Management of an Anteriorly Dislocated Crystalline Lens and Acute Secondary Angle-Closure Glaucoma by Endocapsular Phacoemulsification in the Anterior Chamber and Iris-Fixated Intraocular Lens Implant

Abstract

Purpose: To report a case of an anteriorly dislocated crystalline lens and acute secondary angle-closure glaucoma Method: A case report and review of literature Result: A 44-year-old man experienced severe pain in his right eye for 24 h. Spontaneous anterior dislocation of the crystalline lens and acute secondary angle-closure glaucoma were diagnosed. Treatment with intravenous mannitol, oral acetazolamide, topical mydriatics, and antiglaucoma eye drops proved ineffective in controlling the elevated intraocular pressure (IOP). Therefore, we attempted removal of the dislocated lens through small corneal incisions. However, the hardness of the lenticular nucleus made its complete removal by vitrectomy difficult; hence, endocapsular phacoemulsification was performed in the anterior chamber. After the corneal edema subsided, the patient’s best- corrected visual acuity (BCVA) returned to its preoperative level of 0.7, and the IOP reduced to 12 mmHg without antiglaucoma mediations. After his ocular condition had stabilized for 3 months, a 3-piece soft acrylic iris-fixated intraocular lens (IOL) was implanted in his right eye through sutureless corneal incisions. His BCVA improved to 0.8 thereafter. Conclusion: Small-incision clear cornea endocapsular phacoemulsification and iris-fixated IOL implantation are relatively safe techniques for managing an anteriorly dislocated crystalline lens. The use of small incisions in both these techniques not only prevents potentially devastating surgical complications but also decreases postoperative astigmatism.