Dislocation Of Crystalline Lens Research Articles

Traumatic subconjunctival phacocele – Rare and sui generis

Blunt trauma to the globe can result in indirect scleral rupture with dislocation of crystalline lens into the subconjunctival or sub-tenon space and is known as phacocele. Here, we report a case of traumatic subconjunctival phacocele with history of blunt trauma to the globe 1 month back. The case presented with a mass in the inferonasal quadrant with no previous history of myopia, ocular surgery, or connective tissue disorder.

Postmortem changes in the eye on computed tomography images

BackgroundOcular tension decreases with increasing postmortem interval (PMI) and eyes collapse with extreme progression of postmortem change; however, time-related changes in postmortem computed tomography (PMCT) findings have not been clarified. This study aimed to quantitatively evaluate the vitreous volume and CT values of the vitreous body to clarify time-related changes in PMCT. MethodsWe retrospectively reviewed PMCT images of the eyes of subjects who underwent autopsy at our institution between July 2023 and February 2024. They were classified into four PMI groups: PMI-1: < 1 day, PMI-2: 1–2 days, PMI-3: 3–6 days, PMI-4: ≥ 7 days. The vitreous volumes and mean CT values of the vitreous chambers were measured. Additionally, the presence of intraocular gas and crystalline lens dislocation was observed. ResultsThe PMCT images of 131 eyes of 66 patients (41 males, 25 females) were analyzed. The mean age was 63.7 (22–99) years. The volume of the vitreous cavity was significantly decreased at PMI-3 and PMI-4, which indicated scleral depression. Intraocular gas appeared in PMI-4. Lens dislocation began at PMI-3 and was more frequently observed at PMI-4 and in the higher-temperature environment group. ConclusionOcular findings on PMCT are useful for estimating the time of death.

Comparison of short‐term clinical outcomes between sutured scleral fixation and modified Yamane sutureless scleral fixation

Aims/Purpose: To compare and investigate the short‐term clinical outcomes between 10‐0 polypropylene sutured intraocular lens (IOL) scleral fixation and modified Yamane sutureless IOL scleral fixation in patients with IOL or crystalline les dislocation and aphakic state.Methods: From August 2012 to May 2022, medical records were retrospectively analysed for 43 patients with sutured scleral fixation and 40 patients with sutureless scleral fixation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), total astigmatism, IOL astigmatism, refractive error, corneal endothelial cell density, surgical time and complications were compared before surgery, 1 week, 1 month and 3 months after surgery.Results: In the two groups, after 3 months of surgery, UCVA and BCVA improved compared to before surgery, but there was no significant difference between two groups. The absolute refractive error and total astigmatism for 1 week after surgery and IOL astigmatism for 1 week and 1 month after surgery were significantly lower in sutureless fixation group. There was no significant difference in post‐operative corneal endothelial cell density changes between two groups, and total surgical time and IOL fixation time were measured significantly lower in sutureless fixation group.Conclusions: Although modified Yamane sutureless IOL scleral fixation did not show significant improvement in visual acuity compared with conventional sutured IOL scleral fixation, sutureless fixation provided better stability of IOL in the early stages after surgery and short in the surgical time. So it can be an effective alternative to conventional sutured scleral fixation in patients with IOL or crystalline lens dislocation and aphakic state.

In-Office Lens Repositioning for Anterior Crystalline Lens Dislocation.

We describe an in-office lens repositioning technique for anterior crystalline lens dislocation. We present a case series of four patients with spontaneous or traumatic anterior crystalline lens dislocation. The technique included supine patient positioning, gentle pressure with a cotton swab on the peripheral cornea to guide the lens into the posterior chamber, and the use of a miotic agent afterward to prevent subsequent subluxation. In the four cases described, the in-office technique successfully restored the lens to the posterior chamber, improved vision, and decreased intraocular pressure in most instances by resolving the angle closure secondary to pupillary block. The in-office lens repositioning technique is appropriate as an acute non-surgical intervention or temporizing measure for anterior crystalline lens dislocation. [Ophthalmic Surg Lasers Imaging Retina 2024;55:293-298.].

Vitreous management in Yamane’s technique for crystalline lens dislocation: anterior vitrectomy or PPV?

ObjectiveTo study the postoperative visual outcomes and surgical complications of anterior/pars plana vitrectomy and concurrent Yamane’s IOL fixation for crystalline lens dislocation.MethodsFifty-three patients (56 eyes) with crystalline lens subluxation/dislocation were enrolled in this retrospective interventional study. Patients received anterior/pars plana vitrectomy and concurrent Yamane’s IOL fixation. Main outcome measures were postoperative BCVA and surgical complications. Proportion of spontaneous PVD and preoperative undetected retinal holes/degeneration (PURH/D) were recorded.ResultsTwenty-four eyes were treated with anterior vitrectomy (Group AnV) and 32 eyes with pars plana vitrectomy (Group PPV). Overall incidence of PURH/D was 10.7% (6/56). Spontaneous PVD occurred in 68.8% (24/32) in Group PPV. During six months follow-up, one case of postoperative RRD and one case of choroidal detachment occurred in Group AnV. There was no significant difference between anterior vitrectomy and PPV in the final BCVA and postoperative complications.ConclusionAnterior or pars plana vitrectomy, which are both applicable in YAMANE technique for crystalline lens dislocation, exhibit similar surgical outcomes. Patient’s age, PVD status and PURH helps to determine the route of vitrectomy. Pediatric patients might be potential candidates for transcorneal vitreolensectomy. For adult, PURH managed with total vitrectomy and intraoperative lase retinopexy might be beneficial to decrease the incidence of postoperative RRD.

Closed-loop Scleral Fixation with 4-eyelet Intraocular Lens Implantation for Aphakia: Clinical Outcomes

Purpose: We present a modified, closed-loop scleral fixation technique. We inserted a 4-eyelet intraocular lens (IOL) into the anterior chamber prior to fixation. We investigated the clinical results.Methods: We retrospectively reviewed 39 eyes (39 patients) that underwent modified four-point scleral fixation of an inserted lens in our center from May 2019 to June 2022. The surgical procedure features conjunctival peritomy, 4-eyelet IOL insertion, eyeball penetration using a 9-0 polypropylene needle, eyelet placement using an ab externo technique to form a continuous loop, centering of the optic, and tying of a knot. We compared preoperative and 6-month postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure, and refraction errors, and described postoperative complications.Results: The mean patient age was 62 years. The indications for surgery included complicated cataracts (20.5%), aphakia (20.5%), staged surgery for complicated cataract (12.8%), non-traumatic IOL dislocation (30.8%), traumatic IOL dislocation (12.8%), and crystalline lens dislocation (5.1%). The postoperative BCVA (0.40 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the preoperative BCVA (0.69 logMAR) (&lt;i&gt;p&lt;/i&gt; = 0.018). The postoperative spherical equivalent and the target diopter measurement were in high agreement (&lt;i&gt;p&lt;/i&gt; = 0.002, intraclass correlation coefficient = 0.616). All of ocular hypertension (7.7%), hypotony (5.1%), bullous keratopathy (5.1%), and macular edema (5.1%) were noted, but 78% of the conditions improved with short-term medication. There was no re-dislocation of a fixated IOL.Conclusions: Our surgical technique simply and rapidly treats aphakia. Optic repositioning was easy, the IOL stability high, and the risk of complications during IOL fixation low.

Management of traumatic phacocele

Phacocele is defined as dislocation of normal crystalline lens into sub conjunctival space through scleral defect after blunt trauma.A case of post-traumatic scleral/limbal tear and dislocated normal crystalline lens to the sub-conjunctival space, supero-nasally. On examination the best corrected visual acuity in left eye was finger counting close to face.Wound exploration with tear repair was done under general anaesthesia under nil visual prognosis, anterior chamber was formed.Traumatic phacocele usually occurs due to indirect impact on the globe following blunt trauma and is an emergency condition to be treated as early as possible.

A New Technique of Pars Plana Vitrectomy With Microinterventional Nucleus Disassembly to Reduce the Energy of Fragmatome Lensectomy for Posteriorly Dislocated Crystalline Lens Removal.

To describe a novel technique of lens disassembly in posteriorly dislocated crystalline lens removal. A microinterventional microfilament loop device was introduced through the sclerotomy created for the fragmatome to cleave the lens into smaller, manageable pieces. Five cases were performed with this technique with improved visual acuity and no complications. The use of microinterventional nucleus disassembly during pars plana vitrectomy for retained lens material is a novel approach with potential advantages including decreased operating time and reduced complications secondary to excessive production of ultrasound energy.

Comparison of Short-term Clinical Outcomes between Sutured Scleral Fixation and Modified Yamane Sutureless Scleral Fixation

Purpose: To compare and investigate the short-term clinical outcomes between 10-0 polypropylene sutured intraocular lens (IOL) scleral fixation and modified Yamane sutureless IOL scleral fixation in patients with IOL or crystalline les dislocation and aphakic state.Methods: From August 2012 to May 2022, medical records were retrospectively analyzed for 43 patients with sutured scleral fixation and 40 patients with sutureless scleral fixation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), total astigmatism, IOL astigmatism, refractive error, corneal endothelial cell density, surgical time and complications were compared before surgery, 1 week, 1 month, and 3 months after surgery.Results: In the two groups, after 3 months of surgery, UCVA and BCVA improved compared to before surgery, but there was no significant difference between two groups. The absolute refractive error and total astigmatism for one week after surgery and IOL astigmatism for one week and one month after surgery were significantly lower in sutureless fixation group. There was no significant difference in postoperative corneal endothelial cell density changes between two groups, and total surgical time and IOL fixation time were measured significantly lower in sutureless fixation group.Conclusions: Although modified Yamane sutureless IOL scleral fixation did not show significant improvement in visual acuity compared with conventional sutured IOL scleral fixation, sutureless fixation provided better stability of IOL in the early stages after surgery and short in the surgical time. So it can be an effective alternative to conventional sutured scleral fixation in patients with IOL or crystalline lens dislocation and aphakic state.

Two Cases of Flanged Intrascleral Fixation Performed with Vitrectomy and Air-fluid Exchange

Purpose: We report two cases in which vitrectomy, air-fluid exchange, and flanged intrascleral fixation were employed to treat crystalline or intraocular lens dislocation associated with retinal detachment.Case summary: Two patients visited our clinic complaining of visual disturbance in the right and left eye respectively. At the initial visits, slit-lamp examination revealed subluxation of a crystalline lens (with zonulysis on the nasal side) in case 1 and dislocation of an intraocular lens (IOL) in case 2. Since retinal detachment was accompanied in both patients, they also underwent vitrectomy and air-liquid exchange during surgery. To fix the intraocular lens to the sclera, both ends of IOL haptics were cauterized using a low-temperature handheld device and flanged haptics had been deeply inserted into scleral tunnels. The intraocular pressure fell and vitreous hemorrhage developed immediately after surgery, but improved on additional treatment. At 18 and 6 months (cases 1 and 2) after surgery, the implanted IOLs were moved to the centers of the pupils without complications.Conclusion: Flanged intrascleral fixation is stable and effective when treating a patient who requires vitrectomy and air-fluid exchange to deal with a retinal disease.

Bilateral Anterior Crystalline Lens Dislocation Reveals Homocystinuria

We report the case of a 6-year-old patient with educational backwardness who presented to our hospital with a red, painful eye with decreased vision. Her best corrected visual acuity was 1/10 in both eyes. Slit-lamp examination of the right eye revealed anterior crystalline lens dislocation with central corneal oedema and high ocular pressure. The left eye had the same findings.

The Predictive Value of Computed Tomography Findings for Poor Visual Outcome in Traumatic Eye Injury.

Background The prognosis of visual outcome is important for patients and healthcare providers and guides proper decision-making in traumatic eye injury. In this study, we have evaluated the predictive value of computed tomography (CT) scan findings for poor visual outcomes in patients with traumatic eye injuries. Methods In a retrospective survey, documents of 200 patients with traumatic eye injury who underwent a diagnostic orbital CT scan were reviewed. Disorganized or collapsed globe, intraocular foreign body or gas, increased or decreased anterior chamber size, hemorrhage in the anterior or posterior chamber, crystalline or intraocular lens dislocation, posterior sclera thickening, globe borders haziness, orbital fracture, orbital hemorrhage, and foreign body, optic canal, and optic nerve injuries are the diagnostic clues for eye injury in CT scan. The predictive value of CT scan findings for poor visual outcome was calculated by sensitivity, specificity, accuracy, predictive values, hazard ratios, and binary logistic regression model. Results The sensitivity, specificity, accuracy, and positive predictive values showed to be high. However, there was a low negative predictive value of CT findings for the prediction of poor vision. Among the investigated factors, disorganized/collapsed globe (HR 47.72, CI 6.13–371.62), increased/decreased anterior chamber size (HR 5.04, CI 2.57–9.88), hemorrhage in anterior/posterior chamber (HR 3.58, CI 1.900–6.774/3.62, CI 1.90–6.89), globe borders haziness (HR 3.06, CI 1.33–7.01), orbital foreign body (HR 3.66, CI 1.11–12.05), and optic canal/nerve injury (HR 21.62, CI 4.73–98.78) reached the statistical significance for increasing the hazard ratio for poor visual outcome in patients with a traumatic eye injury. Logistic regression analysis showed only evidence for disorganized/collapsed globe and optic canal/nerve injury in orbital CT scan as independent predictive factors for poor visual outcome. Conclusion CT scan findings can be used as prognostic factors for visual outcomes in patients with a traumatic eye injury.

Crystalline Lens Anterior Dislocation With Posterior Capsular Contraction

A 60-year-old woman presented to the Emergency Department with a 2-week history of blurry vision in her left eye after left ocular contusion by a chair. The uncorrected visual acuity in the left eye was 20/400. The left eye examination by slit lamp microscope with retro-illumination technique showed crystalline lens dislocation into the anterior chamber with golden ring sign and posterior capsular contraction (Figures 1A and 1B). Fundus examination of the left eye revealed mild vitreous hemorrhage.

Spontaneaous dislocation of the crystalline lens in the anterior chamber in a patient with pseudoexfoliation syndrome

Pseudoexfoliation syndrome (PEX) is a systemic disorder of the extracellular matrix that presents primarily via its characteristic ocular manifestations [1]. Typically, white fibrillary residue on the anterior lens capsule and pupillary margin is observed, as are pupillary transillumination defects and pigmentation of the trabecular meshwork [2]. Zonular weakness can be attributed to the deposition of pseudoexfoliative material on the zonular fibers and ciliary processes, resulting in a proteolytic disintegration of the zonule that can lead to spontaneous fragmentation [2]. We report a case of a dislocation of the hole crystalline lens in the anterior chamber in a patient with pseudoexfoliation syndrome.

Epidemiology and Outcome of Open Globe Injury in Geriatric Age Group at Tertiary Hospital (Rural) in Vidarbha Region of Maharashtra

The aim of the study is to look into the epidemiology and outcomes of open globe injury (OGI) in geriatric age group at tertiary hospital (rural) in the Vidarbha region of Maharashtra. Materials and method: a prospective study was done on 46 eyes of 46 patients of more than 60 years of age with OGI who presented to Shalinitaimeghe Hospital &amp; Research Centre (SMHRC), Nagpur, from 20th Dec. 2019 to 20th Dec. 2020. The following data was gathered: patient’s profile, cause of injury and mechanisms, visual acuity (va) at presentation, clinical characteristics, and final va. Results: a total of 46 eyes of 46 patients were included. Of these, 32 (70%) were male and 14 (30%) were female. Conclusion: There is a need to highlight socio-economic and the medical problems that are faced by elderly people in India. Poor visual acuity, rupture globe, Zone 3 injuries, history of penetrating keratoplasty, retinal detachment, vitreous haemorrage, and dislocation of crystalline lens were found to be poor prognostic factors.

Spontaneous lens subluxation into anterior chamber. Importance of an early management

AbstractPurposeTo describe the importance of applying an urgent protocol in cases of lens subluxation into the anterior chamber (AC) in order to diminish the risk of corneal decompensation.MethodsA 60‐year‐old man with a history of ocular trauma in his youth and pseudoexfoliation syndrome, presented pupillary block in the right eye 2 months after an accidental fall without ocular involvement. Visual acuity was 0.05 (decimal) and intraocular pressure was 55 mmHg. Slit lamp examination and anterior segment Optical Coherence Tomography showed a lens subluxation towards AC (lower portion) with endothelial contact and corneal edema. In funduscopy, an inferior giant tear with associated retinal detachment was observed.ResultsAfter treating ocular hypertension with hypotensive agents, Pars Plana Vitrectomy 25 Gauge + Lensectomy + Endolaser + SF6 Tamponading gas were performed, leaving the patient in aphakia for subsequent intraocular lens implantation surgery. Two months later, a substantial loss of endothelial cell count was observed (777 cells right eye VS 2223 cells left eye).ConclusionsIn this type of pathology, it is imperative to take immediate pharmacological, postural and surgical measures to reduce contact between the lens and the cornea, in order to minimize endothelial damage and improve the visual prognosis of these patients.BibliographyKe G, Zhou E, Zhu K, Wei Y, Wang Z, Jia Y, Wang S, Gu Y. Retinal break associated with traumatic lens dislocation or subluxation requiring vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2020 Mar;258(3):693–697. doi: 10.1007/s00417‐019‐04530‐9. Epub 2019 Nov 28. PMID: 31781882.Salehi‐Had H, Turalba A. Management of traumatic crystalline lens subluxation and dislocation. Int Ophthalmol Clin. 2010 Winter;50(1):167–79. doi: 10.1097/IIO.0b013e3181c567de. PMID: 20057305.

Total closure of anterior chamber angle due to crystalline lens dislocation observed by anterior segment optical coherence tomography

Total closure of anterior chamber angle due to crystalline lens dislocation observed by anterior segment optical coherence tomography

Traumatic dislocation of crystalline lens with secondary glaucoma

Traumatic dislocation of crystalline lens with secondary glaucoma

Diagnosis and treatment of microspherophakia.

As a rare congenital disease, microspherophakia (MSP) is characterized by small and spherically shaped crystalline lenses. The common complications of MSP include secondary glaucoma and crystalline lens dislocation or subluxation. Patients with MSP often show high lenticular myopia. The special morphological characteristics and complex complications bring challenges to the treatment of patients with MSP. Although there are some studies on MSP, most are case reports. In this article, the morphological characteristics, complications, genetic diagnosis, and treatment of MSP were systematically reviewed, providing valuable insight into the clinical diagnosis and treatment of this disease.

Traumatic Suprachoroidal Dislocation of Crystalline Lens

ABSTRACT We report a patient with traumatic suprachoroidal dislocation of crystalline lens in the absence of scleral rupture, retinal tear or detachment. Histopathological confirmation of diagnosis is provided, as well as the surgical approach for removal of dislocated lens from the suprachoroidal space.