Glued Intrascleral Fixation of Posterior Chamber Intraocular Lens in Children DHIVYA ASHOK KUMAR, AMAR AGARWAL, DIMPLE PRAKASH, GAURAV PRAKASH, SOOSAN JACOB, AND ATHIYA AGARWAL ● PURPOSE: To evaluate the short-term results of glued intrascleral fixation of posterior chamber intraocular lens (glued IOL) in children without adequate capsular sup- port. ● DESIGN: Noncomparative retrospective observational case series. ● PATIENTS: SETTING: Institutional practice. METHODS: Forty-one eyes of 33 children who underwent glued IOL implantation were retrospectively evaluated. The indica- tions were postsurgical aphakia, subluxated cataract, ectopia lentis, traumatic subluxation, and decentered IOL. MAIN OUTCOME MEASURES: Visual acuity (VA), endothelial cell changes, intraoperative and postoperative complications. ● RESULTS: The mean age at the time of glued IOL was 10.7  3.6 years (range 515). The mean duration of follow-up after surgery was 17.5  8.5 months (range 12-36). The mean postoperative best spectacle-corrected visual acuity (BCVA in decimal equivalent) was 0.43  0.33 and there was significant change noted (P < 0.001). Postoperatively, 20/20 and >20/60 BCVA was obtained in 17.1% and 46.3% of eyes respectively. BCVA im- provement more than 1 line was seen in 22 eyes (53.6%). The mean postoperative refraction was myopic (1.19  0.7 diopters [D]) in 19 eyes and hyperopic (1.02  0.7 D) in 22 eyes. The mean endothelial loss was 4.13% (range 1.3%-5.94%). The 3 causes of re- duced BCVA were the preexisting corneal, retinal pa- thology, and amblyopia. Postoperative complications included optic capture in 1 eye (2.4%), macular edema in 2 eyes (4.8%), and clinical decentration in 2 eyes (4.8%). There was no postoperative retinal detachment, IOL dislocation, endophthalmitis, or glaucoma. ● CONCLUSION: Short-term results in children after glued IOL were favorable, with a low rate of complica- tions. However, regular follow-ups are required since long-term risks are unknown. (Am J Ophthalmol 2012;153:594 – 601. © 2012 by Elsevier Inc. All rights reserved.) I NTRAOCULAR LENS (IOL) IMPLANTATION AFTER CATA- ract surgery in children has been challenging for oph- thalmic surgeons. With excellent results seen in adults, issues such as the surgical technique, choice of the lens, and dioptric power of the lens are constantly being refined and adapted to children’s growing eyes. In eyes with an intraoperative large posterior capsular rent or preexisting ectopia lentis, IOL implantation becomes further compli- cated by lack of normal capsular support. Anterior cham- ber (AC) IOLs or sutured scleral fixated IOLs have been performed in such cases. 1–3 Scleral fixated IOLs, by virtue of their anatomic location, offer numerous advantages over the AC IOL. Glued intrascleral fixation places a posterior chamber (PC) IOL in eyes with deficient capsules using a quick-acting surgical fibrin sealant derived from human blood plasma, with both hemostatic and adhesive proper- ties. We have performed intrascleral IOL fixation with fibrin glue (glued IOL) in adult eyes with deficient capsules in the recent past and have had encouraging results. 4 –11 This study was undertaken to evaluate the postoperative outcome and complications after glued intrascleral PC IOLs in children with no capsular support. MATERIALS AND METHODS THIS IS A RETROSPECTIVE CASE SERIES OF CHILDREN WHO underwent intrascleral IOL fixation with fibrin glue (glued IOL). Eyes operated with glued IOL from January 1, 2008 to January 1, 2010 were included. Children in the age group 5 to 15 years and who came for regular follow-up were included. The preoperative indications for the glued IOL procedure were aphakia with absent capsules, sublux- ated cataracts, ectopia lentis, traumatic subluxation, and decentered IOLs. Patients who were uncooperative and those who were lost to follow-up were excluded. Uncor- rected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA) with Snellen visual acuity charts, retinoscopy, intraocular pressure (noncontact tonometry), slit-lamp biomicroscopy, dilated fundus examination, and anterior chamber cellular reaction (Standardization of Uveitis Nomenclature) were analyzed. Endothelial cell count and percentage of specular cell loss were determined by semi-automated analysis of endothelial pictures (SP- 2000P; Topcon, Tokyo, Japan). Postoperative residual power was obtained from manual refraction and autore- Accepted for publication Sept 21, 2011. From Dr Agarwal’s Eye Hospital and Eye Research Centre, Chennai, India. Inquiries to Prof Amar Agarwal, Dr. Agarwal’s Eye Hospital and Eye Research Centre, 19 Cathedral Rd, Chennai-600 086, India; e-mail: dragarwal@vsnl.com © 2012 BY ELSEVIER INC.ALL RIGHTS RESERVED. 594 0002-9394/$36.00 doi:10.1016/j.ajo.2011.09.027