Indian Journal of Ophthalmology

PHOTO ESSAY
Year
: 2019  |  Volume : 67  |  Issue : 9  |  Page : 1469--1470

Post-traumatic suprachoroidal dislocation of crystalline lens and its management


Mahesh P Shanmugam, Payal Shah, R Rajesh, Divyansh K Mishra, Pradeep Sagar, Abhishek Sheemar 
 Department of Vitreoretina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Payal Shah
Department of Vitreoretina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka
India

Abstract




How to cite this article:
Shanmugam MP, Shah P, Rajesh R, Mishra DK, Sagar P, Sheemar A. Post-traumatic suprachoroidal dislocation of crystalline lens and its management.Indian J Ophthalmol 2019;67:1469-1470


How to cite this URL:
Shanmugam MP, Shah P, Rajesh R, Mishra DK, Sagar P, Sheemar A. Post-traumatic suprachoroidal dislocation of crystalline lens and its management. Indian J Ophthalmol [serial online] 2019 [cited 2019 Oct 16 ];67:1469-1470
Available from: http://www.ijo.in/text.asp?2019/67/9/1469/265090


Full Text



A 34-year-old gentleman met with road traffic accident 3 months ago with multiple fractures and ocular trauma. On examination, his best-corrected visual acuity (BCVA) was perception of light with hyphema in both eyes. Pupil reactions were sluggish; there was no view of fundus in both eyes. Intraocular pressure was 8 and 7 mmHg in the right eye (RE) and left eye (LE), respectively.

Ultrasound showed hyperreflective echoes in the temporal quadrant suspicious of dislocated lens along with vitreous hemorrhage [Figure 1]a in RE and closed-funnel RD in LE.{Figure 1}

RE was operated first. A 6-mm infusion cannula was placed. After clearing vitreous hemorrhage, scar tissue in the periphery was dissected with a cutter. During dissection in the temporal quadrant, fluffy white crystalline lens was seen in a trough formed due to separation of contracted taut choroid from sclera [Video 1 and [Figure 1]b, [Figure 1]c, [Figure 1]d] which was removed with a 23G cutter. The retina was attached. In view of taut choroid, a 240-belt buckle was planned. After peritomy, an occult scleral tear with scarring was noted in the temporal quadrant. After placing tractional stay sutures, the recti were tagged by rail-road technique and sharp dissection of scarred tissue. Scleral tunnels were made in the three quadrants, while in the superotemporal quadrant, the belt was supported using sutures and sleeve was placed in inferotemporal quadrant (ITQ).

[MULTIMEDIA:1]

Subsequently LE was operated and the retina was attached.

At 1 year, BCVA improved to 6/60 in RE and 1/60 in LE. In both eyes, retina was attached.

Posttraumatic lens dislocation into anterior chamber,[1] subconjunctival space,[2] vitreous cavity, and subretinal space [3],[4] has been reported. To the best of our knowledge, this is the first case report on suprachoroidal dislocation of crystalline lens.

Careful peripheral scar tissue dissection helped to visualize the lens in suprachoroidal space in our case. Challenges such as peripheral scar tissue, taut choroid causing sclerochoroidal separation, occult scleral tear, and scarred tenon's tissue posing difficulty in placing belt buckle after trauma are well-demonstrated.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Shuen JA, Malone M, Burke Z, Baquero A. Traumatic anterior dislocation of the lens. J Emerg Med 2018;55:565-6.
2Maurya RP, Bhushan P, Singh VP, Singh MK, Kumar P, Yadav I. Traumatic subconjunctival dislocation of fractured posterior chamber intraocular lens by cow horn injury. J Clin Exp Ophthalmol 2015;6:399.
3Rani A, Pal N, Vohra R, Mandal S, Azad R. Subretinal dislocation of the crystalline lens: Unusual complication of phacoemulsification. J Cataract Refract Surg 2005;31:1843-4.
4Nagaraj BN, Tirumale S, Sriprakash KS, Savitha CS, Jaydev C. Subretinal crystalline lens – An unusual complication of blunt trauma. Asian J Ophthalmol 2013;13:68-70.