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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
Dropped Nucleus during Cataract Surgery in South India: Incidence, Risk Factors, and Outcomes
Published in Ophthalmic Epidemiology, 2022
Stephanie B. Engelhard, Aravind Haripriya, Sathvik Namburar, Maxwell Pistilli, Ebenezer Daniel, John H. Kempen
In our study, the presence of suspected loose zonules from phacodonesis, traumatic, or subluxated cataracts was associated with more than seven times increased risk for DN. These conditions could not be distinguished from each other using the data available and were thus grouped together as these conditions all contribute to zonular laxity, predisposing to lens capsular complications and thus to DN. Similar findings have been found in other studies.11,15–17 DN related to these conditions potentially can be minimized with the use of capsular tension rings and possibly with more controlled creation of capsulotomy with employment of the femtosecond laser,18 although these approaches were used at Aravind frequently during the period studied suggesting that the increased risk cannot be entirely removed. In spite of this, surgeons should always focus on identifying these risk factors preoperatively in order to plan surgeries in such a way as to minimize this risk. Interestingly, the presence of pseduoexfoliation was not an independent risk factor for DN in our study. Although pseduexfoliation has been associated with posterior capsule complications including DN in prior reports,8 it is likely that pseduoexfoliation is only a risk factor if zonular weakness is also present.15 Thus, by adjusting for phacodonesis, the causal pathway for the effect of pseudoexfoliation likely was removed in our study.
Trabeculectomy with Mitomycin-C in Post-Traumatic Angle Recession Glaucoma in Phakic Eyes With no Prior Intraocular Intervention
Published in Seminars in Ophthalmology, 2022
Sirisha Senthil, Divya Dangeti, Mayuri Battula, Harsha L Rao, Chandrasekhar Garudadri
The impact of trauma causing zonular damage with lens subluxation with or without vitreous disturbance is expected in these eyes. Although there was no gross phacodonesis preoperatively, during the surgery, vitreous prolapse was noted at the osteum after surgical iridectomy in two eyes, which was managed with limited vitrectomy using an automated vitrector. This complication should be anticipated and necessary precautions are taken to prevent consequences like the failure of trab or retinal detachment. Limited anterior vitrectomy followed by injection of air bubble in the anterior chamber helped to prevent hypotony and further vitreous loss or osteum block in both cases. One of these eyes had early bleb fibrosis at one month and needed AGM for IOP control. The intraoperative manipulation and inflammation postoperative could have contributed to early failure. One eye had a tenons cyst that developed at twomonths post-surgery, which was treated with topical aqueous suppressants and was considered a failure for complete success. One eye developed central posterior subcapsular cataract 11 months after trabeculectomy; however, the patient was not keen on surgery. None in our series had bleb-related infection or loss of light perception until the follow-up; however we do acknowledge the fact that these complications are time dependent, hence were not encountered with limited follow-up.
Comparison of Wash-out Properties after Use of the Vital Dye Trypan Blue in the Form of an Ophthalmic Dye and Bound in a Sodium Hyaluronate by Raman Spectroscopy
Published in Current Eye Research, 2021
Andreas F. Borkenstein, Eva-Maria Borkenstein, Johannes Rattenberger, Harald Fitzek, Achim Langenbucher
In cases of compromised fundus reflex due to corneal opacities or very advanced lens opacities (cataracta provecta, brunescens, matura) as well as in difficult, challenging situations (e.g. Pseudoexfoliation syndrome, uveitis, post-traumatic cases with phacodonesis and zonule weakness), dye-assisted surgery is preferred to increase the safety of the procedure and achieve a better workflow. The current technique of dyeing is based on a multi-stage process. To stain the anterior lens capsule, the dye (TB) is introduced into the anterior chamber (AC) in a first step. Usually, the surgeon injects a small amount of air into the anterior chamber. This air bubble is used to protect the endothelium from the dye. In a further step, the dye (TB) is removed from the VK by rinsing. The final step is to fill the anterior chamber with a viscoelastic agent (OVD). Good mixing and homogeneous concentration of OVD and dye in the eye or on the scene cannot be controlled in this way. Methods have been described in the past to mix TB and viscoelastic substances before introducing them into the anterior chamber, for example, to limit the contact of the vital dye to the relevant ocular structures. Kayikiçioğlu et al.9 used a combination of TB with sodium hyaluronate to increase the visibility of the anterior lens capsule. In vitreoretinal surgery (peeling), a similar technique using indocyanine green to stain the inner limiting membrane (ILM) has also been described as safe and effective10 However, the methods described carry the risk of contamination.