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Luxation of Lens Through a Retinal Tear into the Subretinal Space
LUXATION OF LENS THROUGH A RETINAL TEAR INTO THE SUBRETINAL SPACE F. BRUCE FRALICK,
M.D.
Ann Arbor, Michigan
In the lifetime of every practicing phy- ous inflammation. A complete iridectomy sician many unusual and interesting path- had been performed, down and in, and ological conditions are presented which the pupil was dilated and the iris tremurelieve the monotony of the more common lous. The vitreous contained innumerable conditions seen. Because of the unique- fine dustlike opacities. The retina was ness of some of these conditions it is often completely detached and presented two worth while to record them briefly for the interest of others. The following case might bear publication, for after careful search no similar one was found to be recorded. Mr. R. S., aged 36 years, presented himself at the University Hospital on January 13, 1937, with the following history: On November 5, 1936, some lime blew into his right eye while he was working in a beet-sugar factory. The eye immediately became inflamed and remained so for some days in spite of local treatment by his physician. As the inflammation subsided he discovered that he could see no better than to distinguish hand movements before his right eye. This condition remained to the time of his enterFig. 1 (Fralick). Subluxated lens as seen ing the hospital. His past history revealed through a large tear in the totally detached the fact that he had congenital subluxa- retina. tion of both lenses. An attempt had been made to remove the left subluxated lens large retinal tears: one up and out, the in November, 1910. This was followed by other down and out. The upper tear was loss of vitreous and prolapse of the iris, situated between the 10- and 12-0'cIock so that no useful vision resulted. Six meridians, two disc diameters from the years later, this eye had been injured by a limits of the ophthalmoscopic field, which piece of steel, which necessitated enucIea- was at the ora, and four disc diameters tion. In December, 1910, a visual iridec- across the tear. The lower tear was betomy, down and in, had been performed tween the 7- and 9-0'c1ockmeridians, four on the right eye without complication, and disc diameters from the ora and four disc the patient was able to work and earn a diameters across the tear horizontally. living up to the time of his present illness. The margins of the lower tear were inExamination revealed a right vision of verted, those of the margins of the upper moving objects and a subnormal intraoc- retinal tear were everted. In the lower ular tension. The eye was quiet and retinal tear was seen the periphery of the showed no slitlamp evidence of a previ- luxated lens, which elevated the detached 795
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F. BRUCE FRALICK
retina in front of it. The remainder of the lens was easily seen through the overlying retina (fig. 1). Because of the completeness of the retinal detachment, the hypotony, and the size of the retinal tears, it was thought to be hopeless to attempt restoration of the patient's vision through any means whatsoever, but due to the fact that this was the patient's only eye, such an attempt was made. He was placed on an anterior Bradford frame, face down. The next day the lens appeared in the anterior chamber and was extracted through a limbal incision down and temporally, with the use of a large conjunctival flap and conjunctival sutures. The patient was first removed from the frame and rotated on his side, his face being kept pointed down and slightly to the right so that the lens would remain in the anterior chamber. A few beads of vitreous were lost in the loop extraction. The patient was then rolled on his back, face up. The postoperative course was uneventful. The large retinal tears could be easily seen by means of oblique illumination as well as with the ophthalmoscope. One month later an attempt was made at reattaching the retina
by diathermy operation, using Walker micropins. This operation was unsuccessful and the vision remained at moving objects. COMMENT
This patient undoubtedly suffered from a total luxation of his previously congenitally luxated lens. Whether the lime burn was incidental or not to the detachment is difficult to state, but it seems only reasonable that the patient should receive total compensation for the loss of the eye. The retinal tear below with its inrolled posterior margin served as a funnel to receive the luxated lens when the patient was in the upright position. The lens could not be locked in the anterior chamber after its appearance there because of the previous complete "iridectomy: thus it was necessary to perform the extraction while the patient was on his face. The presence of a total detachment of the retina, tremendous retinal tears, or hypotony, each alone would render the probability of cure by any method exceedingly doubtful, but when these conditions are found together the outlook for amelioration is hopeless. 408 First National Bank Building.
M.D.
Ann Arbor, Michigan
In the lifetime of every practicing phy- ous inflammation. A complete iridectomy sician many unusual and interesting path- had been performed, down and in, and ological conditions are presented which the pupil was dilated and the iris tremurelieve the monotony of the more common lous. The vitreous contained innumerable conditions seen. Because of the unique- fine dustlike opacities. The retina was ness of some of these conditions it is often completely detached and presented two worth while to record them briefly for the interest of others. The following case might bear publication, for after careful search no similar one was found to be recorded. Mr. R. S., aged 36 years, presented himself at the University Hospital on January 13, 1937, with the following history: On November 5, 1936, some lime blew into his right eye while he was working in a beet-sugar factory. The eye immediately became inflamed and remained so for some days in spite of local treatment by his physician. As the inflammation subsided he discovered that he could see no better than to distinguish hand movements before his right eye. This condition remained to the time of his enterFig. 1 (Fralick). Subluxated lens as seen ing the hospital. His past history revealed through a large tear in the totally detached the fact that he had congenital subluxa- retina. tion of both lenses. An attempt had been made to remove the left subluxated lens large retinal tears: one up and out, the in November, 1910. This was followed by other down and out. The upper tear was loss of vitreous and prolapse of the iris, situated between the 10- and 12-0'cIock so that no useful vision resulted. Six meridians, two disc diameters from the years later, this eye had been injured by a limits of the ophthalmoscopic field, which piece of steel, which necessitated enucIea- was at the ora, and four disc diameters tion. In December, 1910, a visual iridec- across the tear. The lower tear was betomy, down and in, had been performed tween the 7- and 9-0'c1ockmeridians, four on the right eye without complication, and disc diameters from the ora and four disc the patient was able to work and earn a diameters across the tear horizontally. living up to the time of his present illness. The margins of the lower tear were inExamination revealed a right vision of verted, those of the margins of the upper moving objects and a subnormal intraoc- retinal tear were everted. In the lower ular tension. The eye was quiet and retinal tear was seen the periphery of the showed no slitlamp evidence of a previ- luxated lens, which elevated the detached 795
796
F. BRUCE FRALICK
retina in front of it. The remainder of the lens was easily seen through the overlying retina (fig. 1). Because of the completeness of the retinal detachment, the hypotony, and the size of the retinal tears, it was thought to be hopeless to attempt restoration of the patient's vision through any means whatsoever, but due to the fact that this was the patient's only eye, such an attempt was made. He was placed on an anterior Bradford frame, face down. The next day the lens appeared in the anterior chamber and was extracted through a limbal incision down and temporally, with the use of a large conjunctival flap and conjunctival sutures. The patient was first removed from the frame and rotated on his side, his face being kept pointed down and slightly to the right so that the lens would remain in the anterior chamber. A few beads of vitreous were lost in the loop extraction. The patient was then rolled on his back, face up. The postoperative course was uneventful. The large retinal tears could be easily seen by means of oblique illumination as well as with the ophthalmoscope. One month later an attempt was made at reattaching the retina
by diathermy operation, using Walker micropins. This operation was unsuccessful and the vision remained at moving objects. COMMENT
This patient undoubtedly suffered from a total luxation of his previously congenitally luxated lens. Whether the lime burn was incidental or not to the detachment is difficult to state, but it seems only reasonable that the patient should receive total compensation for the loss of the eye. The retinal tear below with its inrolled posterior margin served as a funnel to receive the luxated lens when the patient was in the upright position. The lens could not be locked in the anterior chamber after its appearance there because of the previous complete "iridectomy: thus it was necessary to perform the extraction while the patient was on his face. The presence of a total detachment of the retina, tremendous retinal tears, or hypotony, each alone would render the probability of cure by any method exceedingly doubtful, but when these conditions are found together the outlook for amelioration is hopeless. 408 First National Bank Building.