Long-term results of scleral fixation of posterior chamber intralocular lenses in children

Purpose: To evaluate the long-term results of transsclerally fixated posterior chamber intraocular lenses (SF-PCIOLs) in children without adequate capsular support. Design: Noncomparative interventional case series. Participants: Twenty-five eyes of 23 children who underwent primary (6 eyes) or secondary (19 eyes) implantation of SF-PCIOLs. The primary cases included those undergoing surgery for lens subluxation due to Marfan's syndrome, and secondary cases included those after surgery for congenital cataract (3 eyes) or traumatic cataract (16 eyes). All eyes lacked adequate capsular support and, in secondary cases, manifested contact lens intolerance. Intervention: Ab externo transscleral fixation of PCIOLs. Main Outcome Measures: Visual acuity (VA), IOL position, and postoperative complications. Results: The mean age of patients at the time of SF-PCIOL implantation was 79 +/- 20.2 months (range, 33-120). The mean duration of follow-up after surgery was 81.1 +/- 46.2 months (range, 12-144). Best-corrected VA improved postoperatively in 12 eyes (48%) by >1 Snellen line. The main cause of reduced vision was corneal and retinal pathologies and amblyopia. Complications included transient intraocular hemorrhage in 13 eyes (52%), transient choroidal effusion in 2 eyes (8%), late endophthalmitis in 1 eye (4%), retinal detachment in 1 eye (4%), and late IOL dislocation due to breakage of polypropylene sutures after 7 to 10 years in 6 eyes (24%). Conclusion: Scleral fixation of PCIOLs can be visually rewarding in selected cases, but there is a high rate of complications during a long-term follow-up. Ophthalmology 2008;115:67-72 (c) 2008 by the American Academy of Ophthalmology.