Lens displacement associated with pseudocapsular exfoliation. A report on 19 cases in the Southern Bantu.

Abstract

Consecutive or secondary displacement of the lens is a well-recognized condition caused by stretching, inflammation, or degeneration of the zonule. Degeneration occurs with long-standing glaucoma, high myopia, retinal detachment, and particularly with a mature or hypermature cataract (Duke-Elder, I969).Lens displacement associated with pseudocapsular exfoliation has not been well described. Irvine (I940) reported two cases with tremulous lenses and two in which the lens dislocated when grasped with forceps; these were all complicated by vitreous loss and were taken from a series of 42 cases of glaucoma capsularis. He drew attention to the possibility of a weak zonule, a fluid vitreous, and a friable capsule.Gradle and Sugar (I 940) described 43 eyes with pseudocapsular exfoliation and concluded that, because of zonular degeneration, spontaneous dislocation might occur in advanced cases. There were four attempted intracapsular extractions and in three of them there was vitreous loss. Sugar (I957) quoted two cases of spontaneous dislocation and several in which dislocation occurred during surgery in a series of I54 cases of pseudocapsular exfoliation and concluded that there was a tendency to spontaneous and operative dislocation.Gifford (I958) quoted three cases with spontaneous dislocation in a series of 62 cases. In 22 cataract extractions he noted that the lenses dislocated easily without rupture of the capsule, vitreous loss, or fluid vitreous, indicating that the zonule was more friable than normal.Tarkkanen (i962), in a review of 418 patients, noted nine eyes with displaced lenses out of a total of 635 eyes with pseudocapsular exfoliation. Present investigationsDuring a 2 year clinical study of lens displacement nineteen patients with 22 displaced lenses in association with pseudocapsular exfoliation have been seen. The clinical manifestations of these cases and the results of cataract surgery in eight of them are described below. MaterialDuring I968 and I969 all cases with displacement of the lens seen at the Eye Department of Baragwanath Hospital and the St. John's Eye Hospital, Johannesburg, were referred to the author for clinical assessment, treatment, and follow-up. Of these patients go per cent. are Southern Bantu, the remaining I0 per cent. being Asian or Coloured. 238 eyes with lens displacement have been seen to date, and 22 associated with pseudocapsular exfoliation were seen in nineteen Bantu patients.

Pseudoexfoliation glaucoma in Greece

“…Dehis cense of the anterior capsule of the lens in association with cataract and phakadonesis have been described as concomitant feature of pseudoexfoliation. 35,36 In the present series these signs were observed in four cases and two cases respectively,…”

Phacoemulsification in Pseudoexfoliation Syndrome

“…In contrast, the prevalence of zonulysis and phakodonesis has been extensively reported with PEX [1, 7, 14, 16,40,41,42,43,44]. Moreno et al [11] found a significantly higher incidence of iridophakodonesis in eyes with PEX having light-colored irides than in those with dark irides.…”

Genetic association of LOXL1 gene variants and exfoliation glaucoma in a Utah cohort

“…In addition, it is well known that XFG patients are high risk cataract surgery candidates due to weak zonules, 24 degenerate lens capsules 25 and poor dilation. 26 With the discovery of these SNPs, this will help in identifying those individuals, who are at risk, especially those with very minimal exfoliation syndrome clinical findings that may be overlooked during routine exam but have a strong family history of XFG.…”