Incidence of intraocular lens (IOL) tilt and decentration after secondary IOL sulcus implantation versus optic capture in pediatric aphakia.

PURPOSE: To compare the tilt and decentration between secondary sulcus-implanted versus optic-captured intraocular lens (IOL) in pediatric aphakia using ultrasound bio-microscopy (UBM).

DESIGN

Prospective, comparative study at "Cairo University" pediatric ophthalmology and strabismus unit.

METHODS

Forty-four eyes of 25 aphakics were scheduled for secondary implantation. Patients were randomly divided into two equal groups: Group A underwent sulcus implantation, while Group B underwent optic capture. UBM was performed preoperatively, 3 months and 6 months after surgery to evaluate the anterior chamber depth (ACD), angle width in the four quadrants, horizontal and vertical tilt, and decentration.

RESULTS

Preoperative demographic data, ACD, and angle width did not differ between the groups. Six months after surgery, ACD was significantly higher in the capture group (mean 3.6 mm ± 0.59 [2.25-4.45]) than the sulcus group (mean 3.01 mm ± 0.25 [2.55-3.33]) with a mean difference of 0.59 mm (P = 0.000). The anterior chamber angle (ACA) showed larger values in all four quadrants in the capture group, highly statistically significant in the temporal (47.09° versus 42.23° P = 0.001) and superior (46.38° versus 42.47° P = 0.009) quadrants. Although there was no difference in the horizontal (0.22 versus 0.31 mm) and vertical (0.28 versus 0.30 mm) decentration between both groups, the capture group showed statistically significant more horizontal (1.8 versus 0.83°) and vertical tilt (2.16 versus 0.89°) compared to the sulcus group. This tilt did not affect the target refraction or cylinder and was, therefore, considered clinically insignificant.

CONCLUSION

Secondary IOL implantation with the capture technique appears to provide a deeper AC and a wider angle than sulcus implantation but could result in greater IOL tilt. UBM discloses changes in IOL position that are not clinically detected during follow-up.