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Management of traumatic lens subluxation and dislocation
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
The symptoms of a patient with a displaced lens depend on the position of the lens. The patient may complain of decreased vision caused either by acquired astigmatism and refractive shift or by acquired aphakia in cases of dislocation. Other symptoms are glare and monocular diplopia from the lens edge. A cataract will result in decreased visual acuity and contrast sensitivity (Fig. 48.1). Inflammation, glaucoma, and corneal edema can result in pain and photo-phobia. In cases of blunt injury, one must maintain a high degree of suspicion for an occult rupture. Special attention is paid to visual acuity, corneal status, degree of intraocular inflammation, and IOP. Lens subluxation is occasionally subtle. Zonular dehiscence is marked by the presence of iridodonesis and phacodonesis. The anterior chamber should be examined carefully for the presence of vitreous. The lens itself should be examined for breaks in the anterior and posterior capsule, along with the presence of cataract. One should also carefully evaluate the vitreous and retina for vitreous hemorrhage, retinal tears and detachments, and the presence of cystoid macular edema. Ultrasonography can be very helpful in evaluating the status of the retina and vitreous in eyes with opaque media, and a dislocated lens is easily diagnosed (Fig. 48.2). Computed tomography (CT) may also be helpful in evaluating the possibility of a dislocated lens.19
The Developmental Glaucomas
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Carlo E. Traverso, Alessandro Bagnis
Several systemic conditions are associated with lens malposition and resulting pupillary block. Attenuated and broken zonules can lead to bilateral lens subluxation or complete dislocation into the anterior chamber (Figure 13.21a and b). Lens subluxation is typically superiorly in Marfan’s syndrome and inferiorly in homocystinuria.
Anterior Segment Optical Coherence Tomography in Pediatric Ocular Pathology: Imaging Study of 115 eyes
Published in Expert Review of Medical Devices, 2023
A detailed evaluation of traumatized eyes was possible with the extent of the corneal or scleral tears demarcated; traumatic uveitis (Figure 3a and j), exudate (Figure 3a and f), synechiae, and cataracts including lens rupture were observed as well. Corneal tears were classified into lamellar or partial thickness [1(0.9%)], total thickness, self-sealing [5(4.3%)], and total thickness with iris prolapse [1(0.9%)]. Scleral tears were similarly diagnosed and classified into partial thickness and full thickness 1(0.9%)] each (Figure 1m). Iridodialysis and iris tears were observed as well 1(0.9%)]. Traumatic cataract included total white, lens rupture, and ASCO or PSCO. Traumatic lens subluxation was observed in one eye.
Heterozygote MTHFR A1298C mutation in a case of autosomal recessive bestrophinopathy with branch retinal vein occlusion
Published in Ophthalmic Genetics, 2022
Sara Hemmati, Golnaz Khakpour, Fatemeh Nadjafi-Semnani, Arzhang Gordiz, Masoome Sajadi, Fatemeh Abdi
Bilateral lens subluxation without a history of trauma also requires a full workup. Some of the causes include homocystinuria, Marfan syndrome, Weill-Marchesani syndrome, and sulfite oxidase deficiency (10). Elevated serum homocysteine can influence the development of zonular fibers and lead to lens subluxation or even dislocation, usually, inferiorly (10). The occurrence of bilateral inferior lens dislocation in our patient at 3 years of age should have prompted investigations about its cause and starting treatment at that point would probably have prevented the present vascular occlusion.
Bilateral Subluxation of Microspherophakic Lens in a Child with Cohen Syndrome
Published in Journal of Binocular Vision and Ocular Motility, 2023
Elizabeth A. Chu, Alexandria Cummings, Nicholas Sala, Nicholas Sala
A 5-year-old Amish female presented for initial evaluation at Pediatric Ophthalmology of Erie after her mother noticed her holding objects very close to her face. Given the patient’s non-verbal status, developmental delay, and diagnosis of Cohen Syndrome confirmed by genetic testing, a comprehensive evaluation by a pediatric ophthalmologist was requested to rule out visual and ocular abnormalities. The patient’s mother denied any noticeable strabismus, nystagmus, abnormal head posturing, trauma, or neurologic events. The patient’s mother did not have any lens abnormalities on examination, but the patient’s family history included a brother and six cousins with Cohen Syndrome. The patient was unable to perform quantitative visual acuity testing but was found to be central, steady, and maintained in each eye. She was able to fix and follow. Pupils were equal, round, and reactive with no afferent pupillary defects. Extraocular motility was full with normal alignment at distance and near. Anterior segment examination revealed significant iridodonesis in both eyes (OU) and lens subluxation greater in the right eye (OD) than the left eye (OS). Dilated examination confirmed bilateral lens subluxation and further revealed bilateral microspherophakia and nuclear sclerotic cataracts. The entirety of both lens’ borders was visible through the dilated pupils. It was noted that most of the zonular fibers were disrupted temporally causing the right lens to be subluxated nasally with the edge of the lens visible through the visual axis. There was apparent zonular laxity, as phacodonesis was present in the right lens greater than the left. Photos were attempted but unable to be obtained due to patient noncompliance. Retinoscopy was also attempted but cycloplegic refraction was unable to be obtained, as the reflex was poor secondary to the nuclear sclerotic cataracts and subluxated lenses. Fundus examination revealed mild signs of optic atrophy as well as peripheral pigment mottling in both eyes.