Nanophthalmos with angle closure glaucoma, a challenging case

Elsa Gustianty; Andika Prahasta; Raden Maula Rifada; Sonie Umbara

doi:10.15562/bmj.v12i3.4777

Nanophthalmos with angle closure glaucoma, a challenging case

Elsa Gustianty ,

Andika Prahasta ,

Raden Maula Rifada ,

Sonie Umbara ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i3.4777 |
Published: 2023-10-03

Abstract

Link of Video Abstract: https://youtu.be/eGhTbOkaaQI

Introduction: Nanophthalmos basically is a simple microphthalmos with clinical characteristics of short axial length (AL), shallow anterior chamber (AC), high lens to eye volume ratio, small cornea and thick sclera, associated with angle closure glaucoma. We report a case of nanophthalmos with angle closure glaucoma and cataract who underwent trabeculectomy and end up with malignant glaucoma. Pars plana vitrectomy (PPV) and phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation was done to manage the case.

Case Description: A 41-year-old man came with blurred vision in the right eye with redness and headache for 8 weeks. Intraocular pressure (IOP) was 46 mmHg, visual acuity was counting fingers at 2 m with nystagmus. Slit lamp examination revealed short axial length (AL), shallow anterior chamber (AC), small corneal diameter and high lens to eye volume. Trabeculectomy with 5FU was done with complication of malignant glaucoma. After PPV combined with phacoemulsification and PC IOL implantation, IOP was 14 mmHg, visual acuity 0.125 with deep AC.

Conclusion: Surgical intervention in nanophthalmos with angle closure glaucoma must be managed with good preparation. Malignant glaucoma in this case can be managed with pars plana vitrectomy and phacoemulsification without scleral procedure.

References

Elder MJ. Aetiology of severe visual impairment and blindness in microphthalmos. Br J Ophthalmol. 1994;78(5):332–4.
Wu W, Dawson DG, Sugar A, Elner SG, Meyer KA, McKey JB. Cataract surgery in patients with nanophthalmos: Results and complications. J Cataract Refract Surg. 2004;30(3):584–90.
Yang N, Jin S, Ma L, Liu J, Shan C, Zhao J. The pathogenesis and treatment of complications in nanophthalmos. J Ophthalmol. 2020;2020.
Rajendrababu S, Shroff S, Uduman MS, Babu N. Clinical spectrum and treatment outcomes of patients with nanophthalmos. Eye. 2021;35(3):825–30.
Guo C, Zhao Z, Zhang D, Liu J, Li J, Zhang J, et al. Anterior segment features in nanophthalmos with secondary chronic angle closure glaucoma: An ultrasound biomicroscopy study. Investig Ophthalmol Vis Sci. 2019;60(6):2248–56.
Carricondo PC, Andrade T, Prasov L, Ayres BM, Moroi SE. Nanophthalmos: A review of the clinical spectrum and genetics. J Ophthalmol. 2018;2018: 2735465.
Relhan N, Jalali S, Pehre N, Rao HL, Manusani U, Bodduluri L. High-hyperopia database, part I: Clinical characterisation including morphometric (biometric) differentiation of posterior microphthalmos from nanophthalmos. Eye. 2016;30(1):120–6.
Yang N, Zhao LL, Liu J, Ma LL, Zhao JS. Nanophthalmos: An update on the biological parameters and fundus abnormalities. J Ophthalmol. 2021;2021: 8853811.
Yosar JC, Zagora SL, Grigg JR. Cataract surgery in short eyes, including nanophthalmos: visual outcomes, complications and refractive results. Clin Ophthalmol. 2021;15:4543–51.
Yalvac IS, Satana B, Ozkan G, Eksioglu U, Duman S. Management of glaucoma in patients with nanophthalmos. Eye. 2008;22(6):838–43.
Burgoyne C, Tello C, New T, Eye Y. Cases in controversy nanophthalmia and chronic angle-closure glaucoma questions. J Glaucoma. 2002;11:525–8.
Singh OS, Simmons RJ, Brockhurst RJ, Trempe CL. Nanophthalmos: A perspective on identification and therapy. ophthalmology. 1982;89(9):1006–12.
Calhoun FP. The management of glaucoma in nanophthalmos. Trans Am Ophthalmol Soc. 1975;73:97–122.
Chen X, Guo X, Xu X, Xiao H, Liu X. Is thicker choroid a risk factor for malignant glaucoma? ophthalmic res. 2018;60(3):161–8.
Yuzbasioglu E, Artunay O, Agachan A, Bilen H. Phacoemulsification in patients with nanophthalmos. Can J Ophthalmol. 2009;44(5):534–9.

[1] Elder MJ. Aetiology of severe visual impairment and blindness in microphthalmos. Br J Ophthalmol. 1994;78(5):332–4.

[2] Wu W, Dawson DG, Sugar A, Elner SG, Meyer KA, McKey JB. Cataract surgery in patients with nanophthalmos: Results and complications. J Cataract Refract Surg. 2004;30(3):584–90.

[3] Yang N, Jin S, Ma L, Liu J, Shan C, Zhao J. The pathogenesis and treatment of complications in nanophthalmos. J Ophthalmol. 2020;2020.

[4] Rajendrababu S, Shroff S, Uduman MS, Babu N. Clinical spectrum and treatment outcomes of patients with nanophthalmos. Eye. 2021;35(3):825–30.

[5] Guo C, Zhao Z, Zhang D, Liu J, Li J, Zhang J, et al. Anterior segment features in nanophthalmos with secondary chronic angle closure glaucoma: An ultrasound biomicroscopy study. Investig Ophthalmol Vis Sci. 2019;60(6):2248–56.

[6] Carricondo PC, Andrade T, Prasov L, Ayres BM, Moroi SE. Nanophthalmos: A review of the clinical spectrum and genetics. J Ophthalmol. 2018;2018: 2735465.

[7] Relhan N, Jalali S, Pehre N, Rao HL, Manusani U, Bodduluri L. High-hyperopia database, part I: Clinical characterisation including morphometric (biometric) differentiation of posterior microphthalmos from nanophthalmos. Eye. 2016;30(1):120–6.

[8] Yang N, Zhao LL, Liu J, Ma LL, Zhao JS. Nanophthalmos: An update on the biological parameters and fundus abnormalities. J Ophthalmol. 2021;2021: 8853811.

[9] Yosar JC, Zagora SL, Grigg JR. Cataract surgery in short eyes, including nanophthalmos: visual outcomes, complications and refractive results. Clin Ophthalmol. 2021;15:4543–51.

[10] Yalvac IS, Satana B, Ozkan G, Eksioglu U, Duman S. Management of glaucoma in patients with nanophthalmos. Eye. 2008;22(6):838–43.

[11] Burgoyne C, Tello C, New T, Eye Y. Cases in controversy nanophthalmia and chronic angle-closure glaucoma questions. J Glaucoma. 2002;11:525–8.

[12] Singh OS, Simmons RJ, Brockhurst RJ, Trempe CL. Nanophthalmos: A perspective on identification and therapy. ophthalmology. 1982;89(9):1006–12.

[13] Calhoun FP. The management of glaucoma in nanophthalmos. Trans Am Ophthalmol Soc. 1975;73:97–122.

[14] Chen X, Guo X, Xu X, Xiao H, Liu X. Is thicker choroid a risk factor for malignant glaucoma? ophthalmic res. 2018;60(3):161–8.

[15] Yuzbasioglu E, Artunay O, Agachan A, Bilen H. Phacoemulsification in patients with nanophthalmos. Can J Ophthalmol. 2009;44(5):534–9.

Nanophthalmos with angle closure glaucoma, a challenging case

Abstract

References

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