Cataract Extraction in X-Linked Megalocornea

Abstract

Corneal enlargement and mosaic dystrophy are obvious features of XLM. Anomalies involving the anterior structures of the eye and in particular the lens capsule and zonule are also frequent. Cataract extraction with phacoemulsification and PC IOL implantation can be successful, but special attention must be paid to both surgical technique and IOL selection.

Megalocornea and bilateral developmental cataracts

“…2,3,5 Cataract, usually posterior subcapsular, develops in most patients 5 between 40 years of age and 50 years. 6 To our knowledge, pediatric cataracts have not been described in association with megalocornea.…”

“…2 Cataract extraction in megalocornea is considered difficult, and complications are frequent. 1,6,7 They include vitreous loss, posterior capsule rupture, lens subluxation, and IOL dislocation. 6 The anatomy of the anterior segment, as well as the occasional presence of a subluxated lens, makes the operation technically challenging.…”

Cataract surgery and anterior megalophthalmos: Custom intraocular lens and special considerations

“…Cases of IOL malposition with endocapsular fixation have been reported. [5][6][7][8] Surgeons have tried to prevent this complication by implanting an iris-supported Binkhorst IOL, 9 suturing an anterior chamber IOL, 7 suturing the optic or haptic to the anterior capsule and iris, 10 and placing an iris-clip IOL in the posterior chamber. 3 Kwitko et al 6 experienced dislocation of a standard size posterior chamber IOL.…”

“…Although capsular tension rings were available, it was not necessary to implant one in either eye, as previously reported. 5 The big challenge was selection of the IOL. Cases of IOL malposition with endocapsular fixation have been reported.…”

Phacoemulsification in anterior megalophthalmos

“…Review of the available literature, as well as consultation with experienced colleagues, played a vital role. [1][2][3][4][5] The decision to perform the trabeculectomy augmented with mitomycin-C prior to cataract removal brought the patient's IOP under control to minimize long-term glaucomatous optic neuropathy. There was a risk for failure of the trabeculectomy drainage following the cataract procedure; however, this was minimized with the use of preoperative and postoperative topical and oral steroids and 5-fluorouracil subconjunctival injection at the time of surgery.…”