Spherophakia, An Unusual Challenge

To report a rare case of spherophakia managed by complex cataract surgery and secondary intraocular lens implantation, highlighting it as a surgical challenge where individualization is key.

Glaucoma clinic at our ophthalmology facility.

A 44-year-old woman with no prior ocular or systemic history presented with decreased vision. Best-corrected visual acuity was 20/27 OD and 20/22 OS, with narrow anterior chamber, grade I iridocorneal angle, elevated intraocular pressure OS, nuclear cataract, and spherophakia on anterior segment OCT. Right eye underwent cataract surgery with pars plana vitrectomy, revealing severe zonulopathy and capsular phacodonesis leading to intraoperative aphakia. A secondary retro-pupillary iris-fixated intraocular lens was implanted. Postoperative course was uneventful, achieving intraocular pressure stabilization, visual improvement, and clinical control.

Spherophakia poses significant surgical risks due to zonular instability; preoperative imaging guides individualized strategies like secondary iris-fixated lenses, optimizing outcomes in young patients.