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  • Management of dislocated nucleus with corneal opacity by combined deep anterior lamellar keratoplasty, pars- plana vitrectomy and phaco-fragmentation

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Reminder of important clinical lesson
CASE REPORT
Management of dislocated nucleus with corneal opacity by combined deep anterior lamellar keratoplasty, pars- plana vitrectomy and phaco-fragmentation
  1. Samendra Karkhur1,
  2. Alok Sen1,
  3. Gautam Parmar2 and
  4. Priyavrat Bhatia1
  1. 1 Vitreo-Retina and Uvea Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
  2. 2 Department of Cornea and Refractive Surgery, Shri Sadguru Seva Sangh Trust Chitrakoot Centre, Chitrakoot, Madhya Pradesh, India
  1. Correspondence to Dr Priyavrat Bhatia, gorbi.bhatia{at}gmail.com

Abstract

A 32-year-old man presented with bilateral diminution of vision for 10 years. Visual acuity was light perception in both eyes with inaccurate projection in the oculus dextrus(OD) and accurate projection in the in oculus sinister (OS). Intraocular pressure was 6 and 12 mm Hg in the OD and OS, respectively. Slit-lamp examination revealed the presence of leucomatous corneal opacification with microcornea in oculus uterque (OU). Both eyes had a dislocated nucleus in the vitreous cavity on ultrasound B-scan with advanced cupping in the right eye. Ultrasound biomicroscopy revealed ciliary body atrophy in the OD and preserved ciliary processes (two quadrants) in the OS. In view of a partially preserved ciliary body function and a potential for gaining useful vision, we planned surgical intervention in the left eye. Deep anterior lamellar keratoplasty with pars planavitrectomy (PPV) and phacofragmentation of the nucleus was done. Donor lamellar graft was sutured after completion of PPV and nucleus fragmentation. The patient regained useful ambulatory vision postoperatively with clear corneal graft.

  • DALK
  • Paes Plana Vitrectomy
  • Phacofragmentation
  • Keratoprosthesis
  • Nucleus Drop

https://doi.org/10.1136/bcr-2019-229397

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    Footnotes

    • Contributors SK, AS and GP were involved in patient management. All authors contributed to the concept, design, manuscript review and editing. SK and PB contributed to the literature search and manuscript preparation.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.