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R. Tano, Y. Yamamoto, T. Sakurai, T. Mano; Phacoemulsification With Multifocal Intraocular Lens Implantation for Bilateral Cataract With Anterior Lenticonus. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4566.
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Anterior lenticonus (AL) is usually observed in a patient with Alport’s syndrome, a hereditary defect in the synthesis of collagen in the basement membrane. In this case report, we perform phacoemulsification with multifocal intraocular lens (IOL) implantation for bilateral cataract with AL. Histological findings of lenticonus specimens obtained during surgery was also discussed.
A 59-year-old man consulted our hospital for applying for refractive surgery. The decimal uncorrected visual acuity (VA) was 0.01 and the best corrected VA was 1.0 in both eyes. The refractive status was –17.5D –1.75D x 70 in the right eye and –18.5D –1.5D x 70 in the left eye. Both lenses showed cataract with AL. No other ocular abnormalities were found. The patient had no signs of hearing loss. Serologic or urine examinations showed normal. Phacoemulsification with multifocal IOL implantation using mix & match approach was performed in each eye (OD: Tecnis® ZM900, AMO, OS: ReZoomTM NXG1, AMO). Anterior capsule was obtained during surgery for histological assessment in transmission electron microscopy (TEM).
Although capsulorhexis tear was made in the right eye during surgery because of the fragility of the anterior capsule, IOL was implanted in the capsular bag as planned. There was no surgical complication in the left eye. The uncorrected VA at 5 m, 1 m and 30 cm at post-op 6 months was 1.2, 0.5, 1.0 in the right eye and 0.9, 0.8, 0.2 in the left eye, respectively, with high patient satisfaction. No remarkable decentration of IOL was observed in both eyes. TEM of the anterior lens capsule showed number of vertical dehiscences in the capsule and numerous lacunae in the cytoplasm.
Successful results were gained in post-operative visual acuity and patient satisfaction by implanting multifocal IOL for bilateral cataract with AL. Capsulorhexis should be performed carefully in AL because of the fragility of the capsule.
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