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 Table of Contents  
PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 810-811

Traumatic dislocation of crystalline lens with secondary glaucoma


Glaucoma Service, Narayana Nethralaya-2, Bangalore, Karnataka, India

Date of Submission01-Jan-2021
Date of Acceptance21-Mar-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Sushma Tejwani
Narayana Nethralaya-2, Narayana Health City Campus, Bommasandra, Hosur Road, Bangalore - 560 099, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1_21

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  Abstract 


Keywords: Lens dislocation, secondary glaucoma, trauma


How to cite this article:
Tejwani S, Mehta P. Traumatic dislocation of crystalline lens with secondary glaucoma. Indian J Ophthalmol Case Rep 2021;1:810-1

How to cite this URL:
Tejwani S, Mehta P. Traumatic dislocation of crystalline lens with secondary glaucoma. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:810-1. Available from: https://www.ijoreports.in/text.asp?2021/1/4/810/327618



A 44-year-old male presented with loss of vision with redness and pain in the right eye (RE) following injury with a shuttlecock. His visual acuity in RE was PL+ with IOP of 34 mmHg. Slit-lamp examination revealed circumciliary congestion, clear cornea, and anterior chamber had grade 4 hyphema with vitreous in superotemporal quadrant. There was iridodonesis with multiple clock hours of sphincter tears. Patient was started on topical beta-blockers, alpha-agonist with oral carbonic anhydrase inhibitors. After 1 week, hyphema cleared and lens was seen subluxated inferonasally with 270° of zonular dialysis. It was placed obliquely across the pupillary area, with part of lens equator touching the endothelium [Figure 1]. Optic disc appeared normal with 0.3 cup-to-disc ratio. RE gonioscopy showed 360° angle recession with blood clot over the angle from 12 to 5 o'clock. At 1-month follow-up, IOP was 23 mmHg with three medications. Patient underwent RE lensectomy through superior incision with anterior chamber IOL, anterior vitrectomy and trabeculectomy augmented with MMC.
Figure 1: Slit-lamp diffuse photograph demonstrating inferonasally subluxated, crystalline lens lying across the pupil with zonular dialysis following blunt trauma (a) and equator touching the endothelium (b)

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Postoperatively, patient had BCVA of 6/6p with IOP of 15 mmHg. However, 6 weeks postoperatively, the patient developed cystic changes in the bleb with congestion and IOP rose to 34 mmHg. Four doses of injection 5-FU were given after which IOP improved. After 4 years, vision was 6/6p, diffuse bleb [Figure 2], IOP was 14 mmHg without any medication and stable visual fields.
Figure 2: Late postoperative slit-lamp photograph showing anterior chamber intraocular lens (a) and a diffuse well-filtering bleb (b)

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  Discussion Top


Blunt trauma can have several sequelae in the eye due to compressive and expansive effect.[1],[2] Dislocation of lens from weakening of zonules following blunt trauma is common and requires immediate surgical intervention. Secondary glaucoma and vision loss are complications associated with such trauma.[3] Hence, timely lens extraction with filtration surgery is a good option to prevent such complications.[4] IOP and corneal endothelium should be closely monitored postoperatively. In nutshell, comprehensive preoperative evaluation, meticulous intraoperative planning, and postoperative care are essential to achieve optimal outcomes after trauma.

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 Top

1.
Canavan YM, Archer DB. Anterior segment consequences of blunt ocular injury. Br J Ophthalmol 1982;66:549-55.  Back to cited text no. 1
    
2.
Sihota R, Sood NN, Agarwal HC. Traumatic glaucoma. Acta Ophthalmol Scand 1995;73:252-4.  Back to cited text no. 2
    
3.
De Leon-Ortega JE, Girkin CA. Ocular trauma-related glaucoma. Ophthalmol Clin N Am 2002;15:215-23.  Back to cited text no. 3
    
4.
Wang R, Bi CC, Lei CL, Sun WT, Wang SS, Dong XJ. Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma. Int J Ophthalmol 2014;7:264-72.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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