Anterior lamellar sclerectomy for nanophthalmos

A 38-year-old woman with nanophthalmos suffered bilateral acute angle closure glaucoma. Peripheral iridotomies were unsuccessful in maintaining low intraocular pressure in either eye. The left eye had probable ciliary block glaucoma and was treated with subsequent pars plana vitrectomy and trabeculectomy. Further postoperative complications included a serous choroidal detachment treated by a lamellar sclerectomy in three quadrants with sclerotomies and drainage of suprachoroidal fluid. These procedures were successful in achieving a well-formed left globe with normal intraocular pressures. The right eye, however, continued to manifest elevated intraocular pressure despite peripheral iridoplasties. Before further intraocular surgery in the right eye, prophylactic lamellar sclerectomies in each quadrant, as well as sclerotomies in the inferior two quadrants, were performed in the hope that preplacement might reduce postoperative sequelae of anticipated filtering surgery and/ or vitrectomy. Surprisingly, the lamellar sclerectomies alone resulted in excellent intraocular pressure control. The pathogenesis of nanophthalmos is discussed in view of this finding.