Comparison of clinical outcomes between iris-fixated anterior chamber intraocular lenses and scleral-fixated posterior chamber intraocular lenses in Marfan syndrome with lens subluxation

Background: To compare the clinical outcomes in Marfan's with subluxated lens having phaco-emulsification with simultaneous scleral-fixated posterior chamber intraocular lens or iris-fixated anterior chamber intraocular lens implantation. Design: Randomized case series in the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Participants: Seventy-one eyes of 49 patients with Marfan syndrome with subluxated lens. Methods: This is a randomized case series of patients with Marfan syndrome and subluxated lenses who underwent phaco-emulsification combined with scleral-fixated posterior chamber intraocular lens or iris-fixated anterior chamber intraocular lens implantation. Main Outcome Measures: The evaluation indexes included the surgery time, best corrected visual acuity, intraocular pressure, aqueous flare and cells counts, corneal endothelium counts and complications. Results: Increase in best corrected visual acuity in both groups was not significant. The aqueous flare and cells rose in both groups postoperatively. Significant difference between the two groups at 1 week postoperatively was found, whereas no statistically significant difference was found later. The loss rate of corneal endothelium cells in the scleral-fixated posterior chamber intraocular lens group was 13.2% and 19.5% at 3 months and 1 year postoperatively, which in the iris-fixated anterior chamber intraocular lens group was 13.3% and 19.3% (P > 0.05). Prolapse of vitreous was found in 21 cases intraoperatively. The posterior capsule opacification rate was 32% and 15%, respectively. The decentration of the intraocular lens was found in 19 eyes (48.7%) in the scleral-fixated posterior chamber intraocular lens group 1 year postoperatively, whereas none was found in the iris-fixated anterior chamber intraocular lens group. Conclusions: Iris-fixated anterior chamber intraocular lens after phaco-emulsification presented a safe, simple and efficient approach for managing subluxated lens in Marfan syndrome.