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Results for “Lens Subluxation”

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PubMed1985

Xenon arc photocoagulation for treatment of subluxation of lens.

In the treatment of congenital or acquired subluxation of the lens a conservative approach to reposition the pupil in front of the aphakic area by the use of the xenon arc photocoagulator is emphasised. The management of two cases of subluxation is discussed in detail and the results evaluated. The ease of repositioning the pupil by means of iris photocoagulation and the absence of surgical complications are indications for the use of this non-invasive procedure in the treatment of subluxated lenses.

Adult↗
PubMedDate not supplied

Suture supported P C IOL in a homocystinuric child.

A homocystinuric child presented with a secondary pupillary block glaucoma due to anteriorly subluxated lens. After removal of the subluxated lens, a suture supported posterior chamber IOL was implanted. Postoperative complication of cerebral venous thrombosis following general anaesthesia was managed with high doses of pyridoxine special diet and drugs.

Anesthesia, General↗
PubMed2002

Traumatic subluxation causing variable position of the crystalline lens.

We present a case of traumatic lens subluxation that was evident only when the patient was in the supine position. This case illustrates that a crystalline lens with traumatic zonular rupture can change its position depending on the posture of the patient. If such a lens is suspended by the remaining zonules at the superior quadrant while the patient is erect, phacodonesis may be present while the lens remains in its normal position. However, when the patient is in the supine position, the lens drops back into the vitreous cavity. Examination in erect and supine positions is important in the preoperative assessment of patients with traumatic phacodonesis or iridodonesis.

Aged↗
PubMed2001

Ocular findings among patients with late-diagnosed or poorly controlled homocystinuria compared with a screened, well-controlled population.

INTRODUCTION: Untreated homocystinuria (HCU) leads to systemic and ocular complications preventable by early treatment. METHODS: This study describes the ocular features in HCU patients who had late diagnosis or were noncompliant with treatment compared with a control group of early-diagnosed and well-controlled subjects. RESULTS: Fourteen late-diagnosed HCU patients with a median age at diagnosis of 4 years (range, 1.25-28 years) were studied. Five patients were born outside of Ireland or before screening began. All 14 patients had lens subluxation or dislocation at diagnosis. Only 28.6% of eyes had 20/40 vision or better. Three patients were tested for HCU following the diagnosis in a sibling. Four patients attended ophthalmology departments for a median of 12.8 years (range, 4-23 years) prior to diagnosis of HCU; all had steadily progressive myopic astigmatism and lens subluxation. Six patients who became poorly controlled in their teens or early twenties showed significant progression of their myopia, and 3 had phacodonesis or lens subluxation develop. All eyes in this group had 20/40 vision or better. Fifteen patients who were detected in the newborn period and remained well controlled had no evidence of lens subluxation. All of the control group patients had 20/20 vision bilaterally. The difference in visual acuity between late-diagnosed patients and the control group was highly significant (P =.0002). The differences in refractive errors between the groups were also highly significant (P =.0001). CONCLUSIONS: Lens subluxation is a principal feature of untreated HCU, yet we found a median lag period of 5.5 years in 4 cases before diagnosis. Young persons with marked and progressive myopia or idiopathic lens subluxation should be screened for HCU.

Adult↗
PubMed1997

[Surgical management of Marfan-associated and idiopathic lens dislocations].

BACKGROUND: The ideal and safe surgical method for Marfan-associated or idiopathic lens subluxations is still a matter of debate. PATIENTS AND METHODS: Between 1990 and 1995, 23 eyes were operated for lens subluxations, mainly because of decreased visual acuity, but also because of conservatively uncontrolled secondary glaucoma. Marfan patients were 27.0 (5-62) years old at surgery; patients with idiopathic lens subluxations were 38.5 (11-63) years old. Surgical procedure depended on patient age and anatomical conditions. RESULTS: All patients achieved an increase in visual acuity. Amblyopia existed in six patients. All problems due to glaucoma were controlled postoperatively. Our greatest concern was rhegmatogenous retinal detachment. It occurred in only one eye of a non-Marfan patient. CONCLUSION: The prognosis for lens surgery in Martan-associated and idiopathic lens subluxations is good. The implantation of a posterior chamber lens provides a good and secure means of optical rehabilitation. Our preferred primary transscleral suture technique guarantees high security and stability of position. Previously feared surgical risks have been reduced by modern surgical procedures.

Adolescent↗
PubMed1993

Congenital zonular cataract. Clinicopathologic correlation with electron microscopy and review of the literature.

A whole subluxated lens with a congenital zonular cataract was obtained after intracapsular extraction from an 83-year-old patient for histopathologic examination. The first electron microscopic description of a congenital zonular cataract revealed the presence of many globules ranging in diameter from 0.1 to 2.5 microns, occasionally accompanied by enlarged intercellular spaces and a few multilamellar bodies. Most of the globules were arranged concentrically around the nucleus like a shell, and only a few globules were concentrated in nodular aggregates in the nucleus. Ultrastructural indications of the relationship between globules and lens fiber membranes have substantiated the idea of the transformation from normal lens fibers into cataractous fibers by primary breakdown of the lens fiber membranes and secondary degeneration or liquefaction of the fiber contents.

Aged↗
PubMedDate not supplied

[Examination of corneal endothelium after cataract extraction in children].

Examined were 39 eyes (23 children) after extraction of congenital cataract or a subluxated lens as well as after implantation of an anterior chamber lens; evaluated were changes of density of the corneal endothelial cells. The operation the least damaging the corneal endothelium showed to be the lensectomy through the pars plana of the ciliary body.

Adolescent↗
PubMed2000

[Ultrasound biomicroscopic examination of secondary pupillary block glaucoma].

OBJECTIVE: To study the imaging characteristics of ultrasound biomicroscopy of secondary pupillary block glaucoma. METHODS: 11 cases with pupillary block glaucoma diagnosed by ultrasound biomicroscopy were studied which had been suspected as malignant glaucoma at the beginning. RESULTS: There were no obviously typical characteristics of pupillary block glaucoma shown in the images of ultrasound biomicroscopy in these cases. However, the existence of posterior chamber in each case strongly supported the diagnosis of pupillary block glaucoma. The imaging characteristics of ultrasound biomicroscopy were different in terms of the different primary disorders which resulted in the pupillary block glaucoma including iridocyclitis, lens subluxation resulted from trauma and glaucoma filtration surgery. In the cases of lens subluxation, the main characteristic was the increase of the distance between the lens and the ciliary process at the site of subluxation and the lens forward movement. In the cases of iridocyclitis, anterior and posterior synechiae were the main characteristics. And in the cases of glaucoma filtration surgery there were two main characteristics. One was that the distance between the ciliary process and the equator of lens existed obviously, and the other was the occlusion of the inner ostium of glaucoma filtration surgery or peripheral iridectomy. CONCLUSION: Ultrasound biomicroscopy (UBM) has important value in the diagnosis of secondary pupillary block glaucoma and the differentiation between it and malignant glaucoma. Whether the posterior chamber exists or not is the differential point between the pupillary block glaucoma and the malignant glaucoma.

Adult↗
PubMed2005

Asymmetric pigmentary glaucoma in a patient with Marfan's syndrome.

BACKGROUND: No relationship between Marfan's syndrome and pigmentary glaucoma has previously been described in the ophthalmic literature. We describe the case of a patient with Marfan's syndrome who had bilateral pigment dispersion syndrome and asymmetrical glaucoma. METHODS: A 34-year-old man with Marfan's syndrome developed pigment dispersion bilaterally. In the right eye, elevated intra-ocular pressure was associated with marked glaucomatous excavation of the right disc and corresponding visual field loss. A localised zonular dehiscence was present at the 6 o'clock position in the right eye. RESULTS: Ultrasound biomicroscopy showed marked iris concavity in the right eye, increased iridolenticular contact and superior subluxation of the right lens, resulting in increased dispersion of pigment unilaterally. This explains the asymmetric pattern of the glaucomatous damage. CONCLUSIONS: Asymmetrical progression of pigmentary glaucoma is uncommon and should prompt a search for some other mechanical factor, which might increase the iridozonular contact on one side or reduce it on the other. The association between the two syndromes in this patient was most likely mechanical due to reduced fibrillin expression throughout the eye and particularly in the iris and the lens zonules, resulting in loss of iris tensile strength and marked iris concavity as well as zonular weakness and partial lens subluxation.

Adult↗
PubMed2005

[The estimation of functional results after surgical treatment for ectopia lentis in children].

PURPOSE: To review the visual outcome of planned pars plana lensectomy and vitrectomy with posterior chamber intraocular lens implantation for ectopia lentis in children. MATERIAL AND METHODS: Between 1997-2002, 116 eyes were operated because of lens subluxation, mainly because of decreased visual acuity (<0.4). Lens subluxation was associated with homocystinuria in 4 patients (8 eyes), Marfan's syndrome in 30 (54 eyes), congenital simple ectopia lentis in 16 (31 eyes), post trauma in 6 (6 eyes), and congenital ectopia lentis and pupillae in 9 (17 eyes). Time of observation ranged between 1 to 6 years (mean 3.4). RESULTS: After surgery, we achieved best-corrected visual acuity improvement in 89%. Unsatisfactory visual results were due to amblyopia (9 eyes), complications of retinal detachement surgery (3 eyes), uveitis (2 eyes), glaucoma (1 eye). CONCLUSIONS: Pars plana lensectomy, vitrectomy and scleral-fixated IOL implantation give quick and good functional results. To achieve these results, visual rehabilitation and amblyopia treatment is necessary.

Amblyopia↗
PubMed2004

Ocular axial length in homocystinuria patients with and without ocular changes: effects of early treatment and biochemical control.

PURPOSE: To establish whether myopia in homocystinuria could be due to increased ocular axial length. METHODS: Measurement of ocular axial length by A-scan ultrasound in eyes of homocystinuria patients. RESULTS: Patients were divided into three groups. Group I, with no ocular pathology (28 eyes), had mean refractive error of -0.25 D (spherical equivalent) and mean axial length of 23.4 mm +/- 0.9 (+/-1 standard deviation) mm. Group II, with phacodonesis or lens subluxation (12 eyes), had mean refractive error of -10.7 D and mean axial length of 23.8 mm +/-1.9 mm. Patients with phacodonesis had simple myopia whereas those with lens subluxation had marked myopic astigmatism. Group III included patients with complete lens dislocation in at least one eye (12 eyes) and were optically aphakic with a mean refractive error of +12.9 D and mean axial length of 24.9 mm +/- 0.9 mm. All Group I patients had good long-term metabolic control while those in Groups II and III did not. Group III eyes had significantly longer mean axial length than Group I (P =.0018) or normal eyes (P =.0163). There was no statistical difference in mean axial length between Group I and normal eyes. CONCLUSIONS: Ocular axial length is significantly increased in individuals with homocystinuria and lens dislocation. Increased axial length is a complication that has not been previously described in homocystinuria and may be preventable with early treatment and good biochemical control.

Adolescent↗
PubMed1996

Congenital neoplasms of the nonpigmented ciliary epithelium (medulloepithelioma).

BACKGROUND: Most reports on intraocular medulloepithelioma have been single case descriptions. The authors reviewed ten patients with intraocular medulloepithelioma, discuss some little known clinical features of this entity, and make diagnostic and therapeutic recommendations. PATIENTS AND METHODS: The records of the authors' patients with histopathologically confirmed medulloepithelioma were reviewed, and the clinical features, diagnostic problems, management, histopathology, and prognosis were assessed. RESULTS: Of the ten patients, nine were children, ranging in age from 2 months to 10 years, and one patient was 58 years of age at the time of clinical presentation. In seven patients, there was a delay in diagnosis, ranging from 3 to 28 months, and four patients underwent surgery for cataract, glaucoma, or other secondary conditions while the tumor was unsuspected. All patients had a nonpigmented ciliary body mass and a notched or subluxated lens, and six had neovascular glaucoma and evident cysts in the mass. The authors' initial management was enucleation in four patients and local resection in six. Of the six patients managed by local resection, five eventually required enucleation, four because of local tumor recurrence and one because of ocular inflammation and discomfort. Pathologically, nine tumors were classified as malignant (5 teratoid, 4 nonteratoid) and one as benign. In one patient (the adult), metastasis to the parotid gland developed. CONCLUSION: Intraocular medulloepithelioma generally occurs in the first decade of life as a nonpigmented ciliary body mass. It has a tendency to cause secondary neovascular glaucoma, a characteristic lens notch and subluxation, and a neoplastic cyclitic membrane. Enucleation is the best treatment for advanced cases. For smaller circumscribed lesions, local resection may be attempted, but such treatment is followed frequently by local recurrence. Although most medulloepitheliomas are cytologically malignant, distant metastasis is uncommon.

Cataract Extraction↗