• Courtesy of André Salgado Araújo Marques, Dr. Helena Spohr, Dr. Helena Urbano, Tiago Ferreira, Helena Spohr
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    Cataract/Anterior Segment

    This 82-years old male patient, who didn't have a regular ophthalmic examination, presented to the ER with progressive vision loss in both eyes. His best corrected visual acuity was of light perception on the right eye and 10/200 on the left eye. On slit-lamp examination, it was evident the presence of pseudoexfoliative material on the pupillary border on both eyes, a mature cataract on the left eye and a luxated cataract in the vitreous cavity on the right eye (shown here), which had apparently occurred spontaneously since there was no history of trauma or relevant systemic disease. Although the IOP was elevated in both eyes (32 mmHg in the right and 37 mmHg in the left) and since there was a total cupping of the right optic disc, the eye was calm. We opted to only observe the right eye and procede to extracapsular cataract extraction in the left eye and not to perform phacoemulsification since there was a very high risk of intraoperative lens luxation and related complications due to zonular weakness. Instead of a posterior chamber IOL, we also decided to implant an anterior chamber iris-fixated IOL. Even with the posterior capsule intact and glaucoma, it was also probable a late capsule-IOL complex dislocation a second surgery needed to be performed. His BCVA improved to 20/50 and the IOP is presently being controlled with topical medication (15-16 mmHg), but a second surgical or LASER procedure may be needed in case of insufficient IOP control and glaucoma progression.