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      Cataract Surgery in Anterior Megalophthalmos: A Review

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          Abstract

          Anterior megalophthalmos is characterized by megalocornea associated with a very broad anterior chamber and ciliary ring elongation. It is also called X-linked megalocornea. It is accompanied by early development of cataracts, zonular anomalies, and, rarely, vitreoretinal disorders. Subluxation of a cataract can occur in cataract surgery because of zonular weakness. In addition, in most patients, standard intraocular lens (IOL) decentration is a risk because of the enlarged sulcus and capsular bag. These unique circumstances make cataract surgery challenging. To date, several approaches have been developed. Implantation of a retropupillary iris-claw aphakic intraocular lens may be a good option because it is easier than suturing the IOL and can have better and more stable anatomic and visual outcomes, compared to other techniques.

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          [Retropupillary fixation of the iris claw lens in aphakia. 1 year outcome of a new implantation techniques].

          Beth Mohr, C. Eckardt, F Hengerer (2002)
          There are several surgical options available for the correction of aphakia. We investigated if retropupillary fixation of an iris claw lens is a method combining the advantages of posterior chamber implants with a new low-risk method of intervention. An iris claw lens was implanted in 48 eyes in the plano-convex direction (model 205 Y). For the calculation of the IOL power we estimated an A-constant of 116.8. The lens was pushed via a 5-mm wide corneal incision vertically in the anterior chamber and was fixed in the retropupillary position after turning in the horizontal direction. After aspiration of the viscoelastica the corneal incision was closed by a 10-0 nylon suture. The implantation was successful in all patients. A visual improvement was noted in 27 patients (56.2%), an unchanged visual acuity was seen in 18 patients (37.5%) while 3 patients (6.2%) showed a loss of visual acuity. A cystoid macular edema was found by fluorescein angiography in two cases. Leakages in the area of the enclavation were not seen. The retropupillary fixation of an iris claw lens seems to have the advantages of a true posterior chamber implantation with a low intra- and postoperative risk profile. The easy implantation process with this technique could replace the normally applied sclera suture fixed implantation of a posterior chamber lens as the method of choice.
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            Cataract surgery and anterior megalophthalmos: custom intraocular lens and special considerations.

            Robert H Osher, Gisela Vaz (2007)
            We report a patient who presented with anterior megalophthalmos: corneal diameter of nearly 17.0 mm, anterior chamber depth of 7.0 mm, mild lens subluxation, and nuclear sclerotic cataract. Surgical management consisted of a scleral tunnel incision, capsule staining, a predetermined capsulorhexis size, microcoaxial phacoemulsification with torsional ultrasound, and implantation of a custom IOL to ensure endocapsular fixation. Special consideration must be given to the patient with a very large anterior segment.
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              Iris claw lens: anterior and posterior iris surface fixation in the absence of capsular support during penetrating keratoplasty.

              W J Rijneveld, W H Beekhuis, E F Hassman … (2016)
              Intraocular lens implantation in eyes with pseudophakic or aphakic corneal edema and insufficient posterior capsular support presents a surgical challenge. The iris claw lens has the advantage that it can be fixated to the iris without sutures because the peripheral iris is incarcerated between the claws. We present the results of a study with implantation of an iris claw lens in combination with penetrating keratoplasty in 19 eyes of 19 patients with pseudophakic or aphakic corneal edema which lacked posterior capsular support. The lens was fixated on the anterior iris surface (12 eyes) or posterior iris surface (seven eyes). Mean follow-up time was 11.8 months (7 to 21 months). All grafts remained clear. One patient was lost for follow up after 3 months. Visual acuity improved in 83% of the patients. Twenty-eight percent of the patients had a visual acuity of > or = 20/40. Complications such as pigment dispersion, glaucoma, peripheral synechiae, and lens decentration were rare. We feel iris claw lens implantation combined with penetrating keratoplasty is a safe alternative to achieve pseudophakia in eyes with corneal edema and inadequate posterior capsular support.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Hypothesis Discov Innov Ophthalmol
                Journal ID (publisher-id): mehdiophth
                Title: Medical Hypothesis, Discovery and Innovation in Ophthalmology
                Publisher: Medical Hypothesis, Discovery & Innovation Ophthalmology
                ISSN (Print): 2322-4436
                ISSN (Electronic): 2322-3219
                Publication date (Print): Autumn 2015
                Volume: 4
                Issue: 3
                Pages: 101-108
                Affiliations
                [1 ] Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
                [2 ]Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
                [3 ] Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
                [4 ] Universidad Industrial de Santander, Bucaramanga, Colombia
                Author notes
                Dr. Alejandro Tello, Centro Medico Ardila Lülle, Piso 3, Modulo 7. Floridablanca, Colombia, Tel: +577 6392929; E-Mail: alejandrotello@gmail.com
                Article
                PMC ID: 4921209
                PubMed ID: 27350950
                SO-VID: fe4c399b-14cd-411f-839f-43cd27a655c3
                Copyright © ©2015, Med Hypothesis Discov Innov Ophthalmol.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Review Article

                Keywords: iris-claw intraocular lens,megalocornea,megalophthalmos
                Data availability:
                Keywords: iris-claw intraocular lens, megalocornea, megalophthalmos

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