Save the Titanic Iris fixated IOLs in the management of

Ectopia Lentis : Our Experience…

- Dr Saurabh N. Shah

Financial Disclosure: I do not have any financial interests or relationships to disclose.

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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.

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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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Cases with

Subluxated lens…

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Treatment Options…

AC IOLsAngle fixated anterior chamber

intraocular lenses

SF IOLsScleral fixated intraocular lenses

Iris claw anteriorIris 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.

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

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.

Post op Results…

Post – op with dilated PupilIris Enclavation

• None had serious complicationslike 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

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Complications encountered…

Mild decentration of IOL of 0.5mm to 1mm was

seen in one case…

One eye had pigment deposit on the IOL

surfaceand posterior synechiae

Oval pupil in two cases

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PT Age Eye Follow up Diagnosis Pre OpBCVA

Post OpBCVA 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 pupil4 15 RE,LE 36 Idiopathic 4/60 6/125 13 LE,RE 22 Idiopathic 1/60 6/12  oval pupil6 5 RE,LE 28 Idiopathic 4/60 6/18   7 5 LE 32 Idiopathic 1/60 6/18 Decentred IOL8 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 6/2415 16 LE 26 Idiopathic 3/60 6/18

Master Chart…

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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.

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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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You…Thank

Dr Saurabh Shah