Artisan Aphakic Lens for Cataract Surgery in Anterior Megalophthalmos

Galvis, Virgilio; Tello, Alejandro; Miotto, Giuseppe; Rangel, Carlos Mario

doi:10.1159/000346074

Cited by 19 publications

(23 citation statements)

References 21 publications

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“…In a review on this topic, Galvis et al explained that unlike megalocornea and megalophthalmos in which the corneas have a normal curvature and normal or mildly decreased thickness, the corneas in keratoglobus are remarkably thin and the enlargement of the corneal diameter is small. It is noteworthy that according to their review only two cases of anterior megalophthalmos have been previously described with such significant corneal thinning one case with 377 µm and the other with 390 µm 13. The present case is therefore the one with the thinnest cornea ever reported (328 and 331 µm).…”

Section: Discussionmentioning

confidence: 54%

“…In adults the values were 54.7 D±8.29 D and 49.37 D±7.68 D 3. On the other hand, the keratometries in the published cases of anterior megalophthalmos are around the mean of the normal population 13. In the present case, corneal topography also showed a central curvature of the cornea within normal limits in both eyes (OD: 43.18/44.63 D and OS: 43.39/44.59 D), therefore ruling out the presence of a keratoglobus.…”

Section: Discussionmentioning

confidence: 84%

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Trans-scleral explantation of posteriorly dislocated IOL-CTR complex in a case of anterior megalophthalmos with an unusually thin cornea

Gangwe

Bhatia²,

Agrawal

et al. 2018

BMJ Case Reports

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Anterior megalophthalmos and keratoglobus are characterised by corneal thinning and deep anterior chamber. They are clinically distinguished on the basis of normal to slightly decreased corneal thickness with a large corneal diameter (>13 mm) in case of anterior megalophthalmos, and marked limbus-to-limbus corneal thinning with globular protrusion in keratoglobus. To achieve and maintain a centred and stable intraocular lens (IOL) position in the bag is often difficult in cases of anterior megalophthalmos due to a too large diameter of the capsular bag and ciliary ring. We report a case of a 40-year-old man with features of anterior megalophthalmos with extremely thin cornea. He had spontaneous posterior dislocation of IOL and capsular tension ring (CTR) within the bag after initial successful cataract surgery. The dislocated complex could neither have been repositioned with scleral fixation due to large diameter of ciliary ring nor could it have been explanted through a clear corneal incision due to associated very thin cornea. We performed pars plana vitrectomy and separated the IOL-CTR complex inside the eye and explanted them separately through the sclerotomy, as is done for removal of intraocular foreign body. This avoided incision on the thin cornea. We conclude that this method can be very useful in a similar clinical situation but is complex enough to justify its use in routine cases.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 84%

Trans-scleral explantation of posteriorly dislocated IOL-CTR complex in a case of anterior megalophthalmos with an unusually thin cornea

Gangwe

Bhatia²,

Agrawal

et al. 2018

BMJ Case Reports

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“…Additional power adjustments are only needed if the IOL is planed to be iris -fixated or capsulorhexis captured, as is the cases with large or unstable capsular bag. One such a case was reported by Galvis V. and coauthors (10). Haigis formula was used in that case to calculate Artisan iris fixating lens power, with excellent refractive result.…”

Section: Discussionmentioning

confidence: 99%

“…Cataract extraction in eyes with anterior megalophthalmos is complex because of hyper-deep anterior chamber, zonular laxity and poor visualization. Enlargement of the ciliary ring is often associated with a wide capsular bag, so various methods to secure intraocular lens implant in these circumstances were described in literature: iris fixated artificial lens (10,11), sutured posterior chamber IOL (12,13), anterior capsulorhexis capture of the IOL (14), and custom-made intraocular lens with very wide haptic diameter (4). However, crystalline lens is not always large.…”

Section: Discussionmentioning

confidence: 99%

Cataract surgery and intraocular lens power calculation in a patient with anterior megalophthalmos with normal sized crystalline lens: Case report

Glisic

Jovanović

Gakovic

et al. 2015

SANAMED

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Cataract surgery and intraocular lens power calculation is challenging in patients with anterior megalophthalmos and cataract, with postoperative refractive surprise frequently reported. Deep anterior chamber in these patients substantially influence effective lens position. To minimize possibility of refractive surprise, we used Haigis formula that takes into account anterior chamber depth in the lens power calculation for our patient. Cataract was managed by phakoemulsification with standard intraocular lens implanted in the capsular bag. Postoperatively, satisfying refractive result was achieved and refractive surprise was avoided.

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“…The differential diagnosis of anterior megalophthalmos includes megalocornea, congenital glaucoma, and keratoglobus. [ 6 ]…”

Section: Introductionmentioning

confidence: 99%

Traumatic cataract in patient with anterior megalophthalmos

Chlasta-Twardzik

Nowińska²,

Wąs³

et al. 2017

Medicine

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Rationale:Megalophthalmos anterior is a rare, bilateral, nonprogressive, hereditary, congenital disorder, characterized by the enlargement of all anterior segment structures of the eye, with megalocornea, iris atrophy, and zonular abnormalities commonly found. Usually almost asymptomatic in young patients, with most complaints concerning blurred vision due to the common corneal astigmatism, it might in time lead to several complications including premature cataract formation and pigmentary glaucoma.Patient concerns:This review presents the case of a 47-year old patient referred to our clinic for traumatic cataract surgery, with striking bilateral megalocornea, somehow overlooked during previous ophthalmic examinations in his local outpatient clinic.Diagnosis:We noticed markedly enlarged corneas and deepened anterior chambers of his both eyes, accompanied by intumescent, white cataract of the right eye, and incipient cortical cataract of the left eye. Best corrected visual acuity (BCVA) was counting fingers in the right eye and 20/25 in the left eye. Additional examination revealed multiple abnormalities of the anterior segment, leading to the diagnosis of anterior megalophthalmos. It is astounding the patient remained undiagnosed during previous examinations, with his megalocornea and remarkably deep anterior chamber so apparent.Interventions and outcomes:We performed standard phacoemulsification procedure, with 3 piece posterior chamber intraocular lens (PCIOL) implantation into the lens capsule. The surgery was uneventful, with postoperative BCVA of 20/20 in the right eye, and no dislocation of the lens in 9-month observation period.Lessons:Complicated cataract in patients with anterior megalophthalmos can be successfully treated with standard phacoemulsification procedure followed by the bag PCIOL implantation.Care needs to be taken during cataract surgery in these patients, as zonular abnormalities and lens enlargement are common, resulting in increased rate of intra- and postoperative complications. As patients with anterior megalophthalmos require a more careful follow-up.

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Artisan Aphakic Lens for Cataract Surgery in Anterior Megalophthalmos

Cited by 19 publications

References 21 publications

Trans-scleral explantation of posteriorly dislocated IOL-CTR complex in a case of anterior megalophthalmos with an unusually thin cornea

Trans-scleral explantation of posteriorly dislocated IOL-CTR complex in a case of anterior megalophthalmos with an unusually thin cornea

Cataract surgery and intraocular lens power calculation in a patient with anterior megalophthalmos with normal sized crystalline lens: Case report

Traumatic cataract in patient with anterior megalophthalmos

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