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Anesthetic precautions, such as stockings to prevent deep venous thrombosis, preoperative hydration, or aspirin, were taken in 85% of cases. Other common ophthalmic complications included optic atrophy (23%), iris atrophy (21%), anterior staphylomas (13%), lenticular opacities (9%), and corneal opacities (9%). The authors concluded that with the appropriate anesthetic precautions and modern microsurgical techniques, the risks associated with the surgical management of ocular complications of homocystinuria are reduced. If the lens is in the anterior chamber, dilation of the pupil and gentle pressure over the cornea can lead to repositioning of the lens behind the pupil. Patients are then administered pilocarpine, and a laser peripheral iridotomy is performed to prevent pupillary-block glaucoma. In the case of recurrent dislocations into the anterior chamber, a lensectomy should be performed. A primary lensectomy can also be performed. Prophylaxis of thromboembolic phenomena should be considered whenever these patients need general anesthesia.
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