Corneal biomechanics and their association with severity of lens dislocation in Marfan syndrome.

PURPOSE: To investigate corneal biomechanical properties and its associations with the severity of lens dislocation in patients with Marfan syndrome. METHODS: A total of 30 patients with Marfan syndrome and 30 age-, sex- and axial length (AL)-matched controls were recruited. Corneal biomechanical parameters of both groups were measured by CorVis ST and were compared between groups. Potential associations between corneal biomechanical parameters and severity of lens dislocation were also investigated. RESULTS: Lower applanation 1 velocity (A1V) (0.13 ± 0.004 vs. 0.15 ± 0.003, P = 0.016), shorter applanation 2 time (A2T)(22.64 ± 0.11 vs. 22.94 ± 0.11, P = 0.013), longer peak distance (PD) (5.03 ± 0.07 vs. 4.81 ± 0.05, P = 0.008), longer radius (R) of highest concavity (7.44 ± 0.16 vs. 6.93 ± 0.14, P = 0.012), greater Ambrosio relational thickness horizontal (ARTh) (603 ± 20 vs. 498 ± 12, P < 0.001), and integrated radius (IR) (8.32 ± 0.25 vs. 8.95 ± 0.21, P = 0.033) were detected among Marfan eyes compared with controls (all P < 0.05). Marfan individuals with more severe lens dislocation tended to have increased stiffness parameter as longer A1T, slower A1V, shorter A2T, slower application 2 velocity (A2V), smaller PD and smaller Distance Amplitude (DA) (P < 0.05). CONCLUSION: Marfan patients were detected to have increased corneal stiffness compared with normal subjects. Corneal biomechanical parameters were significantly associated with the severity of lens dislocation in Marfan patients.

A case of iridoschisis with partial lens dislocation in both eyes.

BACKGROUND: Iridoschisis is a rare condition that primarily affects individuals aged 60-70 years. The predominant characteristics of iridoschisis involve the tissue splitting and separation of the iris stromal layers, often resulting in two distinct layers and the presence of floating fibers in the anterior chamber. This article reports the case of a 48-year-old male with iridoschisis with partial lens dislocation in both eyes. CASE PRESENTATION: Trauma is the leading factor in the development of iridoschisis. However, there is no documented case of ocular trauma in the patient's medical history. Visible white atrophic fibers were observed bilaterally in the anterior iris stroma of both eyes of the individual, accompanied by a small quantity of iris tissue within the anterior chamber. In this instance, the magnitude of the iridoschisis corresponded with the degree of lens dislocation. We were apprised that the patient had regularly used a cervical massager for a prolonged period of time, positioning it upon the ocular region. Frequent stimulation of both eyes with excessive force resulted in the development of iridoschisis and the partial dislocation of the lens.During the initial surgical procedure, phacoemulsification (Phaco) was carried out on the left eye without the placement of an intraocular lens (IOL). Following a two-month interval, we proceeded with the IOL suspension. Subsequently, the right eye underwent Phaco, accompanied by the implantation of an IOL. After closely monitoring the patient's progress for two months, it was evident that their vision had significantly improved, substantiating the success of the surgical interventions. CONCLUSIONS: This finding posits that the recurrent friction applied to both eyes may induce iridoschisis and various ocular complications. In the event of ocular intricacies manifesting, expeditious medical intervention becomes imperative.

TRAUMATIC LENS SUBLUXATION FROM PICKLEBALL INJURY: A CASE SERIES.

PURPOSE: The purpose of this study was to describe two cases of traumatic lens subluxation resulting from pickleball injury. METHODS: This is a case series. RESULTS: A 77-year-old man presented with worsening vision and was noted to have subluxation of his intraocular lens 10 days after being struck in the eye with a pickleball. The patient underwent a lens exchange with scleral fixation. A 76-year-old woman presented with blurry vision on the same day as her injury and was noted to have subluxation of her crystalline lens. She also underwent a lens insertion with scleral fixation. However, she experienced additional complications of postoperative cystoid macular edema and traumatic glaucoma. CONCLUSION: We recommend increased use of eye protection in pickleball.

Bimanual phacoemulsification for subluxated cataractous lens.

Bimanual phacoemulsification has been established as a safe and efficacious means of nuclear emulsification in the past. This case report presents the use of this technique in a man in his early forties, who had subluxated cataractous lenses in both eyes. The technique allowed for effective nuclear emulsification within a closed chamber, providing better control over intraocular events. The report emphasizes the safety and effectiveness of bimanual phacoemulsification in cataract extraction, even in challenging cases like a subluxated lens.

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

OBJECTIVE: To study the postoperative visual outcomes and surgical complications of anterior/pars plana vitrectomy and concurrent Yamane's IOL fixation for crystalline lens dislocation. METHODS: Fifty-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. RESULTS: Twenty-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. CONCLUSION: Anterior 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.

Double capsular tension rings in cataracts with large subluxations.

Management of subluxated cataracts is challenging, especially in cases with more than 5 clock hours of subluxation. Capsular bag stabilising devices are of utmost importance in these cases. We report two cases of post-traumatic lens subluxation of more than 6 clock hours, in which the bag was stabilised intraoperatively using two capsular tension rings (CTRs) placed diametrically opposite to each other, in place of the conventional Cionni ring. Slow phacoemulsification was done followed by intraocular lens (IOL) implantation. Postoperatively, the IOLs were found to be well centred. Also, the use of two CTRs maintains the shape of the capsular bag and prevents lens epithelial cell migration and capsular cocontraction.

Implantable Collamer Lens Subluxation in a Patient with Lenticular Coloboma: A Case Report.

BACKGROUND The efficacy and safety of the implantable collamer lens (ICL) in correcting high astigmatism have been previously reported. They are commonly used as an alternative to laser refractive surgery due to advantages such as leaving the cornea untouched, inducing fewer higher-order aberrations, resulting in better optical and visual quality, and it is a reversible procedure. We aim to present the outcome of ICL in managing anisometropia without cataract in an eye with unilateral lenticular coloboma. CASE REPORT A 27-year-old man with a Marfanoid body habitus was seeking refractive surgery for the correction of high astigmatism in the right eye. On presentation, the best corrected visual acuity was 20/30 and 20/20 in the right eye and left eye, respectively. Slit lamp examination indicated inferior lens coloboma extending from the 5 o'clock to the 7: 30 o'clock position in the right eye, after dilation of pupil. Following a complete refractive work-up, a toric ICL implantation was the presumed suitable surgery. Three weeks postoperatively, central vaulting was low, his ICL subluxated inferiorly, and the previously implanted temporal footplates were resting over the lenticular defect inferiorly. A high-resolution ultrasound biomicroscopy confirmed the presence of a ciliary body (CB) cyst at 9 o'clock position. Urgent explantation of the unstable ICL was performed. CONCLUSIONS This case report emphasizes the challenges and limitations associated with ICL implantation in patients with lenticular colobomas and coexisting CB cyst. Selecting smaller lenticular colobomas and avoiding direct interaction between the weak zonules area and the ICL haptics are important steps to ensure the stability of implanted lens.

Visual prognosis and complications of congenital ectopia lentis: study protocol for a hospital-based cohort in Zhongshan Ophthalmic Center.

INTRODUCTION: Congenital ectopia lentis (CEL) is a rare ocular disease characterised by the dislocation or displacement of the lens. Patients with mild lens dislocations can be treated with conservative methods (eg, corrective eyeglasses or contact lenses). In contrast, patients with severe CEL usually require surgical management. However, few studies have focused on the visual prognosis and complications in conservative and surgical management of patients. This study aims to investigate the prognosis and complications in patients with CEL with conservative and surgical management, which is vital for CEL management, especially the choice of surgical timing and surgical method. METHODS AND ANALYSIS: A cohort study will be conducted at Zhongshan Ophthalmic Center. We plan to recruit 604 participants diagnosed with CEL and aged ≥3 years old. Patients with mild lens subluxation and stable visual conditions will be included in the non-surgical group and follow-up at 1, 2 and 3 years after enrolment. Patients with severe lens subluxation who accept CEL surgery will be included in the surgical group. Different surgical techniques, including phacoemulsification, in-the-bag intraocular lens implantation (with or without capsular tension ring) and trans-scleral fixation, will be used depending on the severity of dislocation. Patients will be followed up at 3 months, and 1, 2 and 3 years postoperatively. Over a 5-year follow-up period, patients will receive a detailed ocular examination, including optometry, biological measurement, specular microscopy, ultrasound biomicroscopy, anterior segment and posterior segment optical coherence tomography (OCT), OCT angiography, echocardiography and questionnaires on vision-related quality of life. The primary outcome is the change of best-corrected visual acuity and the incidence of complications in both groups. ETHICS AND DISSEMINATION: Ethics approval was obtained from the ethics committee of the Zhongshan Ophthalmic Center (number: 2022KYPJ207). Study findings will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05654025.

Intraoperative discovery of lens dislocation in a child with Knobloch syndrome.

We present the case of a 14-year-old boy with a known diagnosis of Knobloch syndrome (KS) referred for bilateral cataract evaluation and possible cataract surgery. At time of initial presentation, no lens subluxation was appreciated, and no phacodonesis was detected on slit lamp biomicroscopy. However, 7-weeks later, on the day of surgery, his right eye was found to have a complete lens dislocation into the vitreous cavity, with no zonule attachment. The left eye did not have subluxated lens; however, intraoperatively, after irrigation into the eye, near complete zonular dialysis was observed. This case highlights the importance of regular follow-up of children with KS.

Intraocular lens dislocation: manifestation, ocular and systemic risk factors.

PURPOSE: The aim of this study was to evaluate ocular and systemic risk factors for posterior chamber intraocular lens dislocation, as well as forms of manifestation. METHODS: A retrospective case-control study were all patients presented in the period 2012-2016 having intraocular lens dislocation and being treated with implantation of an iris-fixated intraocular lens was conducted at the University Hospital Mainz. As controls, pseudophakic patients presenting for other reasons were included. RESULTS: 150 eyes of 150 patients (mean age 72.7 ± 12.4 years, range 24-93 years) with IOL dislocation and 150 eyes of 103 controls were included in this study. The average time between primary implantation and IOL luxation was 86 months (iQR: 39.25-127 months) for all dislocations. Previous pars plana vitrectomy (PPV) (crudeOR = 2.14 (95% CI 1.23, 3.72), p = 0.011) and PEX (crudeOR = 11.6 (4.79, 28.12), p < 0.001) was linked with a higher risk of IOL luxation. Luxation occurs also earlier in patients with previous PPV and PEX than in eyes with neither PEX nor previous PPV (82.2 vs. 127 months). Rhegmatogenous retinal detachment was the major pathology that required a previous PPV for eyes with an IOL dislocation (57%). The average time between PPV and IOL dislocation was 74.67 months (range 0-186 months). CONCLUSION: Patients with a coexistence of both: PEX and a previous PPV had an elevated risk of IOL dislocation, and also had a shorter time interval between primary IOL implantation and IOL dislocation followed by eyes with PEX only and eyes with only a previous PPV.

Deslocamento espontâneo do núcleo do cristalino para câmara anterior / Spontaneous displacement of the lens nucleus into the anterior chamber

RESUMO Ao longo da vida, o cristalino produz novas fibras dispostas de forma concêntrica, que aumentam seu diâmetro anteroposterior e peso, tornando seu núcleo mais compacto e endurecido. A catarata hipermadura é uma forma de progressão avançada dessa proliferação de fibras, que pode desencadear uma variedade de complicações. A ruptura espontânea da cápsula anterior do cristalino, evoluindo com deslocamento anterior do núcleo, é uma complicação rara e com poucos casos publicados na literatura. Descrevemos o caso de uma paciente do sexo feminino, 68 anos, que apresentou ruptura espontânea da cápsula anterior do cristalino com deslocamento anterior do núcleo em olho esquerdo sem histórico de trauma ocular. A paciente foi submetida à facoemulsificação do cristalino e ao controle da pressão intraocular, evoluindo com melhora do quadro clínico.

ABSTRACT Throughout life, the lens produces new fibers arranged concentrically, which increase its anteroposterior diameter and weight, making its nucleus more compact and hardened. Hypermature cataract is an advanced stage of this fiber proliferation, which can trigger a variety of complications. Spontaneous rupture of the anterior lens capsule evolving with anterior displacement of the nucleus is a rare complication, with few cases published in the literature. We describe the case of a 68-year-old female patient, who presented spontaneous rupture of the anterior lens capsule with anterior displacement of the nucleus in the left eye, without a history of ocular trauma. The patient underwent phacoemulsification and clinical control of intraocular pressure, improving her condition.

Lens nucleus dislocation in hypermature cataract: Case report and literature review.

INTRODUCTION: Hypermature cataract is a form of late-stage cataract progression that can lead to a variety of complications. Spontaneous capsular rupture with lens nucleus displacement in hypermature cataracts has rarely been reported. We describe 2 cases of spontaneous dislocation of the lens nucleus in a hypermature cataract and perform a review of the literature on this complication. PATIENT CONCERNS: We report 2 rural men aged 50 and 76 years with deteriorating vision. DIAGNOSIS: The final diagnosis was senile hypermature cataract with dislocation of the lens nucleus in both patients and secondary glaucoma for the second patient. INTERVENTIONS AND OUTCOMES: During admission, both patients complained of deteriorating vision. Slit-lamp examination showed lens nucleus dislocation into the anterior chamber. The 50-year-old patient exhibited a residual lens capsule and a turbid cortex, with a normal anterior chamber and intraocular pressure. The 76-year-old patient presented a shrunken and ruptured capsule and no cortex in the pupillary area, mild inflammation in the anterior chamber, and high intraocular pressure. Both patients underwent intracapsular cataract extraction combined with anterior vitrectomy and achieved good postoperative recovery. CONCLUSION: Lens nucleus dislocation in hypermature cataracts can be seen in clinical practice, particularly in underdeveloped areas. Early recognition and surgery can improve vision.

Two Surgical Approaches for Intraocular Lens Dislocation: Pars Plana Vitrectomy Versus Core Vitrectomy with Lens Exchange.

PURPOSE: To compare the efficacy and safety of core vitrectomy and pars plana vitrectomy for lens exchange in patients with intraocular lens dislocation. METHODS: This is a retrospective study conducted at one eye center in Zurich, Switzerland. We reviewed 124 eyes with dislocated intraocular lens undergoing lens exchange carried out by two surgeons between 03/2016 and 12/2019 (45 months). Intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were analyzed preoperatively and at 5 time points up to 12 months after lens exchange. Data on postoperative complications were collected. RESULTS: There were 124 eyes with intraocular lens dislocation that were referred for lens exchange. Of these eyes, 59 (48%) received core vitrectomy and 65 (52%) received pars plana vitrectomy with lens exchange. Glaucoma was more frequent in the core vitrectomy group (78%) than in the pars plana vitrectomy group (32%; p < 0.001). In the core vitrectomy group, 19 (32%) eyes presented with visual impairment, 17 (29%) eyes presented with high IOP alone, and 23 (39%) eyes presented with both at the same time prior to surgery. Mean preoperative IOP in the core vitrectomy group decreased from 22.4 ± 9.2 mmHg to 14.7 ± 3.1 mmHg 12 months after surgery (p < 0.001). Mean BCVA changed from 0.40 ± 0.41 logMAR preoperatively to 0.32 ± 0.37 logMAR at 12 months postoperatively (p = 0.598) in the core vitrectomy group. In the pars plana vitrectomy group, 44 (68%) eyes presented with a change in vision, 7 (11%) eyes presented with high IOP alone, and 14 (22%) eyes presented with pressure elevation and visual impairment at the visit prior to surgery. Mean preoperative IOP in the pars plana vitrectomy group decreased from 20.9 ± 8.3 mmHg to 15.1 ± 3.5 mmHg at 12 months after lens exchange (p < 0.001). Mean BCVA in the pars plana vitrectomy group was 0.57 ± 0.62 logMAR preoperatively and 0.22 ± 0.35 logMAR 12 months postoperatively (p < 0.001). Postoperative pressure decompensation occurred more frequently in the core vitrectomy group (20%) than in the pars plana vitrectomy group (6%; p = 0.018). There was no statistically significant difference for postoperative cystoid macular edema (p = 0.055), anisometropia (p = 0.986), and high astigmatism (p = 0.362). CONCLUSION: Core vitrectomy and pars plana vitrectomy with lens exchange are equally efficient and safe in the management of intraocular lens dislocation.