DR. SUPRIYA SAMAK

, Dr. SRI GANESH

Abstract

Purpose: To discuss management of cataract surgery in nanophthalmos and necessary steps to be taken for an uncomplicated outcome 

Methods: A 59-year-old lady presented with history of angle closure attacks and decreased vision BE since 1 year. She had shallow AC and short AL (16.49mm) with patent PIs and dense cataracts in both eyes, suggestive of nanophthalmos. Right eye had small pupil with posterior synechiae. Under preoperative atropine and IV mannitol and LA, prophylactic sclerostomy was performed, synechiae was released and pupil expanded with the Malyugin ring. Phacoemulsification with custom IOL of +48.5D was implanted. Iridectomy, zonulectomy and hyaloidectomy was done to prevent post-op malignant glaucoma. 

Result: Post operative vision was 6/12 both eyes. 

Conclusion: Cataract surgery in a nanophthalmic eye is challenging with risk of suprachoroidal effusion, shallow AC, iris prolapse and malignant glaucoma.The meticulous precautions herein described give better outcomes.