August 2009




Considering iris-sutured posterior chamber IOLs for pediatric patients

by Maxine Lipner Senior EyeWorld Contributing Editor


Evaluating how these lenses perform in pediatric cases

For those aphakic pediatric patients for whom a traditional lens is not an option, a posterior chamber iris-fixated one may prove to be the answer, finds Kimberly G. Yen, M.D., assistant professor of ophthalmology, Baylor College of Medicine, Houston, and Texas Children’s Hospital, Houston. Dr. Yen reported on study results with the foldable iris-sutured lenses in the January 2009 issue of the American Journal of Ophthalmology. In this retrospective case series involving 17 eyes of 12 consecutive pediatric patients, investigators set out to evaluate how the technique compared to other options. “I think that the jury is still out on what technique is best because there is certainly a concern about suture degradation over time,” Dr. Yen said. “The purpose was to look at whether this would be an improvement over other techniques.”

Forgiving option

The idea of fixating a lens to the iris rather than transclerally suturing is attractive for several reasons. “If you have to suture the lens in, it’s a shorter procedure, it’s technically easier, and it may potentially have a lower chance of suture breakage because the iris is a littler more forgiving than the sclera,” Dr. Yen said. “Also, it may be easier to retrieve the lens if it does partially dislocate since this is closer to the anterior chamber.” Included in the study were pediatric patients who underwent the placement of a foldable iris-sutured posterior chamber intraocular lens between September 2004 and September 2007. The lenses used here included the MA60-AC (Alcon, Fort Worth, Texas) and the AR40 (Abbott Medical Optics, AMO, Santa Ana, Calif.). To be eligible patients either needed to be aphakic or needed to undergo cataract surgery to remove a lens that was dislocated. These patients also had to have limited choices. “They couldn’t have a lens implant placed in the standard fashion—in the bag or in the sulcus,” Dr. Yen said. “They had no other options for a lens implant other than a sutured or an anterior chamber lens.”

Results here were promising. At the one-year mark investigators found that most patients did well with the lenses. “Our results showed that in general the patients’ vision improved in those in which vision could be measured,” Dr. Yen said. Investigators found that the final visual acuity improved from pre-op levels by a mean of 0.23 logarithm of the minimum angle of resolution units.

Marfan’s complications

Some lens dislocations did occur in early cases, but all in one group of patients—Marfan’s patients. “There were a few cases of dislocation of the lens implants early on, all in patients who had Marfan’s disease,” Dr. Yen said. “But we didn’t have any dislocation in the later patients.” Dr. Yen thinks that later patients were not as apt to experience dislocation because a different technique was possibly employed in these cases. “We didn’t have any dislocations in the later patients, and we think the sutures were tied tighter in these patients because a slip knot was used,” Dr. Yen said. “In those early cases we don’t think that a sliding knot was used, and that may have been why some of the lenses dislocated.” There were also a couple of complications that occurred here. “There was one case of a retinal detachment in a patient with Marfan’s disease about eight months after his lens dislocation was sutured back into place,” Dr. Yen said. “However, we don’t know if that was directly related to the dislocation.” In addition, there was one patient who had iris capture of the IOL after surgery.

Dr. Yen sees the study as helping to open the door for use of these posterior chamber iris fixated lenses for pediatric patients. “This is an option to be considered in patients who you feel would benefit from an IOL but who have no chance for either a sulcus-fixated or an in the bag lens,” Dr. Yen said. “We wanted to put this technique out there and show that we have used it successfully in pediatric patients.” She acknowledges, however, that the follow up for the study was relatively short. As a result, there are remaining concerns about suture degradation with the 10-0 prolene that was used here. Even so, it is still something to consider. “It’s now something that you can put on your plate and think about using,” Dr. Yen said. “Hopefully over time we can improve (the technique), and hopefully the children will improve as well.”

Editors’ note: Dr. Yen has financial interests related to her comments.

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Considering iris-sutured posterior chamber IOLs for pediatric patients Considering iris-sutured posterior chamber IOLs for pediatric patients
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