Deadbolt cataract due to misplanted minishunt.

Area of Science:

• Ophthalmology
• Glaucoma Management
• Cataract Surgery

Background:

• A 62-year-old woman with unilateral glaucoma and a history of complex management, including a steroid response and a trabeculectomy with a glaucoma minishunt, presented for cataract surgery evaluation.
• The patient desired refractive cataract surgery to address astigmatism and presbyopia but had concerns about the visual quality and cost of diffractive intraocular lenses (IOLs).

Observation:

• The patient presented with nuclear sclerotic and cortical cataracts in both eyes, significant refractive errors, and an epiretinal membrane in the left eye.
• A key observation was the misplacement of the glaucoma minishunt in the left eye, with its tip penetrating the peripheral iris and entering the superior capsular bag.

Findings:

• Despite the minishunt malposition, intraocular pressure (IOP) was controlled at 10 mm Hg in the left eye without medication.
• Visual acuity was 20/40 in both eyes, with significant myopia and astigmatism, and a visual field defect (inferior nasal step) was noted in the left eye.

Implications:

• The case highlights the need for careful pre-operative assessment and patient counseling regarding complex glaucoma management and cataract surgery options.
• Management strategies must address the mispositioned minishunt, potential risks during cataract surgery, and the selection of appropriate IOLs for visual rehabilitation in a high myope with glaucoma.