Офтальмохирургия (Jan 2014)
Cataract phacoemulsification with intraocular lens implantation after keratoprosthetics by Burn Vascular Leukoma (A case report)
Abstract
ABSTRACT Purpose. To evaluate the phacoemulsification (Phaco) with intraocular lens (IOL) implantation outcome after keratoprosthetics in patient with burn vascular leukoma. Material and methods. A patient, 39 years old, with a thinned burn vascular leukoma as a result of burns, limbal stem cell deficiency of both eyes, local simblefaron in the left eye (OS), secondary glaucoma (OS), after a simblefaron dissection and a glaucoma operation (OS), it was performed keratoprosthetics with a undismountable model of keratoprosthesis with an improvement in visual acuity (VA) from 1/∞ рr. сerta up to 0.5 u/c. But there was a decrease in the VA to 0.01 u/c in 13 months. The aglia with vascularization and total overgrowth on the conjunctiva were observed on admission. Haptic keratoprostheses elements were not visible. Optical cylinder was clear. Anterior chamber depth was less than the average. A pronounced opacity of cortical layers of crystalline lens were defined. Fundus details were not visualized. A disturbance of topographic anatomical correlations in all structures of the anterior segment of the eye (ASE) was revealed by the ultrasound bio-microscopy: corneal thickness — 1.47mm, anterior chamber depth in the central parts — 1.09mm, а lot of irido-corneal adhesions in the anterior chamber angle (ACA) with anterior chamber closing by basal area of the iris, medium hypertrophy of the iris (0.43mm). The maximum size of the ciliary body was 0.74mm. Ciliary zonule fibers were heterogeneous: in three segments they were thickened, hypertrophied and with adhesions between them, in one segment lysed or fused with the iris. Posterior chamber dimensions were acutely asymmetrical. Anterior posterior size of lens w as 5.23mm. Despite the significant impairments of spatial relations in ASE structures in the patient the microinvasive Phaco with soft IOL implantation were carried out with the preventive purpose of possible complications during the highly traumatic large corneoscleral incision with lens extraction. The main technical Phaco features were: a filling of anterior chamber with a heavy viscoelastic, a 3mm capsulorhexis reduced in diameter; a use of maximum sparing modes (reduced irrigation and aspiration, fractional ultrasound pulse mode with reduced power). Results. The surgery and postoperative period proceeded without any complications. It was noted a VA improvement with a stabilization up to 0.2 u/c at 2 months during the control examinations within the whole follow-up (2 years). Biomicroscopy and ultrasound biomicroscopy scans revealed a correct, central IOL position. Conclusion. The Phaco with IOL implantation is an effective treatment method in patients with burn vascular leukoma after keratoprosthetics and provides an improvement of visual functions. The Phaco technique in such patients has particular features in comparison with classical one. All surgery stages are rather complicated and complications during any stage can lead to an impossibility of surgery continuation. The Phaco could be a worth option in patients with vascular leukoma after keratoprosthetics, however it demands a certain experience of the surgeon.
