Phacoemulsification in a patient with simple microphthalmos

Poster Details

First Author: VesnaNovakovic SERBIA

Co Author(s):    Maja Stefanović Vujanić   Vladimir Suvajac   Jovana Suvajac   Gordana Suvajac   Branislav Đurović  

Abstract Details

Purpose:

To present a case of successfully operated cataract in microphthalmic eye despite coexisting ocular and systemic risk factors.

Setting:

: Eye clinic „Profesional - Dr Suvajac“, Belgrade, Serbia

Methods:

Case report. A highly hyperopic patient A.S. (52 years old), was referred to our clinic for the cataract surgery. Before the surgery, she was wearing soft contact lenses (RE +12,0 Dpt, LE +15,0 Dpt). Best corrected visual acuity (BCVA) of the right eye was 20/200 and 20/80 left eye. IOP was 20 mmHg on both eyes. Slit lamp examination of the anterior segment showed posterior subcapsular cataract on both eyes, slightly more pronounced on the right eye. Palpebral fissure was extremly narrow. Anterior chamber was very shallow centrally and extremely shallow peripherally. Amiodarone induced corneal deposits were found in both eyes. Examination of the posterior segment wasn't possible because of the cataract, but B-scan and OCT showed no pathological findings. Biometric characteristics of the eye (Wavelight Allegro Biograph) RE/LE: axial length 18.78/18.69 mm, aqueous depth 2.10/2.03mm, lens thickness 4.21/4.71mm, WTW 12.15/12.10 mm, keratometry 44.60/46.61 and 45.32/45.21. ECC was 1165/1213 cell/mm2. Patient had poorly controlled hypertension and obesity.

Results:

Haigis formula was used for the lens calculation, and +38.0 PCL (Acrysof Natural, Alcon) was selected for both eyes. A week before surgery YAG iridotomy was performed in both eyes. Phacoemulsification was performed on the right eye first, and on the left eye one month later. Hyperosmotic agent (Mannitol 2g/kg) was applied intra-venous 30 min prior surgery, arterial pressure was lowered to 110/70 mmHg and patient positioned with high head and chest rest. Pure topical anesthesia was used. Temporal approach and clear corneal incision were performed; pupil was manually stretched and additional highly viscous viscoelastic was injected into AC forming soft/shell. Endocapsular phacoemulsification was performed using quick chop technique. After bimanual I/A, IOL was implanted into capsular bag. Incisions were hydrated. Postoperative UCVA in the right eye was 20/50 and in the left eye 20/40.

Conclusions:

Simple microphthalmos has short axial lenght with otherwise normal morphological appearance. Still these patients present significant operative risk of iris prolapse, corneal decompensation, uveal effusion, refractive surprise. Surgical risk in this patient was higher due to an approach problem (narrow palpebral fissure), obesity, arterial hypertension, low ECC. Thorough preoperative preparation and surgical steps following nanophthalmos protocol lower the risk in this type of eyes. FINANCIAL INTEREST: NONE