Approach to Cataract Surgery in a Case with Microcornea and Coloboma

TL;DR

This paper discusses the challenges of cataract surgery in a patient with microcornea and coloboma, emphasizing the need for careful planning and postoperative care.

Contribution

The paper presents a case study highlighting the surgical complexities and postoperative complications in cataract surgery for patients with microcornea and coloboma.

Findings

Accurate biometry is challenging in patients with microcornea and coloboma due to structural abnormalities.

Postoperative capsular contraction syndrome can develop rapidly if subcapsular epithelial cells are not adequately removed.

Abstract

Cataract surgery in patients with microcornea and ocular coloboma poses unique surgical and postoperative challenges. The presence of a small corneal diameter, abnormal ocular anatomy, and the risk of postoperative complications require a highly individualized approach. This case highlights the difficulties encountered in biometry measurement and the development of capsular contraction syndrome following phacoemulsification surgery.

A 38-year-old male with bilateral ocular coloboma, microcornea, and nystagmus presented with progressive vision loss. Phacoemulsification with intraocular lens (IOL) implantation was performed in the right eye. Preoperative planning included keratometry by corneal topography and axial length confirmation with both optical and ultrasonic biometry. Despite meticulous planning, a postoperative refractive error and rapid anterior capsular fibrosis developed. Although neodymium: YAG capsulotomy was recommended, the patient declined the intervention.

In eyes with microcornea and coloboma, accurate biometry is often hindered by structural abnormalities, increasing the risk of refractive surprises. Additionally, the risk of intraoperative complications such as capsulorhexis extension, zonular dialysis, or vitreous prolapse is heightened. Postoperatively, capsular contraction syndrome may develop rapidly, especially if subcapsular epithelial cells are not adequately removed. This case emphasizes the need for careful intraoperative management and vigilant postoperative monitoring.

Cataract surgery in patients with microcornea and coloboma requires thorough preoperative assessment, surgical expertise, and tailored postoperative care. Awareness of potential complications such as biometric inaccuracy and capsular contraction is essential to optimize outcomes in these complex cases.

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