Posters

Acute primary angle closure in a nanopthalmic patient: characteristics and surgical resolution

Poster Details

First Author: S.Banderas SPAIN

Co Author(s):    X. Garrell-Salat   D. Aragón-Roca   F. Trejo-Velasco   J. Rigo   M. Castany        

Abstract Details

Purpose:

To describe the implications of nanophthalmos in a case of acute primary angle closure (APAC)

Setting:

Glaucoma Unit. Vall d’Hebron University Hospital. Barcelona, Spain.

Methods:

We report the case of a 38-year-old woman with hyperopia of 9-10D, who presented in emergency room with painful vision loss and nausea. Diagnosis of APAC in the right eye was made. Nd:YAG laser iridotomies were bilaterally attempted, unsuccessfully in the right eye. Peripheral iridoplasty was performed in the right eye, with slight widening of anterior chamber and IOP decrease. During follow-up, gonioscopy showed persistence of angle closure and UBM showed superior serous retinal detachment in the right eye. Nanopththalmos was diagnosed by biometry: axial length of 16.42mm and 16.89mm. Phacoemulsification and goniosynechialysis (PHACO+GSL) were performed in the right eye.

Results:

Intraocular surgery in nanophthalmic eyes has a high incidence of intra and postoperative complications. To lower the risk of uveal effusions, 125ml of intravenous 20% mannitol was administered before surgery. PHACO + GSL turned uneventful and subconjunctival methylprednisolone was injected. Anterior inflammation occurred and was treated with corticosteroid every two hours. Once resolved, PHACO +GSL was performed in left eye. During the following year IOP was under control with no medications, the angle was opened in the left eye and in the superior and temporal quadrants of the right. Both eyes presented posterior synechiae as a sequel of the inflammation.

Conclusions:

Nanophthalmic eyes are predisposed to all forms of angle-closure disease due to their anatomical features: small dimensions with a normal-sized lens. The tendency for choroidal expansion possibly contributes to APAC. Its management includes preferably laser therapy such as iridotomy and argon-laser peripheral iridoplasty. Cataract surgery in patients with nanophthalmos remains a surgical challenge and complications often occur in such high-risk eyes. For this reason precautions have to be taken. Intravenous mannitol allowed low IOP and enough space during the surgery so that no vitrectomy was needed. Postoperative inflammation was observed despite intensive intra and postoperative corticosteroids.

Financial Disclosure:

None