Subluxated Cataract Management In A Tertiary Centre

To describe the various management approaches and surgical techniques of a case series of subluxated cataract with different etiologies diagnosed in adult age and to evaluate its visual outcomes and patient satisfaction.

The cataract subluxation is an acquired or congenital condition due to different causes and it may be associated with other ocular or systemic abnormalities. It may impact significantly the visual acuity or it can be clinically insignificant so a proper evaluation of each individual is fundamental to choose the approach option that better fits in each patient.

This is a 3 years retrospective study of 12 eyes of 12 patients with subluxated cataract caused by trauma, pseudoexfoliative syndrome, Marfan syndrome or idiopathic identified in our Ophthalmology Centre that underwent cataract surgery. Previous to surgery (preop) all patients were submitted to slit lamp evaluation, IOL calculation, corneal topography and endothelial cell count evaluation. Main parameters evaluated were: uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), spherical equivalent, intra and postoperative (intra/postop) complications.

All patients were adults with mean age at the time of the surgery of 58 years old and the majority were male (80%). In 2/3 of the cases the surgical technique used was phaco-emulsification/aspiration (PHACO), bag preservation, capsular tension ring placement and IOL in the bag or sulcus; and in 1/3 was PHACO, anterior vitrectomy, bag removal and iris fixated IOL. PCR occurred in 1 eye, no other major intraop complications occurred like dropped nucleus. Postop lens dislocation occurred in 2 eyes, no complications like CME, endophtalmitis or retinal tear/detachment were noted. During the first month no IOP spikes were noted and no glaucoma surgeries were needed. Mean BCVA improved from 0,20 (decimal scale) preop to 0,65 1 month postop.

The management of cataract subluxation can be a challenge for the anterior segment surgeon. The preferred surgical technique should be minimally invasive and in our Centre the most common is the phacoemulsification/phacoaspiration, bag preservation, capsular tension ring placement and IOL in the bag or sulcus that is a safe procedure. We can achieve good visual outcomes however many factors like the cause of subluxation, the degree of subluxation, age of the patient and the association with other ocular and system abnormalities can impair significantly the prognosis.