Case series: surgical management, IOL power calculation, and long-term follow-up of patients with nanophthalmos

Session Details

Session Title: Cataract Surgery Special Cases I

Session Date/Time: Sunday 14/09/2014 | 14:30-16:30

Paper Time: 15:06

Venue: Boulevard G

First Author: : F.March de Ribot SPAIN

Co Author(s): :    P. Lopez Lizarraga   E. Chavez Mondragon           

Abstract Details

Purpose:

To report the evolution of three patients with narrow secondary anterior chamber, cataract and nanophthamos. Nanophthalmos is an unusual congenital disorder associated with angle-closure glaucoma, cataract surgery in these patients is challenging. We present the clinical manifestations, approach and results in a group of patients.

Setting:

Anterior Segment Department at Instituto de Oftalmología Conde de Valenciana (Mexico City)

Methods:

Case 1 is a patient that arrived with cataract OU and a secondary narrow anterior chamber. The reported axial length of the right and left eye was 15.42 mm and 15.34 mm. Case 2 is a patient that arrived with an acute glaucoma attack secondary to pupillary block due to cataract. Ultrasonography reported an axial length of 16.01 mm, cataract surgery was decided. The third case is a patient that arrived to urgencies with athalamia OU (anterior chamber depth 1.19 and 1.69 mm respectively) and an acute glaucoma attack of the right eye. Posterior lensectomy was decided.

Results:

Case 1: favorable evolution after uneventful phacoemulsification with VA improvement, opening of anterior chamber angles and 3 mmHg IOP reduction. Case 2: was done an Ahmed valve implantation due to persistent angle closure after phacoemulsification because of peripheral sinechiae. After this, there was an adequate long term IOP control. The formulas that more accurately predicted the power IOL these cases were Haigis and SRK-T respectively. Case 3: unfavorable evolution with a postsurgical malignant glaucoma, hemorrhagic choroidal detachment and vitreous hemorrhage. She was made a second surgical time vitrectomy with a final visual acuity of light perception.

Conclusions:

Patients with nanophthalmos will always represent a medical and surgical challenge. Establishing adequate surgical indications and contraindications is important. A highly experienced surgeon is recommended and a close follow up is mandatory due to fatal complications such as spontaneous choroidal effusions or malignant glaucoma that can take place inadvertently.

Financial Interest:

NONE