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Manuel Noronha; Bruno Carvalho; Ana Paixão; Margarida Marques; Hernâni Monteiro; Alcina Toscano; José Pita Negrão.

Oftalmologia Pediátrica, Serviço de Oftalmologia, Centro Hospitalar de Lisboa Central

Apresentado como poster no 3rd World Congress of Paediatric Ophthalmology and Strabismus, Barcelona, Espanha, Setembro de 2015

Purpose: to describe different surgical procedures of intraocular lens implantation (IOL) in pediatric lens subluxation, their advantages/disadvantages and efficacy. The authors report three cases of pediatric lens subluxation that underwent surgery with IOL implantation.
Setting/Venue: Centro Hospitalar Lisboa Central, Ophthalmology Department.
Methods: literature was reviewed for pediatric anterior chamber (AC) and posterior chamber (PC) IOL implantation, through online database search including Medline, Cochrane and Embase databases, published between 1990 and 2014. Six eyes of three children, submitted to lens subluxation surgery with different techniques of IOL implantation, were reported.
Results: prospective, randomized/controlled or not, and retrospective trials were selected from the online search.
Regarding our cases, mean age at the time of surgery was 7,2 ± 3,1 years and follow-up time averaged 30,3 ± 16,2 months. Mean pre-surgical best corrected visual acuity (BCVA) was 0,2 ± 0,1. Different surgical procedures of IOL implantation were employed: two PC in-the-bag IOLs with adjuvant endocapsular ring, one posteriorly iris-sutured PC IOL, one anteriorly iris-fixated AC IOL, and two AC IOL retrofixated to the iris. Post-surgical BCVA averaged 0,8 ± 0,2.
Conclusions: different surgical  techniques of IOL implantation in pediatric lens subluxation have their own specific advantages and disadvantages. With adequate employment they are all similarly effective. Procedure preference depends on clinical features, surgeon experience, potential complications, as well as the specific nature of pediatric eyes. To ascertain an ideal technique in the pediatric age group, more randomized and controlled trials with a longer follow-up are required.