Transscleral suture fixation of posterior chamber intraocular lenses in children under 3 years

Background: Children who have undergone lentectomy for congenital or traumatic cataract do not have adequate capsular support for secondary posterior chamber intraocular lens (PC-IOL) implantation and thus will become severely amblyopic if contact lens intolerance occurs. In order to prevent amblyopia we fixed PC-IOLs by transscleral sutures in three children younger than 3 years. Clinical outcome, visual acuity and course of refraction were studied. Methods: Four eyes of three children with contact lens intolerance were operated. Posterior chamber lenses (PC-IOL) were sutured in the ciliary sulcus by transscleral sutures. Two children had monocular traumatic cataract and one child underwent surgery on both eyes for congenital cataract. To allow adjustment of refraction in situ without removing the primarily implanted and transsclerally fixed PC-IOL we used the piggyback intraocular lens system for implantation. Results: Visual acuity improved in all four eyes. The two children with traumatic cataract achieved visual acuity of 0.7 and 1.0, respectively, and stereopsis. No complications related to the technique of transscleral suture fixation of the PC-IOL were observed. Postoperative changes in refractive power were caused by a myopic shift between -1.0 D and -9.0 D. Follow-up was 25-70 months. Conclusion: Transscleral suture fixation of PC-IOLs did not cause specific complications during follow-up of up to 70 months. This technique offers an important option for the correction of an aphakic refractive error which cannot be corrected otherwise. In future the piggyback intraocular lens system may help to rather atraumatically correct postoperative changes in refractive power.