SUBLUXATION LENS, A NO-RING APPROACH

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Presentation transcript:

SUBLUXATION LENS, A NO-RING APPROACH Antonio Carlos Lottelli Rodrigues, MD Botucatu Medical School, UNESP – São Paulo State University the authors have no financial interest in this project

PURPOSE The aim of this retrospective study is to report the surgical technique and outcomes of a no-ring approach technique, with posterior chamber intraocular lens (IOL) implantation in children and young people with subluxation lens, with or without coloboma lens.

METHODS This retrospective study was approved by the Ethical Committee and consisted of 13 eyes of 10 patients with subluxation lens or subluxation and coloboma lens, and low visual acuity, operated using the technique that will be described. Preoperative analyses: subluxation etiology, CDVA, subluxation extension and presence or absence of coloboma lens. Intraoperative analyses: Scleral haptic fixation (yes or no), complications Postoperative analyses: time of follow-up, IOL centralization, and CDVA. Statistical analyses: improvement of the mean CDVA with Wilcoxon matched pair test. ( p < 0.05)

SURGICAL TECHNIQUE 3.0 mm clear cornea incision, Capsulorhexis and Phacoemulsiphication/ aspiration. Operculum shaped opening in the subluxated capsular bag edge, using scissors. In-the-bag IOL implantation with one haptic out-side-bag through the operculum shaped opening. This haptic is sutured at the sclera if necessary, for a good IOL centralization.

SURGICAL TECHNIQUE

RESULTS Preoperative Characteristics - Age: 12.61 ± 8.04 years (range: 6-28 y.o.) - Follow-up: 21.38 ± 11.29 months - Coloboma lens: 5 eyes (38.46%) Intraoperative Outcomes - No scleral suture: 9 eyes (69,33%) - No intraoperative complication

RESULTS POSTOPERATIVE OUTCOMES - Descentration between 1.00mm and ≤ 1.5mm: 3 eyes (23,08%). Anterior and posterior capsular opacity and capsulorhexis shrinking with some axial obstruction: 13 eyes (100%). Posterior capsule opening and capsulorhexis enlargement: yag laser (8 eyes), surgically (5 eyes).

RESULTS

RESULTS VISUAL OUTCOMES - CDVA was better than preoperatively in all 11 measured eyes - Mean postoperative CDVA statistically better (p= .001)

Case 1: immediate postop. Case 1: late postoperative Case 1: preoperative Case 1: immediate postop. Case 1: late postoperative Case 6: preoperative Case 6: immediate postop. Case 6: late postoperative Case 8 (OS): preoperative Case 8 (OS): immediate postop. Case 8 (OS): late postoperative

Pro’s & Con’s Cionni’s ring approach No-ring approach Bag’s size could be insufficient Stress on remaning zonula Suture durability (?) Could be implanted in coloboma lens No suture and no stress on remaning zonula (majority) If scleral haptic suture, less stress on the suture and remaning zonula No additional implants Limitations: Restrospective nature, small sample size, relatively short follow-up.

CONCLUSION In conclusion, our results indicated that the no-ring technique is a useful alternative and brings a possibility of in-the-bag IOL implantation in eyes with subluxation lens, with or without coloboma lens.