Need of additional iridotomies despite lens extraction in spherophakes

Abstract

Spherophakes are known to have irregular anterior chamber (AC) depths due to their poorly supported zonules. This irregularity leads to an unstable AC, often resulting in angle closure glaucoma from anterior subluxation of globular lenses. A peripheral iridotomy may be helpful to encourage aqueous drainage in initial stages, however, is not often required once lens is extracted. But, we have observed persistent instability of AC in spherophakic eyes despite lens extraction, leading to frequent iridocorneal contact locally over some quadrants. The presumed aetiology in such scenarios could be constant anteroposterior instability of IOL-bag complex due to generalised zonulopathy and hence localised iris bombe in areas with previous iridocorneal contact. Timely identification and performing additional iridotomies during surgery at such sectors even after lens extraction facilitated symmetric deepening of the AC. Hence, we recommend use of additional iridotomies at areas with persistent iridocorneal contact even after lens extraction.

Keywords: anterior chamber; glaucoma; ophthalmology.

Figure 1

(A) Preoperative gonioscopic image showing narrow angle (white arrow) and subluxated lens (B). (C) Inferior PAS after phacoemulsification with ‘in-the-bag’ IOL with CTR, (D) No improvement with intracameral air injection (peripheral shallowing indicated by black arrow), (E) Deepening of anterior chamber after surgical iridectomy in the same patient. (F) Postoperative gonioscopic image showing widening of angle (red arrow). CTR, capsular tension ring; PAS, peripheral anterior synechiae.

Figure 2

Preperative ASOCT (A) and slitlamp imaging (B) shows irregular anterior chamber depth with inferior shallowing and peripheral anterior synechiae formation. Postoperatively with help of localised surgical iridectomy, anterior chamber deepens regularly again as shown in ASOCT (C) and slit-lamp imaging (D). ASOCT, Anterior Segment Optical Coherence Tomography.

Figure 3

Schematic diagram (superior to inferior section of anterior segment) shows that the LAX zonules causes the IOL-bag complex subluxation producing localised pupillary block inferiorly (arrow)(A) whereas an inferior iridectomy helps to relieve the same despite the persist IOL tilt (arrow). (B). IOL, Intraocular lens.