98th Annual Meeting DOG 2000

V 567

Postoperative astigmatism after transscleral suture fixation of posterior chamber intraocular lenses in children

H. Mittelviefhaus, K. Mittelviefhaus, J. Gerling

Background: A considerable astigmatism was observed after transscleral fixation of intraocular lenses in children (1). Since the astigmatism can interfere with amblyopia therapy, we have measured the amount of astigmatism and its course during follow up.

Patients and methods: From April 1993 to April 1999 in 8 eyes of 7 children who had lentectomy (age 1 9/12 to 7 7/12 years, mean = 3 2/12 years) posterior chamber intraocular lenses were fixed in the ciliary sulcus by transscleral sutures. The postoperative astigmatism was measured by retinoscopy every 1 to 2 weeks in the first 2 months followed by monthly intervals thereafter. Keratometry was performed with an automated handkeratometer (Alcon). Follow-up was 8 months to 6 9/12 years (mean 2 8/12 years).

Results: Postoperative astigmatism was 2.5 to 8.0 D (mean = 4.78 D, SD 2.02). The astigmatism regressed to = 0.75 D in 4/8 eyes within 4 weeks and in 5/8 eyes within 16 weeks. In 1/8 eyes the astigmatism decreased to 2.0 D and in 2/8 eyes the astigmatism remained unchanged (2.5 and 2.75 D). The astigmatism did not change any more after 16 weeks postoperatively (range 0.5 to 2.75 D, mean = 1.22 D, SD 0.93). Keratometer readings showed that the astigmatism was not caused by intraocular lens tilt.

Discussion: In case of contact lens intolerance children who had lentectomy can be treated with transsclerally fixated intraocular lenses in order to facilitate amblyopia therapy (2). However, the watertight closure of the rather small eye which is not stabalized by an intact posterior capsule or by the vitreous almost inevitably causes astigmatism. Our study shows that the postoperative astigmatism regresses soon and does not seriously interfere with amblyopia therapy. If greater than > 3 D half of the astigmatism should be corrected with glasses even in the early postoperative period. After 16 weeks full correction is recommended

  1. Sharpe MR, et al. (1996) Scleralfixation of posterior chamber intraocular lenses in children. Ophthalmic Surgery and Lasers 27: 337-341
  2. Mittelviefhaus H, Mittelviefhaus K, Gerling J (2000) Transscleral suture fixation of posterior chamber intraocular lenses in children under 3 years. Graefe's Arch Clin Exp Ophthalmol 238:

Univ.-Augenklinik Freiburg, Killianstr. 5, D – 79110 Freiburg

Back