Long-Term Postoperative Outcomes following Cionni Ring and In-the-Bag Intraocular Lens Implantation in Eyes with Subluxated Lenses.

ABSTRACT

PURPOSE: To report long-term outcomes following Cionni modified capsule tension ring (MCTR) and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. STUDY DESIGN: Retrospective case series METHODS: Setting: Raghudeep Eye Hospital, India Study Population 41 eyes of 31 patients with subluxated lenses Eyes completing a minimum of 5 years postoperative follow-up were included. INTERVENTIONS: Lens extraction, capsular bag fixation with MCTR using 9-0 polypropylene suture and in-the-bag IOL implantation were performed in all eyes. MAIN OUTCOME MEASURES: Corrected distance visual acuity (CDVA), IOL centration, posterior capsule opacification, glaucoma and retinal complications were documented at final follow up. RESULTS: The mean age of the cohort was 20.48 ± 16.46 (standard deviation, SD) years. 24 eyes (58%) were below 15 years of age at the time of surgery. Marfan's syndrome accounted for 37% cases. Mean follow-up was 9.89 ± 3.81 (SD) years. 32 eyes (74%) had a CDVA of ≥ 0.3 Log MAR at final follow up. IOL decentration was noted in 7 eyes (17%) requiring a secondary surgery. The mean duration from primary surgery to re-surgery was 8.79 years. 17 eyes (41%) required a laser capsulotomy, 88% of which were pediatric eyes. Retinal detachment occurred in 4 eyes (10%), 3 of which had Marfan's syndrome. CONCLUSION: Capsular bag fixation with an MCTR using 9-0 polypropylene and in-the-bag IOL implantation had good long term visual outcomes with an acceptable rate of serious postoperative complications in eyes with subluxated lenses. This approach allows preservation of the natural compartments of the eye and placement of an IOL in its most physiological position. However, considering a 17% rate of IOL decentration requiring surgical intervention, long term stability with non-biodegradable suture materials such as polytetrafluoroethylene as well as decentration rates following sutured/ sutureless scleral fixation should be compared.