Clinical study of a complex cataract surgery for congenital aniridia combined with cataract

Abstract

Objective To evaluate the therapeutic effect of a complex surgery that included phacoemulsification, an implanted posterior chamber folding, yellow intraocular lens(IOL) and an embedded capsular tension ring for patients with congenital aniridia complicated with cataract; tinted contact lenses were given postoperatively. Methods This was a prospective case series study. Ten patients (17 eyes) agreed to undergo complex cataract surgery. The surgery used a 3.2 mm clear corneal incision and continuous circular capsulorhexis. The capsulorhexis diameter was less than 6 mm. A capsular tension ring and HOYA yellow, folded posterior chamber IOL were implanted during surgery. All patients wore tinted contact lenses postoperatively. The patients ranged in age 4- 50 years (mean age: 25.4±14.8 years). The best corrected visual acuity (BCVA) preoperatively was 0.05- 0.1. Intraocular pressure (IOP) was 8- 24 mmHg (mean IOP: 16.4 ± 3.9 mmHg). Corneal endothelial cell density was 1 825-3 829/mm2 (mean: 3 280±473). All patients had only an iris root except for one patient who had a partial iris. The lens was completely exposed and the lens suspensory ligament could be seen. There was no lens dislocation. Lens opacity was an uneven petal shape. All patients definitely experienced photophobia and had different degrees of nystagmus. The cornea and fundus were almost normal. A paired t test was used to compare intraocular pressure, and corneal endothelial changes before and after the surgery. Results All phacoemulsifications were completed smoothly by the same ocular surgeon. The mean IOL correction was 24.44±4.30 D (19.50- 30.00 D). BCVA was 0.1- 0.7, 1- 18 months postoperatively. All patient photophobia symptoms significantly decreased and this was more apparent when patients were wearing the tinted contact lens. The cornea was clear at the final postoperative follow- up and there were no symptoms of corneal infection. The lens capsule held all IOLs in place and the lenses were in a good neutral position. IOP was 18.1 ± 3.6 mmHg. There was no secondary glaucoma. Corneal endothelial cell density was 2 669±850/mm2. There was no secondary corneal endothelial decompensation. Conclusion The theraputic effect is good when congenital aniridia complicated with cataract is treated with a complex surgery that included phacoemulsification, an embedded capsular tension ring and an implanted tinted folding posterior chamber IOL. The tinted contact lenses were worn postoperation. This procedure can definitely improve postoperative visual acuity and significantly reduce photophobia symptoms. Key words: Aniridia; Cataract extraction; Tinted intraocular lenses; Capsular tension ring