Management Of Traumatic Crystalline Lens Dislocation Causing Corneal Decompensation

To present the management of a patient who developed anterior crystalline lens dislocation causing corneal decompensation following blunt trauma

University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkiye

A-61-year old male presented with severe pain, decreased vision on his left eye following blunt trauma. On the examination, he had no laseration on the eyelids and the visual acuity was 1.00 logMAR on the right eye and ‘hand motion’ on the left eye. A total anterior dislocation of crystalline lens with inferior lens-endothelial touch, traumatic pupil dilatation with iris sphincter rupture and corneal edema were noticed on biomicroscopic evaluation of the left eye.  The intraocular pressure (IOP) levels were 14 mm Hg, and 54 mm Hg due to pupillary block on the left eye. After lowering IOP, the patient underwent phacoemulsification using capsule tension ring (CTR) device and the capsule -CTR complex was placed in the normal anatomic position behind the iris. Postoperatively, topical antiglaucomatous drops, steroids, 5% NaCl, autologous serum eye drops were given for the treatment of glaucoma and corneal decompensation. Three months after surgery the patient underwent secondry three-piece intraocular lens implantation on the capsule-CTR complex in sulcus with no need of scleral fixation. And after six months because of incomplete recovery of corneal edema the patient needed Descemet-membrane endothelial keratoplasty combined with pupilloplasty.

Capsule-sparing lens surgery is one of the most preferred methods, where we can preserve the normal anatomy. This technique can be used even in cases with traumatic total anterior lens dislocation according to degree of zonular compromise. However, how the capsule-IOL complex stays in the sulcus without scleral fixation remains  still a mystery in this case.