Lenticonus - A Deception to Refractive Surgery
Lenticonus is bulging of the lens capsule and the underlying cortex. Anterior lenticonus is part of the Alport syndrome, a hereditary defect in the synthesis of collagen in the basement membrane, while posterior lenticonus is not associated with systemic disease. We present two cases one with anterior lenticonus without Alport syndrome and another with anterior and posterior lenticonus who underwent clear lens extraction by phacoemulsification with multifocal intraocular lens implantation.
Summary of Content
A 22yr old female consulted our hospital for applying for refractive surgery. No significant past ocular history other than that she had worn spectacles for many years.
On biomicroscopic examination ocular surface and corneas were normal. Oil droplet appearance was prominent in both eyes suggestive of Anterior lenticonus . Fundus examination revealed no specific pathology in the retina or optic disk. The patient had no signs of hearing loss. Serologic or urine examination were normal. Keratometry readings were normal. A-scan biometry was +20.50Ds.
A clear lens phacoemulsification with corneal incision and foldable IOL implantation (a refractive lens exchange) was performed for right eye. A continuous curvilinear capsulorhexis of the fragile anterior capsule was peformed under viscoelastic material technique, hydrodissection, and phacoemulsification with multifocal IOL implantation.
A 25 yrold man presented with a progressive decrease in vision over the preceding 5 to 7 years. Ocular examination showed bilateral anterior and posterior lenticonus. The UDVA and CDVA were 6/36 and 6/12, respectively, in both eyes. The AL was 22.12 mm in the right eye and 22.43 mm in the left eye. There was no other ocular abnormality. No systemic abnormality was found.
Clear lens extraction was performed in both eyes sequentially.
There were no intraoperative complications.
In the first case Postoperative V/A 20/30 unaided 1st postop day. UCVA was 20/50 and improved to nearly 20/20 with a small astigmatic correction. In the second case postoperatively, the UDVA and CDVA were 6/12 and 6/6, respectively, in both eyes. At the end of 6 months, they remained the same.
Successful results were gained in post-operative visual acuity and patient satisfaction by implanting multifocal IOL for bilateral anterior lenticonus . Capsulorhexis should be performed carefully in AL because of the fragility of the capsule.
[ Keyword ]
Anterior lenticonus, alport syndrome / clear lens extraction
[ Conflict of Interest ]