Study examines reoperations after angle-supported anterior chamber IOLs in children
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There are many IOL options for aphakia without capsular support, one being the angle-supported open-loop flexible anterior chamber IOL. Whether it should a hold a place in the pediatric surgeon’s armamentarium is debatable.
“The literature supports the safe and effective use of these lenses, at least in adults; the pediatric experience in the literature is small — small cases with short follow-up,” M. Edward Wilson, MD, said at the virtual American Association for Pediatric Ophthalmology and Strabismus annual meeting.
To explore the question, Wilson retrospectively reviewed 31 eyes of 18 children in whom he had implanted angle-supported anterior chamber IOLs. Ectopia lentis was the diagnosis in the majority.
Median age at time of implantation was 10.6 years, median follow-up after IOL insertion was 7 years, and median best corrected visual acuity was “excellent,” 20/25 at final follow-up, Wilson said.
Of five eyes (16.1%) receiving IOP-lowering drops, no glaucoma surgery has been needed, and overall, no corneal decompensation has been seen.
“However, intraocular lens-related reoperations were required in 11, or 35.5%, of eyes,” Wilson said.
Of these, four eyes (12.9%) required IOL repositioning, three after trauma and one after retinal detachment surgery, and seven eyes (22.6%) required anterior chamber IOL removal or exchange between 3 and 5 years after implantation.
Two eyes were operated for retinal detachment unrelated to the IOL.
Even though there may be an excellent appearance initially, the IOLs can rotate, and pupil distortion with inflammation can occur even years later. And despite the ease of insertion, “Angle-supported IOLs are not well-suited, in my view, for growing pediatric eyes,” Wilson said. “I abandoned this implant style and the angle-supported location 7 years ago and will continue to explore and learn about alternatives for those eyes without capsular support.”
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Wilson ME. Long-term outcome of angle-supported anterior chamber intraocular lens implantation for pediatric aphakia. Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; April 9-11, 2021 (virtual meeting).
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