Senthilkumar, Vijayalakshmi A; Gandhi, Niyati
Department of Glaucoma Services, Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
Address for correspondence: Dr. Vijayalakshmi A Senthilkumar, Department of Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India. E-mail: [email protected]
Received September 02, 2022
Received in revised form November 18, 2022
Accepted November 24, 2022
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A 42 years old young female, a known case of glaucoma on dorzolamide eye drops two times a day in both eyes (BE) since 1 year, presented to us with the best corrected visual acuity (BCVA) of 6/6P with -8 Diopter spherical in the right eye (RE) and 6/9 with -9.5 Diopter spherical in the left eye (LE). The intra-ocular pressure was 20 mmHg in BE. Slit lamp examination BE revealed a variable depth of the anterior chamber much shallower inferiorly with patent peripheral iridotomy and 3600 occludable angles [Figure 1a-b]. The patient was accidentally dilated following which crowning of the lens in the pupillary margin was noted in BE [Figure 1c, d and 2a, b]. Ultrasound biomicroscopy revealed a decreased anterior chamber depth of 1.43 mm and 1.59 mm and an increased lens thickness of 4.69 mm and 4.80 mm in RE and LE, respectively, with stretched zonules in all the quadrants [Figure 3a, 3b]. Fundus examination showed 0.65 cup disc ratio and 0.85 in RE and LE, respectively. Systemic examination was unremarkable. Owing to the advanced optic nerve damage in LE, antiglaucoma medication was stepped up to Misopt eyedrops (dorzolamide hydrochloride 2% + timolol maleate 0.5% BD) in BE. In view of very shallow anterior chambers, the limbal approach was avoided and was planned for sequential pars plana vitrectomy (PPV) + pars plana lensectomy (PPL) + scleral fixation of intra-ocular lens (SFIOL). Unfortunately, the patient lost to follow-up.
Microspherophakia is a rare but potentially blinding disease with a variety of associated systemic syndromes and varied clinical presentations. The appropriate lens surgery and intra-ocular lens (IOL) fixation technique have to be selected, keeping in mind the progressive nature of the zonulopathy. In a prospective, non-randomised, interventional case series by Yang et al., patients with spherophakia and secondary glaucoma were split into two groups and they underwent either phacoemulsification + CTR + IOL or PPL + SFIOL. The authors found that both techniques were effective in lowering the intra-ocular pressure (IOP) and improving visual acuity over a follow-up period of 3 years. The authors also reported the need for medical/surgical control of IOP in the long term after successful lensectomy and IOL implantation. Lensectomy alone cannot be effective if there is significant PAS or angle anomaly. Early identification of the disease, timely visual rehabilitation, and appropriate management of the lens and glaucoma can help us prevent blindness from this condition.
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Conflicts of interest
There are no conflicts of interest.
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Keywords:© 2023 TNOA Journal of Ophthalmic Science and Research | Published by Wolters Kluwer – Medknow
Microspherophakia; secondary angle closure glaucoma; secondary glaucoma