The document discusses lens trauma including subluxation and dislocation. The pathophysiology is described as a compressional force on the eye causing the zonular fibers that anchor the lens to stretch or damage. This can lead to subluxation or complete dislocation of the lens. Clinical findings may include decreased vision, diplopia, myopia, astigmatism, and a tremulous iris. Surgical management depends on the degree of zonular damage and may include lens extraction and intraocular lens implantation. Capsular tension rings can be used to provide circular expansion of the capsular bag and improve stability and centration during surgery.

1. Mariam magdy adly

2.  Lens trauma:
 Lens subluxation
 Lens dislocation
 Anterior
 posterior

3.  Pathophysiology
The mechanism in blunt traumatic lens dislocation
is due to a compressional anterior-posterior force
of the cornea and anterior sclera causing rapid
compensatory equatorial expansion of the globe.
As a result, the zonular fibers, which anchor the
lens to the eye, may become stretched or
damaged.
 Partial zonular dialysis may lead to subluxation
while complete zonular rupture leads to
complete luxation.

5.  Visual acuity:
 Decreased visual acuity
 Poor near vision
 Monocular diplopia
 refraction:
 Myopia and astigmatism

6.  Tremulus iris
 Edges of dislocated lens may be identified in
pupillary space
 Vitreous prolapse
 gonioscopy
 Angle recession

9.  Retinal breaks
 Retinal detachment

10.  Glaucoma
 Uveitis
 Corneal decompensation
 Amblyopia (young age)
 Retinal detachment

11. conservative
Mininmal
 Glasses( phakic)
 Colored contact lens
 Miotics
 Marked
 Glasses(aphakic)
 Optical iridectomy
 surgical

12.  Lens induced uveitis
 Lens induced glaucoma
 Lenticular opacity
 Anisometropia
 Impending lens dislocation

13.  Degree of zonular dehicense
 Up to 4 clock hours
 CTR with IOL implantation
 3 to 6 clock hours
 modified CTR with single loop
 6-9 clock hours
 modified CTR with double loop
With IOL implantation in the bag or the sulcus
More than 9 clock hours
Pars plana Lensectomy
Vitrectomy probe (clear)
Fragmatome (cataractus)
with scleral fixed IOLS,anterior chamber IOLS
Iris fixed IOLS

14.  Perferably away from area of zonular
weakness.
 Use high molecular weight viscoelastic.
 Capsulorrhexis should be intiated in area
remote from the dialysis.
 Capsulorrhexis is more easily performed with
forceps , should be made off center in an eye
with significant lens subluxation

16.  Good sized rhexis
 supra capsular technique to decrease stress
over the zonules
 Visco elevation

17. Devices used in surgery
Capsular tension ring
Indication
1-Missing or damaged zonules
2-Lens subluxation
3-PEX
4-High myopia
5-Marfan syndrome
Mechanism
Circular expansion of the bag
Stable condition during surgery
Improve IOL centration
Reduced risk of capsular fibrosis
Resist capsular shrinkage