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Ectopia Lentis

Ectopia Lentis. Mohammad Ghoreishi , MD Isfahan University of medical sciences info@persianeyeclinic.com. Case history. 20 y/o male Referred for refractive surgery due to high myopia VA OD: CF 4/10 OS: CF 5/10 Refraction OD: -19.5- 0.5 x 180

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Ectopia Lentis

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  1. EctopiaLentis Mohammad Ghoreishi, MD Isfahan University of medical sciences info@persianeyeclinic.com

  2. Case history • 20 y/o male • Referred for refractive surgery due to high myopia • VA • OD: CF 4/10 • OS: CF 5/10 • Refraction • OD: -19.5- 0.5 x 180 • OS: -20.0-1.00 x 180 • IOP • OD: 39 mm Hg • OS: 39 mm Hg He was diagnosed as ectopialentis and microspherophakia with secondary NA glaucom

  3. Definition • Displacement of the crystalline lens from its original position • Subluxation: when displacement is partial with part of the lens still in normal position • Luxation or dislocation: when lens is completely displaced, in AC or Vitreous

  4. Causes • Traumatic (most common cause) • Hereditary ectopialentis without systemic manifestations • Single (isolated) ectopialentis • Ectopialentis et pupillae

  5. Ectopialentis with systemic disease • Marfan syndrome • Autosomal dominant • Tall stature • Arachnodactyly, joint laxity, mitral valve prolapse, aortic dilatation • Axial myopia, and increased incidence of retinal detachment • Lens dislocation (about 75% of patients ) , usually bilateral, symmetrical, and supartemporal

  6. Ectopialentis with systemic disease • Homocystinuria • Absence of cystathionine b-synthetase (the enzyme that converts homocysteine to cystathionine). • Fair skin with coarse hair, osteoporosis, mental retardation, seizure disorder, marfanoidhabitus, and poor circulation • Thromboembolic events constitute the major threat to survival, especially following general anesthesia. • Lens luxation usually is bilateral, symmetrical, and inferonasal, and presents in nearly 90% of patients

  7. Ectopialentis with systemic disease • Weil-Marchesani • Short stature, brachydactyly, limited joint mobility • Microspherophakia , ectopialentis, lenticular myopia • Pupillary block glaucoma • Sulfite oxidase deficiency • Defect in sulfur metabolism • Progressive CNS abnormalities • Ectopialentis • Hyperlysinemia • Enzymatic defect of amino acid metabolism • Mental retardation and lens dislocation. • Increased plasma levels of lysine

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

  9. Indications for surgery • Impaired vision due to cataract or refractive error not improved by other corrective methods • Induced or thread for glaucoma

  10. Preop evaluation • Refraction and vision • Systemic evaluation …Homocystinuria…. …Marfan…. • Glaucoma, angle • Retinal detachment • Corneal endothelium

  11. Loose zonules , no subluxation • Diagnosing the condition is important • Preventive measures • Pupil dilation • Capsular staining, large rhexis • Suporting the capsule with iris retractors • Smooth phaco parameters • Supracapsular technique • CTR without or with fixation if necessary

  12. 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 of zonular weakness

  13. Surgical technique Lensectomy, Artisan aphakia

  14. Surgical technique ECCE, Artisan Aphakia

  15. Surgical technique Zonulolysis, CTR

  16. Pre and postop cases Posteriorly fixed Artisan IOL

  17. Thank you for your attentionn

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