Cataract Surgery In A Patient With Megalocornea And Corectopia: A Clinical Case Report.

To present a case of cataract surgery in a patient diagnosed with megalocornea. To describe the selection and placement of the intraocular lens (IOL), given that this will pose a challenge for the surgeon, not only due to the larger size of the anterior segment and zonular weakness, but also due to the difficulty of calculating the lens power, since standard formulas do not accurately predict refractive outcomes.

Case managed at Hospital Universitario Central de Asturias, a tertiary care academic hospital in Oviedo, Spain.

Description of a clinical case of cataract surgery with an established diagnosis of megalocornea.

A 66-year-old male patient presented with megalocornea (diameters of 13.21 and 13.39 mm), corectopia, and cataracts. His initial best-corrected visual acuity (BCVA) was 0.4 (right eye) and 0.3 (left eye) with deep anterior chambers (>5 mm). The intraocular lens (IOL) power was calculated using optical biometry with topographic guidance. Phacoemulsification surgery required the use of iris retractors due to minimal mydriasis. Despite mild intraoperative phacodonesis, the IOL was successfully implanted in the capsular bag without complications. Postoperatively, BCVA improved to 0.6 in both eyes, with a spherical equivalent of 0 in the right eye and -0.50 in the left eye. Adapted management resulted in successful visual correction.

Megalocornea is a non-progressive congenital eye defect defined by bilateral corneal diameter enlargement (>13 mm) in the absence of ocular hypertension. In the case described, it was associated with mild stromal opacity, corectopia, and iris sphincter defects resulting in minimal mydriasis. A significant part of its management focuses on addressing associated complications, such as refractive error correction and cataract surgery. Surgeons must consider that these patients have a higher risk of lens subluxation, poor dilation, and possible posterior capsule rupture, in addition to potentially presenting with associated abnormalities that complicate lens calculation.