Tugas Baca Displacement of the Lens

7/28/2019 Tugas Baca Displacement of the Lens

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ECTOPIA LENTISRAMA


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!

Displacement of the lens from its normal position

(in patellar fossa) results from partial or complete

rupture of the lens zonules.

Positioned just posterior to the iris and is

supported by zonular fibers arising from the

ciliary body.


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CLINICO-

ETIOLOGICAL


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Clinico-Etiological Types

Ectopia Lentis

Hereditary

w/ Systemic

w/o Systemic

Acquired

Traumatic

Consecutive/Spontaneous


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Without Systemic

AssociationsFamilial Ectopia LentisBilaterally symmetrical

superotemporal

AD fashion

Ectopia lentis et pupillae

Pupil and lens in opposite

directions

Small, slit-like, and dilate-poorly

pupil

Aniridia

Absence of iris


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With Systemic Associations

Marfan Syndrome

AD

Bilaterally symmetrical

superotemporal subluxation (80%)

Dislocation into anterior chamber or

vitreous (20%)


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With Systemic Associations

Homocystinuria:

AR, inborn error of metabolism

Inferonasal


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Traumatic displacement of the

lensAssociated with concussion injuries.Couchingis an iatrogenic posterior dislocation of

lens performed as a treatment of cataract in

olden days.


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Consecutive or spontaneous

displacement

Intraocular diseases giving rise to mechanical

stretching, inflammatory disintegration or

degeneration of the zonules.

Hypermature cataract, buphthalmos, highmyopia, staphyloma, intraocular tumours and

uveitis.


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TOPOGRAPHICAL


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Subluxation

Partial displacement in which lens is moved

sideways (up, down, medially or laterally), but

remains behind the pupil.

Partial rupture or unequal stretching of thezonules.


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Subluxation

Clinical Features

Defective vision

Uniocular diplopia

Anterior Chamberdeep and irregular

Iridodonesis

Dark Edge

Complications

Refractive error

Complete dislocation

Cataractous changesUveitis

Secondary glaucoma

Management

Spectacles/contactlenses

Surgery

Lensectomy with

anterior vitrectomy


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LuxationAll the zonules are severed from the lens.

A dislocated lens may be incarcerated into the

pupil or present in the anterior chamber, the

vitreous (where it may be floating lens nutans;

or fixed to retina

lens fixata), sub-retinal space,subscleral space or extruded out of the globe,

partially or completely.


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LuxationClinical Features

Posterior: deep anterior

chamber, aphakia in

pupillary area, and

iridodonesis.Ophtalmoscopic

examination reveals lens

in the vitreous cavity.

Anterior: deep anteriorchamber and presence of

lens in the anterior

chamber.

Clear lens looks like an oil

drop in the aqueous.

Complications

Uveitis

Secondary glaucoma

ManagementAnterior: ASAP!

Posterior: if only

causing uveitis or

uncontrolledglaucoma


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Khurana, Comprehensive Ophtalmology 4th Edition (Step by Step)

Vaughn and Asburys, General Ophtalmology 17th Edition

Kanski, Clinical Ophtalmology

DANK U WEL

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Tugas Baca Displacement of the Lens