SURGICAL AND IMAGING INSIGHTS IN A CASE OF SUSPECTED ALPORT SYNDROME WITH LENTICONUS AND SECONDARY GLAUCOMA

To demonstrate the surgical approach and optical coherence tomography (OCT)–based monitoring strategy in managing bilateral secondary glaucoma associated with suspected Alport syndrome and lenticonus.

Department of Ophthalmology, AKFA Medline University Hospital, Tashkent, Uzbekistan.

A 35-year-old woman with high myopia, anterior lenticonus, and early-stage cataracts underwent sequential bilateral phacoemulsification with posterior chamber intraocular lens implantation. Optical biometry and OCT imaging were used pre- and post-operatively to guide surgical planning and assess retinal nerve fiber layer (RNFL) integrity. Intraocular pressure (IOP) was controlled using a fixed-combination regimen of brinzolamide/timolol and nightly latanoprost.

Preoperative IOP measured 30.5 mmHg OD and 41.0 mmHg OS, with OCT showing advanced ganglion cell loss in OS. Postoperatively, the right eye achieved best-corrected visual acuity of 1.0 and normalized IOP (16 mmHg), while the left eye improved to 0.3 due to irreversible optic neuropathy. RNFL imaging confirmed stabilization without further thinning during one-year follow-up.

Integrating imaging-guided assessment with tailored surgical planning enables effective visual rehabilitation in syndromic glaucoma cases. In Alport-related lenticonus, vigilant postoperative IOP control and OCT-based monitoring are crucial to preserve remaining optic nerve function.