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2.1
Lens Dislocation
Dislocation of Lens

Presentation

We present 2 cases of intraocular lens (IOL) dislocation that appeared shortly after the patients exercised on a vibration platform. [ncbi.nlm.nih.gov]

Entire Body System

  • Severe Pain

    He is unsure if he lost consciousness but complains of severe pain on the back of his head, left side of his face, and in his left eye. His initial Glasgow Coma Scale was 15 per paramedic report. [tamingthesru.com]

Skin

  • Flushing

    These secondary glaucomas appear as acute corneal edema, increased IOP, blepharospasm, tearing, and ciliary flush. Often, the lens is in front of the pupil and often totally within the anterior chamber. [merckvetmanual.com]

Eyes

  • Aniridia

    Aniridia • Cataract Surgery • Dislocated IOL, subluxed IOL A patient suffered repeat trauma 3-years prior to a traumatic cataract which required a Rauch-Rosenthal aniridia ring (Morcher Gmbh) implantation. [eyetube.net]

    IMPLICATIONS: (see also description for Aniridia ) The child with a dislocated lens may need extra time for tasks requiring clear vision, and may exhibit unusual head positions as he exerts extra energy to see. [tsbvi.edu]

    It can also be associated with other ocular disorders such as aniridia, pseudoexfoliation syndrome, and congenital glaucoma. [visualdx.com]

    It is characterized by aniridia, ectopia lentis, abnormal upper incisors and intellectual disability. It may be associated with high myopia or ectopia lentis. [fr.bab.la]

  • Diplopia

    Subluxation is one of the causes of monocular diplopia. If the luxation is complete the eye becomes markedly hyperopic and is unable to accommodate. [medical-dictionary.thefreedictionary.com]

    Symptoms of these patients mainly included decrease in visual acuity (17 cases, 47.2%), blurred vision (16 cases, 44.4%), glare (1 case, 2.8%), diplopia (1 case, 2.8%), and halo (1 case, 2.8%). [ncbi.nlm.nih.gov]

    Patients may also complain of monocular diplopia and are at risk of developing amblyopia, glaucoma, and retinal detachment. Ectopia lentis can be inherited as an isolated condition, usually autosomal dominant (simple ectopia lentis). [visualdx.com]

    Uniocular diplopia may result from partial aphakia. Anterior chamber becomes deep and irregular. Iridodonesis is usually present. [ikeyes.blogspot.com]

    While most clinicians immediately think of neurological problems when diplopia is mentioned, monocular diplopia is always attributed to some type of media issue, such as a cataract, corneal opacity or subluxated lens. [reviewofoptometry.com]

  • Iridodonesis

    These include: deep anterior chamber, aphakia in pupillary area, and iridodonesis. Ophthalmoscopic examination reveals lens in the vitreous cavity. [ikeyes.blogspot.com]

    L21) See corectopia ; iridodonesis ; pupillary block. Fig. [medical-dictionary.thefreedictionary.com]

    In the setting of lens dislocation, the patient may have trembling or shimmering of either the lens or iris, phakodenesis or iridodonesis, respectively. [tamingthesru.com]

    Iridodonesis — trembling or shimmering of the iris after rapid eye movements in lens dislocation. Look for associated ocular and other injuries. Look for evidence of risk factors (e.g. [lifeinthefastlane.com]

    Likewise, patients with subluxation may display iridodonesis, as well as focal deepening of the angle. [reviewofoptometry.com]

  • Lacrimation

    (Lacrimal Apparatus Diseases) Arcus Senilis Arcus, Corneal (Arcus Senilis) Asthenopia Astigmatism Astrocytoma, Malignant, Optic Nerve (Optic Nerve Glioma) Atrophies, Gyrate (Gyrate Atrophy) Atrophies, Hereditary Optic (Optic Atrophies, Hereditary) Atrophy [provisu.ch]

    He also complained of blur red vision and lacrimation in the left eye in the supine position. The headache had occurred spontaneously without any history of trauma. He has no past medical history without hypertension. [ceemjournal.org]

Psychiatrical

  • Distractibility

    My eye healed fairly quickly but as my vision returned I noticed a very distracting visual disturbance. Wherever I looked my vision would bounce. [tissuetales.com]

Workup

A workup was performed that included echocardiography, serologic testing for syphilis, and urine chromatography, all of which were unrevealing. [nejm.org]

Workup  Cardiac evaluation for Marfan syndrome  Serum and urine levels of homocysteine or methionine for homocystinuria  Axial length measurement 32. [slideshare.net]

Treatment

Before surgery, 62 patients had either preexisting glaucoma (n = 39) or high IOP (≥22 mm Hg) with suspected glaucoma (n = 23), of whom several required preoperative IOP-lowering treatment. [ncbi.nlm.nih.gov]

Throughout the book, the pathology, examination, anesthesia, surgical treatment and nursing care of pediatric lens disorders are discussed in detail. [books.google.de]

TY - JOUR T1 - Medical treatment of crystalline lens dislocation into the anterior chamber in a patient with Marfan syndrome. [unboundmedicine.com]

Prognosis

The prognosis of the disease is poor; various attempts at treatment were not successful so far. Prenatal diagnosis by assay of sulfite oxidase in cultured amniotic fluid cells and by direct measurement of amniotic fluid S-sulfocysteine is possible. [ncbi.nlm.nih.gov]

The format includes the CPT codes for billing purposes, short description of the condition, etiology/incidence, course/prognosis, laboratory findings, differential diagnosis; prophylaxis, treatment (local and systemic, surgical or other), miscellaneous [books.google.de]

Treatment and prognosis Complications An anterior dislocation/subluxation carries greater complications than a posterior one. Such complications include: acute glaucoma corneal injury iridal injury Promoted articles (advertising) [radiopaedia.org]

If dislocation is partial and the lens is clear, visual prognosis is good. Traumatic lens dislocation can follow a blow to the eye. [tsbvi.edu]

Etiology

All charts were reviewed for etiology of dislocation, time elapsed from cataract surgery, best-corrected visual acuity (BCVA), slit-lamp examination, tonometry, and dilated fundus examination. [ncbi.nlm.nih.gov]

The format includes the CPT codes for billing purposes, short description of the condition, etiology/incidence, course/prognosis, laboratory findings, differential diagnosis; prophylaxis, treatment (local and systemic, surgical or other), miscellaneous [books.google.de]

etiology is capsular rupture during cataract surgery. [ophthalmologymanagement.com]

Pathology Etiology trauma systemic and syndromic disorders Marfan syndrome typically upwards and out most common spontaneous cause 2 homocystinuria - typically downwards Weil-Marchesani syndrome Ehlers-Danlos syndrome hereditary (or isolated) ectopia [radiopaedia.org]

Epidemiology

Cases were identified through the Rochester Epidemiology Project. Three controls chosen from the cataract surgery cohort were matched to each IOL dislocation case by age, gender, and duration of follow-up. [ncbi.nlm.nih.gov]

Epidemiology Frequency United States Clinically insignificant decentration occurs in at least 25% of cases. Clinically significant decentration occurs in about 3% of the cases. The frequency of IOL dislocation ranges from 0.2-1.8%. [emedicine.medscape.com]

Diagnosis: Marfan syndrome with lens dislocation Differential diagnosis for crystalline lens dislocation : Trauma Homocystinuria Sulfite oxidase deficiency Weill-Marchesani Syndrome Hyperlysinemia EPIDEMIOLOGY Incidence: 1/5000 - 1/2000. 60-87% with ectopia [webeye.ophth.uiowa.edu]

Pathophysiology

Pathophysiology IOL dislocation can be subdivided into early and late dislocation. [emedicine.medscape.com]

Prevention

Capsular tension rings probably help but do not prevent this complication. Management includes IOL exchange, replacement with an anterior or a sutured posterior chamber IOL, or suturing the IOL through the bag to the iris or the sclera. [ncbi.nlm.nih.gov]

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