Longitudinal observation of posterior capsule opacification in pediatric eyes with Marfan syndrome after in-the-bag intraocular lens implantation

Purpose: To identify risk factors for posterior capsule opacification (PCO) after in-the-bag intraocular lens (IOL) implantation in pediatric patients with Marfan syndrome (MFS) and ectopia lentis (EL). Setting: Eye & ENT Hospital of Fudan University, Shanghai, China. Design: Prospective cohort study. Methods: This study included children who underwent in-the-bag IOL implantation, assisted by modified capsular tension ring (MCTR) or capsular tension ring and capsular hook (CTR-CH). Primary outcome was the incidence of PCO requiring Nd:YAG capsulotomy during follow-up period. Univariate and multivariate regression analyses were performed to identify influencing factors. Results: 152 pediatric patients (152 eyes) were included, with a mean age at surgery of 6.32 ± 0.27 years. The incidence of PCO was 69.08% during the mean follow-up time of 2.84 ± 0.04 years. Patients with PCO had less severe EL severity ( P = .008), were more frequently implanted with AcrySof IQ IOLs compared with TECNIS IOL ( P = .002), and underwent CTR-CH implantation compared with MCTR ( P = .036). Multivariate Cox regression analysis showed that patients receiving surgery younger than 5 years old (hazard ratio [HR], 1.642, P = .019) and using AcrySof IQ IOL (HR, 1.698, P = .013) developed PCO at an earlier stage. Conclusions: PCO is a common but treatable complication after in-the-bag IOL implantation in children with MFS and EL. Patients receiving lens surgery at younger age, especially younger than 5 years old, and those implanted with AcrySof IQ IOLs, compared with TECNIS IOLs, should be informed of higher risks of developing PCO.