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Sulcus Suture Fixation of a Foldable IOL over Preserved Capsule for Managing Lens Subluxation in Marfan's syndrom

Ahmed Samir and Ahmed Moemen Gad

Aim: To study the feasibility and efficacy of removal of the subluxated lens and sclera fixation of a foldable intraocular lens on top of the decentered preserved capsular bag. Patients and methods. Seventeen eyes of 10 patients (9 - 15 years) were done by phacoaspiration followed by trans-scleral fixation of foldable IOL in the sulcus on top of the decentered capsular bag of the subluxated lens.
Results: Postoperative refraction spherical equivalent amplitude ranged from 0.25 to 1.38 diopters with a mean of 1.35 ± 1.13 diopters. The final postoperative BCVA ranged from 6/18 to 6/6 with a mean of 6/9 (0.67 ± 0.25 decimal). Intraoperative complications were hyphema in one case and accidental small zonular injury without vitreous prolapsed during needle passage in two cases. Postoperative complications were transient iridocyclitis in one case. Posterior capsular opacification (PCO) occurred in all cases but in thirteen cases the bag gets contracted and the opacity was away from the visual axis and only four cases needed YAG posterior capsulotomy.
Conclusion: Combined sulcus and scleral fixation of foldable intraocular is a safe and effective method. This technique of keeping the decentered bag attached to the stretched zonules will prevent IOL tilt and avoid working on the vitreous with its known complications. Scleral fixation of the foldable IOL guarantees the long term stability and gets the benefits of small incision surgery.