1/7. Bilateral microcornea and unilateral macrophthalmia resulting in incorrect intraocular lens selection.A 79-year-old man with symmetrical microcornea and a dense unilateral nuclear sclerotic cataract had cataract extraction by phacoemulsification. The SRK/T formula suggested a 10.0 diopter (D) intraocular lens (IOL) for emmetropia (axial length 26.58 mm). The non-cataract eye required a 25.0 D IOL for emmetropia (axial length 21.51 mm). Biometric measurements were rechecked, and an 18.0 D IOL was implanted (axial length 24.02 mm). The 6 week postoperative refraction of -13.0 2.0 x 25 necessitated IOL exchange (10.0 D). Six weeks postexchange, the refraction was -3.75 2.5 x 30. This illustrates that symmetrical anterior microphthalmos does not always coexist with symmetrical posterior microphthalmos. awareness of the association of symmetrical microcornea and unilateral colobomatous macrophthalmia may aid appropriate IOL selection in future cases.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/7. Cataract surgery with primary posterior chamber intraocular lens implantation in nanophthalmos.A 56-year-old Asian woman with nanophthalmos and cataract in the right eye underwent extracapsular cataract extraction with primary posterior chamber intraocular lens implantation of 31.0 D. Intraoperatively, there was severe vitreous upthrust; however, there was no vitreous loss and the lens could be placed in the posterior chamber. The patient's postoperative course was uneventful except for a moderate degree of coagulum over the lens. Her best-corrected visual acuity was 20/80. The patient required YAG capsulotomy one year later. Her intraocular pressure was under control without any medication. With appropriate precautionary measures, primary posterior chamber intraocular lens implantation can be performed in nanophthalmic eyes with a favorable visual outcome.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/7. The management of glaucoma in nanophthalmos.patients with nanophthalmos are prone to develop a chronic painless type of glaucoma in middle age, probably due to the natural increase in the size of the lens which is already relatively too large for the small eye. Although the underlying mechanism is obscure, a slowly progressive "creeping" chronic angle-closure is postulated, but gonioscopic evaluation is difficult due to the shallow anterior chamber, with grade I and slit angles. Response to medical treatment is poor and miotics may even make the condition worse by producing relative pupillary block and by relaxing the lens zonule. Ordinary glaucoma surgery is to be avoided in nanophthalmos because of the fear of postoperative ciliary-block malignant glaucoma. Periopheral iridectomy performed in five eyes at an advanced stage of the chronic angle-closure did not facilitate glaucoma control in three eyes, and in two eyes in which the operation was combined with posterior sclerotomy, the eyes became blind from vitreous hemorrhage. Lenx extraction in five eyes controlled the glaucoma but was followed by choroidal effusion and nonrhegmatogenous retinal detachements in two eyes and blindness in another eye when combined with a posterior sclerotomy. No firm therapeutic recommendations can be made on the basis of the author's experience in the six reported cases. Conventional medical therapy seems ineffectual even when begun early in the glaucoma. Conventional glaucoma surgery must be performed early, before permanent damage to the outflow mechanism occurs but removal of the lens must be anticipated. The surgeon must also remain aware of the high incidence of serious posterior-segment complications which inexplicably follow glaucoma or lens surgery in nanophthalmos, as described by Brockhurst.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/7. A case of angle-closure glaucoma, cataract, nanophthalmos and spherophakia in oculo-dento-digital syndrome.BACKGROUND: We report a new case of oculo-dento-digital syndrome. methods: Case report. RESULTS: We saw a 34-year-old women with oculo-dento-digital syndrome. visual acuity was no perception of light (RE) and 1/35 (LE). Biomicroscopy revealed a flat anterior chamber and an advanced cataract. The intraocular pressure (IOP) was 60 mmHg in both eyes. Ultrasonographic biomicroscopy demonstrated a closed chamber angle in both eyes. Measurements of the axial length and of the diameter of the lens were 18.7 mm/6.0 mm for the RE and 18.7 mm/5.8 mm for the LE respectively. In the time following we conducted a cyclodestructive procedure in the RE and a cataract extraction with implantation of an intraocular lens in the LE. This led to a considerable reduction of the IOP in the RE and combined with local therapy to IOP regulation in the LE. CONCLUSION: In this patient nanophthalmos, cataract and spherophakia led to angle-closure glaucoma in both eyes. We recommend early monitoring of IOP, axial length and lens diameter. This case demonstrates that an early cataract extraction might beneficially influence the natural course of the disease.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
5/7. Nanophthalmic cataract extraction.Nanophthalmos is a rare ophthalmic condition with potential sight-threatening complications. In addition, nanophthalmic eyes have a high incidence of intraoperative and postoperative complications, including uveal effusion and retinal detachment. Prophylactic measures to prevent these complications may be used. The case is presented where cataract extraction for a nanophthalmic eye was performed from a posterior approach in combination with a pars plana vitrectomy and gas procedure. To the authors' knowledge, this method of cataract extraction has not been reported before for this condition.- - - - - - - - - - ranking = 6keywords = extraction (Clic here for more details about this article) |
6/7. Nanophthalmos: ultrasound biomicroscopy and Pentacam assessment of angle structures before and after cataract surgery.We report a case of nanophthalmos with intractable secondary glaucoma. Bilateral cataract extraction with intraocular lens implantation was used as definitive treatment for the chronic angle-closure glaucoma. The changes in angle and ciliary body anatomy were well documented with preoperative and postoperative Pentacam assessment (Oculus Optikgerate GmbH) and ultrasound biomicroscopy (Paradigm Medical Industries) images. We believe these are the first diagnostic and prognostic images of this kind in a nanophthalmic eye.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/7. Cataract surgery in nanophthalmic eyes.Cataract surgery in nanophthalmic eyes may be complicated by postoperative uveal effusion. Evidence is presented that prophylactic lamellar scleral resection with decompression of the vortex veins, performed 2 months or more prior to cataract extraction, may reduce the incidence of this severe complication. A randomized study to determine the benefit of such prophylaxis is advocated.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |