CARLEVALE INTRAOCULAR LENS INSERTION IN A SUSPECTED MARFAN'S PATIENT

Present a case of Carlevale intraocular lens insertion in a patient with suspected Marfan’s syndrome.

A retrospective review of notes and imaging from the electronic medical record system Evolve were used to analyse and compare the results with published data on similar cases.

A 48- year old lady was referred to our ophthalmology department with a recent history significant for reduced visual acuity and intermittent horizontal diplopia affecting the right eye spanning a 2 month duration.

Relevant medical background includes: pulmonary embolism (2 episodes, unprovoked), asthma, depression. She is also currently under investigation for Marfan’s syndrome.

Anterior segment exam revealed zonular loss bilaterally (more pronounced in the right eye), inferiorly displaced crystalline lens in the right eye and phacodonesis bilaterally. The cornea was otherwise clear and the anterior chamber was quiet.

Dilated posterior segment examination revealed cup to disc ratio 0.6 bilaterally, flat retina and the absence of posterior vitreous detachment. The initial right visual acuity was 6/9 with glasses and left visual acuity was 6/7.5 with glasses. The intraocular pressure was 7 mm Hg in the right eye and 10 mm Hg in the left eye.

Bilateral ectopia lentis was the impression at this point, with right eye predominance. An informed decision to proceed to surgical intervention was made. The surgery involved right pars plana vitrectomy, lensectomy, PVD induction and Carlevale intraocular lens implantation. The final right visual acuity was 6/9-1 with glasses with an IOP 10 mmHg.

The patient with suspected Marfans’ syndrome and right eye ectopia lentis experienced an excellent outcome with surgery with scleral fixated Carlevale lens.