Refractive Lens Exchange With Implantation Of Individual Intraocular Lenses In A Patient With Microcornea . Clinical Case

To share the experience of refractive lens exchange with individual manufacture intraocular lens implantation in a patient with microcornea.

Microcornea refers to congenital eye anomalies, in which the diameter of the cornea is less than 10 mm. A feature of eyes with microcornea is a flattened cornea with ophthalmometry up to 30-35 D, normal length, hyperopic refraction, and relative anterior microphthalmos . In this regard, lens surgery has a number of difficulties associated with the limited space for manipulations in the anterior chamber, as well as the choice of the type and method of calculating the intraocular lens (IOL).

A 19-year-old student came to our clinic with complaints of eyestrain and spectacle non-tolerance. Identified: microcornea, corneal astigmatism, high refractive hypermetropia in both eyes, mild amblyopia of the right eye and moderate of the left eye. A decision was made to replace the clear lenses with an IOL. The results of ultrasound biomicroscopy (UBM) substantiated the further choice of IOL: the non-standard diameter of the ciliary sulcus was 11.50 to 12.40 mm, the diameter of the capsular bag was from 8.68 to 8.89 mm. The patient's lenses were replaced with individual IOLs with a total diameter of  9.0 mm, an optical zone diameter of 5.0 mm and an optical power of +39.0 D and +40.0 D, respectively, in the right and left eyes.

The IOLs were implanted through a 2.4 mm incision. Of the features, the need for suture sealing of the tunnel incision in the left eye should be indicated. Visual acuity on the 1st day after surgery in the right eye was 0.7 (6/10), in the left eye - 0.2 (6/30). Postoperative refraction by magnitude of the spherical equivalent was -0.13 D and +0.25 D, respectively, in the right and left eyes. According to UBM, the position of the IOL is central, the haptic elements are not in contact with the ciliary processes. Subjectively, the patient noted an increase in visual acuity and visual comfort, which is not comparable with the use of glasses. The patient is currently under observation, planned follow-up in 6 months

This clinical case demonstrates the need for a thorough preoperative diagnostic approach to prevent intra- and postoperative complications, as well as the benefits of using  individual manufacture IOLs, which allowed to obtain satisfactory visual results in a patient with microcornea.