Managing Cataract in a Myopic Eye with Iridocorneal Endothelial Syndrome and Horizontal Nystagmus: a Rare Clinical...

To report a rare clinical association of iridocorneal endothelial (ICE) syndrome with high myopia, horizontal nystagmus, and cataract, and to highlight the preoperative and intraoperative considerations required to achieve successful cataract surgery in such complex cases.

A 41-year-old female presented with progressive visual deterioration. Examination revealed horizontal nystagmus, narrow palpebral fissures, corneal opacities, iris atrophic changes with superotemporal corectopia, and significant cortico-nuclear lens opacities. Best-corrected visual acuity was 1/50 in the right eye and 2/50 in the left eye, with intraocular pressures within normal limits. The patient underwent phacoemulsification with a foldable hydrophobic acrylic IOL implanted in the capsular bag. Retrobulbar anesthesia stabilized the globe; four iris retractors were used for inadequate pupillary dilation, and trypan blue facilitated capsulorhexis. The soft-shell technique and reduced phacoemulsification parameters were employed to protect the corneal endothelium. No intraoperative complications occurred. At one month postoperatively, BCVA was 2/50 with stable refraction (-2.75 D) and no corneal decompensation.

ICE syndrome complicates cataract surgery due to endothelial compromise, iris abnormalities, and the risk of intraoperative complications. Individualized surgical strategies, including globe stabilization, pupil expansion, careful endothelial protection, and modified phacoemulsification parameters, were critical to achieving a favorable outcome.

Cataract surgery in patients with ICE syndrome complicated by high myopia and horizontal nystagmus is feasible with meticulous preoperative assessment and tailored intraoperative techniques. Favorable visual outcomes can be achieved, but long-term follow-up is essential to monitor for progressive glaucoma and corneal decompensation.