Mohammad Ghoreishi, MD

Isfahan University of Medical Sciences

Surgical Management of Dilocated Lens

Loose zonulesPseudoexfoliationOld age…

Subluxed lenswhen it is partially displaced but

contained within the lens space Dislocated or luxated lens

when it lies completely outside the lens patellar fossa, in the anterior chamber, free-floating in the vitreous, or directly on the retina

Classification

Trauma Hereditary ectopia lentis without systemic

manifestationsSingle (isolated) ectopia lentis Ectopia lentis et pupillae

Systemic conditions commonly associated with ectopia lentis Marfan syndrome Homocystinuria Sulfite oxidase deficiency Hyperlysinemia

Etiology and associated conditions

Etiology and associated conditions

Uncommon systemic conditions associated with ectopia lentis Ehlers-Danlos syndrome Crouzon disease Refsum syndrome Kniest syndrome Mandibulofacial dysostosis Sturge-Weber syndrome Conradi syndrome Pfaundler syndrome Pierre Robin syndrome Wildervanck syndrome Sprengel deformity

Primary ocular disorders associated with ectopia lentis Congenital glaucoma/buphthalmos Pseudoexfoliation syndrome Syphilis/chronic uveitis Retinitis pigmentosa Megalocornea Aniridia Hypermature cataract Intraocular tumor High myopia

Etiology and associated conditions

Preop evaluationSystemic evaluation

…Homocystinuria…GlaucomaRetinal detachmentRefractin and vision

Indications for surgery

Impaired vision due to cataract or refractive error not improved by other corrective methods

Induced or thread for glaucoma

Loose zonules , no subluxation

Diagnosing the condition is importantPreventive measuresPupil dilationCapsular staining, large rhexisSuporting the capsule with iris

retractorsSmooth phaco parametersSupracapsular techniqueCTR without or with fixation if

necessary

Capsular tension rings (CTR)

Standard Cioni Capsular tension

segments (CTS) Inserted before or

after phacoemulsification

The Cionni-modified CTR can be sutured to the sclera.

The CTS, with its 90º arc, can be inserted at a specific site ofzonular weakness

Mild dislocation

Moderate subluxation

Severe subluxation and dislocation

Total lens removalLensectomy, anterior/posterior vitrectomy Intracapsular extractionPhacofragmentation

IOLArtisan aphakiaScleral fixationAC, angle fixation