Results of intraocular lens implantation with capsular tension ring in subluxated crystalline or cataractous lenses in children

Abstract

Purpose: To evaluate the outcome of intraocular lens (IOL) implantation using capsular tension ring (CTR) in subluxated crystalline or cataractous lenses in children.

Setting: Tertiary care setting.

Materials and methods: We prospectively studied 18 eyes of 15 children with subluxation of crystalline or cataractous lenses between 90 degrees up to 210 degrees after phacoemulsification, CTR and IOL implantation. Each child was examined for IOL centration, zonular dehiscence and posterior capsular opacification (PCO).

Results: Age of the patient ranged between five to 15 years. Out of 18 eyes, seven had traumatic and 11 had spontaneous subluxation of crystalline or cataractous lens. Phacoemulsification was successfully performed with CTR implantation in the capsular bag. Intraoperative zonular dialysis occurred in two eyes. Anterior vitrectomy was performed in six eyes to manage vitreous prolapse. IOL implanted was polymethyl methacrylate (PMMA) in eight eyes, hydrophobic acrylic in seven and hydrophilic acrylic in three. Follow-up ranged from 24 months to 72 months. Sixteen eyes had a best corrected visual acuity of 20/40 or better. Nine eyes developed significant PCO and were managed with Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser posterior capsulotomy. One eye with acrylic IOL in the capsular bag had IOL dislocation after two years which was managed with vitrectomy and secondary trans-scleral fixation of IOL.

Conclusions: Phacoaspiration with CTR implantation makes capsular bag IOL fixation possible in most of the eyes with subluxated crystalline or cataractous lenses. PCO still remains a challenge in children with successful phacoaspiration with CTR implantation.

Figure 1

Well centered hydrophobic acrylic IOL implantation in the capsular bag in a child of 5years for approximately 150degree traumatic subluxation of crystalline lens. Continuous curvilinear capsulorhexis of approximately 5mm and also seen in the capsular bag is capsular tension ring

Figure 2

Well centred PMMA IOL in the capsular bag in 12year old child with traumatic subluxation of cataractous lens approximately 150degree. Note capsule tension ring superiorly

Figure 3

(a) Right eye of a 10 years old child with Marfan's syndrome with supero-temporal subluxation of crystalline lens of approximately 200degree. (b) Same eye as in figure 3a showing late decentration of IOL 5 years after implantation. Note clear visual axis after Nd: YAG laser capsulotomy for posterior capsular opacification. Capsular tension ring is also seen inferiorly. (c) Same eye with an undilated pupil, there was reasonable centration of IOL. Opacified anterior edge of the capsulorhexis is passing through the infero-nasal pupil which has helped to prevent diplopia