Clinical study and management outcomes in subluxated lens

Poster Details

First Author: M.Deshpande INDIA

Co Author(s):    R. Deshpande              

Abstract Details

Purpose:

To find out type of subluxation and assess visual impairment, associated signs and to plan management and assess final visual outcome. Material and Methods: study was undertaken from October 2008 to June 2009 comprising of 53 eyes of 40 patients with subluxated lens in a tertiary care institute. Results: Trauma is the most comman cause of acquired subluxation of which males are more prone to it (42%). Congenital subluxation are equally comman (19% each. Significant visual impairment is seen in traumatic lens subluxation (68%). Conclusion: Prompt management either refractive or surgical should be done in cases of congenital subluxation. Presence of subluxated lens is not an absolute indication of surgical removal.

Setting:

H.V.DESAI EYE HOSPITAL. HADAPSAR, PUNE.

Methods:

Study was conducted from October 2008 to june 2009. All age groups were included. Ophthalmic history was noted. All age groups were included. Patients with pseudoexfoliation and patients with infection such as corneal ulcer, corneal melt were excluded from the study. The preoperative examination included age of patient, etiology and visual acuity with Snellens and Cardiff charts ( in children) the visual acuity was graded as good ( > 6/18), moderate visual impairment ( 6/24 to /60), severe ( 6/60 but>=3/60). Detailed slit lamp examination was done to evaluate anterior segment( lens position, vitreous prolapse, grade of subluxation i.e. Grade 1 < 90 degree of zonular weakness, Grade 2 90 to 180 degree of subluxation, Grade 3 > 180 degree of subluxation, direction of subluxation, intraocular pressure and dilated detailed fundus examination. All surgeries were performed by experienced surgeons. Patients were examined postoperatively after 1 day, 1 week, 1 month and 6 months. Points noted were post operative complications, post op. refraction, BCVA, slit lamp examination, intraocular pressure and posterior segment evaluation with 90D and indirect opthalmoscopy

Results:

In the study we examined 43 eyes of 50 patients from October 2008 to June 2009. 25(58%) patients had traumatic subluxation and 2(5%) were idiopathic. It is noticed that 58% had traumatic subluxation which is a very comman cause of subluxation. 28(65%) were males and 15(35%) were females. Occupation wise 5(12%) were housewives, 12(28%) were students, 5 (12%) were skilled, and 21(49%) were unskilled. It was seen that most patients with congenital subluxation(25%) presented with less than 20 years of age. This was seen to be statistically significant(p=0.011). Congenital subluxation was present equally in males and females; but traumatic subluxation had a male preponderance(42%)p= 0.154, which was not significant. Also traumatic subluxation was seen commonly in unskilled workers(49%) such as laborers and drivers. In terms of laterality 32(64%) had unilateral subluxation while 18(36%) had bilateral subluxation. Therefore 56.5% of patients with congenital subluxation had bilateral presentation. In terms of visual impairment 10(20%) had visual acuity between 6/24--6/60 out of which 8(16 %) were congenital and 2 (5%) were traumatic. 5(10%) had v/a between 6/60-3/60 out of which 4(8%) were congenital and 1(2%) was traumatic. 35(70%) had V/A less than 3/60, 7(14%) of which were congenital, 26(52%) were traumatic, 2(4%) were idiopathic.

Conclusions:

Thus out of 45 eyes 32 eyes (68.8%) had final visual acuity of >= 6/18p= 0.01 which was statistically significant thus we conclude that trauma is the most common cause of acquired lens subluxation. Males are more prone to traumatic subluxation. In the present study we found that 18 males out of 28 had history of trauma. Congenital subluxations are equally seen in men and women. Marfans syndrome is the most common cause of congenital subluxation. 50% of patients had marfanoid features in our study. Associated secondary glaucoma is seen in traumatic subluxation(18%) and myopic fundus is seen in patients with congenital subluxation(24%). Significant visual impairment is seen in patients with traumatic subluxation, may be due to assosciated ocular problems. Visual impairment in congenital subluxation could be due to amblyopia, delayed and inadequate refraction Indication for surgical management includes secondary glaucoma, uncorrectable refractive error, reduction in visual acuity. In the present study 68.8% of eyes had final visual outcome of =6/18. Prompt management either refractive or surgical should be done in cases of congenital subluxation. Therefore proper refraction can cause significant improvement in visual acuity in cases of bilateral lens subluxation and improve quality of life. FINANCIAL DISCLOSURE?: No