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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 56  |  Issue : 3  |  Page : 183-184

Posttraumatic zonular dialysis and phacodonesis


Department of Cataract and Refractive Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Web Publication23-Oct-2018

Correspondence Address:
Saurabh Deshmukh
Sri Sankaradeva Nethralaya, 96, Basistha Road, Beltola, Guwahati - 781 028, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_63_18

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How to cite this article:
Deshmukh S, Bhattacharjee H, Gupta K. Posttraumatic zonular dialysis and phacodonesis. TNOA J Ophthalmic Sci Res 2018;56:183-4

How to cite this URL:
Deshmukh S, Bhattacharjee H, Gupta K. Posttraumatic zonular dialysis and phacodonesis. TNOA J Ophthalmic Sci Res [serial online] 2018 [cited 2018 Dec 15];56:183-4. Available from: http://www.tnoajosr.com/text.asp?2018/56/3/183/243764




  Introduction Top


The tremulousness of the lens with the movement of the eye is called phacodonesis. It was first described by D'Ombrain in 1936. Bellow in the year 1940 termed it cataracta tremulans.[1]


  Pathophysiology Top


The zonules of Zinn or the zonular fibers are the supporting structures which maintain the lens in its position. They originate from the ciliary body and insert into the lens capsule at and near the equatorial zone. They are approximately 140 in number and composed of structural proteins, with one major component being fibrillin – a connective tissue glycoprotein that provides strength and elasticity to the fibers. The weakness of these zonular supports lead to phacodonesis.[2]


  Etiology Top


Zonular dialysis can be caused by a variety of conditions including trauma, pseudoexfoliation syndrome, iatrogenic, retinitis pigmentosa, advanced age, and systemic syndromes with defective connective tissue protein synthesis (Marfan syndrome, homocystinuria, Weil-Marchesani syndrome, and Ehlers–Danlos syndrome).[3]


  Diagnosis Top


Diagnosis can be made on the basis of history and dilated slit-lamp examination.


  Case Report Top


A 56-year-old female presented with the complaint of diminution of vision in the right eye for the past 4 months following blunt ocular trauma by a bamboo stick. Her visual acuity at presentation was counting fingers at 2 meters. Slit-lamp examination revealed a temporally subluxated early cataractous lens with zonular dialysis from 12 to 6 o'clock position [Figure 1]a and [Figure 1]b. The phacodonesis could be appreciated very clearly and was video documented [Video clip 1]. The patient underwent successful par plana vitrectomy, lensectomy, and scleral-fixated intraocular lens implantation with full visual recovery. Thus, we present this unique photo and video-documented case of posttraumatic phacodonesis.
Figure 1: Slit-lamp photograph in (a) diffuse illumination and (b) retroillumination showing temporally subluxated cataractous lens with zonular dialysis from 12 to 6 o'clock position

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to thank Sri Kanchi Sankara Health and Educational Foundation, Guwahati, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bartholomew RS. Phacodonesis. A sign of incipient lens displacement. Br J Ophthalmol 1970;54:663-6.  Back to cited text no. 1
    
2.
Kuszak JR, Clark JI, Cooper KE, Rae JL. Biology of the lens: Lens transparency as a function of embryology, anatomy and physiology. In: Albert DM, Jakobiec FA, editors. Principles and Practice of Ophthalmology. 2nd ed. Philadelphia: Saunders; 2000. p. 1355-408.  Back to cited text no. 2
    
3.
Liu XW, Wang Z, Yu WH, Wang ZW, Zhang YN, Liu JJ, et al. Idiopathic phacodonesis in senile cataract patients in Qinghai, China. Int J Ophthalmol 2011;4:508-12.  Back to cited text no. 3
    


    Figures

  [Figure 1]



 

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  In this article
Introduction
Pathophysiology
Etiology
Diagnosis
Case Report
References
Article Figures

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