The Short Eye Challenge: Cataract Surgery With Concurrent Angle Procedures In Primary Angle Closure Glaucoma

To highlight the role of lens extraction with high-power(+40D ) posterior chamber intraocular lens(PCIOL) implantataion in a short, highly hyperopic eye with primary angle-closure glaucoma and to evaluate postoperative visual and intraocular pressure outcomes following combined cataract surgery and Bent Ab Interno Needle Goniectomy(BANG)

This case was managed in a tertiary care ophthalmology center with dedicated cataract and glaucoma services with well equipped phacoemulsification system, biometry, AS-OCT and availability of high power intraoclar lenses(+40D).

A 55 year old patient with primary angle closure glaucoma(moderate glaucomatous field changes) presented with progressively diminished vision in the right eye. Clinical evaluation revealed Nuclear sclerosis with posterior subcapsular cataract and high axial hyperopia. Preoperative visual acuity was FC 2/60 and intraocular pressure was controlled on 2 anti-glaucoma medications.

The patient underwent "in the bag" phacoemulsification (Direct Chop) technique with implantation of  +40D PCIOL combined with Bent angle needle goniectomy. Postoperatively the patient demonstrated signficant visual rehabilitation with best corrected visual acuity improving to 6/18(Snellens's Chart) and intraocular pressure reduced to 9mmHg without evidence of early postoperative complications. The surgical approach was tailored to manage both the visually significant cataract and underlying synechial angle clsosure mechanism. 

This case highlights several important considerations in complicated cataract cases such as accurate biometry, IOL power calculation in high hyperopia and  surgical planning using angle assessment tools (AS-OCT). Combined lens based and angle based surgical approach offers favourable anataomical and functional outcomes in complicated cataract cases.