Abstract

P 015

Bilateral late-onset angle-closure glaucoma in association with spherophakia and relative anterior microphtalmus (RAM) after retinopathy of prematurity (ROP)

Heinrich S., Krause L., Wachtlin J., Willerding G., Bechrakis N., Foerster M. H.
Augenklinik, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin

Objective: Angle-closure glaucoma in adolescence after ROP is often associated with relative anterior microphtalmus. In the few cases described so far, a progressive flattening of the anterior chamber by retrolental fibrous masses is regarded as the main cause. Spherophakia with bilateral angle-closure and decompensation of intraocular pressure (IOP) is a rare entity.
Case report: A 23-year-old male patient with symptoms of acute IOP elevation (up to 62 mmHg on both eyes) and fundus changes of a cicatricial ROP stadium III+ was admitted. Intensive topical and systemic drug treatment could not control IOP (30 mmHg). Even a Yag-Iridotomy (right eye) could not lower the IOP. Skiascopy revealed a myopia with -5.0 and -6.0 dpt. The biometry showed an anterior chamber (AC) depth of 1.95 resp. 2.07 mm and an axislength (AXL) of 21.04 resp. 21.12 mm. The ultrasound examination confirmed the suspected myopic shift caused by spherophakia with a lens-thickness of 4.16 resp. 3.96 mm. We performed a bilateral Lensectomy, whereafter the IOP dropped to 20 resp. 15 mmHg. The refraction was about -0.5 dpt afterwards.
Conclusions: Until now the classical relative anterior microphtalmus following ROP and ROP-treatment is seen responsible for the progressive flattening of the AC, resulting in angle-closure glaucoma. The case described showed a spherophakia associated flattening of the AC. A satisfactorily lowered IOP could be achieved by cataract surgery. The increasing survivability of premature infants can cause an increased prevalence of the pathology described in this case.

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