A Contemplation Of Pediatric Primary Ectopia Lentis

Abstract

PURPOSE: To study the etiology, complications and visual outcome with optical and surgical management in pediatric primary ectopia lentis. MATERIALS AND METHODS: This prospective, non comparative, interventional study was conducted in the Department of Pediatric Ophthalmology atCollegeofOphthalmologyand Allied Vision Sciences /KingEdwardMedicalUniversity, Mayo Hospital Lahore, from July 2010 to December 2011. Thirty eyes of thirty patients, 4 to 12 years of age, having primary crystalline lens sub-luxation were included in the study. Only one eye of each patient was included in the study. Optical management group and surgical management group were identified and catered. Patients with secondary sub luxation of crystalline lens were excluded. Treatment options used were optical correction, endo-bag limbal lensectomy and anterior vitrectomy with aphakic correction by glasses and contact lenses, and endo-bag lens aspiration with posterior chamber intraocular lens implantation with or without capsular tension ring followed by amblyopia therapy. RESULTS: Thirty eyes of thirty patients were included in the study. Eighteen patients were male and twelve patients were female. All had bilateral sub-luxated lenses. Marfan’s syndrome was encountered in 14(46.7%) patients, Weil Marchesani syndrome in 4(13.3%) patients, Homocystinuria in 2(6.7%) patients, Hereditary ectopia lentis in 4(13.3%) of patients and simple ectopia lentis in 6(20%) of patients. Endobag lensectomy was performed on 20(66.7%) eyes while lens aspiration with posterior chamber intraocular lens implantation with capsular tension ring was done in 3(10%)) eyes and in 3(10%) eyes lens aspiration with posterior chamber intraocular lens implantation was done without capsular tension ring. Pre operative best corrected visual acuity was HM-6/60 in 14(46.7%) eyes, 6/36-6/24 in 10 (33.3%) eyes and 6/18-6/12 in 6(20%) eyes. After six months best corrected visual acuity was 6/6-6/9 in 6(20%) eyes, 6/12-6/18 in 16(53.3%) eyes, 6/24-6/36 in 4(13.3%) eyes and 6/60-HM in 4 (13.3%) eyes. Twenty six (86.7%) eyes showed post-operative best corrected visual acuity improvement from 2 to 6 lines on Snellen’s visual acuity chart. CONCLUSION: Endobag limbal lensectomy is a safe and effective technique for management of ectopia lentis in pediatric age group. Endobag lens aspiration with posterior chamber intraocular lens implantation with capsular tension ring is a welcome consideration in management of  pediatric ectopia lentis. KEY WORDS: Ectopia lentis, Subluxation of lens, Dislocation of lens , Aphakia , Endo bag lensectomy , Capsular tension ring .