Spontaneous late anterior dislocation of intraocular lens in pseudoexfoliation syndrome

Session Details

Session Title: Cataract Surgery Complications. IOL Dislocations

Session Date/Time: Monday 07/09/2015 | 17:00-18:30

Paper Time: 17:18

Venue: Room 10

First Author: : E.Mata Diaz SPAIN

Co Author(s): :    C. Monton Gimenez   C. de Pablo Martin   D. Ortiz Martin   B. Jimenez-Rolando   A. Sanchez Ventosa   M. Bermejo Mata     

Abstract Details

Purpose:

To perform ultrasound biomicroscopic analysis of pseudophakic ciliary block glaucoma induced by anterior dislocation of in-the-bag lens, and discuss the clinical presentation , management and the pathophysiology anterior dislocation of the in the bag intraocular lens (PC/IOL).

Setting:

Ophthalmology Department, Hospital de San Jose y Santa Adela, Madrid, Spain

Methods:

A patient with pseudoexfoliation (PES) underwent uneventful cataract surgery 10 years ago. He suddenly presented a pseudophakic ciliary block glaucoma resistant to medical treatment and neodymium YAG iridotomy.The ultrasonic biomicroscope (BMU) showed anterior segment changes that confirmed the diagnosis. A pars plana vitrectomy was performed with resolution of the ciliary block glaucoma. 4 months later the patient presented with posterior vitreous dislocation of in the bag the lens.

Results:

BMU revealed that the intraocular lens was shifted forward, shallowing the anterior chamber. The anterior hyaloids face was displaced backwards from the posterior capsule, making impossible to reach the hyaloid by an anterior approach. The iris was in apposition to the cornea in 360º and the ciliary body rotated anteriorly.

Conclusions:

To the best of our knowledge, this is the first report of late-onset anterior PC/IOL dislocation in PES, generating a permanent ciliary block angle closure glaucoma. Nevertheless we have found 3 other reports in which an spontaneous anterior dislocation of the IOL was reported. The clinical presentation would be miopic shift, followed by angle closure glaucoma. Treatment proposed is surgical management with replacement of the IOL. Ophthalmologists should be aware of this potential complication, which may occur in patients with PES within a considerable period of time after uneventful cataract surgery, and these patients should be warned accordingly.

Financial Interest:

NONE