Cases reported "Lens Diseases"

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1/19. Pseudocapsulorrhexis in a patient with iridocorneal endothelial syndrome.

    We describe a patient with Chandler's syndrome variant of the iridocorneal endothelial syndrome in whom ectopic Descemet's membrane was found intraoperatively on the anterior surface of the lens. Initially, the membrane was confused with the anterior lens capsule during extracapsular cataract extraction, leading to the performance of a pseudocapsulorrhexis. Electron microscopy disclosed that the epilenticular membrane was composed of multiple layers of abnormal basement membrane consistent with the iridocorneal endothelial syndrome.
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2/19. Loss of iridolenticular contact in eyes with exfoliation syndrome may protect against glaucoma.

    PURPOSE: To provide evidence for the hypothesis that dynamic iridolenticular contact predisposes to the development of glaucoma in exfoliation syndrome (XFS). methods: We present four patients with bilateral XFS and unilateral exfoliation glaucoma (XFG) whose normotensive eyes had suffered traumatic loss of dynamic iridolenticular contact. RESULTS: All 4 patients had bilateral XFS and developed XFG only in the untraumatized eyes. One patient had loss of iridolenticular contact in the traumatized eye, two had a nonreactive pupil, and one had had intracapsular cataract extraction at age 28. CONCLUSIONS: Loss of dynamic iridolenticular contact may help to protect against development of glaucoma in eyes with XFS.
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3/19. Bilateral anterior lenticonus: Scheimpflug imaging system documentation and ultrastructural confirmation of Alport syndrome in the lens capsule.

    BACKGROUND: Alport syndrome is a combination of proteinuria, hematuria, and neurosensory high-frequency deafness. Bilateral anterior lenticonus may be a late sign. diagnosis relies on characteristic electron microscopy changes of glomerular basement membranes in renal biopsy specimens. PATIENT: A 38-year-old man was seen for progressive visual acuity loss (20/400 OU; best-corrected visual acuity, 20/60 OD and 20/50 OS). Findings from slitlamp examination included bilateral anterior lenticonus and central posterior subcapsular cataract, documented using a modified Scheimpflug imaging system. Retinal pathology was not present. On detailed questioning, a history of microhematuria and proteinuria since childhood and progressive high-frequency deafness for years were discovered. The family history was negative for nephropathies, deafness, or eye diseases. cataract extraction rehabilitated the patient's vision. RESULTS: Electron microscopy of a fragile capsulorhexis specimen showed typical thinned basal lamina with basement membrane disruptions. CONCLUSIONS: Anterior lenticonus is a rare bilateral progressive developmental anomaly. More than 90% of cases are associated with Alport syndrome. For diagnosis of Alport syndrome, the presence of 3 of 4 criteria is required: family history positive for Alport syndrome, progressive intra-auricular deafness, characteristic eye anomalies, and positive findings from glomerular ultrastructural examination. We believe that ultrastructural proof of anterior lenticonus may also be provided in the lens capsule. Arch Ophthalmol. 2000;118:895-897
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4/19. Complete capsular bag distension syndrome.

    After conventional extracapsular cataract extraction and in-the-bag intr aocular lens (IOL) implantation 3 years previously, the partially cut su perior one-third of the anterior capsulotomy flap resealed in the eye of a 55-year-old woman. With the integrity of the capsular bag restored, it distended fully; the IOL was in the center and milky fluid accumulated inside. A neodymium:YAG laser was used to drain the milky fluid and di srupt the opacified anterior and posterior capsules, restoring vision.
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5/19. Capsular bag distention syndrome after combined cataract-lens implant surgery and Ahmed valve implantation.

    PURPOSE: To describe the capsular bag distention syndrome after combined cataract extraction with posterior lens implant and aqueous drainage device. methods: Case report. RESULTS: A persistently shallow anterior chamber and low intraocular pressure developed after combined cataract extraction with posterior chamber lens implant and Ahmed aqueous drainage device. An optically empty space between the lens implant and posterior capsule was detected 18 days after surgery. The anterior chamber deepened within minutes after Nd:YAG posterior capsulotomy. CONCLUSION: The capsular bag distention syndrome needs to be included in the differential diagnosis of shallow anterior chamber with low intraocular pressure after combined cataract extraction and glaucoma valve implant surgery.
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6/19. Double-ring and double-layer sign of the anterior lens capsule during cataract surgery.

    BACKGROUND: Splitting of the lens capsule with a double-ring contour during continuous curvilinear capsulorrhexis has not often been reported. CASE: An 86-year-old woman underwent phacoemulsification cataract extraction with intraocular lens implantation in the right eye. Preoperatively, the anterior lens capsule appeared normal. OBSERVATIONS: A double-ring sign was observed during capsulorrhexis. During intraocular lens implantation, the capsule developed radial tears, and a double layer of the capsule was noted. The patient's postoperative course was uneventful. CONCLUSIONS: The findings in our patient may be uncommon and may differ from but resemble true exfoliation.
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7/19. Surgical identification of posterior lenticonus.

    A 79-year-old patient was referred for cataract and high myopia. His optometrist noted difficult refraction. biometry predicted an emmetropic intraocular lens power of 22.0 diopters. During cataract extraction, the typical features of posterior lenticonus were noted. A careful look for posterior lenticonus is suggested in cases in which there is a discrepancy between the biometry and refraction and no significant nuclear sclerosis to account for the high myopia. Surgeons should be aware of dehiscence or thinning of the posterior capsule while doing cataract extraction in these patients.
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8/19. Capsular block syndrome in a case with excessive cortical remnants.

    Ten days after cataract extraction with phacoemulsification and in-the-bag acrylic intraocular lens implantation, capsular block syndrome developed in the right eye of a 62-year-old man. Aspiration of the swollen cortical remnants resulted in resolution of the capsular block.
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9/19. multiple myeloma presenting as vortex crystalline keratopathy and complicated by endocapsular hematoma.

    The crystalline keratopathy of multiple myeloma may involve the corneal epithelium, but has not previously been described in a vortex epithelial distribution. Endocapsular hematomas have been described in the period immediately after extracapsular cataract extraction, but not later on or in association with systemic disease. We report a pseudophakic patient who developed a vortex epithelial crystalline keratopathy as a presenting sign of multiple myeloma, and who subsequently developed a spontaneous endocapsular hematoma.
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10/19. Complicated extracapsular cataract surgery in pseudoexfoliation syndrome: a case report.

    Crystalline lens dislocation and zonular dialysis during intraocular surgery are recognised features of the pseudoexfoliation syndrome (PES). A case is reported in which zonular dialysis occurred in both eyes during extracapsular cataract extraction. In particular surgery was complicated by difficulty in performing anterior capsulotomy. Careful preoperative assessment and peroperative technique may help to reduce the risk of surgical complication in PES.
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