Transscleral IOL fixation with CTR yields improved vision, stability in pediatric ectopia lentis

NASHVILLE, Tenn. — Transscleral fixation of an IOL using a capsular tension ring in children with ectopia lentis yielded improved vision and long-term IOL stability, according to a study.

Perspective from Erin D. Stahl, MD

“There is no consensus currently for the best surgical management of patients with ectopia lentis,” Julia M. Byrd, MD, said at the American Association for Pediatric Ophthalmology and Strabismus meeting. “This is partly because it is a fairly rare disease in kids and partly because we don’t have great long-term data for different surgical techniques in this population.”

Julia M. Byrd

Byrd and colleagues undertook a study to provide long-term follow-up data on the use of transscleral fixation of an IOL using a capsular tension ring (CTR) in a large cohort of pediatric eyes with ectopia lentis.

The retrospective review included 67 eyes of 37 patients younger than 18 years of age who underwent cataract extraction with IOL implantation. All patients had ectopia lentis not due to trauma and underwent transscleral fixation of the IOL in the bag using a CTR.

All surgeries were performed at the Moran Eye Center by a single surgeon.

“In analyzing the best postoperative vision, there was a statistically significant improvement in vision when all eyes were analyzed and when one eye per patient was randomly selected for the analysis,” Byrd said.

Looking specifically at percent of eyes with visual acuity of 20/50 or better, there was statistical significance at all time points: 2 months, 1 year, 3 years, 5 years and 10 years, she said.

The most common complication was posterior capsule opacity in 35 eyes (52%), which was similar to rates published in previous studies. Spontaneous IOL dislocation occurred in four eyes (6%), a rate slightly lower than reported in previous studies, Byrd said. Nine of the eyes with PCO did undergo secondary surgery.

“The study demonstrates improved vision and long-term IOL stability using transscleral fixation of a capsular tension device and IOL placement in the bag,” Byrd said. – by Patricia Nale, ELS

Reference:

Byrd JM, et al. Long-term outcomes for pediatric patients undergoing transscleral fixation of the capsular bag with intraocular lens for ectopia lentis. Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; April 2-6, 2017; Nashville, Tenn.

Disclosure: Byrd reports no relevant financial disclosures.

Perspective

Erin D. Stahl, MD

This is a great technique when it can be done. It maintains the vitreous/capsule/lens anatomy in patients with ectopia lentis. The concern still is the stability over time and the skill that it takes to implant. No other techniques have been shown to be superior at this time. It is going to come down to very long-term follow-up to answer the question of what surgical management is best in these cases.

Erin D. Stahl, MD

OSN Pediatrics/Strabismus Board Member

Disclosures: Disclosure: Stahl reports she is an investigator for Ophthotech.