SURGICAL MANAGEMENT OF A WHITE CATARACT IN A 27 YEARS-OLD PATIENT WITH ANIRIDIA

This is a case report that highlights the surgical challenges of managing a white cataract in a 27 years-old patient with aniridia 

A 27 years-old female patient came to a control referring OD Visual Acuity decreased since 2 months ago. She has medical record of Bilateral Aniridia and cataract surgery and Ahmed valve implant in the left eye 1 year ago.  At the moment of the evaluation the BCVA: OD 20/CF 1 mt.   OS 20/30.  IOP OD: 14 mm Hg and the OS: 9 mm Hg.  Biomicroscopy:  OD: aniridia. White intumescent cataract. OS: Ahmed valve in place. Aniridia. 3 pieces lens pseudophakia. 

Under general anesthesia previous pharmacological dilatation  I proceeded to perfom a side port and a main incision. The anterior capsule was stained with Trypan Blue.  The anterior chamber was filled with dispersive viscoelastic. Part of the liquefied cortical  material was aspirated with a 27 gauge needle.  A rhexis was performed.  The nucleuos was removed with the Phaco-Chop technique. The cortex was aspirated with a coaxial hand piece. A one piece IOL was placed in the bag, viscoelastic was removed and finally carbachol was placed in the anterior chamber to close the pupil. 

The next postoperation day the cornea was clear, the anterior chamber was formed and quiet. IOL in the bag and the IOP was 12 mm Hg.
After a week of the surgery the patient came back for a control.  The VA BC (sph: 0.50 Cyl -1.25 x 170) 20/30.  Patient was referred for follow up with the Glaucoma Specialist. 

Aniridia is an bilateral eye disorder where the iris is malformed. In general population occurs in 1 per 50.000-100.000 people and the incidence varies in different regions. Aniridia may occur as an insolated finding os a part of a Syndrome. It can be associated with abnormalities in the cornea, angle structures (causing glaucoma in approximately 50% of the patients) optic nerve and fovea hypoplasia.
Cataracts can occur in 50-80% of the patients. The Phacoemulsification procedure is a safe technique for the cataract treatment of those patients.  The follow up must be done for a multidisciplinary team including cornea, anterior segment, glaucoma and retina specialists.