Surgical Management of a Patient with Anterior Megalophthalmos, Lens Subluxation, and a High Risk of Retinal Detachment

Calculating intraocular lens power in anterior megalophthalmos: A case report

Introduction

We report a case of a man with cataract and anterior megalophthalmos (AM), in which some myopia was retained when calculating intraocular lens (IOL) power using the Haigis formula to avoid postoperative farsightedness.

Case description

A 59-year-old Chinese man was referred to our clinic for cataract surgery in his right eye. He had strong bilateral megalocornea, and his left eye had undergone surgery four times. After complete preoperative examinations and repeated biometry, the Haigis formula was used, and a 3-piece IOL was implanted with a target power of −1.97 D. At 1-year follow-up, the patient showed the best-corrected distance vision of 20/20 with the refraction of −1.50 DC × 160°, and the IOL was stable.

Conclusion

Our patient with anterior megalophthalmos showed postoperative hyperopia drift even though the Haigis formula was used as suggested in previous studies. To prevent farsightedness after surgery, some myopia should be retained when calculating IOL power. The Kane, Holladay II with AL adjustment, and Barrett Universal II formulas may be more accurate for calculating IOL power in such patients.

How many challenges we may encounter in anterior megalophthalmos with white cataract: a case report

Background

Anterior megalophthalmos is a rare congenital disease which mainly features enlargement of the anterior segment. Cataract surgeries in anterior megalophthalmos can be challenging due to the anatomical anomalies while the studies upon the surgical design have been less integrated.

Case presentation

A 37-year-old woman presented with progressively blurred vision in the right eye after a transient fever 10 months ago. Her ocular history included hypermetropia with a spherical equivalent of + 4.00 OU. The review of systems showed bilateral varus deformity of distal interphalangeal joints on the little fingers. The patient denied family history of hereditary ocular diseases and her sister was born with uterus didelphys. On initial examinations, the corrected distance visual acuity was hand motion OD and 20/33 OS. Her intraocular pressure was 15 mmHg OD and 16 mmHg OS. Horizontal corneal diameter was 14 mm OD and 13.88 mm OS and axial length was 24.87 mm OD and 25 mm OS. Anterior segment photography showed bilateral iridal atrophy with deficiency in pupillary dilation and white cortically mature cataract in the right eye. Inspection by anterior segment optical coherence tomography indicated bilateral augmented anterior chambers with backward iridal concave on horizontal orientation. Ultrasound biomicroscopy showed partially peripheral anterior synechiae and pectinate ligaments at chamber angle in both eyes and opacified lens with the apparently elongated suspensory ligaments in the right eye. A deliberately selected 1-piece foldable intraocular lens (IOL) with frame haptics was implanted after phacoemulsification for good IOL stability. During the follow-up, the visual rehabilitation appeared relatively good and a lower degree of IOL dislocation comparing with existing reports was verified by OPD-Scan III aberrometry.

Conclusions

We presented the challenges and the original findings from a case of congenital anterior megalophthalmos with white cataract who underwent phacoemulsification and IOL implantation. This is the first report describing the comparison of the different IOL power calculation formulas in anterior megalophthalmos. Compared to the SRK/T and the Holladay II formulas, the Haigis formula could be a more accurate choice for the IOL calculation in anterior megalophthalmos according to our case. Moreover, the deliberate selection of IOLs is essential for IOL stability in these patients.

Ocular abnormalities and complications in anterior megalophthalmos: a case series

OBJECTIVES

To describe the clinical and Scheimpflug imaging features in cases of anterior megalophthalmos (AM).

METHODS

Retrospective record review was performed for patients with AM who presented between June 2017 and May 2018. Clinical history, slit lamp examination, Scheimpflug imaging indices (Pentacam-HR, Oculus, GmbH), dilated fundus examination and treatment records were reviewed.

RESULTS

The study included eight eyes of four male patients (mean age 6.5 years, range 4-10 years). Corrected distance visual acuity ranged from finger counting to 20/80. The mean horizontal corneal diameter, central corneal thickness, steep keratometry, flat keratometry, anterior chamber (AC) angle, AC depth, maximum pupil diameter and axial length were 13.8 ± 0.5 mm, 538.7 ± 68.9 µm, 42.8 ± 1.6 D, 41.4 ± 0.9D, 47.0 ± 4.2 degree, 3.8 ± 0.3 mm, 3.9 ± 0.1 mm, and 24.9 ± 0.9 mm, respectively. Posterior dislocation of crystalline lens, vitreous degeneration and rhegmatogenous retinal detachment (consequent of retinal dialysis/atrophic hole/lattice with hole) were noted in seven, eight and five eyes, respectively. Pigment dispersion glaucoma was noted in both eyes of one patient, which was managed with topical anti-glaucoma medication. Vitrectomy with silicone oil tamponade was successful in retinal reattachment in all three eyes that underwent surgery.

CONCLUSION

Scheimpflug imaging helps in demonstrating the corneal and anterior segment pathological changes in AM. The disease extends to involve the zonules, vitreous and retina as well. Ophthalmologists should be able to identify this disorder, recognise and manage the associations and complications.

Rhegmatogenous retinal detachment with a giant tear located in the intermediate periphery: Two case reports

RATIONALE

We experienced 2 cases of retinal detachment (RD) with giant tears located in the intermediate periphery of the fundus. In this case report, we investigated the clinical characteristics in these 2 cases.

PATIENT CONCERNS AND DIAGNOSES

Case 1 involved a 63-year-old male, who became aware of metamorphopsia and decreased visual acuity (VA) in his left eye. Upon examination, he was diagnosed with a giant tear at the margin of the intermediate peripheral lattice degeneration. Case 2 involved a 54-year-old male, who became aware of decreased VA in his right eye. Upon examination, he was diagnosed with vitreous hemorrhage and a giant tear located in the upper intermediate periphery. In these 2 cases, there was no obvious previous or familial history.

INTERVENTIONS

In both cases, reattachment was achieved by performing vitrectomies.

OUTCOMES

These 2 cases were characterized by the refraction being close to emmetropia due to the flat corneal curvature, even though there was a long axial length and the eyeballs were spherically large. In both cases, the postoperative clinical course outcome was favorable and no complication occurred LESSONS:: Our findings indicate that intermediate peripheral giant tears may occur in spherically large eyeballs, and that vitreous surgery is effective in such cases. Since the risk of the onset of RD in the fellow eye is thought to be high, strict postoperative follow-up is necessary.