Outcomes of Intralenticular lens aspiration with glued Scleral fixated intraocular lens for Ectopia lentis in Marfan's Syndrome.

Purpose: To evaluate visual and anatomical outcomes of intralenticular lens aspiration (ILLA) with fibrin-glue assisted intrascleral haptic fixation of intraocular lens (glued-SFIOL) in Marfan syndrome patients with Ectopia lentis.

Setting: Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.

Design: Ambispective observational case series.

Methods: Patients with Marfan syndrome and ectopia lentis who underwent ILLA with glued SFIOL from August 2021 to September 2022 were retrospectively enrolled in the study. Intraoperative surgical details were recorded and patients were prospectively followed up. Primary outcome measure was post-operative corrected distance visual acuity (CDVA) at 12 months. Secondary outcome measures were postoperative complications and residual refractive error at 12 months.

Results: Forty-four eyes of 25 patients were enrolled. Mean age of patients was 12.52±6.6 years (14 males, 11 females). CDVA improved from 1.08±0.53 LogMAR pre-operatively to 0.68±0.49 LogMAR on POD-1 (p=0.012), 0.3±0.2 at 3 months (p=0.004) and 0.14±0.18 at 12 months (p=0.001). Moderate negative correlation was observed between age of presentation and post-operative CDVA at 12 months (r=-0.36, p=0.017). Group 2 (Age >10 years) had better CDVA at 3 (p=0.016) and 12 months (p=0.033) than Group 1 (Age ≤10 years). Post-operative complications included vitreous hemorrhage (11.36%), hypotony (4.34%), pupillary capture of IOL (6.5%), haptic extrusion through sclera (2.27%) and posterior dislocation of IOL (2.27%). No eye had clinically apparent pseudophakodonesis.

Conclusion: ILLA with glued-SFIOL is a promising surgical technique for managing ectopia lentis with Marfan's syndrome. Younger age of presentation is associated with poorer postoperative visual outcomes.