The Unseen Tilt: Challenges in the management of occult subluxated lens presenting with elevated intraocular pressure | Scientific Program 2026

Prima Vision Eye Hospital, Indonesia

Title: The Unseen Tilt: Challenges in the management of occult subluxated lens presenting with elevated intraocular pressure

Abstract:

Introduction: Elevated Intraocular Pressure (IOP) in patients with cataract may present with nonspecific symptoms such as headache and can mask underlying zonular weakness. Undetected lens subluxation identified intraoperatively presents significant surgical challenges requiring prompt modification of technique to maintain capsular stability and avoid complications.

Case Report: A 52-year-old man presented with headache and markedly elevated IOP of 35 mmHg in the right eye, along with a visually significant cataract. The patient reported a history of ocular trauma approximately seven years prior, but had remained asymptomatic since the injury and did not experience visual disturbance, pain, or ocular discomfort until the current presentation. Despite initial medical therapy, the IOP remained persistently elevated with minimal reduction. Preoperative slit-lamp examination did not reveal obvious lens instability. Prior to surgery, intravenous mannitol was administered to further reduce IOP and optimize surgical conditions. After adequate IOP control, cataract surgery was performed. During phacoemulsification, approximately 180-degree zonular dialysis with lens subluxation was identified. Iris retractors were placed to provide temporary capsular support. Phacoemulsification was completed cautiously, followed by sequential implantation of two capsular tension rings to redistribute zonular forces and stabilize the capsular bag. A posterior chamber intraocular lens was successfully implanted in the bag without complications.

Discussion: Occult lens subluxation may be overlooked preoperatively, especially in patients presenting primarily with elevated IOP. In cases of extensive zonular weakness, standard techniques must be adapted. The use of iris retractors combined with capsular tension rings can provide adequate intraoperative stabilization, enabling safe cataract extraction and in- the-bag lens implantation.

Conclusion: Intraoperative vigilance is essential in cataract patients with high IOP. Appropriate capsular stabilization techniques allow safe surgical outcomes despite significant zonular defects.

Keywords: Lens Subluxation, Cataract, Intraocular Pressure.

Biography:

Miranda Howen, MD, is a medical doctor currently based in Medan, Indonesia. She earned her medical degree from North Sumatera University and is actively engaged in clinical practice. Her interest in ophthalmology stems from a deep appreciation of the specialty’s unique ability to combine microsurgical precision with meaningful, life-changing patient outcomes. Through both clinical experience and academic involvement, she is committed to continue refining her knowledge and surgical expertise to improve visual outcomes. She plans to pursue ophthalmology residency to further develop her skills and contribute to advancing eye care services.