The authors describe recurrent lens dislocation into the anterior chamber in a young girl with homocystinuria. The patient's 12-year-old sister died after a cerebrovascular accident caused by the same disease. This report highlights the importance of early dietary restrictions and treatment.
Twenty two cases of dropped nucleus following 1,196 phacoemulsification procedures in cataract surgery were examined retrospectively to determine the incidence, predisposing factors and visual outcomes of this dreaded complication. All the cases underwent pars plana vitrectomy and the lens fragments were removed with phacofragmotome, vitrectomy cutter or delivered through limbus. The incidence of dropped nucleus was 1.84%. The predisposing factors were hard cataracts (13.6%), polar cataracts (9.1%), previously vitrectomized eyes (4.5%) and high myopia (4.5%). The final visual outcome was > or = 6/12 in 10 eyes (45.5%); complications were seen in 5 eyes (22.7%). The interval between initial surgery and vitrectomy, the method of fragment removal and the type of lens implanted, did not influence the final visual outcome.
Five patients having uncomplicated phacoemulsification were implanted with CT-Asphina 603P intraocular lenses into the capsular bag. After a few months, three of the patients had haptic flexion anterior to the optic despite minimal capsular fibrosis. One patient had spontaneous dislocation of the intraocular lens into the anterior chamber with only minimal capsular fibrosis. Another patient had one haptic dislocated out of the bag. Late intraocular lens dislocation is also seen in newly designed preloaded intraocular lenses despite the absence of significant capsular fibrosis. Haptic-optic junction design and intraocular lens material play important roles in such complication. A slightly large capsulorhexis might be a deterrent for implantation of this intraocular lens.