Abstract
BackgroundThe management of eyes with nanophthalmos is a dilemma for ophthalmologists due to various complications, especial the eye with malignant glaucoma. We report a case of effective treatment for malignant glaucoma in nanophthalmos.Case presentationAn 82-year-old man was performed phacoemulsification in the right eye with normal ocular pressure and nanophthalmos. The surgery was uneventful: an intraocular lens (IOL) was placed and centered in the capsular bag. 2 months later, the patient presented with malignant glaucoma, and the intraocular pressure fluctuated between 18.6 mmHg and 30.8 mmHg with antiglaucoma medications. The patient did not respond to surgical peripheral iridotomy and goniosynechialysis. Then a single treatment with laser peripheral lens posterior capsulotomy and vitreous anterior membranectomy was performed. The intraocular pressure normalized, and the anterior chamber deepened within 24 h. The patient’s condition remained stable for 9 months with no further treatment, and his Snellen corrected distance visual acuity was 20/50. The left eye of this patient was treated by combined surgery including phacoemulsification, IOL implantation, anterior vitrectomy, surgical peripheral iridotomy (PI), and goniosynechialysis. No intraoperative or postoperative complications were observed.ConclusionsThis case suggests that it is essential to choose a suitable treatment for nanophthalmos patients to deal with malignant glaucoma and to reduce the incidence of malignant glaucoma.
Highlights
The management of eyes with nanophthalmos is a dilemma for ophthalmologists due to various complications, especial the eye with malignant glaucoma
This case suggests that it is essential to choose a suitable treatment for nanophthalmos patients to deal with malignant glaucoma and to reduce the incidence of malignant glaucoma
We describe our successful use of laser peripheral capsulotomy in a patient with a nanophthalmic eye who developed malignant glaucoma after phacoemulsification
Summary
Nanophthalmos is part of the clinical spectrum of microphthalmos, which is typically a small eye without ocular malformations. Nanophthalmos is characterized by a short axial length [1], thickened sclera [2], a shallow anterior chamber, and a normal-to-large lens with a high lens-toeye-volume ratio [3] These basic clinical features account for glaucoma complication in these eyes. Malignant glaucoma is described as normal or elevated intraocular pressure (IOP) associated with axial shallowing of the entire anterior chamber in the presence of a patent peripheral iridotomy (PI). 5 days after PI and goniosynechialysis, the right eye underwent YAG laser lens posterior capsulotomy and vitreous anterior membranectomy in the temple superior where surgical PI had been performed. At the last follow-up visit, 9 months after the YAG laser lens posterior capsulotomy and vitreous anterior membranectomy, the BCVA was 20/50 with + 1.00–1.25 × 106, the IOP was controlled at 11.2 mmHg, and the anterior chamber depth was 2.87 mm. A foldable single-piece posterior chamber IOL (Akreos MI60, Bausch) was inserted into the capsular bag. 7 months after surgery, the BCVA was 20/50 with + 1.50–1.0 × 91, the IOP was controlled at 12.3 mmHg, and the anterior chamber depth was 2.74 mm. (Fig. 1D, Fig. 2D)
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