Docstoc

BROWN MCLEAN SYNDROME AFTER INSERTION OF AN

Document Sample
BROWN MCLEAN SYNDROME AFTER INSERTION OF AN Powered By Docstoc
					ARCH SOC ESP OFTALMOL 2007; 82: 315-318                                                              SHORT COMUNICATION

BROWN-MCLEAN SYNDROME AFTER INSERTION OF AN
    ANTERIOR CHAMBER INTRAOCULAR LENS:
          DESCRIPTION OF ONE CASE
                     SÍNDROME DE BROWN-McLEAN CON LENTE
                       INTRAOCULAR DE CÁMARA ANTERIOR:
                            DESCRIPCIÓN DE UN CASO
    PAREJA-ESTEBAN J1, MONTES MA1, PÉREZ-RICO C1, JIMÉNEZ-PARRAS R1, BOLÍVAR G1


                       ABSTRACT                                                                   RESUMEN
Case report: We report one case of Brown-McLe-                           Caso clínico: Se presenta un caso de síndrome de
an syndrome.                                                             Brown-McLean.
Discussion: In this case, a 71-year-old male deve-                       Discusión: Un varón de 71 años de edad desarrolló
loped a Brown-McLean syndrome after implanta-                            un síndrome de Brown-McLean tras el implante de
tion of an anterior chamber lens in one aphakic eye.                     una lente de cámara anterior en un ojo afáquico. Se
A phacoemulsification procedure was performed in                         realizó facoemulsificación en el ojo contralateral
the other eye without development of corneal clea-                       sin desarrollo de alteraciones en la transparencia
rance alterations in the next 7 years. The cause of                      corneal. El síndrome de Brown-McLean tiene un
Brown-McLean syndrome is still unexplained. It is                        origen incierto todavía. Probablemente, se desarro-
possible that it could develop in eyes with a genetic                    lle en ojos con predisposición genética expuestos a
predisposition when these eyes are exposed to cer-                       ciertas condiciones, como por ejemplo lentes de
tain conditions, such as insertion of an anterior                        cámara anterior.
chamber lens (Arch Soc Esp Oftalmol 2007; 82:
315-318).                                                                Palabras clave: Síndrome de Brown-McLean, len-
                                                                         tes de cámara anterior, predisposición genética, afa-
Key words: Brown-McLean syndrome; anterior                               quia, edema corneal.
chamber lens; genetic predisposition; aphakic; cor-
neal edema.




Received: 31/5/06. Accepted: 18/4/07.
Ophthalmology Service. Prince of Asturias University Hospital. Alcalá de Henares. Madrid. Spain
1 Graduate in Medicine.


Correspondence:
Jesús Pareja Esteban
28806 Alcalá de Henares (Madrid)
Spain
E-mail: jeparejaes@yahoo.es
PAREJA-ESTEBAN J, et al.



               INTRODUCTION
   Brown-McLean’s Syndrome (BMS) is a condi-
tion progressing with a peripheral corneal edema,
not involving the central corneal region, with a cir-
cumferential progression. It takes place usually
after the lens intracapsular extraction, although it
has also been reported after other lens surgical pro-
cedures (1) and even without any surgery history.
The present article describes a BMS case after a
secondary intraocular lens implant (IOL) of the
anterior chamber (AC) in a patient suffering from
aphakia.

                                                         Fig. 1: Peripheral corneal edema and IOL of the ante-
                 CASE REPORT                             rior chamber in the BMS.
   A 71-year-old patient came to the hospital for a
check-up before undergoing a secondary IOL               microscopy was 1,246 cells/mm2. A treatment was
implant on the right eye (RE) and cataract surgery       prescribed with 5% sodium chloride ointment. On
on the left eye (LE). His ophthalmologic history         the other hand, the LE did not reveal corneal edema,
included a RE aphakia caused by a trauma 25 years        neither peripheral nor central, seven years after the
earlier, which resulted in the intracapsular traumat-    surgical procedure took place.
ic cataract extraction. During exploration, the
patient presented an improved visual acuity correct-
ed on the Snellen scale for the right eye and count-                          DISCUSSION
ing fingers with the left eye. Biomicroscopically, he
presented peripheral iridectomy at 12 hours, vitre-         BMS is a rare pathology described at the end of
ous in the anterior chamber and aphakia. The             the seventies, progressing with a corneal edema
corneal transparency was present in 360º at that         which extends itself to the corneoscleral limbo (2 to
time, while the patient presented no symptoms. The       3 mm) and typically not involving the visual central
RE presented a NO4-P4-C1 cataract. The remain-           axis. It may be associated with an orange or brown-
ing ophthalmologic exploration was normal. Dur-          ish endothelial pigmentation with iridodonesis,
ing the first intervention, a LE phacoemulsification
was performed under external anesthesia, with IOL
implant in the posterior chamber. The postoperative
progressed without any complications, with a cor-
rected visual acuity after one month. Secondly, an
anterior vitrectomy was performed with a lens
implant in the anterior biconvex chamber of +18.5
diopters in the RE (STORZ, 121UV, PPMA,
SN:2YXN17, 6 mm in diameter), with normal pre-
mature postoperative. Two months after the proce-
dure, an improved corrected visual acuity was
apparent, and the IOL on the anterior chamber was
centered. Two years after surgery, the patient pre-
sented a peripheral corneal edema with microbullas
not compromising the visual axis and brownish
endothelial central pigmentation of the right eye
(figs. 1 and 2). Central pachymetry was 520 Ìm.          Fig. 2: Brownish endothelium pigmentation in BMS
The central endothelium count with specular              patient.

316                                 ARCH SOC ESP OFTALMOL 2007; 82: 315-318
                                                                                                Brown-McLean Syndrome


appearing more frequently in eyes with IOL in AC          seven years, the contralateral eye in this case pre-
(2). When the symptoms appear, they are usually           served full transparency, which results again in the
accompanied by a foreign body feeling and epithe-         worsening of this condition when an IOL in AC is
lium defects.                                             involved.
   Its origin is uncertain; it has been linked to sev-       Generally, when symptoms appear, they are treat-
eral types of lens surgery such as the extracapsular      ed with hypertonic saline solution, external steroid
lens extraction, phacoemulsification, lensectomy          lubrication, in some case suggesting stromal punc-
pars plana and vitrectomy, the extracapsular lens         tures as an alternative treatment (5).
extraction being the most frequent of all (1),               In other words, even though the BMS etiology
although it has been also described in the absence        remains uncertain, it seems reasonable to assume
of such surgical procedures [spontaneous reabsorp-        that this is a syndrome based on individual suscep-
tion of the lens; lens subluxation, glaucoma due to       tibility (possibly genetic), where an external factor
angle closure and in one case of myotonic dystro-         (such as, for instance, an IOL implant in AC) results
phy (3).] In the present case, it is worth noting a       in the described clinical condition.
trauma history on the right eye which resulted in the
lens intracapsular extraction.
   The onset for this condition since the time of pro-                     BIBLIOGRAFÍA
cedure usually ranges from 6 to 16 years, having
been described even 34 years later (4). In this            1. Gothard TW, Hardten DR, Lane SS, Doughman DJ,
                                                              Krachmer JH, Holland EJ. Clinical findings in Brown-
patient, the edema showed more prematurely (2                 McLean syndrome. Am J Ophthalmol 1993; 115: 729-737.
years) with respect to the time of the IOL implant,        2. Vote BJ, Grupcheva CN, Ormonde SE, McGhee CN. In
although the patient suffered from aphakia for 25             vivo confocal microstructural analysis and surgical mana-
years.                                                        gement of Brown-McLean syndrome associated with spon-
   Other BMS cases have been described after IOL              taneous crystalline lens luxation. J Cataract Refract Surg
                                                              2003; 29: 614-618.
implants in AC [approximately 16 percent of                3. Rutzen AR, Deen A, Epstein AJ, Maldonado MJ, Hemady
patients in the Gothard series (1)], where even               RK. Cataract surgery in a patient with Brown-McLean
though peripheral edemas did not coincide with the            syndrome. J Cataract Refract Surg 2001; 27: 1335-1337.
   haptic condition, as in this case, these could          4. Lim JI, Lam S, Sugar J. Brown-McLean syndrome. Arch
aggravate the development of the syndrome (2).                Ophthalmol 1991; 109: 22-23.
                                                           5. Martins EN, Alvarenga LS, Sousa LB, Orlando Filho VT,
   Bilateralization of this condition has been                Gomes JA, de Freitas D. Anterior stromal puncture in
described after surgery on both eyes, which sug-              Brown-McLean syndrome. J Cataract Refract Surg 2004;
gests a tendency to bilateralization. After more than         30: 1575-1577.




                                     ARCH SOC ESP OFTALMOL 2007; 82: 315-318                                       317

				
DOCUMENT INFO