Dislocation of the Lenses
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《新英格兰医药杂志》
To the Editor: Mathur and Grodinsky, in Images in Clinical Medicine (June 10 issue),1 present a case in which bilateral dislocation of the intraocular lenses was examined by computed tomography (CT). We appreciate the images of this traumatic finding. However, as a technique for the identification of a lens luxation, CT is of minor importance. First, a slit-lamp examination is mandatory to examine the anterior segment of the eye. This simple ophthalmic technique is inexpensive and gives precise information regarding partial luxation (subluxation) as opposed to complete luxation (dislocation) of the lens (Figure 1), which was misdiagnosed in this case. Second, if the view is obscured by intraocular bleeding, an ultrasound examination should be performed to determine the location of the lens, since the resolution of ophthalmic ultrasonography is five times that of CT. Third, other causes of blurred vision, such as occlusion of the central retinal artery, which requires immediate therapy, need to be ruled out by funduscopy.
Figure 1. Image of the Fundus Obtained by Slit-Lamp Examination with the Use of a Three-Mirror Contact Lens.
The luxated lens can be seen in the interior fundus (arrow). The retina and the retinal vessels beneath it appear red.
CT is helpful to localize and diagnose other ocular problems and diseases, such as orbital or scleral ruptures, solid tumors, and the presence of foreign bodies. However, positioning the patient on his or her back during CT can influence the location of the floating lens, possibly leading to misinterpretation.
Stefan Mennel, M.D.
Carsten H. Meyer, M.D.
Peter Kroll, M.D.
Philipps University Marburg
35037 Marburg, Germany
stefan.mennel@lycos.com
References
Mathur SK, Grodinsky D. Dislocation of the lenses. N Engl J Med 2004;350:e22-e22.
Figure 1. Image of the Fundus Obtained by Slit-Lamp Examination with the Use of a Three-Mirror Contact Lens.
The luxated lens can be seen in the interior fundus (arrow). The retina and the retinal vessels beneath it appear red.
CT is helpful to localize and diagnose other ocular problems and diseases, such as orbital or scleral ruptures, solid tumors, and the presence of foreign bodies. However, positioning the patient on his or her back during CT can influence the location of the floating lens, possibly leading to misinterpretation.
Stefan Mennel, M.D.
Carsten H. Meyer, M.D.
Peter Kroll, M.D.
Philipps University Marburg
35037 Marburg, Germany
stefan.mennel@lycos.com
References
Mathur SK, Grodinsky D. Dislocation of the lenses. N Engl J Med 2004;350:e22-e22.