Slit-lamp photographs of the patient on presentation. (A) Slit-lamp photograph of the right eye shows slightly shallow anterior chamber and patent peripheral iridotomy. (B) Slit-lamp photograph of the left eye shows conjunctival hyperemia, significantly shallow anterior chamber, mildly dilated pupil, and patent peripheral iridotomy. 

Slit-lamp photographs of the patient on presentation. (A) Slit-lamp photograph of the right eye shows slightly shallow anterior chamber and patent peripheral iridotomy. (B) Slit-lamp photograph of the left eye shows conjunctival hyperemia, significantly shallow anterior chamber, mildly dilated pupil, and patent peripheral iridotomy. 

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Rationale Laser peripheral iridotomy (LPI) is commonly performed as a primary treatment for acute primary angle closure glaucoma after administration of anti-glaucoma medications or for prevention of this condition. Minor complications may occur following LPI and most of them do not have deleterious consequences. We report a rare case of lens sublu...

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... and 31 mm Hg in the left eye. Corneal endothelial cell density in the right eye was 2310 cells/mm 2 and in the left eye was 2560 cells/mm 2 . Axial length in the right eye was 21.36 mm and in the left eye was 21.45 mm. On slit-lamp examination, the significant shallowing of both peripheral and central anterior chamber was noted in the left eye (Fig. 1B). The LPI was patent in the inferior quadrant in both eyes (Fig. 1A, B). Mild lens opacity with no signs of capsular pseudoexfoliation was observed in both eyes. The cup-to-disc ratio was 0.5 to 0.6 in both eyes. The optical coherence tomography scan revealed the thinning of mean retina nerve fiber layer thickness in the inferior ...
Context 2
... the right eye was 2310 cells/mm 2 and in the left eye was 2560 cells/mm 2 . Axial length in the right eye was 21.36 mm and in the left eye was 21.45 mm. On slit-lamp examination, the significant shallowing of both peripheral and central anterior chamber was noted in the left eye (Fig. 1B). The LPI was patent in the inferior quadrant in both eyes (Fig. 1A, B). Mild lens opacity with no signs of capsular pseudoexfoliation was observed in both eyes. The cup-to-disc ratio was 0.5 to 0.6 in both eyes. The optical coherence tomography scan revealed the thinning of mean retina nerve fiber layer thickness in the inferior quadrant and the standard automated perimetry (Humphrey Field Analyzer, ...
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... and forward rotation, and slight lens tilting toward the iris were observed in the left eye (Fig. 2C, D). The central anterior chamber depth was 1.01 mm in the left eye, while it was 2.09 mm in the right eye. Further examination revealed the possible dehiscence of lens zonula in the inferior quadrant, which corresponded to the LPI position (Fig. 1D). After the cycloplegic provocation, IOP rose to 44 mm Hg, thus the pathogenetic factor related to ciliary block was ...

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... Postcataract surgery lens subluxation is also a common issue for clinical management. Occult lens subluxation could also be secondary to laser peripheral iridotomy [3]. e major changes in lens subluxation of different causes are typical: partial tearing or loosening of zonular ligaments and dislocation of the lens. ...
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Purpose: To evaluate the outcomes of femtosecond laser, modified capsular tension ring, and iris hook-assisted surgical treatment of lens subluxation in patients with elevated intraocular pressure (IOP). Methods: Fifteen patients with lens subluxation and elevated IOP were enrolled in this study. All patients underwent femtosecond-laser-assisted cataract surgery/phacoemulsification/intraocular lens implantation/modified capsular tension ring (MCTR) implantation with iris hook assistance. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), IOP, number of glaucoma medication complications, endothelial cell density (ECD), and tilt of the lens were recorded before and after surgery. All patients were observed for 24 months postoperatively. Results: UCVA and BCVA increased significantly at 1 month, 6 months, 12 months, and 24 months, compared with preoperative UCVA and BCVA (P < 0.001). IOP significantly decreased at 1 month, 3 months, 6 months, 12 months, and 24 months, compared with preoperative IOP (P < 0.001). 3 patients received glaucoma medications to control IOP after surgery. All medications were discontinued at 3 months postoperatively. Conjunctival redness or hemorrhage was observed in 11 patients (73.3%); transient corneal edema was observed in 3 patients (20.0%); and posterior capsule opacification occurred in 1 patient (6.67%). The ECD and tilt of the lens are within an acceptable range. Conclusion: The combined use of a femtosecond laser, MCTR, and iris hooks is an effective and safe method for treating patients with lens subluxation and elevated IOP.
... Usually, PLI is a safe treatment with a very low possibility of minor complication occurrence. Some cases of lens subluxation related to PLI still have been reported (10,11), indicating that the PLI may damage zonular fibers around the related site. In this case, the focal dislocation of the lens was located at the inferior nasal quadrant, which is far from the site of PLI. ...
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Purpose To report a rare case of delayed dislocation of a novel posterior chamber phakic intraocular lens into the vitreous cavity, which was successfully treated by a reformed technique. Case Presentation A 29-year-old female received Ejinn phakic refractory lens (EPRL) implantation to correct her high myopia. Spontaneous dislocation into the vitreous cavity occurred 26-months post-operatively without traumatic history. Pars plana vitrectomy combined with cutting the EPRL into two equal pieces was performed to remove the dislocated EPRL. Conclusion Dislocation into the vitreous cavity of EPRL can be successfully and easily removed by our reformed technique. Concerns about zonules-related complications pre-operatively, intraoperatively, and post-operatively must be raised in the practice of EPRL implantation.
... Lens subluxation has multi-factorial etiology, including congenital or developmental conditions (such as Marfan syndrome, Weill-Marchesani syndrome, and homocystinuria), comorbidities of eye diseases, associated with zonular disease (such as high myopia, retinitis pigmentosa, pseudoexfoliation syndrome, and uveitis), and a history of ocular blunt trauma or previous intraocular surgery (1)(2)(3)(4)(5)(6)(7). This condition can sometimes induce acute secondary angle closure (ASAC) that presents with non-specific signs and symptoms, similar to acute primary angle closure (APAC), such as blurred vision, elevated intraocular pressure (IOP), shallow anterior chamber, severe ocular pain, headache, nausea, and vomiting. ...
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Purpose To evaluate the clinical characteristics and ocular features of patients with acute secondary angle closure, associated with lens subluxation (ASAC-LS). Methods We performed a retrospective study at the EENT Hospital of Fudan University, Shanghai, China. A total of 41 affected eyes from 41 patients were enrolled in this study. Furthermore, 20 affected eyes were part of the ASAC-LS cohort and 21 affected eyes were included in the acute primary angle closure (APAC) cohort. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), axial length (AL), minimum corneal curvature (K1), maximum corneal curvature (K2), and anterior chamber depth (ACD) were measured and compared between the 2 cohorts. In addition, inter-eye (intraindividual) comparison was performed. Results The ASAC-LS cohort exhibited younger ages, more frequent trauma history (35%), lower IOP (27.43 ± 13.86 mmHg vs. 41.27 ± 10.36 mmHg), longer AL (23.96 ± 2.60 vs. 22.49 ± 0.77 mm), shallower ACD (1.28 ± 0.38 vs. 1.58 ± 0.23 mm), and bigger ACD differences (0.99 ± 0.52 vs. 0.15 ± 0.19 mm), as compared with the APAC cohort (all p < 0.05). Moreover, eyes from the lens subluxation cohort experienced worse BCVA, higher IOP, and shallower ACD than their matched unaffected eyes (all p < 0.05). Although longer AL, shallower ACD, and bigger ACD differences were strongly correlated with lens subluxation in a univariate logistic regression analysis, only the ACD difference remained significant in the multivariate model ( p = 0.004, OR = 1,510.50). Additionally, according to the receiver operating characteristic (ROC) curve analysis, both ACD and ACD differences had greater value in the differential diagnosis of ASAC-LS and APAC, with a cut-off value of 1.4 and 0.63 mm, respectively. Conclusions Shallower ACD and larger ACD differences provide the promising diagnostic potential for patients with ASAC-LS.
... Complications of LPI include transient blurring of vision, transient raised IOP, diplopia, corneal damage, minor iris bleed, uveitis, localised lens or zonular damage/subluxation, closure of iridotomies, retinal burns and detachment. 1 Zonular dehiscence following LPI is rare and has been reported in few cases. [2][3][4] Shockwaves from LPI could have damaged the already predisposed or weak zonules causing lens subluxation or dislocation. Athanasiadis et al reported LPI as a possible cause for the zonular dehiscence which occurred during the phacoemulsification. 5 In most of these cases, lens subluxation or dislocation occurred after months to years after LPI and evidence of causality between them was inadequate. ...
... 6 Hu et al also reported an occult lens subluxation related to LPI after 5 days of treatment. 4 We report a rare case of early zonular dehiscence only after 2 days of LPI with the possibility of multiple attempts of peripheral iridotomy of high energy (evident by two visible large peripheral iridotomy with surrounding iris chafing) in a single sitting leading to zonular dehiscence. ...
... There could also be an occult subluxation which may be diagnosed during a lens extraction only. [36] Mild iris bleed is an invariable part of an iridotomy. ...
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... Natural lens dislocation or subluxation is one of the reported complications of the LI. 42,124 The results of this study may not be generalizable to people who would not fulfill the inclusion criteria of the study; however, clear lens extraction has been recommended in PACG patients with a closed angle after LI and uncontrolled IOP with medications. 63,151,162 Peterson and coworkers 104 performed phacoemulsification on 9 patients (3 had clear lens) with plateau iris syndrome who had undergone laser iridoplasty and LI and were on medication. ...
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Primary angle closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that in many patients the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management.
... Laser peripheral iridotomy as well as cataract extraction have proved their effectiveness in treating angle-closure glaucoma since it prevents the closure of the angle. The possible side effects of the treatment are mainly related to the size of the iridotomy, and they include structural zonular damage, corneal endothelium damage, pigment dispersion, double vision, intraocular haemorrhages (Hu et al., 2017). The second part of this work is therefore focused on studying the modification of aqueous flow and pressure in the presence of iridotomy with the aim of understanding the role of the size of the hole. ...
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