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First Author: G.Perganta GREECE
Co Author(s): G. Ioannidis I. Zampros J. Zivkovic A. Theodoridou G. Sakkias
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To report a case of late onset of bilateral dislocation of lens with glaucoma caused by hyperhomocysteinemia
Department of Ophthalmology, Hippokration General Hospital, Thessaloniki, Greece
A 54-year-old male presented to the emergency room with an acute angle-closure glaucoma and athalamia of left eye caused by ectopia lentis.
Slit-lamp examination of left eye showed intraocular pressure: 42 mmHg, athalamia, iridodonesis and phacodonesis. It was treated with pilocarpine and Nd: YAG peripheral iridotomy. Right eye showed normal intraocular pressure, shallow anterior chamber because of lens dislocation, iridodonesis and progressive nuclear cataract. Secondary angle-closure glaucoma was caused by pupillary block after mydriasis we did. The management was lensectomy-anterior vitrectomy and scleral intraocular lens fixation. Blood analysis revealed elevated homocystein (20 ?mol/l) and deficiencies of the vitamins folic acid (B9) and pyridoxine (B6). Cardiac ultrasound showed mitral valve insufficiency. Patient was referred to a specialist pathologist for further identification of concurrent abnormalities and prescription of appropriate nutritional supplements.
Homocysteinemia is an inborn error of metabolism and the second most common cause of hereditary ectopia lentis after Marfan syndrome. Patients with ectopia lentis are very suscreptible to secondary glaucoma due to angle-closure or pupillary blockage.