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OPHTHALMIC IMAGE
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 136

Subluxated spherophakic lens: Zonules still not relinquished


Centre for Sight, Hyderabad, Telangana, India

Date of Web Publication21-Dec-2018

Correspondence Address:
Dr. Vanita Pathak-Ray
Centre For Sight, Banjara Hills, Road No 2, Hyderabad - 500 034, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1154_18

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How to cite this article:
Pathak-Ray V. Subluxated spherophakic lens: Zonules still not relinquished. Indian J Ophthalmol 2019;67:136

How to cite this URL:
Pathak-Ray V. Subluxated spherophakic lens: Zonules still not relinquished. Indian J Ophthalmol [serial online] 2019 [cited 2019 Jan 19];67:136. Available from: http://www.ijo.in/text.asp?2019/67/1/136/248116



Microspherophakic lens are small with weak zonules, leading to clinical manifestations of high myopia, progressive subluxation and/or dislocation, and glaucoma either pupillary block or angle closure.[1]

A 36-year-old patient with bilateral nonsyndromic microspherophakia re-presented with blurred vision; 6 years after, he had undergone prophylactic bilateral laser peripheral iridotomy (LPI) and a right eye trabeculectomy with mitomycin C for unrelated secondary glaucoma (due to anterior uveitis), which complicated his clinical course. When examined, his best corrected visual acuity was 20/40 and 20/50 in the right and left eyes, respectively, with -12.0 dioptre sphere; slit-lamp examination revealed irregular depth of anterior chamber bilaterally with patent LPI. A diffuse bleb was seen in the right eye. Intraocular pressure (IOP) was recorded as 16 and 14 mmHg, respectively. On dilatation, sparse zonules were visible; progressive subluxation was seen, but dislocation was prevented by sentinel zonules [Figure 1], still hanging on to the lens. Rest of the examination of both eyes was within normal limits, including discs and visual fields.
Figure 1: Sparse zonules in a subluxated spherophakic lens

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Patient underwent a lensectomy via the anterior route with intrascleral haptic fixation of a posterior chamber intraocular implant (sclera-fixated IOL) in each eye, accomplished by a glaucoma surgeon.[2],[3],[4]

Patient achieved 20/20 vision in both eyes unaided; N6 with an addition of + 2.50. IOP was controlled with a functioning bleb in the right eye. Other than mild vitreous haemorrhage, no other serious complications were seen in the follow-up period.

To conclude, a regular vigil is essential to prevent posterior dislocation of a microspherophakic lens, enabling an anterior segment approach in its management, thereby avoiding the skill, cost, and potential complications of a posterior approach.

Acknowledgements

Mr. Shiva Sankar, Ophthalmic Photographer, Centre for Sight.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khokhar S, Pillay G, Sen S, Agarwal E. Clinical spectrum and surgical outcomes in spherophakia: A prospective interventional study. Eye (Lond) 2018;32:527-36.  Back to cited text no. 1
    
2.
Yang J, Fan Q, Chen J, Wang A, Cai L, Sheng H, et al. The efficacy of lens removal plus IOL implantation for the treatment of spherophakia with secondary glaucoma. Br J Ophthalmol 2016;100:1087-92.  Back to cited text no. 2
    
3.
Yamane S, Inoue M, Arakawa A, Kadonosono K. Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection. Ophthalmology 2014;121:61-6.  Back to cited text no. 3
    
4.
Kelkar AS, Fogla R, Kelkar J, Kothari AA, Mehta H, Amoaku W, et al. Sutureless 27-gauge needle-assisted transconjunctival intrascleral intraocular lens fixation: Initial experience. Indian J Ophthalmol 2017;65:1450-3.  Back to cited text no. 4
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