Couching of cataractous lens in microphthalmic eyes with irido-fundal coloboma: revisiting the historical technique.

Abstract

Cataract surgery in microphthalmic eyes is challenging due to anatomical restraints, hard bulky nucleus. This series aims to evaluate the safety and efficacy of couching of intraocular lens in irido-fundal coloboma with microphthalmos. Tertiary care centre in South India. Retrospective non-comparative study in eyes with irido-fundal coloboma, corneal diameter < 7mm and brown cataract. Visual acuity less than 6/60 in other eye. Anterior chamber entry made, zonules broken and lens dislocated into the vitreous cavity in a controlled manner. Baseline Clinico-demographic details, corrected distance visual acuity (CDVA), Intra-ocular pressure (IOP), corneal diameter, axial length, lens status and post-surgery CDVA, IOP and complications recorded and followed up for atleast 6months. Fifteen eyes of 15 subjects were evaluated with a mean age 49.4 ± 10.9years. At baseline, mean IOP 14.5 ± 3.8mmHg, mean axial length 19.3 ± 0.5mm, mean corneal diameter was 6.5 ± 0.34mm and CDVA 2 logMAR which improved to 1.5 logMAR at 3months (p value 0.002). Transient spike in IOP in 33.3% subjects was medically managed with no significant difference in IOP (p > 0.05) at baseline (14.5 ± 3.8mmHg), 3months post-surgery (16 ± 2.8mmHg) and 6months post-surgery (14.9 ± 2.5mmHg). One patient underwent re-couching. No other major complications were noted. Couching of cataractous lens is an effective and safe method in microphthalmic eyes with irido-fundal coloboma as last resort procedure, where no other surgical procedure may work. It provides an ambulatory gain of visual acuity in previously non-ambulatory subjects. Corneal measurements help in determining the subset of patients where couching offers viable option.