Phacoemulsification and Intraocular Lens

1
Phacoemulsification and Intraocular Lens
Placement in Eyes with Cataract and
Congenital Coloboma
Luciana
Frizon, MD Karolinne M Rocha, MD Norma
Allemann, MD Yara Lopes, COMT Maira Morales,
MD Eduardo Soriano,MD. Department of
Ophthalmology - Federal University of São Paulo-
Paulista School of Medicine
Purpose To evaluate safety, difficulties
and complications of phacoemulsification and IOL
placement in a series of patients with congenital
coloboma and cataract.
b
a
c
Figure 3 a posterior pole coloboma. b
cortical and nuclear cataract at pupil axis. c
postoperative picture of the same patient
demonstrate IOL covering colobomatous area.

• Methods
• A prospective interventional study was
  conducted including consecutive patients with
  coloboma and cataract who were submitted to
  phacoemulsification and IOL implantation.
  Patients underwent complete ophthalmological
  examination, PAM and ultrasound biometry. Ocular
  ultrasound (US) and ultrasound biomicroscopy
  (UBM) were used to determine the extension of
  coloboma.
• Surgeries were performed by one experienced
  surgeon. Technical procedure included
  peribulbar anesthesia, clear cornea incision
  (2.75mm), linear continuous 5mm-capsulorhexis,
  quick-chop modified phaco and PC IOL (MA60AC)
  implantation in the bag.
• Issues evaluated
• biometric calculation, including axial length
  detemination and IOL calculation
• Eyelid B-mode biometry
• contact A-scan biometry
• immersion A-scan biometry.
• - intra and post-operative complications
• - final refraction
• - visual acuity improvement

• Results
• Twelve eyes (7 patients) with bilateral
  congenital coloboma and cataract were included in
  the study.
• - Demographic points
• - 6 female 1 male
• - Mean age 46.4 years (33 to 76 years)
• - Ocular Ultrasound posterior pole coloboma
  inferiorly, involving or not optic disc and
  macula
• - UBM iris coloboma inferiorly
• US biometry mean AL was used according to
  different techniques (eyelid, immersion, contact)
  to perform IOL calculation.
• All eyes underwent phacoemulsification and IOL
  placement.
• Intra-operative complications
• - 1 eye surgery converted to extracapsular
  cataract extraction
• - 3 eyes discontinued capsulorhexis
• - 4 eyes severe miosis, required iris hooks.
• Visual acuity improved in all eyes.

Figure 1 US posterior pole coloboma.
Conclusions The improvement in vision
observed in this study suggests that
phacoemulsification and IOL placement is
beneficial in patients with congenital coloboma
and cataract. A careful biometry using
combined examination techniques permitted an
acceptable refractive result.
Figure 2 UBM iris inferior coloboma.