients) of a single-piece hydrophobic acrylic IOL (AcrySof SA30AL or SA60AT, Alcon). An analysis of 42 eyes with posterior capsulectomy and vitrectomy was performed. Eyes with traumatic cataract and secondary IOLs were excluded. RESULTS: Single-piece acrylic IOLs were implanted in 42 eyes. The mean age was 33.5 months +/- 28.9 (SD) (range 0.5 to 110 months) and the mean follow-up, 12.0 +/- 8.2 months (range 1.0 to 27.5 months). Postoperative opacification of the visual axis occurred in 7 eyes (16.7%). Secondary surgical procedures were required in 5 eyes (11.9%). Lens deposits were observed in 8 eyes (19.0%) and synechias, in 5 eyes (11.9%). All IOLs were well centered postoperatively. CONCLUSION: The short-term data suggest implantation of the AcrySof single-piece hydrophobic acrylic IOL is safe in the pediatric eye.     

Intraoperative performance and postoperative outcomes of endocapsular ring implantation in pediatric eyes

PURPOSE: To study the intraoperative performance and postoperative outcomes of Cionni modified capsule tension ring (CTR) and intraocular lens (IOL) implantation in the capsular bag in pediatric eyes with ectopia lentis. SETTING: John A. Moran Eye Center, Salt Lake City, Utah, USA. METHODS: Thirty-five eyes (22 children) with ectopia lentis and visually significant cataract that had lens aspiration and in-the-bag implantation of single-piece AcrySof IOL and Cionni CTR were included. Single- and double-eyelet CTRs were used. The rings were sutured to the sclera using 9-0 or 10-0 polypropylene (Prolene) sutures. Preoperative and postoperative best corrected visual acuity (BCVA), intraoperative performance, IOL centration, and complications were studied. RESULTS: The mean patient age was 8.2 years +/- 5.1 (SD) and the median follow-up, 28 months. A double-eyelet CTR was implanted in 12 eyes and a single-eyelet CTR, in 23 eyes. The mean BCVA at the final follow-up (0.37 +/- 0.25 logMAR, 33 eyes) was significantly better than preoperatively (0.78 +/- 0.42 logMAR, 28 eyes) (P = .003). At the last examination, the BCVA was 20/40 or better in 16 eyes (45.7%). Three eyes (8.5%) required resuturing for IOL decentration. Nineteen eyes (54.3%) had a secondary procedure for posterior capsule opacification. Other complications included anterior capsule opacification (2.85%), cystoid macular edema (5.71%), chronic uveitis (5.71%), and vitreous prolapse (2.85%). CONCLUSION: Implantation of the Cionni CTR and single-piece AcrySof IOL in the capsular bag in pediatric eyes with subluxated lenses was safe and effective and led to a stable IOL with few significant complications.     

Pseudophakia and polypseudophakia in the first year of life.

PURPOSE: To report a consecutive series of patients undergoing intraocular lens (IOL) implantation in the first year of life. A new procedure, referred to as temporary polypseudophakia, is reported. METHODS: A retrospective chart analysis was conducted. Ocular growth and refractive change, complications and reoperation rates, and outcomes were analyzed. RESULTS: Forty-seven eyes of 33 patients underwent IOL implantation in the first year of life. Average follow-up was 22 months (range, 7 weeks to 5 years). Thirty-two eyes of 22 patients had a single IOL implanted from 12 days to 11 months of age. Fifteen eyes of 11 infants received piggyback IOLs from 16 days to 6.8 months of age. Reoperation for complications within the anterior segment of the eye was needed in 23% of all patients (22% for single IOLs, 26% for piggyback IOLs). The average first postoperative refraction after single IOL was +7.98 D and after piggyback IOL was +1.67 D. The average last postoperative refraction was +1.76 D and -4.48 D, respectively. On average, eyes grew 2.68 mm over 17.5 months of follow-up. Eight patients were old enough for Snellen visual acuity, but each had deprivation amblyopia with visual acuities from 20/85 to 5/200. Of the remaining 25 patients, 17 had central, steady, and maintained fixation in the implanted eyes. CONCLUSION: IOL implantation in infancy is technically feasible and associated with a reoperation rate of approximately 25% in the first 2 years after implantation. Further follow-up is required before meaningful visual acuity data and long-term results can be reported.     

Long-Term Efficacy and Rotational Stability of AcrySof Toric Intraocular Lens Implantation in Cataract Surgery

Purpose

To evaluate the long-term efficacy and rotational stability of the AcrySof toric intraocular lens (IOL) in correcting preoperative astigmatism in cataract patients.

Methods

This prospective observational study included 30 eyes from 24 consecutive patients who underwent implantation of an AcrySof toric IOL with micro-coaxial cataract surgery between May 2008 and September 2008. Outcomes of visual acuity, refractive and keratometric astigmatism, and IOL rotation after 1 day, 1 month, 3 months, and long-term (mean, 13.3±5.0 months) follow-up were evaluated.

Results

At final follow-up, 73.3% of eyes showed an uncorrected visual acuity of 20/25 or better. The postoperative keratometric value was not different from the preoperative value; mean refractive astigmatism was reduced to -0.28±0.38 diopter (D) from -1.28±0.48 D. The mean rotation of the toric IOL was 3.45±3.39 degrees at final follow-up. One eye (3.3%) exhibited IOL rotation of 10.3 degrees, the remaining eyes (96.7%) had IOL rotation of less than 10 degrees.

Conclusions

Early postoperative and long-term follow-up showed that implantation of the AcrySof toric IOL is an effective, safe, and predictable method for managing corneal astigmatism in cataract patients.     

Functional outcomes of acrylic intraocular lenses in pediatric cataract surgery

PURPOSE: To evaluate the functional outcomes of in-the-bag implantation of acrylic intraocular lenses (IOLs) with posterior continuous curvilinear capsulorhexis (PCCC), without PCCC, with PCCC and anterior vitrectomy, and with PCCC and optic capture in pediatric cataract surgery. SETTING: Pediatric Ophthalmology Service, Guru Nanak Eye Centre, New Delhi, India. METHODS: Forty-two eyes of 25 children were included in this prospective study. All eyes had in-the-bag implantation of an AcrySof IOL (Alcon). Twenty-five eyes had had an anterior continuous curvilinear capsulorhexis (ACCC) (Group A). Seventeen eyes had PCCC along with ACCC (Group B), 4 had anterior vitrectomy combined with PCCC (Group C), and 6 had PCCC with IOL optic capture through the PCCC (Group D). Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. RESULTS: The mean age of the patients was 78 months (range 36 to 144 months). The mean follow-up was 13 months (range 6 to 18 months). Four eyes (16%) in Group A developed visually significant posterior capsule opacification (PCO) involving the central visual axis and required secondary capsulotomy. All eyes in Groups B, C, and D had a clear visual axis at the last follow-up and did not require a secondary procedure. Minimal postoperative inflammation (ie, aqueous flare and IOL deposits ) was seen in all groups. The mean preoperative decimal best corrected visual acuity (BCVA) in Groups A, B, C, and D was 0.095, 0.055, 0.174, and 0.039, respectively. Postoperatively, the BCVA was 0.54, 0.66, 0.66, and 0.66, respectively. CONCLUSIONS: An optimal-sized ACCC followed by in-the-bag implantation of a foldable acrylic IOL helped maintain a clear visual axis by delaying the onset of PCO and leading to milder PCO. The benefits of a foldable acrylic IOL in pediatric cataract surgery can be increased by combining it with PCCC, with or without anterior vitrectomy, or with optic capture of the IOL.     

外伤性无晶状体眼二期后房型人工晶状体植入术

目的探讨外伤后无晶状体眼的二期后房型人工晶状体植入的手术方法和疗效。方法对58例（58眼）外伤性无晶状体眼行二期后房型人工晶状体植入术。其中50例伴有不同程度眼前段结构紊乱,同时行眼前段重建,包括虹膜粘连松解、虹膜根部离断缝合、瞳孔成形、以及瞳孔区机化膜切开等。8例晶状体玻璃体切除术后的无晶状体眼,应用玻璃体腔放置灌注管维持眼压。结果均顺利植入后房型人工晶状体,术后随访5～24个月。后房型睫状沟二期人工晶状体植入41眼（70．69％）,缝襻固定后房型人工晶状体17眼（29．31％）;术后视力均达到或优于术前矫正视力,最佳矫正视力t〉0．3者38眼（65．52％）。术后瞳孔圆者32眼（55．17％）,人工晶状体正位者50眼（86．21％）,7眼稍偏位,1眼人工晶状体倾斜。结论二期后房型人工晶状体植入术是治疗外伤性无晶状体眼的有效而安全术式,可取得良好效果,术前手术设计和熟练的操作技巧是手术成功的关键。     

2.6 mm切口人工晶状体植入治疗白内障合并高度近视的疗效观察

目的：观察使用Monarch Ⅱ折叠推注系统，通过2．6mm角膜切口植入低度数或负度数丙烯酸脂(AcrySof)折叠式人工晶状体治疗白内障合并高度近视的临床疗效。方法：对52例(68眼)白内障合并高度近视患者行超声乳化白内障吸除，使用Monarch Ⅱ折叠推注系统通过2.6mm角膜切口植入低度数或负度数AcrySof折叠式人工晶状体，观察术中和术后并发症、术后视力。术后随访时间平均6个月(3-12个月)。结果：所有人工晶状体均能顺利植入眼内，没有发生人工晶状体断裂、擦痕、断襻或襻变形等情况，术中无并发症发生。术后3个月最佳矫正视力0．12～0．25者8眼(11．8％)，0．3．0．5者21眼(30．9％)，0．6～1．0者36眼(52．9％)，大于1．0者3眼(4．4％)；随访期间出现黄斑囊样水肿2眼，无出现视网膜脱离和后发性白内障者。结论：在白内障合并高度近视超声乳化吸除、低度数或负度数折叠式人工晶状体植人手术中，应用Monarch Ⅱ折叠推注系统可以将通常需要3．5mm左右的切口减少为2．6mm，是一种安全有效的方法。     

Secondary membrane formation after cataract surgery with primary intraocular lens implantation in children

To evaluate the risk factors for secondary membrane (SM) formation after congenital cataract surgery with intraocular lens (IOL) implantation. A retrospective non-interventional comparative study. Thirty-nine patients (63 eyes) aged 1–135 months. The study included patients who underwent cataract extraction and primary IOL implantation between 1994 and 2001 at the University Hospital. The postoperative follow-up was 6–24 months. Thirty-three eyes received a poly(methyl methacrylate) (PMMA) IOL without square edges, 29 eyes received a hydrophobic acrylic IOL with truncated square edges (AcrySof), and there was no data for IOL type in one eye. Thirty-nine eyes had primary posterior capsulotomy (PPC) and anterior vitrectomy (AV) and in 24 eyes the posterior capsule was left intact. Cox proportional hazard regression analysis was performed to identify significant risk factors for SM formation, and Wilcoxon test to evaluate the difference in time from surgery to SM formation. SM developed in 24 eyes (38 %)—58 % of eyes with an intact posterior capsule and 26 % of eyes having PPC and AV, 42 % of eyes with a PMMA IOL, and 34 % of eyes with an AcrySof lens. In multivariate Cox regression analysis intraoperative PPC and AV (P = 0.02) and AcrySof lens implantation (P = 0.097) were associated with decreased postoperative incidence of SM formation. Median time until SM development was 2.9 months with PMMA IOLs (range 1–17 months) and 6 months with AcrySof lenses (range 1–21.8 months) (P = 0.037). Posterior capsule management as well as IOL design and material influence the incidence and the timing of SM formation after primary IOL implantation in children.     

Toric与球面人工晶状体临床效果的对比研究

目的:对比植入AcrySof Toric人工晶状体与AcrySof球面人工晶状体术后的临床效果。方法:收集确诊为老年性白内障并伴有规则角膜散光的患者56例63眼,按照患者自愿原则,分别植入AcrySof Toric人工晶状体(实验组)27例30眼;AcrySofNatural球面人工晶状体(对照组)29例33眼。均施行白内障超声乳化摘除联合人工晶状体植入术,随访时间6mo。观察两组患者术后裸眼远视力、最佳矫正远视力、术前术后角膜散光变化情况、术后散光、AcrySofToric人工晶状体轴位稳定性。结果:两组患者术后1wk,6mo裸眼视力,实验组明显优于对照组,比较差异均有统计学意义(P<0.05),两组患者术后1wk,6mo散光比较差异均有统计学意义(P<0.05)。两组患者术前与术后6mo的角膜散光比较,差异均无统计学意义。术后AcrySof Toric IOL的轴位移动度,术后1d;1wk;1,6moIOL平均轴位移动度分别为:(4.22±1·69)°,(4.64±1.97)°,(4.87±1.91)°,(5.39±1·56)°,差异无统计学意义(F=2.259,P>0.05)。术后6mo96.67%的患眼轴位移动度<10°。结论:与普通球面人工晶状体比较,AcrySof Toric人工晶状体能安全、有效、稳定矫正白内障患者的角膜散光,具有良好的轴位移动稳定性。     

儿童人工晶状体植入术临床观察

目的 探讨儿童人工晶状体植入的最佳时机、屈光度选择及并发症的防治。方法 57例67眼先天性和外伤性白内障，年龄2岁至12岁，行白内障摘出并后房型人工晶状体植入术，术后随访2－14月。结果 除10例患儿不合作，其余患儿术后视力均较术前有所提高，≥0．5为28眼，占53％。术后并发症主要为后囊浑浊，23眼行Ⅱ期后囊切开或YAG激光治疗。其他并发症包括葡萄膜炎、瞳孔多位、人工晶状体瞳孔夹持等。结论 人工晶状体植入术是目前儿童白内障较为理想的复明手段，但应掌握手术时机，及时妥善处理术后并发症。     

Secondary posterior chamber intraocular lens implantation in children.

BACKGROUND: Primary intraocular lens (IOL) implantation after cataract aspiration is a widely accepted means of correcting pediatric aphakia. However, little is available in the literature on secondary IOL implantation in children. We present our experience over the past 6 years. METHODS: The charts of 57 aphakic children (61 eyes) who underwent secondary posterior chamber IOL implantation between January 1989 and April 1996 were reviewed. In general, these children were either intolerant of or noncompliant with their contact lenses. An attempt was made to correlate visual outcome with patient variables. Evaluation of the ciliary sulcus structure was made in selected patients by ultrasonographic biomicroscopy to reveal any changes resulting from the presence of the IOL haptic in the sulcus. RESULTS: The age range at the time of surgery was 2 to 16 years (mean 8 y). Mean follow-up was 14 months (range 6 to 48 months). Forty-two percent of the patients had a best-corrected visual acuity of 20/40 or better and 78% saw better than 20/80. Posterior capsular opacification occurred in 10 eyes, 8 of which required neodymium:yttrium-aluminum-garnet laser capsulotomy. No major complications occurred. Ciliary sulcus evaluation by biomicroscopy did not reveal any significant ciliary body or scleral erosion. No changes were noted when the implanted sulcus was compared with the normal contralateral side. CONCLUSION: Although follow-up was short, this review suggests that secondary posterior chamber IOL implantation is a safe alternative when other methods of correcting pediatric aphakia fail.     

Secondary Artisan-Verysise aphakic lens implantation

PURPOSE: To evaluate efficacy, predictability and safety of Artisan-Verysise intraocular lens (IOL) secondary implantation for aphakia correction. SETTING: Instituto de Microcirugía Ocular, and Autonoma University of Barcelona, Barcelona, Spain. METHODS: Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, endothelial cell count, and clinical complications were evaluated. Sixteen consecutive eyes of 14 patients with aphakia were submitted to surgery. Postoperative examinations were done at 6 weeks, 6 months, 1 year, and every year for at least 3 years. An iris-supported Artisan-Verysise IOL was implanted for aphakia correction. RESULTS: Thirty-six months after Artisan-Verysise lens implantation, BSCVA was 20/40 or better in 6 eyes (37.5%). Preoperatively, 5 eyes had the same BSCVA (31.25%). Mean postoperative spherical equivalent (SE) was 0.46 diopter (D). Mean endothelial cell loss was 10.9% 36 months postoperatively. The cell loss occurred predominantly during the first year (7.78%). Cystoid macular edema was observed in 2 cases, 1 of them associated with chronic unresponsive low intraocular pressure. No other serious complications were observed. CONCLUSION: Artisan-Verysise IOL implantation seems a safe, predictable, and effective option for aphakic eyes without capsule support.     

儿童Ⅱ期人工晶状体植入术两种手术方式的对比研究

目的探讨儿童无晶状体眼Ⅱ期人工晶状体植入术的两种手术方式的效果。方法3．5～9岁儿童白内障术后无晶状体眼58例（71眼）,随机分成2组：A组36眼,行后囊切开、前段玻璃体切除及后房人工晶状体植入;B组35眼,单纯行后囊切开及人工晶状体植入。结果术后3月,矫正视力〉10．05者,A组30跟（83．33％）,B组30眼（85．71％）;≥0．3者,A组21眼（58．33％）,B组20眼（57．14％）。脱盲率及脱残率2组之间差异均无显著性（P〉0．05）,但两组分别与术前相比差异均有统计学意义（P〈0．01）。两组术后各种并发症之间差异也无统计学意义。结论儿童无晶状体眼Ⅱ期人工晶状体植入术的两种术式均是安全的、有效的,单纯的后囊切开更符合患儿的生理特点。     

Black diaphragm intraocular lens implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy

PURPOSE: To evaluate the efficacy of secondary black diaphragm intraocular lens (IOL) implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy (PPV). SETTING: Shandong Eye Institute and Hospital, Qingdao, China. METHODS: This retrospective study comprised 15 aphakic eyes with aniridia and no vitreous that had implantation of a secondary black diaphragm IOL 6 to 72 months after PPV. The PPV was performed as a result of trauma to the posterior segment. Before implantation of the IOL, all patients had reduced visual acuity from aphakia and intolerable glare from aniridia. Eyes were aphakic as a result of previous extracapsular cataract extraction (1 eye), lens extrusion during trauma (3 eyes), or simultaneous cataract lensectomy during PPV (11 eyes). Significant iris defects were present, with 9 eyes being aniridic after the injury. The mean follow-up was 17 months (range 3 to 34 months). The postoperative visual acuity, intra- ocular pressure (IOP), endothelial cell density, IOL centration, and intraocular inflammation were monitored. RESULTS: All 15 eyes had improved visual acuity and marked glare reduction after IOL implantation. No major IOL decentration was seen. Five patients had increased IOP 3 to 5 days after IOL implantation; 3 were known to have secondary glaucoma from trauma before surgery and their IOP was controlled preoperatively (< 21 mm Hg) with timolol 0.5% eyedrops. The other 2 patients had normal- appearing angles, and 1 was diagnosed with hemolytic glaucoma after IOL insertion. Postoperative elevated IOP was controlled by timolol eyedrops (4 eyes) or selective laser trabeculoplasty (1 eye). Hyphema was seen in 1 patient on the first day after IOL implantation, but no further bleeding was noted. Vitreous hemorrhage was seen the first day after IOL insertion in 2 patients. One resolved without sequelae; the other required vitreous washout. Retinal detachment and cystoid macular edema did not occur in any patient. CONCLUSIONS: Black diaphragm IOL implantation can be considered in eyes with coexisting aphakia and aniridia and without vitreous. Intraoperative IOP regulation is crucial in vitrectomized eyes to prevent complications such as expulsive hemorrhage. In general, visual function was better after IOL insertion as a result of better visual acuity and glare reduction. Although this IOL appears to be safe, long-term results must be assessed in studies with a longer follow-up and a larger study group.     

Visual outcomes and complications in surgery for ectopia lentis in children

PURPOSE: To evaluate postoperative visual acuity and complications in eyes with ectopia lentis having surgery with a sutured capsular tension ring (CTR) and intraocular lens (IOL). SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: Thirty-seven eyes of 22 children had surgery for lens dislocation. Two types of capsular rings were used; a Cionni modified CTR and a conventional CTR. In all cases, the rings were sutured to the sclera with a 10-0 polypropylene (Prolene) suture, the CTR and an AcrySof IOL (Alcon) were implanted in the capsular bag, and the posterior capsule was left intact. The preoperative and postoperative best corrected visual acuity (BCVA) and complications were studied retrospectively. RESULTS: The mean age of the patients was 52 months. Thirty-three eyes had implantation of a Cionni modified CTR and 4 eyes, of a conventional CTR. The median preoperative BCVA (22 eyes) was 0.26 (range 0.015 to 0.65). The median postoperative BCVA (36 eyes) was 0.59 (range 0.2 to 1.0). The median follow-up period was 27 months (range 1 to 59 months). Twenty-six eyes had secondary surgery for visual axis opacification, with 5 eyes requiring 2 to 3 reoperations. Two eyes required secondary suturing for IOL decentration. Persistent amblyopia was observed in 3 eyes, with poor postoperative visual development. No eye had serious complications such as retinal detachment, endophthalmitis, or glaucoma. CONCLUSION: Surgery for ectopia lentis with a CTR and an AcrySof IOL implanted in the capsular bag and sutured to the sclera appears to be safe in children.     

Scleral-fixated intraocular lens implantation in unilateral aphakic children

OBJECTIVE: To assess the feasibility of scleral-fixated intraocular lens (IOL) implantation as an alternative form of optical correction in aphakic children intolerant of contact lenses and whose anterior segments lack capsular support. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: A total of 11 eyes of 11 unilateral aphakic children in the age group 4 to 9 years (mean, 6.45 years) were included in the study. INTERVENTION: Secondary scleral-fixated IOL implantation was performed in all cases. The patients underwent anterior vitrectomy at the time of IOL implantation. Amblyopia therapy in the form of patching was given post-IOL surgery. The follow-up ranged from 4 to 18 months (mean, 10.90 months). MAIN OUTCOME MEASURES: Postoperative best-corrected visual acuity (BCVA) in comparison to preoperative visual status and complications from the procedure were analyzed. RESULTS: Postoperative BCVA remained within 1 Snellen line of the preoperative visual status in six eyes, or 54.5% of patients; it improved by more than 1 Snellen line in three eyes, or 27.2% of patients, and decreased by more than 1 Snellen line in two eyes, or 18.1% of patients. The complications encountered were suture erosion through the conjunctiva in two eyes (18.18%), marked postoperative anterior chamber reaction in two eyes (18.18%), IOL decentration in one eye (9.09%), glaucoma in one eye (9.09%), and cystoid macular edema in one eye (9.09%). CONCLUSION: Secondary scleral-fixated IOL implantation was successful in achieving BCVA comparable to preoperative BCVA. However, a longer follow-up is required to document any further complications.     

Comparison of secondary implantation of flexible open-loop anterior chamber and scleral-fixated posterior chamber intraocular lenses

PURPOSE: To analyze and compare the outcomes and complication rates of secondary implantation of flexible, open-loop, anterior chamber intraocular lenses (AC IOLs) and single-piece, scleral-fixated, posterior chamber IOLs (PC IOLs). SETTING: Departments of Ophthalmology, Gaziantep University Medical Faculty, Research Hospital, Gaziantep, and In?nü University Medical Faculty, Research Hospital, Malatya, Turkey. METHODS: This study comprised 124 eyes of 113 aphakic patients (61 men, 52 women) with insufficient capsule support who had secondary IOL implantation from January 1997 to June 2001. In Group 1 (n = 73 eyes), a flexible, open-loop AC IOL was implanted and in Group 2 (n = 51 eyes), a single-piece, scleral-fixated PC IOL. The mean follow-up was 34 months (range 6 to 53 months) and took place at several different clinical settings. The mean interval between the initial cataract operation and secondary IOL implantation was 63 months (range 6 months to 12 years). The postoperative outcomes, safety, efficacy, and complication rates were analyzed, and the preoperative and postoperative best spectacle-corrected visual acuities (BSCVAs) were compared. RESULTS: The postoperative mean BSCVA was 20/34.8 +/- 45.2 (SD) in Group 1 and 20/32.1 +/- 33.7 in Group 2; the difference was not significant (P =.718). A BSCVA of 20/40 or better was achieved in 62 eyes (84.9%) in Group 1 and 45 eyes (88.2%) in Group 2. A BSCVA of 20/25 or better was achieved in 40 eyes (54.8%) and 33 eyes (64.7%), respectively. The difference between the 2 groups was not significant (P =.472). Complications occurred in 25 eyes (34.2%) in Group 1 and 13 eyes (25.5%) in Group 2 (P >.05). The most frequent complications in Group 1 were early transient corneal edema, intraocular pressure elevation, cystoid macular edema, hyphema, secondary glaucoma, and iris capture or pupil decentration and in Group 2, suture erosion, a tilted or decentered IOL, fibrin reaction, and vitreous prolapse into the anterior chamber. CONCLUSIONS: The AC IOLs and PC IOLs were safe and effective for secondary implantation to correct aphakia. Secondary implantation of the scleral-fixated PC IOL seemed to provide a more favorable outcome and a lower complication rate than the open-loop AC IOL in complicated cataract cases with inadequate capsule and zonular support. As scleral-fixated PC IOL implantation is technically more difficult than AC IOL implantation, the decisive factor in choosing a secondary IOL is surgical experience. Long-term comparison of both techniques is required.