Risk factors of anterior capsular contraction syndrome in Marfan syndrome after intraocular lens and modified capsular tension ring implantation

Purpose To identify risk factors for anterior capsular contraction syndrome (ACCS) after in-the-bag intraocular lens (IOL) implantation in patients with Marfan syndrome (MFS) and ectopia lentis (EL). Methods This study included patients diagnosed with MFS and EL, who underwent in-the-bag IOL with modified capsular tension ring (MCTR) implantation. The incidence of ACCS demanding Nd:YAG capsulotomy during 2 years of follow-up was the primary outcome. Univariate analysis and generalized estimating equations (GEE) analyses were performed to identify influencing factors. Results A total of 177 eyes from 108 patients were included. The median age at surgery was 6.00 (IQR: 5.00–11.00) years old. The incidence of ACCS was 6.21% (11/177), during a median onset time of 3.00 (IQR: 1.00, 5.00) months postoperatively. Multivariate GEE analysis identified more severe EL ( OR = 4.411, 95% CI: 1.115–17.447, P = 0.034), the implantation of AcrySof IQ IOL ( OR = 25.594, 95% CI: 1.693–387.030, P = 0.019), compared to TECNIS and Rayner IOLs, and greater central corneal thickness (CCT) ( OR = 1.024, 95% CI: 1.001–1.048, P = 0.043), were associated with higher ACCS incidence. All patients with ACCS underwent Nd:YAG laser anterior capsulotomy, with no cases of IOL dislocation or ACCS recurrence during follow-up. Conclusions In patients with MFS and EL who underwent IOL-MCTR implantation, severe EL, use of AcrySof IQ IOL and greater CCT were associated with ACCS postoperatively. Meticulous preoperative assessment and tailored IOL selection are required in these patients to improve surgical outcomes and reduce the incidence of ACCS, ultimately enhancing long-term visual prognosis.