to report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa ( rp ) .
a 45-year - old male with rp presented with elevated intraocular pressure ( iop ) in the right eye and was treated with laser iridotomy ( li ) .
surgical intervention , including anterior vitrectomy , intracapsular cataract extraction ( icce ) , and iol scleral fixation was performed .
two years later , the same episode occurred in his left eye and a similar treatment was done .
this is the first report of bilateral spontaneous anterior lens dislocation in a rp patient .
a 45-year - old korean male presented on march 27 , 2003 with right ocular pain .
right and left iop , measured by a goldman applanation tonometer , was 66 and 11 mmhg , respectively .
right and left eye best corrected visual acuity ( bcva ) was 20/70 with -4.50 + 1.00165 and 20/100 with -3.50 + 1.00180 , respectively .
right eye slit lamp examination showed steamy opaque cornea and a central anterior chamber depth of 2 corneal thickness ( ct ) .
, bone - spicule pigmentation sparing macula , and pale optic disc was noted in the right eye ( fig .
the patient was given intravenous 15% mannitol ( 300 ml ) , oral acetazolamide ( diamox ) ( 500 mg ) , oral 50% glycerin ( glycerol ) ( 50 cc ) , carbonic anhydrase inhibitor ( cosopt ) , and 0.2% brimonidine ( alphagan ) eye drops .
one day after treatment right eye iop decreased to 50 mmhg , the cornea became clear , and the central anterior chamber depth remained 2 ct .
six days later , the cornea was clear , the anterior chamber was deep and clear bilaterally , and the right eye li opening was patent . using the humphrey visual field ( model 750 , humphrey instruments , inc , dublin , california ; c24 - 2 program )
2 ) , and electroretinogram findings were prolonged in a and b amplitudes ( fig .
the right eye li opening was patent , and the anterior chamber was deep and clear .
six months later , on december 19 , 2003 , the patient presented with right ocular pain .
for the surgical procedure , pupillary constriction was achieved using 4% pilocarpine , administered 3 times in 5 minute intervals .
a 7 mm wide scleral tunnel was made 1.5 mm posterior to the limbus at the superotemporal side .
healon gv was injected into the anterior chamber to create space between the posterior lens capsule and iris .
icce was done successfully using capsule forceps . prolapsed vitreous in the anterior chamber was removed by vitrector .
a posterior chamber lens ( alcon cz70bd ) was introduced and sutured to the sclera by the ab interno method .
three days postoperatively , the iol was well positioned and no abnormal ocular findings were noted .
two years later , on june 8 , 2005 , the patient presented with left ocular pain lasting one day .
right and left bcva was 20/50 with -1.50 + 2.00165 and 20/160 with -3.50 + 1.0010 , respectively .
slit lamp showed anterior lens dislocation with mild inflammatory cells , and there were no abnormal findings in the right eye ( fig .
4 ) . anterior vitrectomy , icce , and iol scleral fixation was done on the left eye .
four weeks post - operatively , left bcva and iop was 20/200 with -1.50 + 1.2515 and 10 mmhg , respectively .
the causes of ectopia lentis are trauma , pseudoexfoliation syndrome , spontaneous dislocation , and various heredofamilial diseases including marfan syndrome , homocystinuria , and rp.4,5 in rp patients , hayashi et al . has suggested that zonular weakness can cause ectopia lentis6 and namiki et al
. showed unilateral zonular dehiscence.7 we report the first case of anterior lens dislocation in an rp patient following high iop .
after glaucomatous attack , mid - dilated pupil occurred with a weakened iris and ciliary body ; these structure caused anterior segment lens dislocation .
the mechanisms of glaucoma associated with a dislocated lens are pupillary block , lens degenerative changes , and concomitant anterior chamber angle damages.8 allingham et al .
these include pupillary block by subluxating the lens posterior to the iris , lens incarceration directly within the pupil , and complete lens dislocation into the anterior chamber.9 in this case , iop elevation was due to posterior pupillary block , which responded dramatically to laser iridotomy .
if the lens is displaced into the anterior chamber , it may be possible to relieve the condition by dilating the pupil and allowing the lens to reposition into the posterior chamber .
however with a totally dislocated lens in the anterior chamber , it is better to constrict the pupil and surgically remove the lens .
choi et al . have treated anteriorly dislocated lens by lensectomy , vitrectomy , phacoemulsification , and ab externo scleral iol fixation.10 for scleral fixation , young et al . used a scleral tunnel to relieve iol fluctuation and to maintain anterior chamber depth.11 in this case , the anteriorly dislocated lenses were removed using a 7 mm wide scleral tunnel , combined with an anterior vitrectomy and ab interno scleral fixation .
this is the first case of bilateral spontaneous anterior lens dislocation in an rp patient reported in the literature .
 purposeto report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa ( rp).methodsa 45-year - old male with rp presented with elevated intraocular pressure ( iop ) in the right eye and was treated with laser iridotomy ( li ) . 
 after li , complete crystalline lens dislocation into the anterior chamber occurred . 
 surgical intervention , including anterior vitrectomy , intracapsular cataract extraction ( icce ) , and iol scleral fixation was performed . 
 two years later , the same episode occurred in his left eye and a similar treatment was done.resultssurgery was successful in both eyes.conclusionsthis is the first report of bilateral spontaneous anterior lens dislocation in a rp patient . 