Surgical outcomes of modified capsular tension ring and intraocular lens implantation in Marfan syndrome with ectopia lentis

Objective: To evaluate surgical outcomes of modified capsular tension ring (MCTR) and intraocular lens (IOL) implantation in eyes of Marfan syndrome (MFS). Methods: This retrospective case series included MFS patients receiving MCTR transscleral fixation and IOL in-the-bag implantation. The MCTR was sutured to the sclera through a sulcus by 9–0 polypropylene with the modified knotless Z-suture technique. Main outcomes were visual acuity and postoperative complications. Results: A total of 109 MFS patients (187 eyes) had the surgery. Patients were 15.47 ± 14.36 years old and followed up for 10.07 ± 8.99 months. MCTR and IOL implantations were performed in 174 eyes (93.05%). The postoperative BCVA (LogMAR) was 0.24 ± 0.24 (1 month), 0.26 ± 0.20 (3 months), 0.22 ± 0.20 (6 months), 0.20 ± 0.19 (12 months) and 0.25 ± 0.32 (over 12 months), which was significantly better than preoperatively (0.63 ± 0.35) ( p < 0.001). Major complications included posterior capsular opacification (PCO) in 41 eyes (23.56%) and decentered anterior capsular opacification (ACO) in 15 eyes (8.62%). The mean occurrence time was 9.44 ± 7.08 and 8.87 ± 15.08 months respectively. Other complications included transient intraocular pressure elevation in seven eyes (4.02%), retinal detachment in two eyes (1.15%), cystoid macula edema in one eye (0.57%), and endophthalmitis in one eye (0.57%). No eye had suture breakage or IOL dislocation. Conclusions: The visual improvement is significant in eyes of MFS undergoing MCTR transscleral fixation and IOL in-the-bag implantation. The long-term monitoring of complications is warranted, especially in the first-two years.

Removal of Silicon Oil from the Vitreous Cavity via the Anterior Chamber. Eight Years of the Author’s Experiences

Purpose: To evaluate usefulness and safety of removal of silicone oil from the vitreous cavity via the anterior chamber. Methods: The procedures were performed between 2012 and 2020 in 31 patients who required endotamponade with the use of light silicone oils. In most of the patients, the procedure was combined with cataract removal, secondary lens implantation or transscleral fixation of an artificial lens. A passive bimanual technique was used to replace silicone oil with fluid. Results: The procedure to remove silicon oil via the anterior chamber proceeded without serious intra- and postoperative complications. There were no hypotony observed in first postoperative day. Conclusion: Patients eligible for the procedure are those who have preoperative indications for silicone oil removal and whose removal path via the anterior chamber is not associated with a special need to remove the lens from the eye.