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Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 235

Rays of rising sun or threads of sinking vision?

Department of Cataract, Raghudeep Eye Hospital, Ahmedabad, Gujarat, India

Date of Web Publication20-Jan-2023

Correspondence Address:
Pinkal Ratpiya
Raghudeep Eye Hospital, Gurukul Road, Ahmedabad – 380 052, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1818_22

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How to cite this article:
Ratpiya P, Vasavada V, Ghiya P, Vaishnav V, Vasavada S. Rays of rising sun or threads of sinking vision?. Indian J Ophthalmol Case Rep 2023;3:235

How to cite this URL:
Ratpiya P, Vasavada V, Ghiya P, Vaishnav V, Vasavada S. Rays of rising sun or threads of sinking vision?. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:235. Available from: https://www.ijoreports.in/text.asp?2023/3/1/235/368175

Subluxated lens is a challenging problem, both for patients and surgeons. In absence of trauma, subluxation should evoke suspicion of concomitant hereditary systemic disease or associated ocular disorder.[1]

A 14-year-old male presented with best-corrected visual acuity (BCVA) of 6/24 in RE and 3/60 in LE. On dilated slit-lamp examination, there was subluxation of lens along with the vitreous in the pupillary area with diffuse zonular weakness and superotemporal subluxation >270° [Figure 1]. Detailed systemic evaluation was performed and no systemic association was found. Management consisted of pars plana lensectomy and vitrectomy with intra-scleral fixation of intraocular lens (SFIOL) using Yamane's technique. The final BCVA was 6/9 in RE and 6/18 in LE.
Figure 1: Superotemporal subluxation >270° with lax zonules - normal and retroillumination

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Disruption or dysfunction of the zonular fibers of the lens is the underlying pathophysiology of subluxation. The most common cause of subluxation is trauma; other systemic associations include Marfan syndrome, Weill–Marchesani syndrome, homocystinuria, etc.

Treatment should be aimed at ophthalmic as well as systemic cause and managing complications.[2] Surgical intervention has two options: try and preserve the capsular bag and fixate it using single or double islet Cionni-modified capsule tension ring. In cases of extensive subluxation, performing a thorough pars plana lensectomy/vitrectomy with sutured or sutureless SFIOL is also a valid option.

Early diagnosis of subluxation with appropriate optical correction can prevent amblyopia and visual outcomes can be improved. However, long-term monitoring is of utmost importance.

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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Clark CC. Ectopia lentis: A pathologic and clinical study. Arch Ophthalmol 1939;21:124-53.  Back to cited text no. 1
Konradsen T, Kugelberg M, Zetterström C. Visual outcomes and complications in surgery for ectopia lentis in children. J Cataract Refract Surg 2007;33:819-24.  Back to cited text no. 2


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