Zonular Insufficiency in Case of Acute Angle Closure Crisis

A patient presented to the BPEI Emergency Room with painful red eye and blurred vision. Prior history included possible eye trauma in the contralateral eye with inferior lens subluxation and normal lens anatomy without phacodonesis in the affected eye. He was noted to be in acute angle closure and a therapeutic laser peripheral iridotomy was attempted. However, medical management and LPI were unsuccessful at lowering the intra-ocular pressure so a decision was made to undergo cataract extraction with goniosynechioloysis. Intra-operatively, severe zonular loss was noted. The lens capsule was stabilized with capsule hooks permitting completion of the continuous curvilinear capsulorrhexis and phacoemulsification. A capsular tension ring was placed opposite the area of zonular loss. An Ahmed capsule tension segment was placed in area of zonular loss and sutured to the sclera. At post operative day 1 patient had normal intraocular pressure and visual acuity of 20/50. At post operative month 2, the patient had a best corrected vision of 20/30 with normal intraocular pressure on no drops.

Presentation Date: 12/14/2023

Issue Date: 12/22/2023