Suturing Techniques In Pedriatic Ectopia Lensis And Marfan Syndorme – Our Surgical Experience
Published 2024 - 42nd Congress of the ESCRS
Reference: PO478 | Type: Free paper | DOI: 10.82333/s2ar-wg45
Authors: Călin Petru Tătaru* 1 , Cătălina Ioana Tătaru 1 , Paul Filip Curcă 2 , Andrei Sebastian Vătafu 3 , Xenia Tătaru 3 , Carmen Ecaterina Chiriță 3 , Cristina Cojan 3 , Maria Cristina Halici 3
1Ophthalmology,Clinical Hospital for Ophthalmological Emergencies Bucharest,Bucharest,Romania;Anterior Pole Surgery,Alcor Clinic,Bucharest,Romania;Ophthalmology,Carol Davila University of Medicine and Pharmacy Bucharest,Bucharest,Romania, 2Ophthalmology,Clinical Hospital for Ophthalmological Emergencies Bucharest,Bucharest,Romania;Ophthalmology,Carol Davila University of Medicine and Pharmacy Bucharest,Bucharest,Romania, 3Ophthalmology,Clinical Hospital for Ophthalmological Emergencies Bucharest,Bucharest,Romania
Purpose
To present our surgical experience in pediatric Marfan Syndrome Ectopia Lentis. Depending on the grade of lens bag displacement and intraoperative conditions three surgical techniques were employed: Cionni ring scleral-suturing with IOL implantation in the bag or vitrectomy with either flanged-lens fixation or sutureless scleral fixation of three-piece lens
Setting
Clinical Hospital for Ophthalmological Emergencies Bucharest
Methods
Retrospective analysis of visual and refractive data and surgical procedures. 1) If capsulorhexis is successful and no vitreous is present in the anterior chamber after lens aspiration, then salvation of the lens bag is optimal. To this end repositioning of the lens bag is possible by implanting a Cionni ring inside the bag and using the Cionni eyelet to pass a scleral anchoring suture. The resultant exterior-interior (Cionni eyelet) – exterior suture is tightened. A small scleral pocket ensures prevention of suture erosion. 2) If vitreous prolapse occurs intraoperatively then vitrectomy is performed and flanged-suture anchoring of the IOL to the sclera is utilized.
Results
We present several cases: A) a 7-year-old patient with Marfan Syndrome and bilateral ectopia lentis that exemplifies usage of both techniques: externalized-haptic type flange in the eye with ample lens displacement and a bag-conservative Cionni-Ring Suture technique in the eye with less lens displacement; B) 31 Diopter Toric T7 lens flanged suturing with intraoperative guidance from an Image Guiding System for axis marking and alignment; C) an 8-year-old patient that presented 2 months after surgery with breakage of one IOL haptic and survival of the 7-0 prolene scleral flange-point - IOL was explanted and a 3-piece IOL was anchored using a Yamane-type sutureless technique.
Conclusions
Marfan Syndrome Ectopia Lentis poses significant variability in lens bag displacement and variance in surgical challenges. Salvaging the lens bag by repositioning it with a scleral-fixation Cionni Ring is preferable. If the bag cannot be saved, then flanged scleral fixation of the IOL is less intrusive than other techniques and is highly adaptable. In our experience flanged IOL fixation offers IOL stability and long-term resistance - The likely weak-point is the IOL material itself and not the flange-points. If flanged-fixation is not feasible then Yamane-like technique is an alternative