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Scleral-fixated capsular tension rings and segments for ectopia lentis in children
Eric J Kim1, James P Berg1, Mitchell P Weikert2
1Department of Ophthalmology, Texas Children's Hospital, Houston, Texas; Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
Insights
Scleral-fixated capsular tension rings and segments with intraocular lenses safely improved vision in pediatric ectopia lentis patients. Most achieved 20/40 vision, though posterior capsule opacification was common.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Intraocular Lens Implantation
Background:
- Ectopia lentis in pediatric patients presents challenges for intraocular lens (IOL) implantation.
- Scleral fixation techniques are employed to manage lens instability.
- Capsular tension devices aid in stabilizing the IOL within the capsular bag.
Purpose of the Study:
- To evaluate the short-term outcomes of scleral-fixated capsular tension rings (CTRs) and/or capsular tension segments (CTS) with IOLs in pediatric ectopia lentis.
- To assess the safety and efficacy of this surgical approach in young patients.
- To document the types and frequency of complications associated with the procedure.
Main Methods:
- Retrospective, observational case series involving 13 pediatric patients (19 eyes).
- Surgical procedures included in-the-bag IOL implantation with Cionni modified CTR or CTS and conventional CTR.
- Scleral fixation utilized 9-0 polypropylene or CV-8 Gore-Tex sutures.
Main Results:
- Mean corrected distance visual acuity (CDVA) significantly improved from 0.58 to 0.10 logMAR (P < .001).
- Final CDVA was 20/40 or better in 94.7% of eyes; all IOLs were well-centered.
- Complications included posterior capsule opacification (57.9%), requiring neodymium-yttrium-aluminum-garnet (Nd:YAG) capsulotomy (47.4%) or vitrectomy (15.8%).
Conclusions:
- Scleral-fixated CTRs/CTS with IOLs represent a safe and effective method for visual rehabilitation in pediatric ectopia lentis.
- The technique provides significant visual acuity improvement.
- While effective, potential complications like posterior capsule opacification should be monitored.
Purpose:
To report the short-term outcomes and complications of implantation of scleral-fixated capsular tension rings and/or capsular tension segments with intraocular lenses (IOL) in pediatric patients with ectopia lentis.
Design:
Retrospective, observational case series.
Methods:
Thirteen consecutive pediatric patients (19 eyes) underwent placement of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring between January 1, 2009 and March 30, 2013 by 3 anterior segment surgeons at a single academic center. The scleral fixation suture was 9-0 polypropylene in 16 eyes and CV-8 Gore-Tex (expanded polytetrafluoroethylene) in 3 eyes. Outcome measures included change in corrected distance visual acuity (CDVA) and complications.
Results:
The mean age was 10.2 years ± 4.8 (SD) and the median follow-up, 23.4 months. A Cionni modified capsular tension ring was implanted in 5 eyes and a capsular tension segment with an unsutured capsular tension ring was implanted in 12 eyes. In 2 eyes, capsular tension segment alone was placed. The mean CDVA at the final follow-up (0.10 ± 0.11 logMAR, 18 eyes) was significantly better than preoperatively (0.58 ± 0.26 logMAR, 15 eyes) (P < .001). The CDVA at the final follow-up was 20/40 or better in 18 eyes (94.7%). All IOLs were well centered. Posterior capsule opacification developed in 11 eyes (57.9%), 9 eyes (47.4%) required neodymium-yttrium-aluminum-garnet capsulotomy, and 3 eyes (15.8%) required pars plana vitrectomy and posterior capsulotomy. Other complications included broken suture (5.3%) (9-0 polypropylene at CTR eyelet, repaired with CV-8 Gore-Tex), conjunctival dehiscence (5.3%), suture exposure (5.3%) (trans-scleral 9-0 polypropylene), and vitreous strand at inferior paracentesis (5.3%).
Conclusions:
Implantation of in-the-bag IOL with either a Cionni modified capsular tension ring or a capsular tension segment in conjunction with a conventional capsular tension ring appears to be a safe and effective technique for visual rehabilitation in pediatric ectopia lentis.
