Spontaneous lens subluxation into anterior chamber. Importance of an early management

• Published in: Acta ophthalmologica (Oxford, England) England), 2022-01, Vol.100 (S267), p.n/a
• Main Authors: El Bakkali, Ismael Bakkali, Arias, Pablo Cisneros, El Bakkali, Mohamed Bakkali, Rivasés, Guillermo Pérez, de Rivas, Marta Orejudo, Murillo, Ana Boned, Núñez Moscarda, Eva Josefina, Díaz Barreda, María Dolores, Buey Sayas, María Ángeles Del, Ascaso Puyuelo, Francisco Javier
• Format: Article
• Language: English
• Subjects: Acuity; Anterior chamber; Cornea; Dislocation; Edema; Endothelial cells; Eye; Patients; Retina; Trauma
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2022.126

Purpose To describe the importance of applying an urgent protocol in cases of lens subluxation into the anterior chamber (AC) in order to diminish the risk of corneal decompensation. Methods A 60‐year‐old man with a history of ocular trauma in his youth and pseudoexfoliation syndrome, presented pupillary block in the right eye 2 months after an accidental fall without ocular involvement. Visual acuity was 0.05 (decimal) and intraocular pressure was 55 mmHg. Slit lamp examination and anterior segment Optical Coherence Tomography showed a lens subluxation towards AC (lower portion) with endothelial contact and corneal edema. In funduscopy, an inferior giant tear with associated retinal detachment was observed. Results After treating ocular hypertension with hypotensive agents, Pars Plana Vitrectomy 25 Gauge + Lensectomy + Endolaser + SF6 Tamponading gas were performed, leaving the patient in aphakia for subsequent intraocular lens implantation surgery. Two months later, a substantial loss of endothelial cell count was observed (777 cells right eye VS 2223 cells left eye). Conclusions In this type of pathology, it is imperative to take immediate pharmacological, postural and surgical measures to reduce contact between the lens and the cornea, in order to minimize endothelial damage and improve the visual prognosis of these patients. Bibliography Ke G, Zhou E, Zhu K, Wei Y, Wang Z, Jia Y, Wang S, Gu Y. Retinal break associated with traumatic lens dislocation or subluxation requiring vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2020 Mar;258(3):693–697. doi: 10.1007/s00417‐019‐04530‐9. Epub 2019 Nov 28. PMID: 31781882. Salehi‐Had H, Turalba A. Management of traumatic crystalline lens subluxation and dislocation. Int Ophthalmol Clin. 2010 Winter;50(1):167–79. doi: 10.1097/IIO.0b013e3181c567de. PMID: 20057305.