Medical treatment of crystalline lens dislocation into the anterior chamber in a patient with Marfan syndrome

Objective To observe the treatment effects of chop hook-assisted phacoemulsification surgery in patients with crystalline lens dislocation. Methods Thirty-seven eyes with cataracts and crystalline lens dislocations underwent cataract surgery. An L-shaped chop hook was introduced into the anterior chamber, and the tip was pushed or pulled to the centre of the anterior capsular edge of the zonular dialysis during the cataract operation. Postoperative follow-up was conducted for ≥ 1 month. Results All patients’ postoperative visual abilities improved except one patient with glaucoma. One patient who underwent −5D intraocular lens implantation exhibited vision of 1/50. Visual acuity was less than 6/20 in 6 eyes, 6/20 to 10/20 in 7 eyes, and greater than 10/20 in 22 eyes. Conclusions L-shaped chop hooks can be used to push or pull the anterior capsular edge of the zonular dialysis for protection and avoidance of further zonular damage. This strategy provides satisfactory effects and reduces use of additional instruments.

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Surgical management of crystalline lens dislocation into the anterior chamber with corneal touch and secondary glaucoma

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2003.07.012 ◽

2004 ◽

Vol 30 (3) ◽

pp. 718-721 ◽

Cited By ~ 15

Author(s):

Dong-Youk Choi ◽

June-Gone Kim ◽

Byung-Joo Song

Keyword(s):

Anterior Chamber ◽

Surgical Management ◽

Crystalline Lens ◽

Secondary Glaucoma ◽

Lens Dislocation

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Bilateral spontaneous crystalline lens dislocation to the anterior chamber: A case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1312800j ◽

2013 ◽

Vol 141 (11-12) ◽

pp. 800-802 ◽

Cited By ~ 2

Author(s):

Milos Jovanovic

Keyword(s):

Intraocular Pressure ◽

Case Report ◽

Anterior Chamber ◽

Crystalline Lens ◽

Time Intervals ◽

Lens Dislocation ◽

Elevated Intraocular Pressure ◽

History Of ◽

Sudden Decrease ◽

The Right

Introduction. There are various reasons for the lens dislocation. Spontaneous dislocation of a clear lens is extremely rare, especially its dislocation to the anterior chamber. Case Outline. The author presents a case of spontaneous clear lens dislocation to the anterior chamber in both eyes in a patient without the history of any trauma. Dislocation occurred spontaneously, first in the left eye, along with a sudden decrease of vision. The ophthalmologist found a clear lens in the anterior chamber, without any sign of an elevated intraocular pressure, as should have been expected. The dislocated lens was removed surgically (intracapsular extraction) with the preventive basal iridectomy. Two years later, the same happened in the right eye: clear lens moved spontaneously to the anterior chamber, with a decrease of vision, but again without any rise of intraocular pressure and/or any pain. Intracapsular extraction of the lens with basal iridectomy was done again. Conclusion. The presented case demonstrates that spontaneous dislocation of the transparent lens to the eye anterior chamber can occur in both eyes at different time intervals. We suggest the removal of dislocated lens in the anterior chamber by the intracapsular extraction.

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Outcomes of three surgical approaches for managing ectopia lentis in Marfan syndrome

European Journal of Ophthalmology ◽

10.1177/1120672121992950 ◽

2021 ◽

pp. 112067212199295

Author(s):

Gurkan Erdogan ◽

Nilay Kandemir Besek ◽

Betul Onal Gunay ◽

Alper Agca

Keyword(s):

Marfan Syndrome ◽

Crystalline Lens ◽

Surgical Approaches ◽

Posterior Chamber ◽

Ectopia Lentis ◽

Iol Implantation ◽

Capsular Tension Ring ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective: To investigate the clinical outcomes of three surgical approaches for ectopia lentis in Marfan syndrome (MS) patients who had undergone crystalline lens removal with posterior chamber intraocular lens (IOL) implantation techniques comprising the intrascleral fixation of IOL, sutured scleral fixation of IOL, and IOL implantation with the use of a Cionni capsular tension ring (CTR). Methods: This is a retrospective comparative study, including 35 eyes of 21 patients who underwent the intrascleral fixation of IOL (group 1), scleral IOL fixation with the Z-suture (group 2), and IOL implantation with the use of a Cionni CTR (group 3) following crystalline lens removal. The surgical indications were as follows: no improvement in visual function after eyeglasses or contact lens application due to excessive irregular astigmatism and advanced crystalline lens decentration in which the edge of the crystalline lens came up to the optical axis, or dislocation of the crystalline lens resulting in aphakia and secondary glaucoma due to lens dislocation. The surgical outcomes and complications due to surgery were compared between the groups. Results: The mean age of the patients in the study was 12.3 ± 8.7 years (5–32 years). There were 10 eyes in group 1, 13 eyes in group 2, and 12 eyes in group 3. Visual acuity improved significantly in each group after surgery. Ocular residual astigmatism did not differ significantly between the groups ( p = 0.51). Conclusion: There were no significant differences between the three surgical approaches in the current study in terms of the postoperative results and complications.

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A Dislocated Crystalline Lens in a Patient With Marfan Syndrome

JAMA Ophthalmology ◽

10.1001/jamaophthalmol.2021.1533 ◽

2021 ◽

Vol 139 (6) ◽

pp. e211533

Author(s):

Thomas Meirick ◽

Dong Yang ◽

Michele D. Lee

Keyword(s):

Marfan Syndrome ◽

Crystalline Lens

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Effect of a Suction Device for Femtosecond Laser on Anterior Chamber Depth and Crystalline Lens Position Measured by OCT

Journal of Refractive Surgery ◽

10.3928/1081597x-20091016-06 ◽

2009 ◽

Vol 25 (11) ◽

pp. 1005-1011 ◽

Cited By ~ 3

Author(s):

Kathleen S. Kunert ◽

Marcus Blum ◽

Matthias Reich ◽

Manfred Dick ◽

Christoph Russmann

Keyword(s):

Femtosecond Laser ◽

Anterior Chamber ◽

Anterior Chamber Depth ◽

Crystalline Lens ◽

Suction Device ◽

Lens Position

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Pars Plana Vitrectomy and the Risk of Ocular Hypertension and Glaucoma: Where Are We?

Journal of Clinical Medicine ◽

10.3390/jcm9123994 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3994

Author(s):

Tommaso Rossi ◽

Guido Ripandelli

Keyword(s):

Anterior Chamber ◽

Ocular Hypertension ◽

Oxygen Tension ◽

Pars Plana Vitrectomy ◽

Open Angle Glaucoma ◽

Crystalline Lens ◽

Cataract Extraction ◽

Oxygen Scavenger ◽

Clinical Series ◽

Pars Plana

Purpose is to review the pathogenic mechanism for ocular hypertension and glaucoma development after pars plana vitrectomy. Both acute and chronic causes are considered, and special attention is paid to the theories and clinical evidence on the risk of developing Open Angle Glaucoma (OAG) after Pars Plana Vitrectomy (PPV). Most existing scientific literature on the issue agree on the role of ascorbate as an oxygen scavenger within the vitreous chamber. Oxygen tension in the vitreous and anterior chamber is maximum inn proximity of the retinal surface and endothelium, respectively and steeply decreases toward the lens, on both sides, and trabecular meshwork. Vitreous removal and, to a lesser extent, liquefaction, greatly reduces oxygen tension gradient in vitreous chamber while cataract extraction has similar effects on anterior chamber oxygen gradients. Oxygen derivatives originated from the cornea and retina are actively reduced by the vitreous gel and/or the crystalline lens. Vitreous removal and cataract extraction reduce drastically this function. Most reported clinical series confirm this hypothesis although protocol difference and follow-up length greatly impact the reliability of results.

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