Homocystinuria as a cause of ocular complications requiring surgical intervention

A 41-year-old man underwent surgery in both eyes due to diagnosed lens subluxation with significant decrease in visual acuity. In the left eye, an acute attack of angle-closure glaucoma caused by lens subluxation into the anterior chamber resulted in a combined procedure of lensectomy with posterior vitrectomy and silicone oil endotamponade due to iatrogenic retinal detachment. In the right eye, a procedure was performed to remove the subluxated natural lens with simultaneous intrascleral fixation of an artificial lens. During this procedure, the author’s “Vampire” technique was used to facilitate the removal of the practically subluxated natural lens and reduce the risk of vitreous loss. Due to intraoperative complications, the left eye required further surgical procedures. Silicone oil removal from this eye was combined with repeat diagnostic testing to identify the cause of lens subluxation. The cause was found to be previously undiagnosed homocystinuria.