Long-term outcomes of ciliary sulcus versus capsular bag fixation of intraocular lenses in children: An ultrasound biomicroscopy study

Yun-E Zhao, Xian-Hui Gong, Xue-Ning Zhu, He-Ming Li, Meng-Jun Tu, Terry G Coursey, Stephen C Pflugfelder, Feng Gu, Ding Chen, Yun-E Zhao, Xian-Hui Gong, Xue-Ning Zhu, He-Ming Li, Meng-Jun Tu, Terry G Coursey, Stephen C Pflugfelder, Feng Gu, Ding Chen

Abstract

Purpose: To evaluate the long-term outcomes of ciliary sulcus versus capsular bag fixation of intraocular lenses (IOLs) in children after pediatric cataract surgery.

Methods: IOL was implanted in the ciliary sulcus in 21 eyes of 14 children, and in the capsular bag in 19 eyes of 12 children for the treatment of pediatric cataract in an institutional setting. Ultrasound biomicroscopy (UBM) was performed. Main outcome measures included IOL decentration, IOL tilt, anterior chamber depth (ACD), angle-opening distance at 500 μm (AOD500), trabecular-iris angle (TIA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and incidence of postoperative complications.

Results: The mean follow-up period was 6.81 ± 1.82 years. Comparing to the capsular bag fixation group, the ciliary sulcus fixation group had higher vertical IOL decentration, horizontal IOL tilt, and vertical IOL tilt (p = 0.02, 0.01,0.01, respectively), higher incidence of iris-IOL contact and peripheral anterior synechia (p = 0.001, 0.03, respectively), smaller ACD, AOD500, and TIA (p = 0.02, 0.03, 0.04, respectively), higher mean IOP (17.10 ±6.06 mmHg vs.14.15± 4.74 mmHg, p = 0.01), and higher incidence of secondary glaucoma (28.57% vs. 10.53%, p = 0.007).There was no significant difference between the two groups with regard to the BCVA, refractive errors, incidence of myopic shift, nystagmus, strabismus, and visual axis opacity.

Conclusions: Ciliary sulcus fixation of IOLs in pediatric eyes may increase IOL malposition and crowding of the anterior segment, and may associate with a higher risk of secondary glaucoma compared to capsular bag fixation of IOLs.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Measurement of the anterior chamber…
Fig 1. Measurement of the anterior chamber depth (ACD) and intraocular lens (IOL) decentration and tilt on the ultrasound biomicroscopy image of the anterior segment.
ACD was determined from the central inner corneal surface, perpendicular to the corneal surface to the most anteriorly visible part of the IOL. A line (line AB) was drawn between the two scleral spurs (SSs), as the base line of reference for IOL position. Two perpendicular lines were drawn from both optical endpoints of the IOL (C and D) to the base line with intersection points (E and F). IOL decentration was equal to half of the differences between distance AE and FB, i.e. IOL decentration = (|AE—FB|) / 2. IOL tilt was determined by the angle (θ) formed by the line between the two optical endpoints and the base line. A line parallel to line AB was drawn intersecting one of the optical endpoints (D). Angle θ was calculated with following formula: θ=arctan⁡(CGDG)×180π=arctan⁡(|CE−DF|EF)×180π
Fig 2. Measurement of the angle on…
Fig 2. Measurement of the angle on the ultrasound biomicroscopy image of the anterior segment.
Angle-opening distance at 500 μm (AOD500) was measured on a line perpendicular to the trabecular meshwork at points 500 μm from the scleral spur. Trabecular-iris angle (TIA) was measured with the apex in the iris recess and the arms of the angle passing through a point on the trabecular meshwork 500 μm from the scleral spur and the point on the iris perpendicularly opposite.
Fig 3
Fig 3
Comparison of intraocular lens (IOL) decentration (A) and IOL tilt (B) between the ciliary sulcus fixation and capsular bag fixation groups in horizontal and vertical directions. (* indicates significant difference groups, p < 0.05)

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