GLAUCOMA AFTER LENSECTOMY WITH MULTIFOCAL LENS IMPLANTATION IN A PATIENT WITH SPHEROPHAKIA – CASE REPORT

To present a difficult case of a patient with chronic angle-closure glaucoma secondary to spherophakia who underwent lensectomy and multifocal lens implantation complicated by glaucoma.

Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland

Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia in Katowice, Katowice, Poland

A 12-year-old boy, with high myopia and shallow anterior chamber of both eyes (OU), was diagnosed with spherophakia using ultrabiomicroscopy. At the age of 22 peripheral iridotomy (LPI) OU was performed due to angle-closure glaucoma. Despite patent LPI, the iridocorneal angles were still narrow. The patient underwent selective laser trabeculoplasty OU due to the high intraocular pressure (IOP). A couple of months later, the aspirations of subluxated lenses with implantations of multifocal AcrySof reStor intraocular lenses (IOL) were performed OU.

In the next 7 years, the patient experienced numerous recurrent vitreous hemorrhages in the left eye (OS) both after blunt traumas and spontaneously. At the age of 30, he underwent pars plana vitrectomy (PPV) OS. In the next 3 years, trabeculectomy and 4 times transscleral cyclophotocoagulation OS were performed. The IOP still remained high on full pharmacological treatment. At the age of 33, multifocal lens removal with PPV OS was performed. Currently, at the age of 34, the aphakic patient remains on full topical antiglaucoma treatment and IOP is within normal limits. Best corrected visual acuity is 0,75/50 and visual field is highly constricted.

Lensectomy should be a first-line treatment for angle-closure glaucoma secondary to spherophakia. Due to combined effects of a smaller capsular bag, weakened Zinn zonules, shallow anterior chamber and common peripheral anterior and/or posterior synechiae, the surgery is difficult and associated with high risk of complications. Despite successful procedure, the IOP may remain uncontrolled, especially when blunt trauma occurs. Therefore, the implantation of multifocal IOL seems to be risky in post-spherophakic eyes and it may be required to remove multifocal IOL in the case of malignant glaucoma.