Visual Outcomes in Ectopia Lentis in Marfan Syndrome: A Study of Four Surgical Techniques in Children and Adults.

Background/Objectives: To evaluate how the surgical technique and type of implanted intraocular lens influence the postoperative visual acuity and complications in ectopia lentis associated to Marfan syndrome patients. Materials and Methods: The medical records and videos of ectopia lentis surgeries in patients (children and adults) with Marfan syndrome, were retrospectively reviewed and compared. The study included 33 eyes that underwent four different intraocular lens implantation (IOL) techniques: IOL in conjunction with a simple capsular tension ring, IOL in conjunction with a Cionni modified capsular tension ring (m-CTR), two-point scleral IOL fixation and IOL with one haptic in the bag and one haptic sutured to the sclera. Results: Vision significantly improved from a mean preoperative visual acuity of 0.1122 to a mean postoperative visual acuity of 0.4539 in both age groups (p < 0.0001), with no difference in the primary outcome between children and adults. The most common surgical technique used in both age groups was IOL in conjunction with an m-CTR. There was only one major postoperative complication requiring additional surgery. Conclusions: Zonular weakness mainly influenced by age was the most important selection criterion for the surgical approach. Regardless of the technique employed, the postoperative visual acuity was improved in both adults and children.

Ectopia lentis surgery in Marfan's syndrome: from "couching" to the use of intracapsular tension rings.

In the course of time, correction of the ectopia lentis in Marfan's syndrome has been approached through quite many surgical techniques. They addressed the iris, or the lens and aimed at increasing the aphakic zone, the opacification or removal of the lens. Although associated to many complications, the first techniques proved the courage and imagination of pioneer surgeons and are worth mentioning. They were steps towards the invention of current techniques and devices that make surgery of ectopia lentis safe, easy, and having a favorable prognosis.

Enhancing rotational stability of toric intraocular lenses using a type 2L Cionni capsular tension ring in patients with high myopia.

We present the technique used in a patient with high myopia to obtain rotational stability of a plate-haptic multifocal toric intraocular lens (IOL) (AT LISA tri toric 939MP). Both of the patient's eyes had long axial lengths and large capsular bags. The first operated eye experienced consecutive toric IOL malpositions. In the fellow eye, toric IOL alignment was preserved by implanting a type 2L Cionni capsular tension ring. This was reversely inserted so the two eyelets, which are positioned slightly anterior to the ring, pressed the IOL on the posterior capsule. This unsophisticated technical artifice provided rotational stability of the IOL, even at 12 months postoperatively.

Modified bean-shaped ring segments for suture fixation of the bag-in-the-lens intraocular implant.

We describe a surgical technique for secondary stabilization of a bag-in-the-lens intraocular lens (BIL IOL) using 2 modified bean-shaped ring segments in cases of zonular dehiscence associated with pseudophakodonesis. The first modified bean segment is anchored in the sulcus with a suture to the sclera in the area of maximum zonular dehiscence, and the second segment is implanted in the opposite sulcus area. Both segments are placed in the BIL IOL interhaptic groove. The segments stabilize and center the BIL IOL by creating an artificial zonule that provides the necessary extra support for the IOL.

Modified injector for optimal insertion of standard CTRs in lax zonules.

PURPOSE: Capsular tension rings (CTRs) are commonly used for stabilizing the capsule in lax zonules. Blind and uncontrolled maneuvering of the ring free end may cause intraoperative incidents during CTR insertion. We improved the design of a standard CTR typical injector that eliminates the risks associated with the lack of control during its insertion. METHODS: We present a modification of a typical injector used for insertion of standard CTR as well as the insertion technique. The modification consists of a metal anchoring element attached to the free end of the tube, on which the second eyelet of a standard CTR is fixed. The device was used in the surgical treatment of 50 adult patients with cataract associated with lax zonule. RESULTS: The improved injector led to a reduced injection duration and complexity, and there were no intraoperative incidents or postoperative complications. CONCLUSIONS: The fixation of the second eyelet allows a controlled insertion of the standard CTRs, which facilitates the intraocular implantation technique, reduces surgical complications associated with the blind maneuvering of the free end of the ring inserted by traditional methods, and has a less disruptive action on the integrity of the remaining undamaged zonular fibers in the lax zonules. The accessory attached to the typical injector tube reduces the risk of surgical incidents caused by the uncontrolled progression of the ring's free end inside the capsular bag.