International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 4, Issue 9 | Case Report | Open Access DOI
Karen Allison*
Brittany Hodges, Nikki Neequaye, Abdullah Virk, Eugene Wang, Ugur Celik and Karen Allison*
University of Rochester School of Medicine and Dentistry, Flaum Eye Institute, New York, USA
*Correspondence to: Karen Allison
Fulltext PDFBackground: This case report is relevant to the field of ophthalmology because it enhances understanding of diagnosis and surgical management for complicated cataract procedures in patients with narrow angle glaucoma, high hyperopia, and nanophthalmos. These coexisting morbidities are of primary concern due to increased risk for serious complications including angle-closure glaucoma, uveal effusions, refractive surprise, aqueous misdirection, and retinal abnormalities. This case report will help to close knowledge gaps by offering a patient example. Case Presentation: A 54-year-old Caucasian male ship engineer with no significant past medical history but an ocular history of anatomical narrow angle, high intraocular pressures, high hyperopia, and previous bilateral Laser Peripheral Iridotomy (LPI) performed in 2011. He has no family history of ocular disease and no relevant social history. The patient presented to a Flaum Eye Institute satellite clinic for a routine comprehensive eye exam with an optometrist in early December 2022. Anterior segment exam was unremarkable except for bilateral LPI and narrow angle. Distance visual acuity with correction was 20/30 in both eyes (OU) with improvement to 20/20 in the right eye (OD) and 20/25 +3 in the left (OS) following refraction. Refraction was OD: +10.75 -1.00 x 075 and OS: +9.75 -1.00 x 105. Intraocular Pressure (IOP) documented during the encounter was initially 19 OD and 21 OS. Dilation precipitated an IOP spike to 38 OD and 40 OS after 40 minutes. He was then treated with two drops each of Dorzolamide-Timolol and Brimonidine OU, which reduced IOP to 18 OD and 18 OS over the next 2 hours. He was prescribed Dorzolamide-Timolol QAM and Latanoprost QHS OU drops to use at home. He was referred and seen by the glaucoma service 13 days later for further evaluation. Following a comprehensive examination that included gonioscopy, it was determined that he had Shaffer grade 1 narrow angle with pigmentation in both eyes and signs of optic nerve damage in the right eye (early superior defects, cup-to-disc ratio of 0.5). Consequently, he was scheduled for laser iridoplasty in the right eye eight days later. Laser iridoplasty in the right eye was well tolerated, resulting in an intraocular pressure of 14 mmHg in the right eye. The patient was prescribed Prednisolone drops to be administered four times daily for a duration of one week. During the follow-up assessment in January 2023, it was observed that the patient had improved to Shaffer grade 2 in the right eye. Additionally, he was informed about the The patient was lost to follow-up and was not seen again until late August 2024 when he returned for possible cataract evaluation. He was made aware of the heightened risk of cataract surgery due to his ocular history. During his next visit in late October 2024, the patient reported experiencing itchiness and burning in the left eye, as well as glare in both eyes. Upon examination, his visual acuity with correction was measured at 20/25 in the right eye and 20/30 in the left eye. Manifest refraction was OD: +9.75+1.00 x 165 and OS: +8.75 +1.00 x 015. He was determined to have visually significant cataracts OU limiting activities of daily living. Axial length was 18.97 mm OD and 19.12 mm OS, with an anterior chamber depth of 2.52 mm OD and 2.49 mm OS. Given these findings, the patient was initially scheduled for cataract extraction with Posterior Chamber Intraocular Lens (PCIOL) implantation and goniotomy OS December 2024. One week after surgery, the patient reported visual symptoms of aniseikonia and anisometropia and was found to have a tilted Intraocular Lens (IOL) with posterior synechiae OS on Slit Lamp Examination (SLE) which was further confirmed by Ultrasound Biomicroscopy (UBM). The patient subsequently had intraocular lens repositioning and anterior vitrectomy OS with resolution of visual symptoms. Four months later in April 2025, the patient underwent cataract extraction and PCIOL implantation, anterior vitrectomy, and goniotomy OD. The procedure was uncomplicated and he reported no visual complaints on subsequent follow-up.
Conclusions: This case report underlines the importance of early diagnosis, appropriate surgical management, and potential complications of patients with nanophthalmos and cataracts.
Aniseikonia; Anisometropia; Anterior vitrectomy; Cataract; Cataract extraction; Goniotomy; Nanophthalmos; Posterior chamber intraocular lens; Iridoplasty; Iridotomy
Brittany Hodges, Nikki Neequaye, Abdullah Virk, Eugene Wang, Ugur Celik and Karen Allison. Nanophthalmos and Cataract Surgical Management: A Case Report. Int Clinc Med Case Rep Jour. 2025;4(9):1-10.