Femtosecond laser-assisted cataract surgery in a spherophakic lens: An unusual case report
Rationale: Spherophakia is a rare diagnosis which is often associated with a shallow anterior chamber, angle-closure glaucoma, lens subluxation, and lenticular myopia. When cataracts occur with subluxation of the lens, vision is often markedly affected. This often presents surgeons with a unique challenge of maintaining good visual outcomes while minimizing potential complications. Patient concerns: A 48-year-old female was referred for ophthalmological assessment due to decreased vision in the left eye. In the left eye, the best-corrected visual acuity at distance was 20/125 with manifest refraction of −6.5D + (−0.75) D × 118°. The slit lamp examination showed iridodonesis and a significant nuclear cataract (C3N3) with tremor in the left eye. After pupil dilation, a subluxated lens, weak zonules, and “fake golden ring” within the lens was noted. Diagnosis: Due to the patient's symptoms, examination results, she was diagnosed with cataract, subluxation of the lens and spherophakia in left eye. Interventions: The patient underwent an uneventful femtosecond laser-assisted cataract surgery (Alcon Fort Worth, TX). The laser was able to perform a circular free-floating anterior capsulotomy and easy lens fragmentation. Outcomes: There were no postoperative complications. At 3 months postoperatively, the uncorrected visual acuity was 20/25, and the manifest refraction was −0.25 D − 0.75 D × 148° with the corrected...
Publication date: Available online 15 January 2020Source: Journal of American Association for Pediatric Ophthalmology and StrabismusAuthor(s): Arif O. Khan, James BaconA 56-year-old woman with pseudophakia and glaucoma was referred because of left eye hypotropia and esotropia noted following superotemporal Ahmed glaucoma valve implantation in that eye. Examination suggested left heavy eye syndrome, and it was confirmed the patient had high axial myopia before her cataract surgeries. Both nasal displacement of the left superior rectus muscle and inferior displacement of the left lateral rectus muscle were noted intraoperati...
In most cases, myopia occurs due to excessive axial elongation of the eyeball. Nowadays, it is possible to correct vision even in cases of high myopia using various types of spectacles, contact lenses (CL) or refractive surgery. However, a significant concern related to myopia is the increased risk of ocular pathologies related to excessive eye growth, such as glaucoma, cataract, idiopathic retinal detachment or choroidal neovascularization . In recent decades, the prevalence of myopia has increased dramatically worldwide [2 –4].
The actual numbers of people blind or with poor vision continue to increase despite so excellent progress that is being made in reducing the prevalence or percentage of people affected. More attention is required to provide quality outcomes for cataract surgery, prevent and manage myopia, detect and treat diabetic retinopathy, glaucoma, and age-related macular degeneration (AMD). Although more ophthalmologists are needed to provide this eye care, it is important that ophthalmologists work in effective teams with allied eye health personal to be able to meet the community needs.
A child receives treatment in the northeastern district of Mymensingh, Bangladesh. Credit: Naimul Haq/IPS By External SourceGENEVA, Oct 8 2019 (IPS) A staggering 2.2 billion people already suffer from eye conditions and visual impairment today, but the global need for eye care is set to increase “dramatically”, with lack of exercise a key factor, the UN health agency said on Tuesday, unveiling its first ever report on vision across the world. While welcoming recent successes in eliminating common conditions such as trachoma in eight countries, the World Health Organization (WHO) highlighted evidence indicating ...
Conclusions: The present case is the first to describe the unusual presentation of pseudoexfoliation in a young individual along with presenile cataract. Simultaneous occurrence of pseudoexfoliation with cataract could be due to previous intraocular surgery, iris trauma, possible low-grade inflammation, and high myopia in a predisposed eye. The clinician should be aware that although a rare condition, pseudoexfoliation can occur in the young and may be associated with presenile cataract.
The frequency of late in-the-bag intraocular lens (IOL) dislocation has increased over the past decades. Important predisposing factors are pseudoexfoliation syndrome (PXF), myopia, previous vitreoretinal surgery, and trauma,1 –3 and there is also an association with glaucoma.1–4 Furthermore, some studies report high intraocular pressure (IOP) in eyes with IOL dislocation despite no known glaucoma.1–5 Accordingly, it has been speculated whether the dislocation can cause an IOP increase.
The worldwide prevalence of myopia has increased significantly in recent years [1 –4]. In East Asia, myopia prevalence rates are much higher than those in the west. A Korean study recently reported that 96.5% of 19-year-old males in South Korea were myopic . Sun et al.  reported a similar figure of 95.5% for Chinese university students. Myopia is associated with several d isadvantages that include the financial cost of optical correction devices, the possible complications of refractive surgery, and the increased risk of ocular diseases such as cataract, glaucoma, macular degeneration, and retinal detachment [7,8].
CONCLUSION: To the best of our knowledge, we report herein the first documented case of an axial length change of this magnitude after glaucoma filtering surgery. PMID: 30175614 [PubMed - as supplied by publisher]
Our six experts, geographically diverse, all glaucoma fellowship trained, provide mostly uniform recommendations in the management of this patient. None favored non-surgical observation with continued medical therapy despite the fact the patient had only mild loss of RNFL and a generally full visual field. Each of the expert surgeons recognized the importance of avoiding hypotony and the increased risk inherent to transscleral surgery in this patient with axial myopia. Accordingly, none of the experts recommended transscleral surgery, or even supraciliary surgery as the next step.
This patient developed glaucoma at an early age with minimal RNFL loss and a normal visual field with underlying axial myopia.