PubMed · 7306870
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B Milder. 1981. The aphakic correction.. https://pubmed.ncbi.nlm.nih.gov/7306870/
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OBJECTIVE: To compare the rate of refractive growth in pseudophakic children's eyes to that of aphakic eyes. DESIGN: Multicenter, retrospective observational case series. PARTICIPANTS: 83 patients with pseudophakic eyes (100 eyes) and 74 patients with aphakic eyes (106 eyes), with an age of surgery between 3 months and 10 years and a minimum follow-up time of 3 years or more, depending on the age at surgery. METHODS: A logarithmic model was used to analyze the rate of refractive growth for each eye. MAIN OUTCOME MEASURES: Age at surgery, intraocular lens power, intraocular lens A-constant, initial postoperative refraction, final refraction, and final age. RESULTS: Overall, pseudophakic eyes showed a lesser rate of refractive growth than aphakic eyes (-4.6 diopter vs. -5.7 diopter, P = 0.03). This trend was also present but less significant when the eyes were grouped into those less than 6 months of age at surgery (-3.3 diopter vs. -4.6 diopter, P = 0.09) and older patients (-5.0 diopter vs. -6.1 diopter, P = 0.07). However, the mean quantity of myopic shift was greater in pseudophakic eyes than in aphakic eyes (-5.26 diopter vs. -4.54 diopter), despite shorter follow-up times in the pseudophakic eyes. This is due to the optical effects of a constant intraocular lens power in a growing eye. CONCLUSIONS: Pediatric pseudophakic eyes have a slightly lesser rate of refractive growth than aphakic eyes. The new rate values should be used for predicting future refractions in these eyes.
OBJECTIVE: To assess the feasibility of scleral-fixated intraocular lens (IOL) implantation as an alternative form of optical correction in aphakic children intolerant of contact lenses and whose anterior segments lack capsular support. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: A total of 11 eyes of 11 unilateral aphakic children in the age group 4 to 9 years (mean, 6.45 years) were included in the study. INTERVENTION: Secondary scleral-fixated IOL implantation was performed in all cases. The patients underwent anterior vitrectomy at the time of IOL implantation. Amblyopia therapy in the form of patching was given post-IOL surgery. The follow-up ranged from 4 to 18 months (mean, 10.90 months). MAIN OUTCOME MEASURES: Postoperative best-corrected visual acuity (BCVA) in comparison to preoperative visual status and complications from the procedure were analyzed. RESULTS: Postoperative BCVA remained within 1 Snellen line of the preoperative visual status in six eyes, or 54.5% of patients; it improved by more than 1 Snellen line in three eyes, or 27.2% of patients, and decreased by more than 1 Snellen line in two eyes, or 18.1% of patients. The complications encountered were suture erosion through the conjunctiva in two eyes (18.18%), marked postoperative anterior chamber reaction in two eyes (18.18%), IOL decentration in one eye (9.09%), glaucoma in one eye (9.09%), and cystoid macular edema in one eye (9.09%). CONCLUSION: Secondary scleral-fixated IOL implantation was successful in achieving BCVA comparable to preoperative BCVA. However, a longer follow-up is required to document any further complications.
PURPOSE: To evaluate long-term follow-up in eyes of children who had sulcus fixation of an intraocular lens (IOL) without capsular support. SETTING: St. Eriks Eye Hospital/Karolinska Institute, Stockholm, Sweden. METHODS: This retrospective study included 21 eyes of 13 children. Seven eyes had Marfan's syndrome, 7 essential lens dislocation, 2 perforation with lens injury, and 5 spherophakia. The IOL implantation was primary in 16 eyes and secondary in 5 eyes. Lensectomy was performed with a limbal approach. An IOL with holes in the haptics was sutured in the sulcus, with the knots buried in the scleral bed. RESULTS: Mean patient age was 5.8 years +/- 2.6 (SD). Follow-up ranged from 9 to 33 months. No complications occurred during surgery. In all cases after IOL implantation, best corrected visual acuity was equal to or better than preoperatively. After surgery, no opacification of the visual axis, secondary glaucoma, or retinal complication was recorded. Posterior synechia formation occurred in 4 eyes, and 4 had cells on the IOL surface in 2 eyes, the IOL optic subluxated into the anterior chamber with the haptics in place. Both cases were successfully treated with pilocarpine 4%. CONCLUSION: Our results suggest that sulcus fixation of an IOL without capsular support is an option to correct aphakia in children.