Visual outcomes of scleral-fixated posterior chamber intraocular lenses in children with genetic ectopia lentis: a 6-year retrospective study

Background To assess the feasibility and outcomes of lensectomy with sulcus-sutured intraocular lens (IOL) implantation in pediatric patients with atraumatic ectopia lentis. Methods Pediatric patients with atraumatic (sub-)luxated crystalline lenses that underwent lensectomy, anterior vitrectomy and sclera-fixated implantation of a polymethylmethacrylate (PMMA) IOL in the sulcus were included in this retrospective study. Outcome measures included corrected distance and near visual acuities (LogMar), refractive outcomes (spherical equivalent, prediction error), and complication rates. Follow-up averaged 6.14 ± 3.1 years with a minimal follow-up of two years and a maximal follow-up of 11 years. Results A total of 19 children (36 eyes; 55% male; mean age 5.11 ± 1.9 years) were included. Preoperative mean best corrected visual acuity (BCVA) improved from 0.72 ± 0.3 (near) and 0.48 ± 0.2 (distance) to 0.14 ± 0.3 and − 0.01 ± 0.1 postoperatively, respectively. Spherical equivalent changed from − 6.28 ± 4.6 diopters (D) preoperatively to + 1.41 ± 1.4D at one month, to -0.26 ± 3.6D at 6-year. The difference between spherical equivalent and targeted refraction was 0.59 ± 1.01D at 1-month and − 1.69 ± 2.3D at 6-year. Complications included 5 cases of IOL subluxation (4 spontaneous and one traumatic). Conclusions Lensectomy with scleral-fixated sulcus IOL implantation is an option for managing pediatric patients with ectopia lentis, yielding significant visual improvement and manageable refractive outcomes.