Total
Lens Dislocation Caused by Pseuodexfoliation
Peter
Glasman, Ivan Yip, Carl Groenwald, Anshoo Choudhary
Peter James Glasman, Ivan Yip, Carl
Groenwald, Anshoo Choudhary, St. Paul’s Eye Unit, Royal Liverpool University
Hospital, Liverpool, United Kingdom
Correspondence to: Peter James Glasman, St. Paul’s Eye
Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
Email: peter.glasman@doctors.net.uk
Telephone: +44-151-7062000
Received: January 27,
2015
Revised: February 10, 2015
Accepted: February 14, 2015
Published online: June 1, 2015
ABSTRACT
Pseudoexfoliation
(PXF) is a well-known cause of complications during cataract surgery,
particularly dropped nucleus and vitreous loss. Such complications must be
managed by appropriate vitreoretinal intervention.
© 2015 ACT. All
rights reserved.
Key words: Cataract surgery; Complications; Vitreous loss
Glasman PJ, Yip I,
Groenwald C, Choudhary A. Total Lens Dislocation Caused by
Pseuodexfoliation. International Journal of Ophthalmic Research 2015; 1(1): 32-33
Available from: URL: http://www.ghrnet.org/index.php/ijor/article/view/1232
INTRODUCTION
A 78 year old lady underwent cataract surgery. Pseudoexfoliation (PXF)
and phacodonesis were noted pre-operatively, but the eye was otherwise healthy.
The intraocular pressure was normal, the pupil dilated well and there was no
glaucomatous neuropathy. On the operating table, the crystalline lens was quite
mobile but capsulorrhexis and hyrdodissection were completed satisfactorily.
All the zonules appeared to be weak as there was no decentration in any particular
direction. However, the lens was too mobile to safely continue
phacoemulsification and it was therefore decided to stabilise the lens with
insertion of a capsular tension ring. Just as the ring was inserted, the entire
lens dislocated into the vitreous cavity and required removal by pars plana
vitrectomy (Figure 1).
DISCUSSION
PXF is a systemic disorder of unknown cause whereby amyloid-like
proteins are abnormally deposited throughout the body. The condition can be
found worldwide but is much more common in certain geographical areas,
particularly Scandinavia. The chief manifestations are in the eye, where it can
be discerned by slit lamp examination; it is a common cause of secondary
glaucoma and is also associated with complications during cataract surgery,
owing to lens/zonular instability. However, it may also manifest itself
systemically, with evidence implicating PXF in cardiovascular diseases such as
abdominal aortic anuerysm[1], renal artery stenosis[2],
heart disease and stroke[3].
PXF is strongly
associated with complications during cataract surgery, with a vitreous loss
rate of up to 27%[4]. Surgical strategies which may be indicated
include pupil enlargement manoeuvres (stretching, iris hooks or the Malyugin
ring), extreme caution when inflating the anterior chamber or performing
hydrodissection and capsular tension ring or sutured tension ring (Cionni)
segment insertion. In cases where phacodonesis is evident pre-operatively, it
may be wise to refer the patient to a vitreo-retinal surgeon.
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REFERENCES
1 Pseudoexfoliation
syndrome and aneurysms of the abdominal aorta. Schumacher S et al. Lancet 2001,
357: 359-60.
2. Renal
artery stenosis and abdominal aorta aneurysm in patients with pseudoexfoliation
syndrome. Gonen KA, Gonen T, Gumus B.
Eye 2013, 27(6):735-41.
3. Shrum
KR, Hattenhauer MG, Hodge D (2000) Cardiovascular and cerebrovascular mortality
associated with ocular pseudoexfoliation. Am J Ophthalmol 129: 83-86.
4. Naumann GO, Schlötzer-Schrehardt U,
Küchle M (1998) Pseudoexfoliation syndrome for the comprehensive
ophthalmologist. Intraocular and
systemic manifestations. Ophthalmology 105: 951-968.
Peer reviewer: Gabor Hollo, MD, PhD,
DSc, Professor of Ophthalmology, Department of Ophthalmology, Semmelweis
University, Maria u. 39. Budapest, Hungary.
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