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

Abstract

We report a patient who presented with anterior megalophthalmos: corneal diameter of nearly 17.0 mm, anterior chamber depth of 7.0 mm, mild lens subluxation, and nuclear sclerotic cataract. Surgical management consisted of a scleral tunnel incision, capsule staining, a predetermined capsulorhexis size, microcoaxial phacoemulsification with torsional ultrasound, and implantation of a custom IOL to ensure endocapsular fixation. Special consideration must be given to the patient with a very large anterior segment.

Anterior Megalophthalomos Phacoemulsification and IOL Implantation

“…1 Various methods of IOL fi xation in Anterior megalophthalmos have been described in the past to prevent IOL decentration like iris supported Binkhorst IOL, suturing of an ACIOL, suturing the optic or haptic to the anterior capsule and iris clip IOL in posterior chamber, Artisan aphakic lens, special Sinskey posterior chamber IOL. [2][3][4] We adopted diff erent techniques of posterior chamber IOL implantation in our cases. In case 1, we achieved stabilization of IOL by fi xating it to sclera whereas in case 2, it was achieved by capturing the optic through an anterior capsule opening with haptics lying in the sulcus.…”

Phacoemulsification with corneal astigmatism correction with the use of a toric intraocular lens in a case of megalocornea

“…1-3 Undoubtedly, the need for cataract surgery can, as in this case, create intraoperative problems. [8][9][10][13][14][15][16] A deep anterior chamber as well as enlarged lenticular and iridial surfaces decrease accessibility to the lens nucleus during surgery. [7][8][9] The scale of the procedure difficulty increases because of a narrow pupil and lens instability caused by the damaged ligaments that induce iridodonesis.…”

“…[8][9][10][13][14][15][16] A deep anterior chamber as well as enlarged lenticular and iridial surfaces decrease accessibility to the lens nucleus during surgery. [7][8][9] The scale of the procedure difficulty increases because of a narrow pupil and lens instability caused by the damaged ligaments that induce iridodonesis. [8][9][10]17,18 The ligament damage can affect proper control of the capsulorhexis, particularly when the pupil is narrow.…”

“…[7][8][9] The scale of the procedure difficulty increases because of a narrow pupil and lens instability caused by the damaged ligaments that induce iridodonesis. [8][9][10]17,18 The ligament damage can affect proper control of the capsulorhexis, particularly when the pupil is narrow. 7,8,18 It is also emphasized that thin CCT can affect proper wound sealing in the postoperative period.…”

“…The cornea is thinner, and mosaic degeneration is observed. [3][4][5][6][7][8][9] These are most frequently observed in the anterior and central part of the corneal proper substance; when the posterior part is affected, there may be damage to Descemet membrane. 5 A tendency toward premature cataract has been observed in megalocornea.…”