Adapted Bag-in-the-Lens Implantation Technique in Children with Congenital Ectopia Lentis

Abstract Background Subluxation of the crystalline lens in childhood confronts the surgeon with a dilemma: to operate or to wait and see. Surgery is usually not performed when the subluxation is still limited. However, postponing the surgery increases the surgical difficulty as the capsular bag becomes more difficult to use as a means of support for the intraocular lens (IOL). A large number of children already present a pronounced subluxation at first presentation. In this paper, we describe a technique to optimise centration and fixation of the bag-in-the-lens (BIL) IOL in children younger than 7 years of age with congenital ectopia lentis. Methods Between October 2019 and December 2020, we performed lens extraction using a combination of bean-shaped segments to support the BIL IOL and a 6 – 0 polypropylene loop fixated at the sclera, following the Yamane technique, for the purpose of centration. We used this technique for seven eyes of four patients. The patients were between 2 and 6 years old; 3 boys and 1 girl. A definite diagnosis of Marfan syndrome was made for two children; for the other two, there was no proven underlying pathology. The luxation was upwards in all cases. The degree of luxation was severe in all eyes. The preoperative refraction values showed high astigmatism values for all eyes, ranging from 6.5 to 11.25 dioptres. Three out of the four patients were myopic, ranging from − 1.5 to − 9 dioptres. Results The surgery could be performed without major complications in all eyes. Good centration was obtained, which remained stable in the postoperative period. Refraction improved with greatly diminished degrees of astigmatism (ranging from 0.25 to 3 dioptres) and myopia (spheres ranging from − 2 to + 1.75 dioptres). Conclusion Our novel technique incorporated the BIL technique with the addition of bean-shaped segments and a polypropylene 6/0 suture fixated at the sclera. In this way, we were able to obtain good centration and stability of the implanted IOL, as well as a good refractive outcome in all cases.

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Capsular bag stabilization during lens extraction and intraocular lens implantation in cases of Marfan syndrome with ectopia lentis using ultra-high-viscosity ophthalmic viscosurgical devices

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2016.08.012 ◽

2016 ◽

Vol 42 (10) ◽

pp. 1397-1401 ◽

Cited By ~ 1

Author(s):

Kenneth J. Rosenthal ◽

Nandini Venkateswaran

Keyword(s):

Marfan Syndrome ◽

Intraocular Lens ◽

High Viscosity ◽

Intraocular Lens Implantation ◽

Ectopia Lentis ◽

Lens Extraction ◽

Lens Implantation ◽

Capsular Bag

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Faculty Opinions recommendation of Capsular bag stabilization during lens extraction and intraocular lens implantation in cases of Marfan syndrome with ectopia lentis using ultra-high-viscosity ophthalmic viscosurgical devices.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726975073.793525420 ◽

2016 ◽

Author(s):

Abhay R Vasavada ◽

Vaishali Vasavada

Keyword(s):

Marfan Syndrome ◽

Intraocular Lens ◽

High Viscosity ◽

Intraocular Lens Implantation ◽

Ectopia Lentis ◽

Lens Extraction ◽

Lens Implantation ◽

Capsular Bag

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Outcomes of three surgical approaches for managing ectopia lentis in Marfan syndrome

European Journal of Ophthalmology ◽

10.1177/1120672121992950 ◽

2021 ◽

pp. 112067212199295

Author(s):

Gurkan Erdogan ◽

Nilay Kandemir Besek ◽

Betul Onal Gunay ◽

Alper Agca

Keyword(s):

Marfan Syndrome ◽

Crystalline Lens ◽

Surgical Approaches ◽

Posterior Chamber ◽

Ectopia Lentis ◽

Iol Implantation ◽

Capsular Tension Ring ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective: To investigate the clinical outcomes of three surgical approaches for ectopia lentis in Marfan syndrome (MS) patients who had undergone crystalline lens removal with posterior chamber intraocular lens (IOL) implantation techniques comprising the intrascleral fixation of IOL, sutured scleral fixation of IOL, and IOL implantation with the use of a Cionni capsular tension ring (CTR). Methods: This is a retrospective comparative study, including 35 eyes of 21 patients who underwent the intrascleral fixation of IOL (group 1), scleral IOL fixation with the Z-suture (group 2), and IOL implantation with the use of a Cionni CTR (group 3) following crystalline lens removal. The surgical indications were as follows: no improvement in visual function after eyeglasses or contact lens application due to excessive irregular astigmatism and advanced crystalline lens decentration in which the edge of the crystalline lens came up to the optical axis, or dislocation of the crystalline lens resulting in aphakia and secondary glaucoma due to lens dislocation. The surgical outcomes and complications due to surgery were compared between the groups. Results: The mean age of the patients in the study was 12.3 ± 8.7 years (5–32 years). There were 10 eyes in group 1, 13 eyes in group 2, and 12 eyes in group 3. Visual acuity improved significantly in each group after surgery. Ocular residual astigmatism did not differ significantly between the groups ( p = 0.51). Conclusion: There were no significant differences between the three surgical approaches in the current study in terms of the postoperative results and complications.

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Visual and Refractive Outcome of Lens Extraction or Cataract Surgery Combined with Limbal Relaxing Insicion in Keratoconic Eyes

Medeniyet Medical Journal ◽

10.5222/mmj.2015.147 ◽

2015 ◽

Author(s):

Hanefi Çakır ◽

Mehmet Tetikoğlu ◽

Medine Aslı Yıldırım ◽

Feyza Altın ◽

Uğur Çelik

Keyword(s):

Cataract Surgery ◽

Refractive Outcome ◽

Lens Extraction

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Novel p.G1344E mutation in FBN1 is associated with ectopia lentis

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315265 ◽

2020 ◽

pp. bjophthalmol-2019-315265

Author(s):

Yuan Yang ◽

Ya-li Zhou ◽

Teng-teng Yao ◽

Hui Pan ◽

Ping Gu ◽

...

Keyword(s):

Late Onset ◽

Family Members ◽

Crystalline Lens ◽

Pathogenic Mutation ◽

Ectopia Lentis ◽

Skeletal Involvement ◽

Suspensory Ligament ◽

Pathogenic Variants ◽

Fibrillin 1 ◽

Systemic Examination

BackgroundEctopia lentis refers to dislocation or subluxation of the crystalline lens. Fibrillin-1, encoded by FBN1, is an important microfibrillar structural component that is specifically required for the suspensory ligament of the lens. FBN1 mutations may cause abnormal structure of microfibrils and has been associated with a broad spectrum of clinical phenotypes. In this study, we characterised a Chinese dominant family with late-onset isolated ectopia lentis caused by a novel missense FBN1 mutation.MethodsEight family members, including four patients with suspected isolated ectopia lentis, were recruited from Shanghai. Clinical data and family history of the proband and other affected family members were collected. Ophthalmic examination, systemic examination and echocardiography were performed. Whole exome sequencing and Sanger sequencing were used to detect potential pathogenic variants.ResultsA novel heterozygous missense mutation c.4031 G>A/p.Gly1344Glu in exon 33 of FBN1 was identified. This mutation was detected in all affected family members and led to specific ocular system phenotypes (ectopia lentis, microspherophakia and secondary glaucoma) with minor skeletal involvement (hallux valgus).ConclusionThe novel c.4031G>A mutation in FBN1 is a likely pathogenic mutation for isolated ectopia lentis. Our study expands the spectrum of FBN1 mutations and contributes to better comprehension of genotype-phenotype correlations of ectopia lentis disease.

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Post-operative capsular opacification

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v1i1.3673 ◽

1970 ◽

Vol 1 (1) ◽

pp. 43-59 ◽

Cited By ~ 4

Author(s):

SM Raj ◽

AR Vasavada ◽

SR Kaid Johar ◽

VA Vasavada ◽

VA Vasavada

Keyword(s):

Clinical Studies ◽

Experimental Studies ◽

Surgical Techniques ◽

Crystalline Lens ◽

Posterior Capsular Opacification ◽

Pharmacological Agents ◽

Low Contrast ◽

Physiological Consequence ◽

Culture Models ◽

Capsular Bag

Post-operative capsular opacification (PCO) is a multifactorial physiological consequence of cataract surgery. Opacification involving the central posterior capsule has a significant impact on high and low contrast acuity and low contrast sensitivity. The assessment of PCO on cadaver eyes, experimental studies and culture models and in clinical studies has provided an understanding of its pathogenesis. The proliferation, migration and abnormal differentiation of residual lens epithelial cells and fibers in the capsular bag have been implicated in the pathogenesis of PCO. The incidence and severity of PCO correlates to the use of surgical techniques, intraocular lens (IOL) optic edge designs and IOL materials. This article summarizes the clinical studies with recommendations for retarding the development of central PCO. It discusses experiments with pharmacological agents broadly categorized as anti-inflammatory, immuno-modulating, antiproliferative, antiadhering and antitransdifferentiating agents for the prevention of PCO. These studies will remain critical for future endeavors undertaken for the eradication of PCO. Key words: posterior capsular opacification; capsular opacification; cataract; crystalline lens; phacoemulsification DOI: 10.3126/nepjoph.v1i1.3673 Nep J Oph 2009;1(1):43-59

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Intra-lenticular caterpillar seta in ophthalmia nodosa

European Journal of Ophthalmology ◽

10.1177/1120672119858899 ◽

2019 ◽

pp. 112067211985889

Author(s):

Arshi Singh ◽

Umesh Chandra Behera ◽

Hitesh Agrawal

Keyword(s):

Clinical Examination ◽

Pars Plana Vitrectomy ◽

Complete Resolution ◽

Clinical Course ◽

Crystalline Lens ◽

Posterior Uveitis ◽

Lens Extraction ◽

Close Observation ◽

Pars Plana ◽

Ophthalmia Nodosa

Purpose: To report the clinical course of ophthalmia nodosa with a retained lenticular seta misdiagnosed and treated as non-infectious posterior uveitis for 7 consecutive years. Methods: Meticulous clinical examination led to discovery of the caterpillar seta embedded in the crystalline lens and the intravitreal setae. Results: Lens-sparing pars plana vitrectomy and removal of free-floating vitreal seta resulted in complete resolution of vitritis and uveitis. Conclusion: Embedded seta within a clear lens may remain sequestered, and may be left untouched under close observation, precluding a clear lens extraction in such patients.

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