Abstract

Spontaneous lens dislocation is a result of disruption of the ciliary body zonules and may develop because of damage of the zonule fibers that holds the lens in place. Lens luxation may occur spontaneously in association with ocular or systemic disease or can follow trauma. In exfoliative glaucoma, exfoliation material affects the zonular system, creating fragility and weakening of the zonular support leading to subsequent laxity of the lens [1-4]. We report herein an uncommon case of unilateral spontaneous lens luxation in a patient with exfoliative glaucoma.

Citation: Kaimbo Wa Kaimbo D, Kaimbo MT. Spontaneous lens luxation in an 88-year old female with exfoliative glaucoma. J Clin Images Med Case Rep. 2023; 4(11): 2688.

Description

An 88-year-old black female presented to our clinic on February 03 2016 for decreased vision. She was known to have open-angle glaucoma secondary to pseudo exfoliation in her left eye since 2009. At that time, her visual acuity was 7/10 with +1.25+0.50x0° in the right eye and 5/10 with -0.75-1.50x90° in the left eye. Slit-lamp examination revealed a nuclear cataract in the right eye, a nuclear cataract, and exfoliation material on the pupillary marginal and the lens in her left eye. Her intraocular pressures were well controlled with medication (Xalatan®).

At her visit, she complained of gradual deterioration of vision. There was no history of trauma. Her medical history revealed pulmonary tuberculosis. The uncorrected vision was less than 1/10 in both eyes. Intraocular pressures were normal. Slit-lamp examination showed a nuclear cataract in the right eye and an inferiorly dislocated lens with cataract in the vitreous of the left eye. Exfoliative material was present at the pupillary margins, the superior equator of the lens and the zonule fibers of the left eye. There was a poor pupillary dilation (Figure 1), no evidence of uveitis and ophthalmoscopy revealed a dry age-related macular degeneration.

Comment

Our patient was in her late eighties (80’s). In 2009 she had been diagnosed with open-angle glaucoma secondary to exfoliation syndrome in her left eye. She developed a spontaneous lens luxation, which can be explained by deposition and accumulation of exfoliative material on zonules with increasing age. This led to progressive degenerative changes of the zonular system resulting in zonular dialysis, laxity and development of spontaneous lens luxation [1-4].

This case reminds us three things [5]. First, exfoliation syndrome should be considered as a differential diagnosis in older patients presenting with spontaneous lens luxation.

Second, this case advocates for the need to perform early and careful cataract surgery on elderly patients with exfoliative glaucoma. Third, patients with exfoliative glaucoma also need to be made aware of the possibility of spontaneous lens luxation.

Figure 1: The photograph of the left eye shows, aphakic, subluxated lens, exfoliative material at the pupillary margin, at the superior equator of the lens, and at zonular fibers; a poor dilatation.

References

1. Prince AM, Ritch R. Clinical signs of the pseudoexfoliation syndrome. Ophthalmology. 1986; 93: 803-7.
2. Schlotzer-Schrehardt U, Naumann COHo. A histopathologic study of zonular instability in pseudoexfoliation syndrome. Am J Ophthalmol. 1994; 118: 730-43.
3. Freissler K, Kuchle M, Naumann GOH. Spontaneous dislocation of the lens in pseudoexfoliation syndrome. Arch Ophthalmol. 1995; 113: 1095-6.
4. Carpel EF. Pupillary dilatation in eyes with pseudo-exfoliation syndrome. Am J Ophthalmol. 1988; 105: 692-4.
5. Tyagi AK, McDonnell PJ. Pseudoexfoliaion syndrome and spontaneous lens dislocation. Eye (Lond) 1998; 12: 1033-4.