Cataract surgery in large buphthalmic eyes

1. S S Pandav
2. Jagat Ram
3. Anupam Banger
4. Sushmita Kaushik
5. Srishti Raj

Advanced Eye Center, PGIMER, Chandigarh, India

Managing pediatirc cataract is challenging. Managing cataract in a patient with congenital glaucoma is a real challenge. Intraocular lens implants (IOL) are designed for normal sized eyes. In a large buphthalmic eye the lens may not centre well even after successful phaco-aspiration and in the bag IOL insertion.

We operated on 3 eyes with cataract in eyes that had been operated for congenital glaucoma previously. Intraocular pressure was controlled followoing trebeculotomy in 2 eyes and Ahmed Glaucoma Valve following a failed trabeculectomywith mitomycin -C in one eye. Corneal diameters were large in all three eyes (13 mm, 14 mm and 14mm). The age at the time of cataract surgery was 14 months 2 years and 27years. All eye underwent phaco-aspiration through a 4mm anterior capsulorhexis. The IOL was inserted in the sulcus with the optic of the IOL captured in the bag through anterior capsular rhexis.

Postoperatively the IOLs were very well centred and stable in all three eyes with clear visual axes.