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Intraoperative performance and postoperative outcomes of endocapsular ring implantation in pediatric eyes
Vaishali Vasavada1, Viraj A Vasavada, Robert O Hoffman
1John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah, USA. vvasavada@hotmail.com
Insights
Cionni modified capsule tension rings (CTR) with intraocular lens (IOL) implantation safely improved visual acuity in pediatric eyes with ectopia lentis. This effective surgical approach resulted in stable IOL placement with minimal complications.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Surgical Innovation
Background:
- Ectopia lentis in pediatric patients presents challenges for intraocular lens (IOL) implantation due to lens instability.
- Standard IOL placement may lead to decentration and suboptimal visual outcomes in these cases.
Purpose of the Study:
- To evaluate the intraoperative performance and postoperative results of using the Cionni modified capsule tension ring (CTR) with a single-piece AcrySof IOL in pediatric eyes with ectopia lentis.
- To assess the safety and efficacy of this combined surgical technique.
Main Methods:
- A retrospective study included 35 eyes (22 children) with ectopia lentis and visually significant cataract.
- Lens aspiration followed by in-the-bag implantation of a single-piece AcrySof IOL and Cionni CTR (single- or double-eyelet) was performed.
- The CTRs were sutured to the sclera. Preoperative and postoperative best corrected visual acuity (BCVA), intraoperative performance, IOL centration, and complications were analyzed.
Main Results:
- Mean follow-up was 28 months. Mean BCVA significantly improved from 0.78 preoperatively to 0.37 postoperatively (P = .003).
- At final follow-up, 45.7% of eyes achieved BCVA of 20/40 or better.
- Complications included IOL decentration requiring resuturing (8.5%), posterior capsule opacification (54.3%), anterior capsule opacification (2.85%), cystoid macular edema (5.71%), chronic uveitis (5.71%), and vitreous prolapse (2.85%).
Conclusions:
- Implantation of the Cionni CTR with a single-piece AcrySof IOL in the capsular bag is a safe and effective treatment for pediatric eyes with subluxated lenses.
- This technique provides stable IOL placement and leads to significant visual acuity improvement with a low rate of major complications.
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.
