Retropupillary Iris Claw Lens Implantation In Pediatric Patients With Non Traumatic Ectopia Lentis Secondary To Marfan's Syndrome- A Long Term Retrospective Analytical Study.

To analyze the visual outcome,effect on corneal endothelial cell count and complication rate after implanting retropupillary iris claw lens in pediatric patients with ectopia lentis secondary to Marfan’s syndrome.

This is a retrospective analytical study conducted on medical records of our hospital Sankara eye hospital, India. 34 pediatric patients between age group of 4-17yrs were enrolled.The patients with monocular/binocular aphakia secondary to ectopia lentis due to marfan’s syndrome were included.Patients with coexisting retinal pathologies, corneal decompensation, uveitis from any cause, glaucoma and amblyopia were excluded.

This Retrospective study comprised of 34 eyes of 24 children with subluxation of natural lens in Marfan’s syndrome with inadequate capsular support who underwent lensectomy followed by primary/secondary retropupillary iri claw lens implantation between 2011 and 2023 at the cornea department of sankara eye hospital,Coimbatore.30 patients underwent primary iris claw implantation while 4 patients needed a secondary iris claw lens implantation.Preoperative and postoperative UCVA,BSCVA,effect on IOP and ECC and other complications were studied.

The mean patient age was 8.5yrs (age group: 4-17yrs) and the mean follow up period was for 25.38 months (range: 2 to 117 months). The mean logMAR BSCVA improved from 0.85±0.30 preoperatively to 0.38±0.20 postoperatively, at the last follow-up visit (P < 0.0001). The final BSCVA improved in 32 eyes (94%), remained unchanged in only 2 eyes (6%), and worsened in none.

Postoperative average astigmatism was reported as -1.10D (range: 0.5–2.25D) and intraocular pressure as 15.5 mmHg (range: 9–26 mmHg). The mean endothelial cell density decreased from 2907.35±387.07 cells/mm2 before surgery to 2612.02±435.90 cells/mm2 after surgery (at last follow-up visit), which implies an average endothelial cell loss of 10.16% at the end of the study.

The retropupillary iris claw implantation is an effective and relatively safe procedure in pediatric patients with ectopia lentis secondary to Marfan’s syndrome. The endothelial cell loss as low as  10.16 % seems to be in acceptable range, and we have not reported major posterior segment complications till the present date.Then complication rate was insignificant in comparison to the benefits of RP IC IOL which makes it a favorable option to consider in presence of inadequate capsular support.