Cataract surgery in eyes with congenital ocular coloboma
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CATARACT
Cataract surgery in eyes with congenital ocular coloboma Maria Phylactou 1,2
&
Francesco Matarazzo 1 & Alexander Clifford Day 1,2,3,4 & Badrul Hussain 1 & Vincenzo Maurino 1,2
Received: 21 May 2020 / Revised: 10 August 2020 / Accepted: 25 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess the safety, efficacy, and complication rate of phacoemulsification and intraocular lens (IOL) implantation in patients with congenital uveal coloboma and to evaluate the role of pupilloplasty. Methods A retrospective review of 41 eyes (31 patients) with congenital coloboma that underwent phacoemulsification and IOL implantation between September 2012 and September 2018. Preoperative, intraoperative, and postoperative data were collected for analysis. Results The mean patient age at surgery was 53.9 years (range 15–82). The primary indication for surgery was cataract removal for visual improvement, and lens subluxation was additionally present in two eyes (5%) preoperatively. The mean preoperative corrected distance visual acuity (CDVA) was 0.90 LogMAR. Phacoemulsification surgery was performed in all cases and nine eyes (22%) had pupilloplasty for pupil reconstitution at the time of the procedure. Surgeon grade varied from trainee surgeon under supervision to consultant. Eight patients (19.5%) had posterior capsular rupture (PCR) with or without vitreous loss requiring anterior vitrectomy. Of these, 2 cases (5%) had dropped nuclear fragments requiring subsequent pars plana vitrectomy and lens fragment removal. The mean postoperative CDVA was 0.62 LogMAR (p = 0.0003). Conclusion Patients with iridolenticular choroidal coloboma appear to be more at risk of complications, as were cases performed by non-consultant surgeons. Contrary, patients with phakodonesis, preoperative anterior chamber vitreous, dense cataracts, and cases were iris hooks used had no significant difference at PCR rate. The risk of postoperative glare and pupilloplasty needs to be considered in cases with good visual potential to avoid a possible second procedure.
Keywords Coloboma . Cataract surgery . Phacoemulsification . Pupilloplasty . Iridoplasty Abbreviations IOL Intraocular lens AC Anterior chamber
PCR PCO
Posterior capsule rupture Posterior capsule opacification
Introduction * Maria Phylactou [email protected] 1
Cataract Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
2
Cornea and External Diseases Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
3
NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust , London, United Kingdom
4
Institute of Ophthalmology , University College London , London, United Kingdom
Congenital ocular colobomata are clefts caused by the absence of tissue in the inferonasal quadrant due to incomplete closure of the ectodermal optic vesicle fissure during embryogenesis [1]. Colobomata can affect various structures of the eye including the iris, ciliary body, lens, zonular
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