What is a coloboma? A coloboma is an area of missing eye tissue. The eye tissue in these areas never developed since conception. The missing tissue that never fully developed includes the iris, zonules, and even the retina.

This patient is in her late 30’s and has a unilateral cataract. She also has amblyopia in the cataract eye. Would you remove her cataract and perform a pupilloplasty to fix her pupil shape? Her pupil can be rounded out by placing a couple of sutures. But if you fix one, you really ought to fix the other for cosmetic symmetry.

Some considerations:

First - the cataract. This patient has a dense cataract with corneal astigmatism, as well as amblyopia. The cataract removal should be routine, but which lens implant should we place?

She explained that she would not mind at all the wearing of reading glasses, but that she wanted the best possible far vision. Therefore, in my plan, I didn’t want to sacrifice any quality of far vision in exchange for RANGE of vision. My goal was to give her the best far vision as possible. Based on her measurements, the options were the Light Adjustable Lens, the IC-8 Apthera, a Toric lens, or a basic monofocal lens.


Next - the coloboma.
Although this patient is young with mostly healthy zonules at least in the non-colobomatous parts of her eye, She has a long life ahead of her and we don’t know what the status of her zonules will be in 40 or 50 years, so we will place a Capsule tension ring, a CTR, to provide some support to the weak zonule area within the coloboma.

As for the suture pupilloplasty to repair her pupil, there are a few things to consider:

She’s young with light colored eyes, and so the colobomas are extremely noticeable. Symmetry between the two eyes is most important. If a repair on one is performed, a repair of the other side needs to be considered to keep a symmetric appearance. A pupilloplasty should also help with light sensitivity .

Upon asking this patient about both the cosmetic appearance of her eyes and the presence of light sensitivity, she denied issues with either. She was confident with her appearance and denied significant light sensitivity. Therefore, we decided to perform just the cataract surgery at this time, and let her know that there is a treatment option available in the future if she experienced significant light sensitivity or desired and smaller, rounder pupil.

Overall the patient had the outcome we predicted. She was very happy with her vision and denied any significant light sensitivity. As always, I appreciate your attention. thank you so much for watching. I’ll catch you on the next one. Peace

www.EyeOC.com
[ Ссылка ]

If you have any questions, feel free to leave them in the comment section below!

свернуть