Schäfer S., Spraul C. W., Lang G. K.

Department of Ophthalmology, University Ulm, Prittwitzstrasse 43, 89075 Ulm

Background: More than 50% of all lens luxations are caused by acute trauma. Luxations into the vitreous body are common, in contrast to luxations into the anterior chamber are rare. Here we report two patients who have developed a dislocation of a primary into the vitreous body luxated lens into the anterior chamber.
Methods: We report the clinical findings including the surgical proceedings in these patients. Additionally, we performed a Medline search for similar cases.
Results: Both patients presented with lens luxation to the vitreous body secondary to blunt ocular trauma. Several days later a spontaneous dislocation of the into the vitreous body luxated lens into the anterior chamber occurred. We immediately performed a YAG-iridotomy followed by intracapsular lens extraction and implantation of a anterior chamber intraocular lens. The Medline search revealed no similar cases.
Conclusions: As a result of whiplash-like movements of the vitreous body, a dislocation of an into the vitreous body luxated lens into the retroiridal space my occur. This may be facilitated by undamaged zonular fibers. The immediately retroiridal lens position may cause a pupillary block with l fluid misdirection into the space behind the iris-lens-diaphragma resulting in a consecutive pressure increase. This pressure increase causes an anterior movement of the lens and may be followed by a complete dislocation into the anterior chamber especially in the case of coexisting traumatic mydriasis. As a result of this lens dislocation into the anterior chamber an inverse papillary block develops. The situation necessitates an iridotomy prior to the surgical lens extraction.

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