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40-year-old woman was seen in the office on October 3, 2011. She has had dislocated lenses since she was a child. She doesn’t know when it completely dropped, but the right eye is seeing pretty well. The left eye unfortunately has declining vision since July. She had an episode, which was disturbing though, where the right eye went blank on her for several hours and then cleared. It must have been that the lens, which was completely dislocated positioned in the visual axis and then moved again. She takes Timolol for her glaucoma. We were unable to check her pressure today. VISUAL ACUITY: OD 20/32, OS 20/125. Pinhole 20/50. Color vision is normal in both eyes. SLIT EXAMINATION: The right eye’s lens is completely out of the visual axis and out of the pupil and there is some vitreous at the pupil margin, but not in the anterior chamber. The left eye has a 3+ nuclear sclerotic lens dislocated superonasally with the edge of which is just barely visible inside a relatively small pupil. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. The macula and periphery look healthy. OS: Vertical C/D ratio is 0.2. The macula and periphery look healthy. IMPRESSION: 1. MARFANS SYNDROME 2. ECTOPIA LENTIS 3. CATARACT – LEFT EYE DISCUSSION: I explained to the patient that the left lens is dislocated, but obstructing the visual axis and I think surgery there would substantially improve her visual function. She is currently adapted to the aphakic correction in the right eye. The right lens is dislocated, but it is possible that lens will absorb and unless it is continuing to cause her trouble, I don’t think the surgery in that eye needs to be considered at this point. It could always be done anytime in the future. She is going to think about the surgery and I will work on scheduling for her. She is comfortable how she is and I think it would be better not to put a lens in the eye at the time of surgery, since she has adapted so well to her aphakic status. I warned her there is a risk of retinal detachment, infection and bleeding with surgery, but given her visual function, I think it is acceptable risk.

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Ectopia Lentis and Cataract - Marfan's Syndrome509 views40-year-old woman has had dislocated lenses since she was a child. The right eye is seeing well with an aphakic correction. The left eye unfortunately has declining vision for 4 months. OD 20/32, OS 20/125. Pinhole 20/5000000
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Ectopia Lentis and Cataract - Marfan's Syndrome339 views40-year-old woman has had dislocated lenses since she was a child. The right eye is seeing well with an aphakic correction. The left eye unfortunately has declining vision for 4 months. OD 20/32, OS 20/125. Pinhole 20/5000000
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40-year-old woman was seen in the office on October 3, 2011. She has had dislocated lenses since she was a child. She doesn’t know when it completely dropped, but the right eye is seeing pretty well. The left eye unfortunately has declining vision since July. She had an episode, which was disturbing though, where the right eye went blank on her for several hours and then cleared. It must have been that the lens, which was completely dislocated positioned in the visual axis and then moved again. She takes Timolol for her glaucoma. We were unable to check her pressure today. VISUAL ACUITY: OD 20/32, OS 20/125. Pinhole 20/50. Color vision is normal in both eyes. SLIT EXAMINATION: The right eye’s lens is completely out of the visual axis and out of the pupil and there is some vitreous at the pupil margin, but not in the anterior chamber. The left eye has a 3+ nuclear sclerotic lens dislocated superonasally with the edge of which is just barely visible inside a relatively small pupil. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. The macula and periphery look healthy. OS: Vertical C/D ratio is 0.2. The macula and periphery look healthy. IMPRESSION: 1. MARFANS SYNDROME 2. ECTOPIA LENTIS 3. CATARACT – LEFT EYE DISCUSSION: I explained to the patient that the left lens is dislocated, but obstructing the visual axis and I think surgery there would substantially improve her visual function. She is currently adapted to the aphakic correction in the right eye. The right lens is dislocated, but it is possible that lens will absorb and unless it is continuing to cause her trouble, I don’t think the surgery in that eye needs to be considered at this point. It could always be done anytime in the future. She is going to think about the surgery and I will work on scheduling for her. She is comfortable how she is and I think it would be better not to put a lens in the eye at the time of surgery, since she has adapted so well to her aphakic status. I warned her there is a risk of retinal detachment, infection and bleeding with surgery, but given her visual function, I think it is acceptable risk.