Evaluation of Clinical Outcomes After Side-Port Lensectomy and IOL Transscleral Sulcus Suture Fixation in Pediatric Marfan Syndrome

Sunday, April 19, 2015: 3:11 PM
Room 1B (San Diego Convention Center)
Koh Sasaki, MD
Miyuki Nagahara, MD, PhD

To evaluate clinical outcomes with combined side ports lensectomy and small incision intraocular lens (IOL) implantation with trans-scleral sulcus suture fixation in pediatric Marfan syndrome.

A retrospective analysis of medical records of 11 eyes (Male 7 eyes, Female 4 eyes) with sub-luxated lens induced monocular diplopia in pediatric Marfan syndrome who underwent side ports lensectomy with 25G vitrector and small incision (2.75mm) IOL implantation with trans-scleral sulcus suture fixation from Dec 2004 to July 2011 in the University of Tokyo Hospital was reviewed. Preoperative and postoperative parameters were best corrected visual acuity (BCVA), corneal curvature, refractive cylinder power, corneal cells loss and intraocular pressure (IOP). Postoperative complications were evaluated with wound leakage, hemorrhage, iris capture, cystoid macula edema, IOL dislocation, retinal detachment and endophthalmitis. Wilcoxon’s signed-rank test was used to analyze each parameter.

The mean age was 9.3±5.0 (mean±SD) ranged from 4 to 18 years old. A 6.5mm optic diameter of IOL was put in 7 eyes and a 7mm was put in 4 eyes. At 3 years follow-up, the mean BCVA (logMAR) was increased from 0.9 (median) to -0.05 (p<0.01). The mean refractive cylinder power was -1.27±0.68D (mean±SD), corneal astigmatism, cornel cells loss and IOP were no significant difference before and after surgery. Repeated iris capture was observed in eyes without peripheral iridectomy, however, it was decreased after 6 months and there are no severe complications after surgery.

Monocular diplopia was disappeared and visual acuity was excellent improved after surgery. Long-term follow-up is needed to observe complications, however, this surgical procedure should be considered for low vision treatment in pediatric Marfan syndrome.