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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.