Evaluation of Artisan aphakic intraocular lens in cases of pediatric aphakia with insufficient capsular support Ghada I. Gawdat, MD, Sameh G. Taher, MSc, Marwa M. Salama, MD, and Adel A. Ali, MD PURPOSE To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support. METHODS In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients .2 years of age with insufficient capsular support who underwent Artisan intraoc- ular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth \ 3 mm, central endothelial cell density (CECD) \ 2500 cells/mm 2 , uncontrolled glaucoma, or uveitis were excluded. Best-corrected visual acuity, intraocular pressure (IOP), and CECD were measured at 1, 6, and 12 months postoperatively. RESULTS A total of 25 aphakic eyes of 18 patients (mean age, 7.86  3.08 years) with insufficient capsular support for a standard posterior chamber IOL were included, 18 eyes with sublux- ated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95  0.36; for patients with subluxation, 0.7  0.26. Values improved at 1 year to 0.38  0.15 (P \ 0.002) and 0.3  0.2 (P \ 0.0001), respectively. One year after surgery the CECD (2892.64  441.79 cells/mm 2 ) was significantly reduced from the preoperative and 1 month postoperative values (3573.36  468.9 cells/mm 2 , 3081  495 cells/mm 2 ; P \ 0.0001, P \ 0.02 resp.). Two cases (8%) developed traumatic dislocation. Pupillary block occurred in 1 case (4%). CONCLUSIONS Artisan IOL implantation for pediatric aphakia achieved a good visual outcome. ( J AAPOS 2015;19:242-246) P ediatric cataract is a significant cause of childhood blindness in all regions of the world. The increasing use of intraocular lens (IOL) implants in children has created a new set of challenges for surgeons treating pediatric cataracts. 1 Unfortunately, pediatric aphakia with insufficient capsular support is a common occurrence. In these cases, an angle- or iris-supported anterior chamber intraocular lens (ACIOL), and a trans- sclerally fixed posterior chamber IOL (PCIOL) offer alter- natives for correction of aphakia. 2-4 Several studies have been published on pediatric aphakic patients with angle-supported ACIOLs. 1,5,6 Due to a high incidence of secondary glaucoma, progressive pupil distortion, corneal endothelial cell loss, and the limited experience with these IOLs in children, angle-supported IOLs have not gained widespread acceptance. 7 Scleral fixa- tion of IOLs is considered a more acceptable alternative. However, scleral fixation of IOLs raises concerns about the risk of erosion of scleral sutures, possibly leading to infection or endophthalmitis. IOL tilt, dislocation of the lens in the vitreous cavity, vitreous or ciliary body hemor- rhage, and secondary glaucoma are also considered possible complications. Consequently new techniques of scleral fix- ation that use scleral tunnels have been developed. 8-11 The Artisan IOL (Ophtec BV, Groningen, The Nether- land) is one of the latest versions of the iris-fixated anterior chamber IOLs with a substantially different lens design than the previous generations of iris-fixated IOLs. It has been reported as a suitable choice in the absence of capsular support, for example in aphakia after surgery for luxation of the crystalline lens (ie, Marfan syndrome) or traumatic cataract. 12 The present study aimed to evaluate the postoperative outcome of Artisan lens implantation in aphakic pediatric eyes lacking adequate capsular support regarding the best- corrected visual acuity, the effect on intraocular pressure (IOP), the central endothelial cell density (CECD), and possible complications over a follow-up period of 1 year. Patients and Methods The study was approved by Cairo University Research Ethics committee and followed the tenets of the Declaration of Helsinki. Author affiliations: Ophthalmology Department, Faculty of Medicine, Cairo University & Research Institute of Ophthalmology, Cairo, Egypt Submitted October 26, 2014. Revision accepted March 22, 2015. Correspondence: Marwa M. Salama, MD, 31 Ahmed Heshmat Street, Zamalek, Cairo, Egypt 11211 (email: marwasalama2177@yahoo.com). Copyright Ó 2015 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00 http://dx.doi.org/10.1016/j.jaapos.2015.03.014 242 Journal of AAPOS