Mohammad Ghoreishi, MD Isfahan University of Medical Sciences Mohammad Ghoreishi, MD Isfahan University of Medical Sciences Surgical Management of Dilocated Lens

Loose zonules Loose zonules Pseudoexfoliation Pseudoexfoliation Old age… Old age… Subluxed lens Subluxed lens when it is partially displaced but contained within the lens space when it is partially displaced but contained within the lens space Dislocated or luxated lens Dislocated or luxated lens when it lies completely outside the lens patellar fossa, in the anterior chamber, free-floating in the vitreous, or directly on the retina when it lies completely outside the lens patellar fossa, in the anterior chamber, free-floating in the vitreous, or directly on the retina Classification

Trauma Trauma Hereditary ectopia lentis without systemic manifestations Hereditary ectopia lentis without systemic manifestations Single (isolated) ectopia lentis Single (isolated) ectopia lentis Ectopia lentis et pupillae Ectopia lentis et pupillae Systemic conditions commonly associated with ectopia lentis Systemic conditions commonly associated with ectopia lentis Marfan syndrome Marfan syndrome Homocystinuria Homocystinuria Sulfite oxidase deficiency Sulfite oxidase deficiency Hyperlysinemia Hyperlysinemia Etiology and associated conditions

Uncommon systemic conditions associated with ectopia lentis Uncommon systemic conditions associated with ectopia lentis Ehlers-Danlos syndrome Ehlers-Danlos syndrome Crouzon disease Crouzon disease Refsum syndrome Refsum syndrome Kniest syndrome Kniest syndrome Mandibulofacial dysostosis Mandibulofacial dysostosis Sturge-Weber syndrome Sturge-Weber syndrome Conradi syndrome Conradi syndrome Pfaundler syndrome Pfaundler syndrome Pierre Robin syndrome Pierre Robin syndrome Wildervanck syndrome Wildervanck syndrome Sprengel deformity Sprengel deformity

Primary ocular disorders associated with ectopia lentis Primary ocular disorders associated with ectopia lentis Congenital glaucoma/buphthalmos Congenital glaucoma/buphthalmos Pseudoexfoliation syndrome Pseudoexfoliation syndrome Syphilis/chronic uveitis Syphilis/chronic uveitis Retinitis pigmentosa Retinitis pigmentosa Megalocornea Megalocornea Aniridia Aniridia Hypermature cataract Hypermature cataract Intraocular tumor Intraocular tumor High myopia High myopia Etiology and associated conditions

Preop evaluation Systemic evaluation Systemic evaluation …Homocystinuria… …Homocystinuria… Glaucoma Glaucoma Retinal detachment Retinal detachment Refractin and vision Refractin and vision

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

Loose zonules, no subluxation Diagnosing the condition is important Diagnosing the condition is important Preventive measures Preventive measures Pupil dilation Pupil dilation Capsular staining, large rhexis Capsular staining, large rhexis Suporting the capsule with iris retractors Suporting the capsule with iris retractors Smooth phaco parameters Smooth phaco parameters Supracapsular technique Supracapsular technique CTR without or with fixation if necessary CTR without or with fixation if necessary

Capsular tension rings (CTR) Standard Standard Cioni Cioni Capsular tension segments (CTS) Capsular tension segments (CTS) Inserted before or after phacoemulsification 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

Mild dislocation

Moderate subluxation

Severe subluxation and dislocation Total lens removal Total lens removal Lensectomy, anterior/posterior vitrectomy Lensectomy, anterior/posterior vitrectomy Intracapsular extraction Intracapsular extraction Phacofragmentation Phacofragmentation IOL IOL Artisan aphakia Artisan aphakia Scleral fixation Scleral fixation AC, angle fixation AC, angle fixation