Axial growth and binocular function following bilateral lensectomy and scleral fixation of an intraocular lens in nontraumatic ectopia lentis.

PURPOSE: To evaluate binocular function (BF) and changes in axial length (AL) bilaterally in pseudophakic eyes of children after lensectomy and scleral fixation of an intraocular lens (IOL) for nontraumatic ectopia lentis.

METHODS

In 15 children who had undergone bilateral lensectomy and scleral fixation of an IOL for nontraumatic ectopia lentis, AL was measured preoperatively and at last follow-up, and BF was assessed at last follow-up. Axial growth was compared with the expected and observed patterns of normal eyes, and the results were compared between patients with isolated ectopia lentis and those with Marfan syndrome.

RESULTS

Ten of the 15 patients had Marfan syndrome. Mean age at surgery was 5.2 +/- 2.4 years; mean follow-up was 51.7 +/- 29.2 months. A mean axial growth rate of 0.39 mm/year during 51.7 postoperative months was greater than the expected (0.07 mm/year) or the observed (0.09-0.24 mm/year) rates in age-matched normal eyes. The axial growth rates in isolated ectopia lentis patients and Marfan patients were not significantly different (P = 0.159). Binocular fusion and stereoacuity of < or =800 seconds of arc were achieved by nine patients, and worse or no BF was achieved by the remaining six patients. These six patients were significantly more likely to have pre- or postoperative anisometropia of > or =3.0 D (66.6%) than the other nine patients (0%).

CONCLUSIONS

Because of greater than normal axial growth, more undercorrection of the IOL power is required than is usual in bilateral surgery for nontraumatic ectopia lentis. Good or moderate levels of postoperative BF were achieved in more than half of patients.