Glaucoma in a Patient with Nanophthalmos

The patient presented herein is a 34-year-old woman with nanophthalmos and secondary glaucoma. Her mental ability is mildly impaired. She has no history of systemic disorders and is not receiving any systemic medications except acetazolamide 250 mg every 6 hours. She has history of bilateral peripheral laser iridectomies, phacoemulsification with implantation of a posterior chamber intraocular lens (IOL) in the right eye, followed by an anterior chamber Artisan lens, 5 years before presentation. The power of the IOLs was not available. Glaucoma had been diagnosed in both eyes since 2 years before. Initial examination upon presentation was as follows: best corrected visual acuity was 1/10 in the right eye with +12, and 6/10 in the left eye with +12-1.5×150°. Slit lamp examination of the right eye revealed mild conjunctival injection, mild corneal haziness and stromal edema, and a deep anterior chamber with a centered Artisan lens in touch with the corneal endothelium peripherally. A peripheral iridectomy was present and some posterior synechiae were noted between the pupillary margin and the posterior chamber IOL. Moderate posterior capsule opacity was also evident. In the left eye the cornea was clear, the anterior chamber was shallow and quiet, there was a peripheral iridectomy and the crystalline lens was clear (Fig. 1). On gonioscopy, the right eye had 360 degrees of peripheral anterior synechiae (PAS), and the left eye had more than 300 degrees of PAS. Intraocular pressure (IOP) was 36 and 30 mmHg in the right and left eyes respectively with Xalatan 0.005% (latanoprost) daily, Cosopt (dorzolamide 2% / timolol 0.5%) twice a day, brimonidine 0.02% three times a day in both eyes, and acetazolamide 250 mg every 6 hours. Central corneal thickness (CCT) was 610 and 585 microns in the right and left eyes respectively. Fundus examination revealed a vertical cup/ disc ratio of 0.5 bilaterally, in small crowded discs (vertical disc diameters, 1.2 mm) which were moderately pale. The fundus examination was otherwise unremarkable. Perimetry was attempted a couple of times but was totally unreliable with a clover leaf pattern in both eyes. Ocular biometric, u l t r a s o n i c b i o m i c r o s c o p i c (U B M) , a n d Pentacam measurements were obtained and are summarized in table 1. We were unable to capture high quality fundus or optical coherence tomography (OCT) images. Anterior …