• 8 SECTIONGlaucoma Pediatric

Posterior Lens Dislocation

Key Facts

•Displacement of lens into vitreous cavity

•Occurs secondary to:

•trauma • intraoperative rupture of posterior lens capsule • pseudoexfoliation

•inherited familial disorders (Marfan syndrome, Weill–Marchesani syndrome)

•metabolic disorders (sulfite oxidase deficiency, homocystinuria)

•Immediate decrease in visual acuity

•Trauma and surgical complications are monocular

•Pseudoexfoliation, familial and metabolic disorders are bilateral

Clinical Findings

•Lens (either entire lens or pieces of lens material from surgery) in vitreous cavity

•Intraocular inflammation

•Elevated IOP from phacolytic glaucoma

•Vitreous hemorrhage from trauma or surgery

•Iridodonesis

Ancillary Testing

•Ultrasound if view to the retina is poor

•Evaluation for metabolic or familial disorders in conjunction with primary care physician

Differential Diagnosis

• Based on the metabolic or familial cause of the lens dislocation

Treatment

•Observation if no intraocular inflammation or elevated IOP from the dislocated lens

•Pars plana vitrectomy with lensectomy should be performed immediately after complicated cataract surgery or traumatic displacement of the lens if elevated IOP cannot be controlled with maximal medical therapy

•Surgical placement of an appropriate intraocular lens implant during vitrectomy surgery

•If no lens implant is performed, aphakic correction with contact lens may be used

Prognosis

• Good visual prognosis