1. SUBLUXATION LENS, A NO-RING APPROACH
Antonio Carlos Lottelli Rodrigues, MD
Botucatu Medical School, UNESP – São Paulo State University
the authors have no financial interest in this project

2. PURPOSE
The aim of this retrospective study is to report the surgical technique and outcomes of a no-ring approach technique, with posterior chamber intraocular lens (IOL) implantation in children and young people with subluxation lens, with or without coloboma lens.

3. METHODS
This retrospective study was approved by the Ethical Committee and consisted of 13 eyes of 10 patients with subluxation lens or subluxation and coloboma lens, and low visual acuity, operated using the technique that will be described.
Preoperative analyses: subluxation etiology, CDVA, subluxation extension and presence or absence of coloboma lens.
Intraoperative analyses: Scleral haptic fixation (yes or no), complications
Postoperative analyses: time of follow-up, IOL centralization, and CDVA.
Statistical analyses: improvement of the mean CDVA with Wilcoxon matched pair test. ( p < 0.05)

4. SURGICAL TECHNIQUE
3.0 mm clear cornea incision, Capsulorhexis and Phacoemulsiphication/ aspiration.
Operculum shaped opening in the subluxated capsular bag edge, using scissors.
In-the-bag IOL implantation with one haptic out-side-bag through the operculum shaped opening. This haptic is sutured at the sclera if necessary, for a good IOL centralization.

5. SURGICAL TECHNIQUE

6. RESULTS Preoperative Characteristics - Age: 12.61 ± 8.04 years
(range: 6-28 y.o.)
- Follow-up: ± months
- Coloboma lens: 5 eyes (38.46%)
Intraoperative Outcomes
- No scleral suture: 9 eyes (69,33%)
- No intraoperative complication

7. RESULTS POSTOPERATIVE OUTCOMES
- Descentration between 1.00mm and ≤ 1.5mm: 3 eyes (23,08%).
Anterior and posterior capsular opacity and capsulorhexis shrinking with some axial obstruction:
13 eyes (100%).
Posterior capsule opening and capsulorhexis enlargement: yag laser (8 eyes), surgically
(5 eyes).

8. RESULTS

9. RESULTS VISUAL OUTCOMES
- CDVA was better than preoperatively in all 11 measured eyes
- Mean postoperative CDVA statistically better (p= .001)

10. Case 1: immediate postop. Case 1: late postoperative
Case 1: preoperative
Case 1: immediate postop.
Case 1: late postoperative
Case 6: preoperative
Case 6: immediate postop.
Case 6: late postoperative
Case 8 (OS): preoperative
Case 8 (OS): immediate postop.
Case 8 (OS): late postoperative

11. Pro’s & Con’s Cionni’s ring approach No-ring approach
Bag’s size could be insufficient
Stress on remaning zonula
Suture durability (?)
Could be implanted in coloboma lens
No suture and no stress on remaning zonula (majority)
If scleral haptic suture, less stress on the suture and remaning zonula
No additional implants
Limitations: Restrospective nature, small sample size, relatively short follow-up.

12. CONCLUSION
In conclusion, our results indicated that the no-ring technique is a useful alternative and brings a possibility of in-the-bag IOL implantation in eyes with subluxation lens, with or without coloboma lens.