Free Papers

Medical and surgical management of congenital lens dislocation

Free Paper Details

First Author: E.Gijon SPAIN

Co Author(s):    I. Yago   C. Hernandez Martinez   J. Marin Sanchez              

Abstract Details

Purpose:

To evaluate the current management of congenital lens dislocation in terms of indications, surgical procedures and clinical results.

Setting:

Pediatric Ophthalmology Department, Hospital Universitario Virgen de la Arrixaca, Murcia (Spain).

Methods:

We conducted a retrospective study of patients with congenital lens dislocation at a tertiary-care hospital. The therapeutic management -medical or surgical- in each case was decided according to the best corrected visual acuity (BVCA), the refractive error (RE) and the presence of amblyopia. In the group treated surgically, apart of the lens aspiration and the 3-piece-intraocular lens (IOL) implantation, the capsular bag-IOL complex was sulcus-fixated either directly with a capsular tension ring (CTR) or via an Ahmed segment (AS) or a Cionni ring (CR).

Results:

Fourteen eyes with lens dislocation were analysed. The causes were Marfan syndrome (42,86%), ectopia lentis (42,86%) and homocystinuria (14,29%). The mean age at diagnosis was 3,28 ± 0,73 years and at surgery was 4 ± 0,76 years. Patients treated medically (42,86%) achieved 0,71 ± 0,08 BCVA with a mean spherical equivalent (MSE) of -7,35 ± 4,61 dioptres (D). The group treated surgically (57,14%) improved in BVCA (from 0,28 ± 0,05 to 0,77 ± 0,05) and showed a reduction in MSE (from -11,5 ± 4,61D to +0,95 ± 1,96D).

Conclusions:

As described in the literature and resembled in this study, a medical management is the best option in patients with a mild lens dislocation that supposes a RE presumed to be corrected with visual spectacles. However, in severe situations, surgery seems to be an effective and secure option. Suturing the capsular bag-IOL complex in sulcus -with an AS or a CR- and the use of a CTR facilitate the lens centration, strengthening the zonule, what is particularly important in those progressive situations, such as homocystinuria.

Financial Disclosure:

-