Improving ectopia lentis surgical results

This article reviews the surgical management of ectopia lentis, including clinical evaluation and the use of various techniques, devices and methodologies.

The authors say that a thorough understanding of the challenges inherent in ectopia lentis cases and the management of intraoperative complications will ensure that surgeons approaching the correction of these eyes will achieve the best possible surgical results. With the advent and development of current adjunctive surgical devices, they write that most of these cases can now be treated with excellent visual and anatomic results, much better than could be accomplished just a few decades ago.

This is such an important topic as there seem to be an amazing number of patients with ectopia lentis showing up. Someone in every community needs to be facile at handling these patients, since the average surgeon is not performing these procedures. I have even had some patients referred to me after a surgeon has opened an eye for surgery, seen the missing zonules for the first time and closed it up. Certainly such patients are one of the reasons for arguing for centers of excellence. 

The management of these patients begins with a thorough clinical history, extensive clinical examination and appropriate referral to medical specialists to evaluate potential metabolic and systemic abnormalities.

Surgery presents numerous challenges and options. The approach to phacoemulsification of the subluxated crystalline lens differs depending on the degree of zonulopathy and the underlying pathophysiologic origin. The continued refinement of surgical techniques and adjunctive prosthetic devices has led to incremental improvements in the ability to achieve successful in-the-bag placement and centration of IOLs while reducing complications.

They write that although this article attempts to give a rational method for approaching these cases, it in no way suggests there is one correct method of addressing these eyes. Each surgeon will have his or her own preferences or biases for when and how to use the various prosthetic devices, which fixation sutures and fixation methods work best in his or her hands, and which IOLs are appropriate for each clinical presentation. In addition, what is currently believed to be state-of-the-art may in the future be considered archaic and crude.

They conclude that each surgeon should keep an open mind on alternative methods of treating ectopia lentis patients while making every attempt to be educated about the challenges and options present today.