Outcomes of Four-Point Sutured Scleral-Fixated Intraocular Lens Implantation Using Gore-Tex Suture in Paediatric Eyes

Intraocular lens implantation in children with insufficient zonular support can be challenging. Scleral-fixated intraocular lens (SFIOL) implantation can be useful in these cases. We aim to report the visual and refractive outcomes of four-point sutured SFIOL in children.

A retrospective review of children who underwent primary or secondary four-point SFIOL using Akreos AO60 or Luxgood intraocular lens with polytetrafluoroethylene monofilament (PTFE, Gore-Tex) at Queensland Children's Hospital, Brisbane, Australia.

Fifty-three eyes of 31 children were included for review. The mean age of SFIOL implantation was 7.86 ± 3.71 years. The median follow-up time was 24 months (IQR 35, range 1-77). The majority of children had subluxed crystalline lenses secondary to Marfan syndrome (44 eyes, 83.02%). Best corrected visual acuity (BCVA) was maintained or improved from the preoperative BCVA in 92.6% of eyes. Median postoperative BCVA improved to logMAR 0.2 (IQR 0.16) at 1-year follow-up (p < 0.01). Compared to target refraction, the postoperative refraction was more myopic, but this was not statistically significant. In 33 eyes that had more than 1 year of follow-up, residual refractive error was within 1.00D for 21 eyes, within 2.00D for 7 eyes, within 3.00D for 3 eyes and greater than 3.00D for 2 eyes. Retinal detachment occurred in three eyes (5.66%). Asymptomatic IOL tilt/decentration was noted in one eye (1.88%).

Four-point SFIOL implantation using Gore-Tex suture offered excellent visual and refractive outcomes. Postoperative complications were rare and there were no new cases of amblyopia during the follow-up period.