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Megalocornea and megalophthalmus as a cause of secondary unilateral glaucoma: case presentation

Poster Details

First Author: M.R SERBIA

Co Author(s):    P. Jovanovic   G. Stankovic-Babic   B. Dzunic   S. Novak   J. Djordjevic-Jocic   L. Bojovic

Abstract Details

Purpose:

The aim of these work is to present a rare, unusual case of mostly primary, unilateral, congenital corneal developmental disorder-megalocornea associated with megalophthalmus and adult onset secondary glaucoma, refractory to treatment that impaired visual function of affected eye. Megalocornea is non-progressive enlargement of the cornea greater than 13mm. Corneal structure histologically normal could be presented as an isolated finding or associated with systemic or ocular abnormalities: megalophthalmus anterior, buphthalmus, iridolental dysgenesis. Patomechanisms includes: failed fuson of optic cup allows more space for corneal growth, gene ventroptin mutation.

Setting:

Patient for these case presentation is examined, observed and treated in Eye Clinic of Clinical Center Nis. Any required further treatment or operation is also planned to be performed in Eye Clinic Nis.

Methods:

B.S(66) female; redness, pain in right eye; without systemic comorbidity VOD=amaurosis VOS=0,7-0,8 TOD=30mmHg TOS=16mmHg Slit lampOD Engorged conjunctival-episcleral vessels, transparent dome-shaped megalocornea, increased horizontal/vertical corneal diameters(15/14mm), deep AC without flare, posteriorly positioned iris-lens diaphragm, iridodonesis, relative afferent pupillary defect, white dense lens opacification, juxtalimbal anterior staphyloma. Slit lampOS Opacification of anterior lens cortex, regular corneal apearance Keratometry OD 46.00/47.25 OS 45.00/45.00 Gonioscopy OD Open angle, III-IV gradus(Shaffer), sectorialy widened ciliary band, rare iris processus; OS Open-angle III gradus(Shaffer) Ophtalmoscopy FOS C/D=0,1/I SAPerimetry(Humphrey) OS Within normal limits MD=2,14dB Ultrasonography ODLax=27,91mm;ACD=4,40mm OSLax=22,40mm;ACD=2,92mm B(scan)OD Posterior vitreous detachment, no retinal detachment, optic disc cupping.

Results:

Based on examination Dg:OD Megalocornea.Megalophthalmus.Cataracta complicata matura.Glaucoma secundum absolutum decompensatum. Exotropia OS Cataracta senilis corticalis incipiens. Although patient is suffering more than 10years from glaucoma in her right eye, which was amblyopic from childhood and treated only with timolol 0,5%, considering the fact that eye is amaurotic(blind) primary medicamentous therapy was administered. Topical antiglaucoma drugs(timolol, dorsolamide, brimonidine, bimatoprost) lowered IOP(23mmHg). Surgical treatment of glaucoma and cataract will be performed when necessary in case of complications that may include: lens subluxation or luxation, secondary phacomorphic or phacolytic acute glaucoma. Regular IOP examinations and staphyloma control, if scleral thining(scleroplastica) are obligatory.

Conclusions:

Ophthalmologist should be aware of all ocular findings that may be associated with many complications in megalocornea/megalophthalmus. Satisfactory prognosis in simple megalocornea recquires only correction of refractive error. Associated with megalophthalmus anterior, risk for glaucoma and cataracts should be monitored , because difficulties in treating these patients. Cataract operations in these patients are very challenging due to zonular weakness, enlarged structures and IOL selection. Screening for pigment dispersion and glaucoma sequelae are necessary. Therefore timely dignosing and treatment, also patient education of potential ocular complications are important in succesfull care.

Financial Disclosure:

NONE

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