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Subluxated spherophakic lens

Zonules still not relinquished

Pathak-Ray, Vanita

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Indian Journal of Ophthalmology: January 2019 - Volume 67 - Issue 1 - p 136
doi: 10.4103/ijo.IJO_1154_18
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Microspherophakic lens are small with weak zonules, leading to clinical manifestations of high myopia, progressive subluxation and/or dislocation, and glaucoma either pupillary block or angle closure.[1]

A 36-year-old patient with bilateral nonsyndromic microspherophakia re-presented with blurred vision; 6 years after, he had undergone prophylactic bilateral laser peripheral iridotomy (LPI) and a right eye trabeculectomy with mitomycin C for unrelated secondary glaucoma (due to anterior uveitis), which complicated his clinical course. When examined, his best corrected visual acuity was 20/40 and 20/50 in the right and left eyes, respectively, with -12.0 dioptre sphere; slit-lamp examination revealed irregular depth of anterior chamber bilaterally with patent LPI. A diffuse bleb was seen in the right eye. Intraocular pressure (IOP) was recorded as 16 and 14 mmHg, respectively. On dilatation, sparse zonules were visible; progressive subluxation was seen, but dislocation was prevented by sentinel zonules [Fig. 1], still hanging on to the lens. Rest of the examination of both eyes was within normal limits, including discs and visual fields.

F1-40
Figure 1:
Sparse zonules in a subluxated spherophakic lens

Patient underwent a lensectomy via the anterior route with intrascleral haptic fixation of a posterior chamber intraocular implant (sclera-fixated IOL) in each eye, accomplished by a glaucoma surgeon.[234]

Patient achieved 20/20 vision in both eyes unaided; N6 with an addition of + 2.50. IOP was controlled with a functioning bleb in the right eye. Other than mild vitreous haemorrhage, no other serious complications were seen in the follow-up period.

To conclude, a regular vigil is essential to prevent posterior dislocation of a microspherophakic lens, enabling an anterior segment approach in its management, thereby avoiding the skill, cost, and potential complications of a posterior approach.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgements

Mr. Shiva Sankar, Ophthalmic Photographer, Centre for Sight.

1. Khokhar S, Pillay G, Sen S, Agarwal E. Clinical spectrum and surgical outcomes in spherophakia: A prospective interventional study Eye (Lond). 2018;32:527–36
2. Yang J, Fan Q, Chen J, Wang A, Cai L, Sheng H, et al The efficacy of lens removal plus IOL implantation for the treatment of spherophakia with secondary glaucoma Br J Ophthalmol. 2016;100:1087–92
3. Yamane S, Inoue M, Arakawa A, Kadonosono K. Sutureless 27-gauge needle-guided intrascleral intraocular lens implantation with lamellar scleral dissection Ophthalmology. 2014;121:61–6
4. Kelkar AS, Fogla R, Kelkar J, Kothari AA, Mehta H, Amoaku W, et al Sutureless 27-gauge needle-assisted transconjunctival intrascleral intraocular lens fixation: Initial experience Indian J Ophthalmol. 2017;65:1450–3
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