Abordarea chirurgicală a unui caz cu subluxație bilaterală marfanoidă – prezentare caz

A. Albert

Albert Optimun Medicals Sfântu Gheorghe

Cuvinte cheie: subluxație bilaterală, cristalin EDOF,

Prezint cazul unui pacient de 62 de ani, care s-a prezentat la examinare cu subluxație cristaliniană
bilaterală și scăderea vederii. Subluxația bilaterală era cunoscută anamnestic, fără alte modificări ale
sindromului Marfan. Both eyes had nuclear cataract, iridodonesis, subluxated lenses (RE sup-nas,
LE sup-temp). Visual acuity was on right eye 0,4 with -6,0 Dsf, left eye 0,5 with -7,0Dsf. Biometry
didn’t showed corneal astigmatism, and so in order of the patient’s wishes we decided to implant
EDOF lenses, aiming micro-monovision. After removing the lens by phacoemulsification, the
capsular bag was stabilized with capsular ring, that permitted in the bag implantation of the IOL.
The chosen IOL was Miniwell from Sifi, which has four round haptics enabling a good centration
and stability. It’s co-polimer material is facilitating good maneuverability and easy implantation.
The two operations were done sequentially at one week in topical anesthesia, on 2.2 clear cornea
incision, without complications. Visual acuity on the second day was RE 0,6 -1,0/90, LE 0,5 not
correcting. At one month the patient was almost perfectly satisfied, with acuity RE 1.0, LE 0.6
without correction and good reading ability. The IOL in his left eye is a bit inferior decentered.
The biggest challenge during the two interventions was the stability of the capsular bags. This was
obtained by using a PMMA capsular hook after performing CCC. It is still a question to implant
multifocal or EDOF lenses in damaged capsular system eyes, but careful surgery and circumspect
patient information and consent makes it a viable choice.

Surgical approach of bilateral marfanoid subluxation – case study

A. ALBERT

I present the case of a 62 male patient, who presented for examination with bilateral subluxated
lenses and decreased visual acuity. The bilateral subluxation was known anamnestic, without other
modifications of Marfan syndrome. Both eyes had nuclear cataract, iridodonesis, subluxated lenses
(RE sup-nas, LE sup-temp). Visual acuity was on right eye 0,4 with -6,0 Dsf, left eye 0,5 with -
7,0Dsf. Biometry didn’t showed corneal astigmatism, and so in order of the patient’s wishes we
decided to implant EDOF lenses, aiming micro-monovision. After removing the lens by
phacoemulsification, the capsular bag was stabilized with capsular ring, that permitted in the bag
implantation of the IOL. The chosen IOL was Miniwell from Sifi, which has four round haptics
enabling a good centration and stability. It’s co-polimer material is facilitating good
maneuverability and easy implantation. The two operations were done sequentially at one week in
topical anesthesia, on 2.2 clear cornea incision, without complications. Visual acuity on the second
day was RE 0,6 -1,0/90, LE 0,5 not correcting. At one month the patient was almost perfectly
satisfied, with acuity RE 1.0, LE 0.6 without correction and good reading ability. The IOL in his left
eye is a bit inferior decentered.
The biggest challenge during the two interventions was the stability of the capsular bags. This was
obtained by using a PMMA capsular hook after performing CCC. It is still a question to implant
multifocal or EDOF lenses in damaged capsular system eyes, but careful surgery and circumspect
patient information and consent makes it a viable choice.