Approach To A Rare Case Of Microcoria, Microphthalmia, And Nystagmus In A Filipino Infant

Anterior segment dysgenesis can have a wide spectrum of presentation. This report describes a combination of microcoria, microphthalmia, and nystagmus.

A 3-month old Filipino infant presented to the outpatient clinic with a 1 month history of inward eye deviation. Patient was born full-term to a 30-year-old with a history of urinary infection during pregnancy.

On ocular examination of both eyes, the patient could fixate and follow. Slit lamp examination showed clear corneas of 7 x 7 mm diameter and pinpoint pupils, non-reactive to light. Alignment testing revealed alternating esotropia with horizontal nystagmus, but no limitations in motility. Intraocular pressures were normal. 

The operative approach included pupilloplasty, anterior vitrectomy, lensectomy, and examination under anesthesia. Intraocular pressures were within normal, and axial lengths were 16.71 and 16.70 for the right and left eye, respectively. Angles opened until the posterior trabecular meshwork. Manual pupillary dilation was done with microscissors and a Sinsky hook. There was no lens nucleus visualized, but the anterior and posterior capsules were seen fused and opacified. Patient was left aphakic. Funduscopy was unremarkable.

Post-surgery, the pupil enlarged to 3mm with the patient demonstrating improved fixation ability. Post-operative outcomes showed enhanced visual stimuli exposure with improved fixation duration despite persistent nystagmus. Refraction indicated a +20.00 sphere for both eyes.

Enlarging the initial < 1 mm pupil size expanded visual stimulus reception. Early detection is crucial for preventing deprivation amblyopia and optimizing visual outcomes in challenging cases.