Annular Salzmann degeneration: Avoiding perturbations and pitfalls in phacoemulsification surgery
Bia Z Kim1, Peter J Wilson1, Charles N J McGhee1
1From the Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Journal of Cataract and Refractive Surgery
|December 26, 2015
Summary
Salzmann nodular degeneration can cause vision loss, but superficial keratectomy can improve measurements for cataract surgery. This procedure, followed by phacoemulsification, successfully restored visual acuity in an elderly patient.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Cataract Surgery
Background:
- Salzmann nodular degeneration (SND) is a benign degenerative condition of the cornea.
- Extensive SND can obscure the visual axis and interfere with ocular measurements.
- Cataracts can coexist with SND, further reducing visual acuity.
Observation:
- An 84-year-old male presented with reduced visual acuity due to bilateral extensive Salzmann nodules and moderate cataracts.
- Superficial keratectomy was performed to remove large, annular Salzmann lesions in both eyes.
- Post-keratectomy, keratometry and biometry measurements showed significant improvement in reproducibility and accuracy.
Findings:
- Phacoemulsification cataract surgery was uneventful 4 weeks after keratectomy.
- Pronounced epithelial bullae developed in the excised nodule areas during phacoemulsification.
- Final uncorrected distance visual acuity was 20/20 in the right eye and 20/25 in the left eye.
Implications:
- Superficial keratectomy is a viable option for managing extensive Salzmann nodules that impede accurate pre-operative measurements for cataract surgery.
- While generally safe, surgeons should be aware of potential post-keratectomy epithelial complications during subsequent intraocular procedures.
- Successful management of SND can lead to significant visual acuity restoration when combined with cataract surgery.
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