Lens surgery in Marfan's Syndrome
People with Marfan's syndrome have a host of potential health concerns. Modern medicine has much to offer and surgical correction of heart and aortic problems have transformed life expectancy in this condition.
For an ophthalmologist, the main concern is the lens subluxation (decenteration) which results in reduced vision, and even if the vision is corrected with glasses or contact lenses, the quality of vision may be poor as the patient is looking through the edge of the natural lens in the eye, rather than the centre. As a general rule, in all optical systems the best quality image is obtained when one uses the central part of the lens system. The more the peripheral parts of lens are used, the more the quality of vision deteriorates. The picture on the right show's the typical upwardly decentred lens in Marfans syndrome.
Unfortunately, this is not the only eye problem associated with Marfan's syndrome. Marfans patients have an increased risk of glaucoma and retinal detachment detachment (up to 11% of patients with Marfan syndrome, and 8–38% in those who have dislocation of the lens or have undergone lens surgery)[i]
Because of these concerns any surgical approach to treating the lens must take into consideration strategies which could potentially reduce the risk of future secondary glaucoma and retinal deatchment.
Som has a well established interest in managing the subluxed len in Marfan syndrome, with no disturbance to the vitreous. This elegant approach reduces the risk of future retinal problems. Som's work on this was recently recognised by an award from the American Society of Cataract and Refractive Surgery (ASCRS). He was awarded the first prize in the special interest category for his film demonstarting his technique fordealing with subluxed lens in Marfan syndrome. The following video summarises his technique.
The video shows the lens being recentred with the aid of 'hooks', followed by removal of lens matter after a capsule tension ring (CTR) has been implanted to stabilise the capsular bag. A small segment is then used to secure the capsular bag to the wall of the eyeball and a lens is implanted into thecapsular bag (much like in routine cataract surgery.
This results in a stable intraocular lens which is centred well allowing high qaulity vision.
Mr Prasad has refined this technique over years and has very good outcomes from this very complex procedure. He has published and presented his techniques and results with Marfan eyes to much acclaim internationally:
Lens surgery in Marfan syndrome; Film festival prize winning presentation at the American Society for Catract and Refractive Surgery (ASCRS) annual congress, Boston, April 2010.
You don’t have to do it from behind! Annual meeting of The British & EIRE Vitreo Retinal society combined with the Dutch Vitreoretinal Society meeting, 19-20 November 2009, Amsterdam. (A presentation highlighting the approach which restores anatomical relationships is probably superior to others which disrupt vitreous)
Lens Surgery in Marfan Syndrome. Kumar N & Prasad S. Techniques in Ophthalmology. 7(4):146-151, December 2009
Standardized Surgical Strategy to Manage Subluxated Lens in Marfans Syndrome. S. Prasad & F. Ali. Paper presented at the American Society for Catract and Refractive Surgery (ASCRS) annual congress, Boston, April 2010.
Cataract Surgery in Eyes with subluxed lenses - Managing complex cataracts symposium - Co-chairs Milind Pande & Som Prasad. All India Ophthalmology Society Annual Congress - Kolkata, India January 2010
Subluxed lens - Around the World in 80 Minutes: International Symposium on Devices for Complicated Cataract Cases - What are American Surgeons Missing? - American Academy of Ophthalmology Annual Meeting, Atlanta, USA, 2008.
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[i] Maumenee IH. The eye in the Marfan syndrome. Trans Am Ophthalmol Soc 1981;79:684–733.
This page was last modified on May 02, 2010