Management of bilateral anterior dislocation of a lens in a child with Marfan's syndrome

A 13-year-old boy with Marfan's syndrome presented with bilateral, acute, complete anterior dislocation of the crystalline lens. The lens substance was aspirated intracapsularly after 2 linear capsulotomies were created. The empty capsular bag was removed from the eye as a vitrectome was used to severe the adhesions between the capsule and vitreous face through 1 paracentesis and a forceps was used to pull the capsule through the other paracentesis. Aphakia was corrected by glasses and contact lenses. Two years after surgery, the best corrected visual acuity was 20/32 in both eyes.     

Bilateral spontaneous dislocation of posterior chamber intraocular lens in a patient with gyrate atrophy

We report a patient with gyrate atrophy, a rare metabolic disease, who had bilateral late spontaneous posterior dislocation of in-the-bag posterior chamber intraocular lens (PCIOL). He underwent pars plana vitrectomy, PCIOL retrieval and anterior chamber intraocular lens implantation in both eyes. This report may imply that patients with gyrate atrophy are at risk for spontaneous dislocation of intraocular lenses.     

Clear lens extraction and intraocular lens implantation in Marfan's syndrome

Intracapsular clear crystalline lens extraction and intraocular lens (IOL) implantation were performed in 4 highly myopic eyes of 2 patients with Marfan's syndrome. One eye of each patient received an anterior chamber IOL and the other, a scleral-fixated posterior chamber IOL. The preoperative spherical equivalent ranged between -14.50 and -28.00 diopters (D) and axial length range, between 25.32 and 36.02 mm. The SRK II formula was used. Mean uncorrected visual acuity improved from counting fingers to 20/80. Postoperative spherical equivalent correction ranged from -0.75 to +2.75 D. One eye had vitreous loss that was managed by anterior vitrectomy. Modern surgery for cataract and management of its complications suggest that clear crystalline lens extraction and IOL implantation can be attempted in selected cases with Marfan's syndrome.     

Inflamed eye in Marfan's syndrome with posteriorly luxated lens

A 34-year-old man with Marfan's syndrome complained of redness and pain in the left eye. The right eye had been blind because of untractable retinal detachment. The left eye had had three surgical procedures for retinal detachment, and the lens had been luxated in the vitreous for more than 14 years. Ultrasonography demonstrated the spontaneously luxated lens as the possible cause of the inflammatory reaction. The diagnosis of lens-induced endophthalmitis was confirmed by histopathologic examination of the excised lens.     

Bilateral late posterior chamber intraocular lens dislocation with the capsular bag in a patient with gyrate atrophy

A pseudophakic patient with gyrate atrophy of the choroid and retina presented with bilateral intraocular lens (IOL) dislocation with the capsular bag several years after uneventful cataract surgery. The patient had not performed strenuous physical activity. One IOL was initially repositioned by nonsurgical manipulations, while the other required surgical repositioning. Eventually, IOL exchange was performed successfully in both eyes.     

The results of removing a transparent lens in Marfan's syndrome

In 112 eyes of 65 patients a clear lens in the Marfan's syndrome was removed through the approach in the flat part of the ciliary body. Before operation, in all patients who had peripheral degeneration of the retina peripheral prophylactic argon laser coagulation of the retina was made. At the time of operation, in 12 eyes some pieces of lenticular substance penetrated into anterior segments of the vitreous body, which in all cases was removed by means of a lens vitreotome. One month after lensectomy, in 1 patient retinal detachment developed that totally reattached after surgical intervention. In 99 eyes (88.4%) visual acuity improved after surgery as compared with that before surgery. The analysis of the obtained results has shown that transciliary lensectomy is a reliable method of surgical treatment for subluxation of a clear lens in the Marfan's syndrome.     

Late-onset anterior dislocation of a posterior chamber intraocular lens in a patient with pseudoexfoliation syndrome

Here, we report on a patient with pseudoexfoliation syndrome who developed acute angle-closure glaucoma with a marked myopic shift due to anterior dislocation of the posterior chamber intraocular lens almost 16 months after an uneventful phacoemulsification. Examination with a Scheimpflug camera was extremely useful in confirming the diagnosis. This is the fist case of late-onset angle-closure glaucoma with a significant myopic shift due to anterior dislocation of the posterior chamber intraocular lens, which resulted in a permanent alteration of the postoperative target refraction.     

Bilateral spontaneous anterior lens dislocation in a retinitis pigmentosa patient

PURPOSE: To report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa (RP). METHODS: A 45-year-old male with RP presented with elevated intraocular pressure (IOP) in the right eye and was treated with laser iridotomy (LI). After LI, complete crystalline lens dislocation into the anterior chamber occurred. Surgical intervention, including anterior vitrectomy, intracapsular cataract extraction (ICCE), and IOL scleral fixation was performed. Two years later, the same episode occurred in his left eye and a similar treatment was done. RESULTS: Surgery was successful in both eyes. CONCLUSIONS: This is the first report of bilateral spontaneous anterior lens dislocation in a RP patient.     

Intralenticular bimanual irrigation: aspiration for subluxated lens in Marfan's syndrome

We describe a new technique of aspiration of subluxated lens in young patients with Marfan's syndrome. Two small circular anterior capsulorhexis (1.5 mm to 2.0 mm) openings were created, and bimanual irrigation/aspiration was performed by introducing the irrigation cannula through 1 capsular opening and the aspiration cannula through the other. The irrigation cannula served the dual purpose of hydrating the lens matter and holding the lens in central position to ensure complete aspiration of the lens matter. The lens capsule was later removed and anterior vitrectomy performed by a vitrectomy cutter. This new technique of intralenticular irrigation/aspiration is effective and safe in performing lens aspiration in extensively dislocated crystalline lens in Marfan's syndrome.     

后房人工晶状体脱位的临床探讨

目的：探讨后房人工晶状体植入要后各种晶状体脱位的原因及对视力的影响。方法：随访后房人工晶状体植入术病例,对晶状体的脱位情况及与并发症的关系进行观察和分析。结果：有21例在术后2周－1年发生各种晶状体脱位造成视力减退。结论：人工晶状体植入术中应注意晶状体植入的情况,术后应定期随访及时治疗并发症,可减少晶状体脱位的发生。