Cito Case Report

TRAUMATIC ANTERIOR LENS

DISLOCATION WITH IRIDODIALYSIS

Vandaristya P Ardani, Indri Wahyuni

INTRODUCTION
Blunt trauma to the eye

Sudden compressive
deformation of the globe

Zonular fibers are

damaged

Dislocation or subluxation
of the lens
 LENS DISLOCATION
- Ectopia lentis  the dislocation or displacement
of the natural crystalline lens
Free-floating
in the vitreous

Luxated In the anterior

(dislocated) chamber
Ectopia lentis
Lies directly
Subluxed
on the retina
 IRIDODIALYSIS

- Iridodialysis  dehiscence of the iris from the

ciliary body at its root as a results from
compresion of the anterior-posterior aspect of
the globe, which stretches the anterior
segment structures and leads to the
separation of the iris root from the ciliary body
- The pupil is typically D-shaped and the dialysis
is seen as a dark biconvex area near the limbus
CASE PRESENTATION
 PATIENT’S IDENTITY
• Name : Mrs. H
• Sex : Female
• Age : 53 years old
• Adress : Ponorogo
 SUBJECTIVE
Chief complaint : Blurred vision on the right eye
- Patient complaint sudden blurred vision on the right
eye since 2 weeks ago after got hit by a belt. Redness
(+), pain (+), teary (+), seeing halo (+), bleeding (-),
glare (-), headache (-), nausea (-), vomiting (-). After
the accident patient couldn’t see anything but after 2
days treated with anti-glaucomatous medicine her
vision was getting better (she can see hand movement)
- Patient was referred from Ponorogo General Hospital
with diagnose RE Lens Luxation + susp Corpus Vitreous
Hemorrhage.
 SUBJECTIVE
- Patient was hospitalized in Ponorogo General
Hospital and got Dexamethasone-Neomycin-
Polymixin Sulphate ED, Timolol ED, Glaucon tab
and KSR tab as theraphy. After a week
hospitalized patient was referred to Dr. Soetomo
Hospital.
- History of wearing spectacles (-), Diabetic Mellitus
(-), Hypertension (-)
- History of eye surgery (-)
- Social history : patient is a housewife
 GENERAL STATUS

• Glasgow Coma Scale : 4-5-6

• Blood Pressure : 150/90 mmHg
• Heart Rate : 88 x/m
• Respiratory Rate : 20 x/m
• Temperature : 36.8°C
 OBJECTIVE
(November 2nd 2017)
• Visual Acuity:
– RE : 1/300 projection illumination good in all
direction, red green test good
– LE : 5/7.5 cc S+0.50  5/5

• Intraocular Pressure :
– RE : 37.2 mmHg (on theraphy)
– LE : 19.6 mmHg
 Anterior
Right Eye Left Eye
Segment
Edema (-), Spasm (–) PALPEBRA Edema (-), Spasm (–)

Hyperemia (+) CONJUNCTIVA Hyperemia (-)

Hazy CORNEA Clear
Vitreous (+), coagulum ANTERIOR
Deep
(+), lens (+) CHAMBER
Iridodialisis at 4-8
IRIS Radier
o’clock
Not round, Ø 9 mm Round, Ø 3 mm
PUPIL
Light Reflex (+) Light Reflex (+)
Opaque (+),
LENS Clear
Anterior dislocation (+)
PATIENT’S PICTURE
RE LE
 FUNDUSCOPY

Right Eye Left Eye

Fundal Reflex (+)
Detail difficult to evaluated
Fundal reflex (+)
Optic nerve head sharp
margin, normal colour
Retina : bleeding (-),
exudate (-)
Macular reflex (+)
 USG
Moestidjab, MD,
Ophth(C) (Nov 6th 2017) :
• Vitreous echogenic
lesion berbentuk
partikel dan membran
dengan echospike yang
rendah
• Pada realtime
gambaran partikel Kesimpulan :
maupun membran • Perdarahan vitreous
mobilitasnya tinggi dan PVD
• Retina on place • Retina attached
 ANCILLARY TESTS
• Laboratory (Nov 3rd 2017)
– WBC : 10.43

• Chest X-Ray (Nov 3rd 2017)

– Cor dan pulmo tak tampak kelainan
 CONSULTATION
• Indri Wahyuni, MD, Ophth(C) (Nov 2nd 2017):
- Pro OD Ekstraksi Lensa dengan GA
- Terapi glaukoma dilanjutkan

• Yulia Primitasari, MD, Ophth(C) (Nov 2nd 2017) :

– Pro case
– Iridodialisis di jam 4-8, lensa luksasi lewat celah
iridodialisis
– Terapi tetap
– Pro ekstraksi lensa sesuai TS Katarak
 CONSULTATION
• Evelyn Komaratih, MD, Ophth(C) (Nov 6th 2017):
- Pro cito case
- Tindakan dilakukan setelah presentasi kasus

• Moestidjab, MD, Ophth(C) (Nov 6th 2017) :

– Iridodialisis (+), lensa luksasi lewat celah iridodialisis
– Saran ekstraksi lensa dengan tehnik ICCE (insisi di
superior), buat jahitan persiapan di daerah insisi
– Sebelum dilakukan tindakan, TIO harus rendah dan
stabil dalam beberapa hari untuk meminimalisir
resiko terjadinya choroidal detachment
 CONSULTATION
• Cardiology Department
CRI Class I
Hipertensi stage I JNC VII

• Anesthesiology Department
PS ASA II
 PROBLEM LISTS
• Right eye got hit by a belt
• History of sudden blurred vision, pain and
redness after the accident
• Right eye : hyperemia conjunctiva, vitreous,
coagulum and lens mass in anterior chamber,
iridodialisis at 4-8 o’clock, pupil not round, lens
opaque and dislocated into anterior chamber
• USG : vitreous hemorrhage and PVD
DISCUSSION
 Lens luxation or subluxation and zonular damage
after ocular trauma may be associated with vision-
threatening glaucoma

Lens
Vitreous
dislocation
prolapse
anteriorly

Pupillary
block
glaucoma
 Small asymptoma Requires no
iridodialysis tic treatment

Wide Presence of Surgical

iridodialysis symptoms intervention
 Non
Surgery
surgery
• The prognosis for patients with traumatic
dislocation of the lens is good with prompt
recognition of this type of injury and treatment
of glaucoma
• Urgent ophthalmologic consultation is
necessary.
• The outcome may be poor if prolonged anterior
lens dislocation results in corneal
decompensation, or if glaucoma associated with
lens dislocation is not promptly recognized and
treated.