Pars plana vitrectomy with novel posterior chamber IOL implantation method improves visual acuity

Am J Ophthalmol. 2011;151(2):287-296.

Endoscopic-guided placement of a sulcus-fixated sutured posterior chamber IOL during pars plana vitrectomy is a viable treatment option for diseased or injured aphakic eyes contraindicated for anterior chamber IOLs.

Outcomes were similarly positive in pediatric and adult patients.

"Placement of an endoscopic sulcus-fixated sutured posterior chamber intraocular lens offers an excellent surgical rehabilitation option for the treatment of aphakia in the absence of capsular support," the study authors said.

The retrospective study included 21 eyes of 20 children and 53 eyes of 51 adults. Median age was 52 years in the adult group, and mean age was 11 years in the pediatric group.

The most prevalent preoperative diagnoses were trauma, subluxated lenses without capsular support, uveitis, congenital cataract, Marfan syndrome and ectopia lentis.

Patients received a CZ70BD IOL (Alcon) fixated with separate double-armed 10-0 Prolene sutures.

Mean follow-up was 46 months in the pediatric group and 21 months in the adult group.

Snellen visual acuity improved from about 20/400 preoperatively to 20/80 postoperatively in the pediatric and adult groups.

Two eyes in the pediatric group and nine eyes in the adult group had elevated IOP before surgery; IOP was controlled postoperatively in all but one eye in the adult group.

Advantages of the technique included optimal visualization and lens centration. Disadvantages included a steep learning curve, longer surgical time and concerns about suture stability, the authors reported.