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Couching of cataractous lens in microphthalmic eyes with irido-fundal coloboma: revisiting the historical technique

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Abstract

Purpose

Cataract surgery in microphthalmic eyes is challenging due to anatomical restraints, hard bulky nucleus. This series aims to evaluate the safety and efficacy of couching of intraocular lens in irido-fundal coloboma with microphthalmos.

Setting

Tertiary care centre in South India.

Design

Retrospective non-comparative study in eyes with irido-fundal coloboma, corneal diameter < 7 mm and brown cataract. Visual acuity less than 6/60 in other eye.

Methods

Anterior chamber entry made, zonules broken and lens dislocated into the vitreous cavity in a controlled manner. Baseline Clinico-demographic details, corrected distance visual acuity (CDVA), Intra-ocular pressure (IOP), corneal diameter, axial length, lens status and post-surgery CDVA, IOP and complications recorded and followed up for atleast 6 months.

Results

Fifteen eyes of 15 subjects were evaluated with a mean age 49.4 ± 10.9 years. At baseline, mean IOP 14.5 ± 3.8 mmHg, mean axial length 19.3 ± 0.5 mm, mean corneal diameter was 6.5 ± 0.34 mm and CDVA 2 logMAR which improved to 1.5 logMAR at 3 months (p value 0.002). Transient spike in IOP in 33.3% subjects was medically managed with no significant difference in IOP (p > 0.05) at baseline (14.5 ± 3.8 mmHg), 3 months post-surgery (16 ± 2.8 mmHg) and 6 months post-surgery (14.9 ± 2.5 mmHg). One patient underwent re-couching. No other major complications were noted.

Conclusion

Couching of cataractous lens is an effective and safe method in microphthalmic eyes with irido-fundal coloboma as last resort procedure, where no other surgical procedure may work. It provides an ambulatory gain of visual acuity in previously non-ambulatory subjects. Corneal measurements help in determining the subset of patients where couching offers viable option.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Retina and Vitreous Services, Aravind Eye Hospital, 1, Anna Nagar, Madurai, Tamil Nadu, 625020, India

    Naresh Babu Kannan, Ananya Goswami, Muthukrishnan Vallinayagam & Avik Dey Sarkar

Authors
  1. Naresh Babu Kannan
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  2. Ananya Goswami
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  3. Muthukrishnan Vallinayagam
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  4. Avik Dey Sarkar
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Contributions

All authors made a significant contribution to this paper. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Muthukrishnan Vallinayagam.

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Conflict of interest

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript and have no relevant financial or non-financial interests to disclose.

Ethical approval

Necessary ethical approval was provided by Institutional Ethics Committee (ECR/182/Inst/TN/2013/RR-19).

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Written informed consent was taken from the subjects.

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Kannan, N.B., Goswami, A., Vallinayagam, M. et al. Couching of cataractous lens in microphthalmic eyes with irido-fundal coloboma: revisiting the historical technique. Int Ophthalmol 44, 198 (2024). https://doi.org/10.1007/s10792-024-03132-7

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