Abstract

MANAGEMENT OF ECTOPIA LENTIS IN MARFAN SYNDROME WITH

CAPSULAR TENSION RING

Zahratul Riadho* Alie Solahuddin*

Departement of Ophthalmology, Medical Faculty University of Sriwijaya, Palembang,
Indonesia

INTRODUCTION
Marfan Syndrome (MFS) is a connective tissue disorder caused by a fibrillin-1 gene mutation
which is located on chromosome band 15q21.1. The fibrillin-1 protein is a major component
of the elastic microfibril of ciliary zonules, which can lead to a series of abnormal features in
ocular system including ectopia lentis, myopia, axial length, astigmatism, and flat cornea. The
surgical management of ectopia lentis in MFS represents a challenge to the ophthalmologist.
Capsular tension rings (CTR) have provided the opportunity to perform small-
incision phacoemulsification and in-the-bag implantation of a posterior chamber IOL
(PCIOL). A capsular tension ring functions by exerting a centrifugal force at the capsular
equator, expanding the capsular bag and redistributing tension from the weakened zonules to
stronger, intact zonules.

OBJECTIVE
To report a surgical management of ectopia lentis in Marfan Syndrome with Capsular Tension
Ring.

CASE PRESENTATION
A 35 years old Woman diagnosed with Marfan Syndrome presented with complaint of blurred
vision in the right eye since 6 months ago. On ophthalmologic examination the visual acuity
of her right eye was 2/60, can’t be corrected with glasses. Intra ocular pressure was 13 mmHg,
the eye movements were normal to all directions. Examination of the anterior segment showed
no injection, clear cornea, and clear anterior chamber. There was nasal superior lens
subluxation on the right eye with zonular pull. Examination of posterior segment showed
positive non-uniform fundus reflex, however the vitreous body, retina, and macula were
difficult to evaluate. The patient underwent phacoemulsification with insertion of a capsular
tension ring along with an intraocular lens inside the bag and was advised to come to the eye
clinic every month for evaluation.

CONCLUSION
Capsular tension rings are indicated for the stabilization of the capsular bag in the presence of
weakened or compromised zonules. For eyes with subluxated lens secondary to MFS, a CTR
technique could lead to less degree of IOL decentration and tilt. CTR technique could reduce
capsular bag shrinkage and maintains the stability of the capsular bag.

KEYWORDS: Corneal tension rings, Ectopia lentis, Marfan Syndrome