Posterior Microphthalmos

Author: Hazem Elnashar (Egypt)

Co-authors:

Purpose

Show the effect on posterior segment when doing phaco in posterior microphthalmos cases especially in this case in which posterior microphthalmos associated with mature hard cataract, PEX with poor dilation of pupil , zonular dialysis , elevated IOP and very shallow anterior chamber

Setting/Venue

Memorial institute for ophthalmic research (MIOR)

Methods

Female patient 60 years old complaining of drop of vision in left eye . Examination of left eye show mature hard cataract with shallow AC , PEX with poor dilation of pupil , limited zonular dialysis and IOP 30 mmhg. Ultrasound show very small axial length 16 mm with localized area of choroidal effusion . Right eye aphakic with with BCVA 1/60. Patient is medically free . Give her antiglaucoma treatment and follow up IOP and start preparing for phaco. One hour before phaco start mannitol and her IOP became 16 just before surgery. Start phaco using Iris hooks to dilate pupil then stain and do capsulirehexis in very shallow AC while doing phacoemulsification of nucleus i use CTR to avoid increase dialysis . I complete phaco and implant IOL . I think at this point I did great jop but notice Iol tilted vertically in bag I tried many times to reposit even with Healon but tilted again . I decided to do anterior vitrectomy through sclerotomy 3 mm from limbus after few seconds notice blood in vitreous and expulsive hge rapidly I get out and sutured sclerotomy

Results

After surgery VA was HM with elevated Iop and ultrasound show localized Supra choroidal hge with vitreous hge . Follow up for 2 weeks under full anti glaucoma treatment . In follow up hge start to improve and IOP controlled and I decided to continue conservative without intervention but in 3rd week VA dropped to PLGP and ultrasound show retinal detachment. PPV was done for here and we found during surgery that site of sclerotomy although at 3 mm it is not in parsplana but in retina and it cause retinal tear which cause retinal detachment and also we found supra choroidal hge resolved without need for drainage and after PPV by 1 month BCVA reach 6/60

Conlusions

There is high risk to get rhegmatogenous retinal detachment in cases of phaco in posterior microphthalmos especially if we need to do sclerotomy due to disturbed anatomy. there is high risk of expulsive hge during doing phaco for posterior microphthalmos so if this occur only urgently close the globe and prepare all your tools for this moment as not to lose any second. Try to avoid anterior vitrectomy in these cases and if it is a must do your sclerotomy 1.5-2.00 mm and do very minimal anterior vitrectomy Mannitol is mandatory before surgery In such difficult cases u should prepare all your weapons healon , stain, CTR , 3piece IOL , Iris hooks

Financial Disclosure

i have no financial interest to disclose