2020–2021 BCSC Basic and Clinical Science Course™
6 Pediatric Ophthalmology and Strabismus
Part II: Pediatric Ophthalmology
Chapter 23: Childhood Cataracts and Other Pediatric Lens Disorders
Dislocated Lenses in Children
Optical correction of the refractive error caused by lens dislocation is often difficult. With mild subluxation, the patient may be only myopic, and corrected visual function may be good. More severe dislocation causes optical distortion, because the patient is looking through the far periphery of the lens. Because the resultant myopic astigmatism is difficult to measure accurately by retinoscopy or automated refractometry, using an aphakic correction may provide the patient with better vision, as long as the subluxated lens does not fill the pupillary space. Refraction before and after pupil dilation is often helpful for selecting the best type of optical correction. If satisfactory visual function cannot be achieved with glasses or if visual function worsens, lens removal should be considered.
Subluxated lenses can be removed either from the anterior segment through a limbal incision or posteriorly through the pars plana. In most circumstances, complete lensectomy is indicated. Lens removal is easier when the lens is not severely subluxated.
In the United States, contact lenses or glasses are usually used for postoperative vision rehabilitation, with good visual results. Anterior chamber or scleral-fixated IOLs are sometimes implanted. The latter should be used with caution if sutures are used for fixation because of the high rate of suture breakage. Iris-claw lenses (Artisan; OPHTEC BV, Groningen, the Netherlands) are widely used in other countries and are currently under investigation in the United States.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.