First Author: A.Khudiakov RUSSIA
Co Author(s): V. Egorov V. Rudenko
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Posterior lenticonus (PL) is a rare progressive disease characterized by protrusion of the posterior lens capsule along with lens cortex into the vitreous cavity. PL is associated with rupture of the posterior lens capsule resulting from hyaloid artery traction, disturbances in the tunica vasculosa lentis, congenital weakness of the posterior capsule, systemic diseases. The main method of treatment is lens extraction with implantation of IOL. In rare cases PL may be complicated with rupture of the posterior capsule with hanging of lenticular cortex in vitreous cavity. Purpose – the analysis of our results of surgical treatment of complicated PL.
The research was performed in the State Institution Eye Microsurgery Complex named after academician S.N. Fyodorov, Khabarovsk, Russia
7 patients (7 eyes) with complicated PL were observed. The age of the patients ranged from 1.5 to 4 years old. One patient was of 14 years old. There were 5 girls and 2 boys. During first examination unilateral cataract was revealed in all patients. There were total opacification and swelling of the cortex of the lens in 4 cases. In 3 cases the anterior cortex remained particularly clear and round defect of posterior capsule with lenticular cortex hanging in vitreous cavity (fish tail sign) were observed. There were signs of phacogenic uveitis in all patients. The visual acuity was correct light perception in all cases. One patient of 14 years old characterized visual loss as “acute”. B-scan ultrasonography showed a mass bulging from the posterior surface of the lens toward the vitreous, vitreous opacities of varying degrees. Vitreoretinal tufts appeared in two cases with long-term phacogenic uveitis. Combined surgery was performed in all patients: phacoaspiration with implantation of posterior chamber IOL in capsular bag, 25 Ga three-port pars plana vitrectomy with removing of lenticular masses and proliferative tissue. Follow up period varied from 4 months to 3 years.
Surgical treatment of patients with PL consisted of: making corneoscleral tunnel 2.2 mm under the conjunctival flap, anterior capsulorhexis, cataract extraction by phacoaspiration, implantation of elastic IOL in capsular bag. Then 25 Ga pars plana vitrectomy with removing of lenticular masses and destructively changed vitreous, dissection and removing of vitreoretinal tufts were performed. There were not intraoperative complications in all cases. There was postoperative moderate fibrinoid reaction in anterior chamber in 3 cases, which was reduced in 2-4 days. Object recognition appeared in 3-5 days of postoperative period in all cases. Local anti-inflammatory therapy was performed until 1 month of postoperative period. There was not recurrence of uveitis in all cases. Courses of orthoptic and pleoptic therapy of amblyopia were performed in 6 cases. 2 patients achieved visual acuity of 0.2, 3 patients – 0.4, 1 patient – 0.7, 1 patient – 0.9 by the follow up of 3 years.
1. The analysis of the results of treatment of PL revealed that there are difficulties with correct diagnosis of this disease at the level of primary health care. 2. Complicated PL is associated with phacogenic uveitis in all cases that can be threat not only for visual functions, but also for eye as an organ. 3. Usage of modern combined methods of vitreoretinal surgery allows successfully eliminating the consequences of complicated PL and achieving fine functional results, according to the initial condition of the eye and existence and degree of the amblyopia.