BROWN-MCLEAN SYNDROME IN AN APHAKIC PATIENT AFTER SPONTANEOUS ANTERIOR EMPTY CAPSULAR BAG DISLOCATION

Out-of-the-bag dislocations are rare and usually occurs in the late postoperative period. The major factors predisposing are still uncertain, but most cases are due to surgical complications or pseudoexfoliation. The aim of this study is to describe the diagnosis and treatment of a spontaneous empty capsular bag dislocation to the anterior chamber with no prior history of presumed traumatic damage and the evolution years later in a Brown-Mclean syndrome.

Department of Ophthalmology. Elda’s General University Hospital, (Alicante), Spain

A 66-year-old high myopic woman arrived at our emergency service complaining about a white spot in her right eye. Her medical history was as follows, she reported deep amblyopia on her right eye and she underwent uncomplicated cataract extraction in both eyes 25 years before. On examination, her best corrected visual acuity (BCVA) was hand movements on her right eye and 20/40 on her left eye. The slit-lamp examination revealed an anterior dislocation of the empty capsular bag with cortical debris. On the fundus examination we just could view the posterior pole that showed an advanced myopic degeneration.

The patient was given topical cycloplegic every 8 hours and 1% prednisolone drops every 2 hours. The ultrasonography B showed the intraocular lens dislocated into the vitreous cavity. We performed an intraocular 23-gauge vitrectomy surgery to extract the capsular bag and the intraocular lens and we opted to leave the patient aphakic. Five years after the surgery the patient arrived at our clinic complaining about pain in her right eye and she presented a clear central cornea with peripheral corneal edema. She was diagnosed with Brown-Mclean syndrome.

Few cases of spontaneous anterior dislocation of the empty capsular bag have been reported and the main predisposing factors proposed are ocular trauma in highly myopic eyes or severe rubbing. An advance myopic degeneration and previous poor vision delayed the diagnosis of out-of-the-bag dislocation. Brown-Mclean syndrome is a rare condition with peripheral corneal edema observed in aphakic patients. This case highlights the importance of an early diagnosis to perform an early intervention and the follow-up of this kind of patients for the management of corneal decompensation.