Intravitreal luxated lens stuck on the optic disc: a case report

Abstract

Background: We encountered a rare patient with lens luxation in which the lens had become stuck on the optic disc. Findings obtained during vitreous surgery suggested that the luxated lens had become stuck on the optic disc via residual vitreous gel.

Case presentation: An 88-year-old Japanese man experienced lens luxation into the inferior vitreous cavity while undergoing treatment for glaucoma in his left eye. Because no inflammation was present upon examination, we observed the patient without prescribing any additional medications except for the eye drop treatment for glaucoma. Two years later, the patient revisited our clinic after suddenly noticing a visual disturbance in his left eye. A fundus examination revealed that the luxated lens had become stuck on the optic disc and displayed no changes in relation to the patient's head position or eye movement. Subsequently, vitreous surgery was performed to remove the luxated lens. During the surgery, we observed an aggregation of vitreous gel between the luxated lens and the optic disc. The luxated lens was successfully mobilized by pushing with a vitreous cutter and then extracted through a corneoscleral incision using perfluorocarbon liquid. At 4 months after surgery, the patient's visual acuity had improved to 20/25.

Conclusions: The findings of this study suggest that the luxated lens had become stuck on the optic disc via residual vitreous gel on the optic disc. The surgical procedure of extracting the luxated lens through a corneoscleral incision using perfluorocarbon liquid was found to be both safe and effective.

Fig. 1

a Preoperative anterior segment of the patient’s left eye. Slit-lamp examination revealed absence of the crystalline lens and deep anterior chamber. b Preoperative fundus image of the left eye. The luxated lens in the vitreous cavity can be seen stuck to the optic disc. The patient’s visual acuity in that eye was 20/400. c B-mode ultrasonography findings. No movement of the luxated lens was observed in relation to changes in the patient’s head position or eye movement

Fig. 2

a Image showing the intraoperative findings. An aggregation of vitreous gel (arrows) on the optic disc was found. The luxated lens probably became stuck on the optic disc via this residual vitreous gel. b An illustration depicting this mechanism

Fig. 3

a Postoperative anterior segment of the patient’s left eye. Slit-lamp examination revealed no new changes. b Postoperative funduscopic image of the left eye. Following vitreous surgery, the macula could be visualized and the corrected visual acuity in that eye had improved to 20/25