title: Outcomes Associated With Concurrent Iris-Sutured Intraocular Lens Placement and Subluxated Crystalline Lens Extraction.
abstract: OBJECTIVE
  We have developed a novel surgical technique, to our knowledge, for the management of subluxated crystalline lenses involving preplacement of an iris-sutured posterior chamber intraocular lens (PCIOL) before pars plana vitrectomy and lensectomy.
  
  
  OBJECTIVE
  To investigate the outcomes of eyes with subluxated crystalline lenses, predominantly a result of Marfan syndrome (14 eyes [58%]) or trauma (5 eyes [21%]), that underwent pars plana vitrectomy and lensectomy with placement of an iris-sutured PCIOL.
  
  
  METHODS
  We performed a retrospective, noncomparative case series of 24 eyes from 17 consecutive adult patients with surgically treated subluxated crystalline lenses presenting to the Wilmer Eye Institute at Johns Hopkins Hospital from October 6, 2006, through May 1, 2013. The mean (SD) postoperative follow-up was 24.4 (20.5) months for eyes with at least 6 months of follow-up (last date, October 13, 2014). We performed the analysis from January 21, 2014, through January 3, 2015.
  
  
  METHODS
  Improvement in best-corrected visual acuity using an automated Snellen chart and induction of astigmatism for eyes with at least 6 months of follow-up (n = 18) and IOL stability during follow-up for all eyes (n = 24).
  
  
  RESULTS
  The mean (SD) age at surgery was 49.4 (10.7 [range, 29-67]) years. We found an improvement in mean (SD [95% CI]) best-corrected visual acuity from 0.66 (0.71 [0.30-1.02]) logMAR preoperatively (Snellen equivalent, approximately 20/90; range, 20/30 to hand motions) to 0.07 (0.11 [95% CI, 0.01-0.12]) logMAR postoperatively (Snellen equivalent, approximately 20/23; range, 20/15 to 20/50). We found little change in astigmatism postoperatively (mean change, -0.1 [95% CI, -0.5 to 0.13] diopters). Postoperative complications included retinal detachment (1 eye [4%]), retained cortical fragment (1 [4%]), cystoid macular edema (2 [8%]), and IOL subluxation (3 [13%]) owing to haptic slippage within 3 months of the procedure. The overall probability of successfully achieving placement of a centered iris-sutured PCIOL in patients with follow-up of longer than 6 months (n = 18) was 100% (95% CI, 81.5%-100%).
  
  
  CONCLUSIONS
  Placement of iris-sutured PCIOLs at the time of subluxated lens extraction with a pars plana surgical approach yields favorable results in terms of postoperative visual outcomes and surgical complications. This technique offers an effective procedure for surgeons to use when treating clinically significant subluxated crystalline lenses.
authors.affiliation: Division of Cornea, Cataract and External Diseases, Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Scott F
authors.initials: SF
authors.lastname: McClellan
authors.affiliation: Division of Cornea, Cataract and External Diseases, Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Uri
authors.initials: U
authors.lastname: Soiberman
authors.affiliation: Retina Division, Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Gehlbach
authors.affiliation: Johns Hopkins Biostatistics Center, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Murakami
authors.affiliation: Division of Cornea, Cataract and External Diseases, Wilmer Eye Institute at Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Stark
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D007498:Iris / Q000601:surgery*; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007906:Lens Subluxation / Q000601:surgery*; D007908:Lens, Crystalline / Q000601:surgery; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy