Mohammad Ghoreishi , MD Isfahan University of Medical sciences Isfahan, Irann
Mohammad Ghoreishi, MD Isfahan University of Medical Sciences Mohammad Ghoreishi, MD Isfahan...
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Transcript of Mohammad Ghoreishi, MD Isfahan University of Medical Sciences Mohammad Ghoreishi, MD Isfahan...
Mohammad Ghoreishi, MD
Isfahan University of Medical Sciences
Surgical Management of Dilocated Lens
Loose zonulesPseudoexfoliationOld age…
Subluxed lenswhen it is partially displaced but
contained within the lens space Dislocated or luxated lens
when it lies completely outside the lens patellar fossa, in the anterior chamber, free-floating in the vitreous, or directly on the retina
Classification
Trauma Hereditary ectopia lentis without systemic
manifestationsSingle (isolated) ectopia lentis Ectopia lentis et pupillae
Systemic conditions commonly associated with ectopia lentis Marfan syndrome Homocystinuria Sulfite oxidase deficiency Hyperlysinemia
Etiology and associated conditions
Etiology and associated conditions
Uncommon systemic conditions associated with ectopia lentis Ehlers-Danlos syndrome Crouzon disease Refsum syndrome Kniest syndrome Mandibulofacial dysostosis Sturge-Weber syndrome Conradi syndrome Pfaundler syndrome Pierre Robin syndrome Wildervanck syndrome Sprengel deformity
Primary ocular disorders associated with ectopia lentis Congenital glaucoma/buphthalmos Pseudoexfoliation syndrome Syphilis/chronic uveitis Retinitis pigmentosa Megalocornea Aniridia Hypermature cataract Intraocular tumor High myopia
Etiology and associated conditions
Preop evaluationSystemic evaluation
…Homocystinuria…GlaucomaRetinal detachmentRefractin and vision
Indications for surgery
Impaired vision due to cataract or refractive error not improved by other corrective methods
Induced or thread for glaucoma
Loose zonules , no subluxation
Diagnosing the condition is importantPreventive measuresPupil dilationCapsular staining, large rhexisSuporting the capsule with iris
retractorsSmooth phaco parametersSupracapsular techniqueCTR without or with fixation if
necessary
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 ofzonular weakness
Mild dislocation
Moderate subluxation
Severe subluxation and dislocation
Total lens removalLensectomy, anterior/posterior vitrectomy Intracapsular extractionPhacofragmentation
IOLArtisan aphakiaScleral fixationAC, angle fixation