Misdiagnosis induced intraocular lens dislocation in anterior megalophthalmos

Anterior megalophthalmos (AM) is an uncommon developmental anomaly of the anterior segment of the eye with a constellation of findings that includes enlarged cornea, deep anterior chamber, posterior positioning of the iris and lens, iris stroma atrophy, hypoplasia of iris dilator, pupil displacement, large capsular bag, lens subluxation, prematurely cataract and the tendency to retinal detachment. AM, especially when symptoms are mild, is not an easy disease to diagnose. We present 3 AM cases that were misdiagnosed as congenital cataract with weak zonule and megalocornea. Intraocular lenses (IOLs) dislocated after standard cataract surgeries and subsequent surgery (replacing the dislocated IOLs with iris-claw intraocular lenses) achieved satisfactory outcome. Although rare, AM should be included in the differential diagnosis of enlarged cornea and we recommend implanting Artisan lens in AM patients.