Visual outcomes of scleral-fixated posterior chamber intraocular lenses in children with genetic ectopia lentis: long-term follow-up.

Background Ectopia lentis in the pediatric population poses significant surgical challenges given the need for long-term optical rehabilitation. This study evaluated the feasibility and clinical outcomes of lensectomy combined with scleral-sutured intraocular lens (IOL) implantation in pediatric patients with genetic ectopia lentis.Methods We conducted a retrospective study of pediatric patients with atraumatic (sub)luxation of the crystalline lens who underwent lensectomy, anterior vitrectomy, and scleral-fixated polymethylmethacrylate (PMMA) IOL implantation in the sulcus. Outcome measures included best-corrected distance and near visual acuities (LogMAR), refractive outcomes and complication rates. Mean follow-up duration was 6.5 ± 2.9 years (range: 1.7-11.5 years).Results Nineteen children (36 eyes; 55% male; mean age 5.1 ± 1.9 years) were included. BCVA improved significantly for near vision (0.72 ± 0.3 to 0.19 ± 0.3; p < 0.001) and distance vision (0.48 ± 0.2 to 0.05 ± 0.2; p = 0.008). The spherical equivalent shifted from - 6.3 ± 4.6 D preoperatively to + 1.5 ± 1.4 D at one month, then to - 0.7 ± 2.6 D at final follow-up, reflecting a mean myopic shift of - 2.26 ± 2.11 D. Vision-threatening IOL subluxation occurred in 5 eyes (14% of eyes; 21% of patients). Kaplan-Meier analysis estimated its cumulative incidence at 7% at 5 years and 16% at 10 years.Conclusions Lensectomy combined with scleral-fixated sulcus PMMA IOL implantation is a viable surgical strategy for pediatric ectopia lentis, yielding substantial visual improvement and acceptable refractive outcomes. IOL subluxation remains the primary long-term concern, underscoring the need for sustained postoperative surveillance.