Posters

Cataract surgery in cases of proptosis

Poster Details

First Author: P.Singh INDIA

Co Author(s):    M. Bajaj                    

Abstract Details

Purpose:

Proptosis is an important, albeit uncommon presenting complaint in any ophthalmic practice. Adult patients with proptosis can develop cataracts, either as a consequence of age related changes or secondary to treatment with radiation therapy. However, there is currently no literature addressing the technique of performing cataract surgery in such patients. We aim to describe the challenges faced while performing cataract surgery in a series of 5 patients with proptosis.

Setting:

The study was performed at Dr. Rajendra Prasad Institute of Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi.

Methods:

Five patients with proptosis and visually significant cataract were identified from the oculoplasty clinic over 18 months . All patients had undergone optimal treatment for their orbital pathology and were clinically stable for at least 1 year. Baseline examination included corrected distance visual acuity (CDVA), intraocular pressure (IOP), anterior and posterior segment examination, Hertel’s exophthalmometry and orbital imaging. Phacoemulsification surgery with posterior chamber intraocular lens (IOL) implantation in the bag was performed for all patients under topical anesthesia. Follow-up evaluation included CDVA, IOP and anterior segment examination on post-operative day 1, day 7, 1 month, 3 months and 6 months.

Results:

The median age of the patients was 59 years. Orbital pathologies comprised 3 cases of cavernous hemangioma, 1 case of Rosai-Dorfman disease and 1 case of non-specific orbital inflammation. Median amount of proptosis was 4mm (range 3-6mm). Difficulty in speculum placement was seen in one case. Intra-operative anterior chamber (AC) instability was observed in 3 cases. Suture placement at wound site was required in 2 cases. Post-operatively, increased IOP was observed in two patients, one of whom needed AC reformation surgery at 1 week. At the 6-month follow up, CDVA for 4 cases was 20/20 and 20/40 for one case.

Conclusions:

Cataract surgery in patients with proptosis presents with its own set of unique complications. It is important to monitor these patients for cataract as a cause of vision loss and observe precautions for minimizing intra-operative problems. A close post-operative follow-up is also essential to recognize and manage any complications that are likely to occur later. To conclude, optimal results can be obtained in these cases with careful planning and execution.

Financial Disclosure:

None