Konstantinos Chalioulias, MD, MRCOphth | Birmingham & Midland Eye Centre, UK Aristeidis Konstantinidis, MD, MRCOphth | Coventry and Warwickshire University Hospital Ioannis Athanasiadis | Coventry and Warwickshire University Hospital Yajati K. Ghosh, MBBS, FRCSEd | Birmingham & Midland Eye Centre Ajai K. Tyagi, FRCS, FRCOphth | Birmingham & Midland Eye Centre
Our patient had a known diagnosis of Marfan syndrome in which lens dislocation due to zonular weakness is a common feature. The main constituent of the ciliary zonules that supports the lens is the glycoprotein fibrillin. It has been suggested that mutations in this glycoprotein are responsible for increased susceptibility to the proteolytic activity of serine proteases and matrix metalloproteinases, compromising the structural integrity of the zonules.(1)
Well-known conditions that are associated with fibrillin disruption are Marfan syndrome and ectopia lentis and both may present with lens dislocation.(1) Previous reports have highlighted on surgery for subluxed/dislocated lens in Marfan patients.(2,3) There is also reference in literature about retinal re-attachment surgery in such patients.(4) Spontaneous lens dislocation has been reported in pseudoexfoliation(5), uveitis(6) and following scleral buckling procedure.(7, 8)
In our patient the causes for the spontaneous dislocation of the lens could be attributed to either a subclinical zonular weakness related to Marfan or due to peri-operative imperceptible zonular damage during vitrectomy and subsequent gas pressure on the lens. Surgery for retinal re-attachment has been associated with many postoperative complications. To the best of our knowledge spontaneous dislocation of lens following vitrectomy is a very rare complication.