Pediatric secondary lens implantation in the absence of capsular support

Purpose: To describe and evaluate alternate techniques for implanting intra ocular lenses in children in the absence of adequate capsular support for t raditional lens implantation. Methods. Postoperative results of 18 eyes wit h posterior chamber intraocular lenses (PCIOLs) sutured to the ciliary sulc us and 10 eyes implanted with anterior chamber intraocular lenses (ACIOLs) were reviewed. Visual outcomes were divided into 2 groups: onset of aphakia during the critical period of visual development (less than or equal to9 y ears) and onset after the critical period (>9 years). Visual outcomes and c omplications were recorded. Results: Average follow-up was 10.3 months in t he PCIOL group and 49.2 months in the ACIOL group. Eyes that became aphakic after the critical period of visual development achieved better overall fi nal visual acuity than the eyes that became aphakic during the critical per iod; indeed, the eyes that became aphakic during the critical period did no t achieve significantly improved vision. There were no complications in the PCIOL group. Complications in the ACIOL group included corectopia, haptic migration through the operative wound requiring removal, and pigment deposi ts on the lens. Conclusions. PCIOLs sutured to the ciliary sulcus offer a s uperior option to ACIOLs for correction of childhood aphakia in children la cking capsular support. ACIOLs had a high rate of serious complications (10 %) in this small series. Secondary implantation with transsclerally sutured PCIOLs should be considered in complicated cases when more conservative op tions have been exhausted.