title: Long-term outcomes of ciliary sulcus versus capsular bag fixation of intraocular lenses in children: An ultrasound biomicroscopy study.
abstract: OBJECTIVE
  To evaluate the long-term outcomes of ciliary sulcus versus capsular bag fixation of intraocular lenses (IOLs) in children after pediatric cataract surgery.
  
  
  METHODS
  IOL was implanted in the ciliary sulcus in 21 eyes of 14 children, and in the capsular bag in 19 eyes of 12 children for the treatment of pediatric cataract in an institutional setting. Ultrasound biomicroscopy (UBM) was performed. Main outcome measures included IOL decentration, IOL tilt, anterior chamber depth (ACD), angle-opening distance at 500 μm (AOD500), trabecular-iris angle (TIA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and incidence of postoperative complications.
  
  
  RESULTS
  The mean follow-up period was 6.81 ± 1.82 years. Comparing to the capsular bag fixation group, the ciliary sulcus fixation group had higher vertical IOL decentration, horizontal IOL tilt, and vertical IOL tilt (p = 0.02, 0.01,0.01, respectively), higher incidence of iris-IOL contact and peripheral anterior synechia (p = 0.001, 0.03, respectively), smaller ACD, AOD500, and TIA (p = 0.02, 0.03, 0.04, respectively), higher mean IOP (17.10 ±6.06 mmHg vs.14.15± 4.74 mmHg, p = 0.01), and higher incidence of secondary glaucoma (28.57% vs. 10.53%, p = 0.007).There was no significant difference between the two groups with regard to the BCVA, refractive errors, incidence of myopic shift, nystagmus, strabismus, and visual axis opacity.
  
  
  CONCLUSIONS
  Ciliary sulcus fixation of IOLs in pediatric eyes may increase IOL malposition and crowding of the anterior segment, and may associate with a higher risk of secondary glaucoma compared to capsular bag fixation of IOLs.
authors.affiliation: Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Yun-E
authors.initials: YE
authors.lastname: Zhao
authors.affiliation: Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Xian-Hui
authors.initials: XH
authors.lastname: Gong
authors.affiliation: Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Xue-Ning
authors.initials: XN
authors.lastname: Zhu
authors.affiliation: Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: He-Ming
authors.initials: HM
authors.lastname: Li
authors.affiliation: Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Meng-Jun
authors.initials: MJ
authors.lastname: Tu
authors.affiliation: Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States of America.
authors.forename: Terry G
authors.initials: TG
authors.lastname: Coursey
authors.affiliation: Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States of America.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Pflugfelder
authors.affiliation: Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Gu
authors.affiliation: Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Chen
mesh_terms: D002648:Child; D002675:Child, Preschool; D002924:Ciliary Body / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007903:Lens Capsule, Crystalline / Q000601:surgery*; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D008853:Microscopy / Q000379:methods*; D012189:Retrospective Studies; D014465:Ultrasonics