Save The Titanic Iris Fixated Iols In The Management Of Ectopia Lentis : Our Experience…
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This study evaluated the technique, efficacy, and safety of using iris-claw intraocular lenses for optical correction in 15 patients with ectopia lentis or displaced lenses. The procedure involved removing the lenses and inserting iris-claw IOLs through the pupil and securing the haptics behind the iris. Post-operatively, most patients achieved good vision between 6/12 and 6/24 with no serious complications, demonstrating iris-claw IOLs are an effective treatment option for patients lacking capsular support.
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Save The Titanic Iris Fixated Iols In The Management Of Ectopia Lentis : Our Experience…
- 1. Financial Disclosure: I do not have any financial interests or relationships to disclose.
- 2. Page 2 Ectopia Lentis… • Ectopia lentis is a displacement or malposition of the eye's crystalline lens from its normal location. • The surgical correction of eyes without adequate capsular support usually presents a difficult management problem. • Purpose of this study is evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel incision for optical correction in patients with ectopia lentis.
- 3. Page 3 Inclusion criteria… • More than 180 degrees lens subluxation • BCVA less than 20 /80 • Monocular diplopia In this interventional case series, 15 patients were included having subluxated or dislocated lens with poor vision or diplopia. All the patients underwent lens removal and retro-pupillary iris fixated intraocular lens (IOL) implantation.
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- 5. Page 5 Treatment Options… AC IOLs Angle fixated anterior chamber intraocular lenses SF IOLs Scleral fixated intraocular lenses Iris claw anterior Iris fixated intraocular lenses surgical options for optical correction include • ACIOLs and SFIOLs are associated with significant complications like high risk of corneal decompensation also SFIOL implantation is technically more difficult. • IFIOLs have the advantage of Retropupillary implantation with enough space between themselves and the endothelium to avoid injury to the endothelium.
- 6. Surgical Procedure… . Intracameral Pilocarpine was used to constrict the pupil. Two paracentesis (side ports) were made diagonally opposite, i.e. at 3 o′ clock and 9 o′ clock positions. Iris claw IOL was inserted in AC and rotated such that haptics were in line with the side ports. 6-mm superior corneo-sceral tunnel Continuous curvilinear capsulorhexis (CCC) with forceps. Hydroprocedure and Phacoaspiration with I & A cannula. Capsular bag was removed with forceps
- 7. Surgical Procedure… Holding the optic of the lens with a lens fixation forceps, IOL was slipped through the pupillary area and one haptic was pushed under the iris with gentle manipulation. Maintaining the horizontal position, the IOL was recentered over the pupil behind the iris. Simultaneously, dialor was passed through the paracentesis on the same side and Enclavation done by applying gentle pressure over it through the slotted center of the lens haptic. End point was noting the dimple at the site of enclavation. Similarly, haptic encalvation in the other side was done. Peripheral iridectomy was performed. Scleral tunnel was closed with a 10-0 nylon suture.
- 8. Post op Results… Post – op with dilated PupilIris Enclavation • None had serious complications like endophthalmitis, retinal detachment, clinically significant cystoid macular edema or glaucoma during the follow up. • No case developed significant uveitis • No cases required secondary surgical intervention…. Post - Op Round Pupil
- 9. Page 9 Complications encountered… Mild decentration of IOL of 0.5mm to 1mm was seen in one case… One eye had pigment deposit on the IOL surface and posterior synechiae Oval pupil in two cases
- 10. Page 10 PT Age Eye Follow up Diagnosis Pre Op BCVA Post Op BCVA Complications 1 15 LE 19 Idiopathic 2/60 6/24 2 12 RE 28 Marfans's 1/60 6/24 3 12 LE,RE 18 Marfans's 3/60 6/18 oval pupil 4 15 RE,LE 36 Idiopathic 4/60 6/12 5 13 LE,RE 22 Idiopathic 1/60 6/12 oval pupil 6 5 RE,LE 28 Idiopathic 4/60 6/18 7 5 LE 32 Idiopathic 1/60 6/18 Decentred IOL 8 13 RE 34 Idiopathic 4/60 6/24 9 11 RE,LE 20 Marfans's 6/60 6/18 10 13 RE,LE 26 Marfans's 4/60 6/24 11 8 RE 34 Idiopathic 3/60 6/18 pigment on IOL 12 13 RE 30 Idiopathic 6/60 6/12 13 13 LE 14 Idiopathic 3/60 6/12 14 12 LE 28 Idiopathic 1/60 6/24 15 16 LE 26 Idiopathic 3/60 6/18
- 11. Page 11 Discussion… • In our study, 21 eyes gained BCVA between 6/12 to 6/24 … • One child had dislocated IOL following trauma. The IOL was successfully reenclaved. • No significant postoperative complications were observed. • At the end of 6 months In all cases the IOL was well-centered, the pupil was regular, and the eye was quiet with no sign of iritis… • Our results suggest that the retro-pupillary fixated Iris-claw intraocular lens is a very attractive alternative in cases ladicking capsular support.The retro- pupillary fixation of an iris claw lens is easy to perform and has the advantages of a true posterior chamber implantation with a low intra and postoperative risk profile.
- 12. Page 12 Conclusion… • The retro-pupillary fixation of an iris claw lens has the advantages of a true posterior chamber implantation with a low intra and postoperative risk profile. • The implantation process with this technique is easy. • We believe it is a better option than a scleral-fixated or angle- fixated IOL or leaving the child aphakic with subsequent treatment with glasses or contact lenses.
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