Einstein (São Paulo) (Mar 2009)
Lens subluxation grading system: predictive value for ectopia lentis surgical outcomes
Abstract
Objective: To present a classification system to grade ectopia lentis and to assess its usefulness as a predictor for surgical outcomes. Methods: Fifty-one eyes of 28 patients with either simple (19 patients) or Marfan syndrome-associated ectopia lentis (nine patients) with variable degrees of subluxation were operated on. Lens subluxation intensity was graded according to the lens subluxation grading system (LSGS) from grade 1 (lens on the whole pupillary area) up to grade 4 (lens absent from the pupillary area). Thirty eyes underwent cataract extraction (“dry” aspiration) with endocapsular ring and in-the-bag intraocular lens (IOL) implantation. Twenty-one eyes underwent cataract extraction (“dry” aspiration) with scleral fixation of the IOL. The predictive value of the LSGS was assessed by analyzing the post-operative outcomes, including visual acuity (VA), endothelial cell loss, and complications for each grade on the grading system. Rresults: Patients were classified into grade 1 (19.6%), grade 2 (51%) and grade 3 (29.4%). Post-operative VA was lower for eyes with larger degrees of subluxation. The higher the subluxation grade, the higher the endothelial cell loss, as well as, the frequency of vitreous loss and surgical time. Higher subluxation grades prevented optimal surgical outcomes with endocapsular ring and in-the-bag IOL implantation. Cconclusions: The LSGS provides an estimate of the surgical success of ectopia lentis. Adequate standardization of lens subluxation is crucial for understanding studies dealing with the surgical correction of this disorder.
