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array:24 [ "pii" => "S2173579420302267" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.07.015" "estado" => "S300" "fechaPublicacion" => "2021-02-01" "aid" => "1805" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2021;96:93-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669120303245" "issn" => "03656691" "doi" => "10.1016/j.oftal.2020.07.028" "estado" => "S300" "fechaPublicacion" => "2021-02-01" "aid" => "1805" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2021;96:93-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Luxación posterior bilateral del cristalino en una paciente agitada, ¿causa o consecuencia?" 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"apellidos" => "Martínez Toldos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579420302267" "doi" => "10.1016/j.oftale.2020.07.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420302267?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120303245?idApp=UINPBA00004N" "url" => "/03656691/0000009600000002/v1_202101310756/S0365669120303245/v1_202101310756/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579420302292" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.07.018" "estado" => "S300" "fechaPublicacion" => "2021-02-01" "aid" => "1802" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2021;96:97-101" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "“White-puncture”: A simple technique to prevent tearing of the anterior capsule during capsulorhexis in intumescent white cataracts" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "101" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Blancopunción: una técnica simple para prevenir el desgarro de la cápsula anterior durante la capsulorrexis en cataratas blancas intumescentes" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 492 "Ancho" => 1305 "Tamanyo" => 89669 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) White-puncture: note how the anterior capsule of a hypermature cataract is punctured as a first surgical step with the help of a 30<span class="elsevierStyleHsp" style=""></span>G needle. b) Anterior capsule opened after the white-puncture and later dyed with trypan blue prior to starting capsulorhexis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Blanco, C. Rocha-de-Lossada, P. Navarro, S.F. Lerner, L. Perrone, F.L. Soler Ferrández" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Blanco" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Rocha-de-Lossada" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Navarro" ] 3 => array:2 [ "nombre" => "S.F." "apellidos" => "Lerner" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Perrone" ] 5 => array:2 [ "nombre" => "F.L." "apellidos" => "Soler Ferrández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S036566912030321X" "doi" => "10.1016/j.oftal.2020.07.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036566912030321X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420302292?idApp=UINPBA00004N" "url" => "/21735794/0000009600000002/v1_202101300818/S2173579420302292/v1_202101300818/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173579420302164" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.06.018" "estado" => "S300" "fechaPublicacion" => "2021-02-01" "aid" => "1815" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2021;96:89-92" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Pyogenic granuloma after cosmetic eye whitening" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "89" "paginaFinal" => "92" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granuloma piogénico tras blanqueamiento ocular cosmético" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 50847 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right eye exhibited avascular areas and pyogenic granuloma at nasal region.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V.A. Romero-Morales, A. Marchese, E. Miserocchi, F. Bandello, G. Modorati" "autores" => array:5 [ 0 => array:2 [ "nombre" => "V.A." "apellidos" => "Romero-Morales" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Marchese" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Miserocchi" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Bandello" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Modorati" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S036566912030349X" "doi" => "10.1016/j.oftal.2020.06.034" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036566912030349X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420302164?idApp=UINPBA00004N" "url" => "/21735794/0000009600000002/v1_202101300818/S2173579420302164/v1_202101300818/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Posterior bilateral lens luxation in an agitated patient: Cause or consequence?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "93" "paginaFinal" => "96" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C.E. Monera Lucas, J. Escolano Serrano, D. Romero Valero, A. Navarro Navarro, J.J. Martínez Toldos" "autores" => array:5 [ 0 => array:4 [ "nombre" => "C.E." "apellidos" => "Monera Lucas" "email" => array:1 [ 0 => "carlosmonera@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Escolano Serrano" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Romero Valero" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Navarro Navarro" ] 4 => array:2 [ "nombre" => "J.J." "apellidos" => "Martínez Toldos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Luxación posterior bilateral del cristalino en una paciente agitada, ¿causa o consecuencia?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 836 "Ancho" => 905 "Tamanyo" => 75594 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography of the skull and orbits. The presence of the lens in the vitreous cavity is evident in both eyes.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The lens is located in the posterior chamber of the eye, connected to the ciliary body by the Zinn zonule. The lens can be partially dislocated (subluxation) or completely dislocated (dislocation) due to weakness or rupture of zonular fibers.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Complete dislocations are rare clinical conditions. The congenital forms are known as <span class="elsevierStyleItalic">ectopia lentis</span> and are the consequence of various genetic mutations. <span class="elsevierStyleItalic">Ectopy lentis</span> can occur in isolation at the ocular level or in the context of systemic connective tissue pathology (Marfan syndrome, homocystinuria, Weill-Marchesani syndrome).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Iatrogenic complications during cataract surgery are the main global cause of lens dislocation,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> while trauma is the main non-iatrogenic cause of this entity.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is generally due to closed eye trauma in the anteroposterior direction. The direction of this force vector produces distension in all directions and rupture of the zonular fibers.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Dislocation of the lens therefore usually occurs unilaterally, and bilateral forms are very rare. However, the latter have been described in the context of epileptic seizures<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and as a result of high-energy trauma.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The lens can move completely into the anterior chamber or, more frequently, into the vitreous cavity. The subretinal migration of the lens through a giant tear has also been described.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Dislocations of the lens into the vitreous chamber can produce an inflammatory reaction known as phacolytic uveitis. In addition, they can cause dialysis and retinal detachment. Generally, lens dislocations are managed surgically. However, in patients with surgical contraindications and good symptomatic control in the absence of complications secondary to the dislocation, a conservative attitude can be maintained. In these cases it is necessary to prescribe an optical correction in aphakia.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Bilateral lens dislocation can be a potential trigger for the appearance of acute confusion in predisposed individuals due to sudden visual deprivation. However, until now, no cases of acute confusional syndrome have been described for this reason.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 70-year-old woman was referred to the Emergency Department for bilateral eye redness and visual acuity deterioration after a week of evolution. She was of Central European origin, with a history of dementia and schizoaffective disorder, for which she was in treatment with different psychoactive pharmaceuticals. Phenotypically, the patient was tall and had arachnodactyly. At the time of assessment in the Emergency Department, the patient showed an evident state of agitation in the context of acute confusional syndrome or delirium of unknown etiology. Due to the language barrier, the pathological history and clinic it was not possible to question the patient. Her relative reported that the patient had been banging her head against the wall repeatedly during the previous days, presumably as a result of her agitated state.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Due to the rapid onset of her confusional state, it was decided to perform a cranial CT scan in order to rule out the presence of ischemic areas, cerebral hemorrhage and other acute diseases that could justify the clinic exhibited by the patient. However, the tomographic sections at the orbital level, the presence of the two lens dislocated to the vitreous cavity was identified (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The result of the rest of the neuroimaging study was normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was assessed by the Ophthalmology Service. At the time of examination, the pupils were isocoric and weakly reactive to light. The slit lamp examination showed the absence of lens in both eyes. The intraocular pressure measured by means of a rebound tonometer (ICare®) was 32 in the right eye and 34 in the left eye. Fundus examination showed complete bilateral posterior dislocation of the lens into the vitreous cavity.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient was diagnosed with bilateral phacolytic uveitis. Due to her history, it was decided to perform a medical control of the signs and subsequent optical correction in aphakia. A topical treatment with dexamethasone, cyclopentolate, thymolol and apraclonidine was started in both eyes. Ten days after the diagnosis, due to the persistence of uveitis despite the medical treatment and once the agitation was controlled with systemic drugs, it was decided to consider surgical management.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Pars plana vitrectomy was performed with phacofragmentation and implant of an intraocular lens anchored to the iris in a retropupillary position in both eyes. Intraoperatively, the presence of a retinal detachment secondary to retinal dialysis in the temporal area, which had not been previously diagnosed, was identified in the left eye (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Therefore, it was decided to change the initial surgical approach and a silicone cerclage of 2.5<span class="elsevierStyleHsp" style=""></span>mm at 14<span class="elsevierStyleHsp" style=""></span>mm of the corneal limbus was implanted. Due to the presence of retinal detachment, it was decided to use liquid perfluorocarbon (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A) to direct the lens from the vitreous cavity to the posterior chamber (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B), with the objective of performing phacofragmentation while minimizing the risk of damaging the retina. Finally, an iris-anchored intraocular lens (Artisan®, Ophtec, Boca Raton, FL, USA; FDA approval 2004) was implanted in retropupillary position in both eyes. The surgery was performed using a 3D visualization system (TrueVision® Systems, Inc., Santa Barbara, CA, USA).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">One week after surgery, the patient was stable, intraocular inflammation was controlled, and the intraocular lenses were kept in the proper position. Intraocular pressure was 22 in the right eye and 24 in the left eye.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Acute confusional syndrome or delirium is a clinical entity characterized by the rapid onset of a set of symptoms including altered consciousness, low level of attention, disorientation, and perceptual disturbances.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> The etiology of acute confusional syndrome is in most cases multifactorial, although numerous risk factors have been identified. These factors have been classified to two groups: predisposing factors, which increase the vulnerability of the patient for the appearance of delirium, and precipitating factors, which in most cases are diseases or acute alterations that trigger the confusional state. The most frequent precipitating factors are intercurrent diseases, iatrogenic complications, primary neurological disease, consumption of toxins or drugs, and uncontrolled pain.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">On the other hand, in elderly patients or those with dementia and previous mental disorders, visual sensory deprivation has been defined as a trigger for acute confusional syndrome.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> In most cases, the sensory deficit is progressive due to age and previous illnesses, and allows the patient to adapt. However, when sensory deprivation occurs abruptly, it can lead to the appearance of acute agitation and confusion symptoms. Visual disturbances have been closely and independently associated with the early development of acute confusional syndrome.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> For this reason, it is important to take into account the visual sensory deficit in patients with delirium, especially if there is a predisposing pathological history.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Our patient was an elderly woman with a history of dementia and schizoaffective disorder, and was in treatment with different psychoactive drugs on a chronic basis. Due to her phenotypical features, Marfan disease was suspected, so one of the hypotheses raised that justified the appearance of the clinic was the possibility that a spontaneous posterior bilateral dislocation had occurred, which would have caused an acute visual sensory deprivation, triggering agitation and confusion. On the other hand, it was hypothesized that the agitation was secondary to the mental comorbidity and predisposing factors of the patient, and that she had banged her head as a result of the state of agitation and confusion, causing the dislocation of the lens in a patient with a certain degree of previous subluxation due to Marfan syndrome, in turn exacerbating the confusional state due to the visual deficit. This could more plausibly justify the acute appearance of the clinic. The development of a phacolytic uveitis secondary to the bilateral dislocation of the lens indicated a rapid and recent physiopathological mechanism. On the other hand, it is less likely that the bilateral dislocation occurred spontaneously secondary to zonular weakness due to a connectopathy than the possibility that it was secondary to a trauma in a patient predisposed to said connectopathy. Therefore, the hypothesis that was accepted as more likely was the one that explained the posterior dislocation of the lens due to a traumatic cause. Repeated head trauma against the wall could have caused the force of the movement vector in the anteroposterior direction to be greater than the elasticity of the zonular fibers, which led to their rupture and subsequent dislocation of the lens in both eyes, so it could have been both the cause and the consequence of acute confusional syndrome.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The patient was referred to the Internal Medicine Service to screen for systemic connectopathies and confirm the clinical suspicion of Marfan disease. However, a few weeks after surgery the patient was lost to follow up, so the study was not carried out.</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ectopia lentis</span> and secondary lens dislocations pose a challenge for ophthalmologists. In any case, there is consensus that the main objective in these cases is to achieve optimum visual acuity that allows the patient to maintain autonomy or prevent amblyopia in a pediatric population.</p><p id="par0080" class="elsevierStylePara elsevierViewall">It is important to make an individualized evaluation of each patient with the aim of identifying the etiology of the dislocation, secondary complications and ocular and systemic comorbidities. The exhaustive evaluation of each patient allows us to discern in which cases a conservative attitude can be maintained and which requires surgical treatment as the first therapeutic option.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In our experience, vitrectomy and refloating of the lens with liquid perfluorocarbon to the posterior chamber is an effective technique in cases of posterior lens dislocation with associated retinal detachment, since it provides with a triple benefit: protection of the macula and the posterior pole during phacofragmentation, reapplication of the detached retina and elevation of the lens to the posterior chamber.</p><p id="par0090" class="elsevierStylePara elsevierViewall">To our knowledge, this case report is the first report of a patient diagnosed with bilateral lens dislocation in the context of acute confusional syndrome. We consider that it could be useful to take into account this clinical entity in patients who associate systemic agitation and deterioration of visual acuity in emergency hospital services.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1456424" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1327705" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1456423" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1327706" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack509467" "titulo" => "Acknowledgements" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-14" "fechaAceptado" => "2020-07-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1327705" "palabras" => array:6 [ 0 => "Dislocation" 1 => "Lens" 2 => "Sensory deprivation" 3 => "Delirium" 4 => "Traumatism" 5 => "Refloating" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1327706" "palabras" => array:6 [ 0 => "Luxación" 1 => "Cristalino" 2 => "Privación sensorial" 3 => "Delirium" 4 => "Traumatismo" 5 => "Reflotamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Complete posterior lens dislocation is an infrequent clinical entity. Trauma is the first cause of secondary lens dislocation. Most of the cases are unilateral, and bilateral cases are unusual. We report the uncommon case of a 70-year-old woman with evidence of a posterior bilateral dislocation of the lens in the context of an acute onset of confusional syndrome. We discuss about sensory deprivation as a trigger for acute confusion and agitation in patients with predisposing conditions. In addition, we describe the benefits that, in our experience, the refloating technique with perfluorocarbon liquid provides for the surgical approach to these cases.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las luxaciones posteriores completas del cristalino son entidades clínicas poco frecuentes. Los traumatismos son la principal causa de luxación secundaria del cristalino no iatrogénica. La mayor parte de los casos son unilaterales, siendo los casos de luxación bilateral muy poco frecuentes. Presentamos el inusual caso clínico de una mujer de 70 años que presentó una luxación bilateral posterior del cristalino en el contexto de un cuadro de instauración aguda de síndrome confusional. Discutimos acerca de la privación sensorial como un factor desencadenante de cuadros de confusión aguda y agitación en pacientes con enfermedades predisponentes. Además, describimos los beneficios que, en nuestra experiencia, nos aporta la técnica de reflotamiento con perfluorocarbono para el abordaje quirúrgico de estos casos.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Monera Lucas CE, J. Escolano Serrano, D. Romero Valero, C. Fernández Martínez, A. Navarro Navarro, J.J. Martínez Toldos. Luxación posterior bilateral del cristalino en una paciente agitada, ¿causa o consecuencia? Arch Soc Esp Oftalmol. 2021;96:93–96.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 836 "Ancho" => 905 "Tamanyo" => 75594 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography of the skull and orbits. The presence of the lens in the vitreous cavity is evident in both eyes.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 906 "Ancho" => 905 "Tamanyo" => 86792 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Photo frame of the left eye surgery. Dialysis and retinal detachment secondary to traumatic lens dislocation.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1540 "Ancho" => 905 "Tamanyo" => 145432 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Refloating the with liquid perfluorocarbon (A) and phacofragmentation via pars plana in the posterior chamber (B).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dislocation of the lens: a study of 166 hospitalized cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.H. 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