title: Phacoaspiration with a Cionni ring versus pars plana lensectomy, vitrectomy and sutureless transscleral IOL fixation in pediatric patients with a subluxated lens.
abstract: OBJECTIVE
  To compare outcomes of phacoaspiration (PA) with Cionni ring-assisted posterior-chamber intraocular lens implantation (PCIOL) versus pars plana lensectomy (PPL) with anterior vitrectomy (AV) and sutureless transscleral fixation of the IOL (TSFIOL) assisted with fibrin glue in the management of a subluxated lens.
  
  
  METHODS
  In this prospective and comparative interventional study, one eye of children with a bilateral subluxated lens was randomized to undergo PA with PCIOL using a Cionni ring (group A: n = 14 eyes), and the other eye underwent PPL + AV with glue-assisted TSFIOL (group B: n = 14 eyes). The outcome measures included best-corrected visual acuity (BCVA) in logMAR units and rates of complications at 12-month follow-up visits.
  
  
  RESULTS
  28 eyes of 14 children (age: 8.06 ± 4.49 years) were included in the study. BCVA improved from preoperative value of 1.21 to 0.4 (p = 0.001) in group A and from 1.53 to 0.31 (p = 0.001) in group B at month 12. There was no significant difference in the BCVA on comparing the two groups at month 12 (p > 0.411). Postoperative complications in group A included corneal edema (two eyes), Cionni hook capture (one eye), elevated IOP (one eye), and posterior capsular opacification (five eyes). In group B, corneal edema was seen in two eyes, hypotony in one eye, vitreous hemorrhage in one eye and pupillary optic capture in four eyes.
  
  
  CONCLUSIONS
  Head-to-head comparison of the two techniques demonstrates no significant difference in the rates of complications at month 12. The decision to choose either technique may be based on the operating surgeon's skill, experience and preference.
authors.affiliation: Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Bikram Bahadur
authors.initials: BB
authors.lastname: Thapa
authors.affiliation: Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ramandeep
authors.initials: R
authors.lastname: Singh
authors.affiliation: Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Parul Chawla
authors.initials: PC
authors.lastname: Gupta
authors.affiliation: Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drjagatram@gmail.com.
authors.forename: Jagat
authors.initials: J
authors.lastname: Ram
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular / Q000295:instrumentation / Q000379:methods*; D007906:Lens Subluxation / Q000601:surgery*; D007908:Lens, Crystalline / Q000601:surgery*; D007910:Lenses, Intraocular; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D013536:Suture Techniques; D014014:Tissue Adhesives / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives
keywords: Anterior vitrectomy; Cataract; Cionni ring; Ectopia lentis; Glued IOL; Intraocular lens; Phacoaspiration; Subluxated lens; Transscleral fixation