Visual Rehabilitation by Scleral Fixation of Posterior Chamber Intraocular Lenses in Amblyopic Aphakic Children

BACKGROUND/AIMS: To report on the outcome of scleral fixated posterior chamber intraocular lens (S-IOL) implantation in aphakic amblyopic children after 1 year. METHODS: Amblyopic children with aphakia after traumatic and congenital cataract surgery unsuitable for spectacle or contact lens correction were operated with an anterior vitrectomy and inside-out double thread scleral fixation of an Alcon CZ70BD pcIOL. Refraction and vision was compared after 12 months. RESULTS: From 2001-2006, 23 S-IOLs were implanted in 16 children (19 unilateral, 4 bilateral) aged 2-16 years: 10 eyes with traumatic [Group A], and 13 eyes with congenital cataracts including 3 eyes with ectopia lentis [Group B]. Preoperative UCVA compared to postoperative UCVA improved in 9/10 eyes in group A and 12/13 eyes in group B. Preoperative BCVA compared to postoperative UCVA improved in 9/10 eyes (90 percent) in group A and 4/13 eyes (31 percent) in group B. Mean age at surgery in group A was 6.8 years (1.5-16yrs) and in group B 10.5 years (4-16 years). More than one year elapsed in 2/10 eyes of group A and 8/13 eyes in group B. Postoperative refraction was within 2.0D of target in 17/23 eyes. Complications included temporary IOP rise in 2, vitreous hemorrhage in 1, and iris capture in 3 eyes. Two eyes required revision surgery. CONCLUSION: S-IOL implantation may be beneficial for aphakic children lacking other means for visual rehabilitation to improve vision. Amblyopia may be improved in most trauma, but only few congenital cataract eyes.