20 y/o male Referred for refractive surgery due to high myopia VA – OD: CF 4/10 – OS: CF 5/10 Refraction – OD: x 180 – OS: x 180 IOP – OD: 39 mm Hg – OS: 39 mm Hg

Displacement of the crystalline lens from its original position Subluxation: when displacement is partial with part of the lens still in normal position Luxation or dislocation: when lens is completely displaced, in AC or Vitreous

Traumatic (most common cause) Hereditary ectopia lentis without systemic manifestations – Single (isolated) ectopia lentis – Ectopia lentis et pupillae

– Marfan syndrome Autosomal dominant Tall stature Arachnodactyly, joint laxity, mitral valve prolapse, aortic dilatation Axial myopia, and increased incidence of retinal detachment Lens dislocation (about 75% of patients ), usually bilateral, symmetrical, and supartemporal

– Homocystinuria Absence of cystathionine b-synthetase (the enzyme that converts homocysteine to cystathionine). Fair skin with coarse hair, osteoporosis, mental retardation, seizure disorder, marfanoid habitus, and poor circulation Thromboembolic events constitute the major threat to survival, especially following general anesthesia. Lens luxation usually is bilateral, symmetrical, and inferonasal, and presents in nearly 90% of patients

– Weil-Marchesani Short stature, brachydactyly, limited joint mobility Microspherophakia, ectopia lentis, lenticular myopia Pupillary block glaucoma – Sulfite oxidase deficiency Defect in sulfur metabolism Progressive CNS abnormalities Ectopia lentis – Hyperlysinemia Enzymatic defect of amino acid metabolism Mental retardation and lens dislocation. Increased plasma levels of lysine

– Congenital glaucoma/buphthalmos – Pseudoexfoliation syndrome – Syphilis/chronic uveitis – Retinitis pigmentosa – Megalocornea – Aniridia – Hypermature cataract – Intraocular tumor – High myopia

Impaired vision due to cataract or refractive error not improved by other corrective methods Induced or thread for glaucoma

Refraction and vision Systemic evaluation …Homocystinuria…. …Marfan…. Glaucoma, angle Retinal detachment Corneal endothelium

Diagnosing the condition is important Preventive measures Pupil dilation Capsular staining, large rhexis Suporting the capsule with iris retractors Smooth phaco parameters Supracapsular technique CTR without or with fixation if necessary

Standard Cioni Capsular tension segments (CTS) Inserted before or after phacoemulsification The Cionni-modified CTR can be sutured to the sclera. The CTS, with its 90º arc, can be inserted at a specific site of zonular weakness