Nanophthalmos: a perspective on identification and therapy

Area of Science:

• Ophthalmology
• Medical Genetics

Background:

• Nanophthalmos is a rare, blinding ocular disorder characterized by a small eye, shallow anterior chamber, and uveal effusion.
• Intraocular surgery in nanophthalmic eyes is associated with a high incidence of severe complications and vision loss.

Purpose of the Study:

• To evaluate the efficacy and safety of various treatment modalities for angle-closure glaucoma in nanophthalmic patients.
• To identify optimal treatment strategies for managing glaucoma in nanophthalmos.

Main Methods:

• Retrospective analysis of 32 eyes (16 patients) with nanophthalmos and angle-closure glaucoma.
• Categorization of eyes based on angle closure and intraocular pressure.
• Review of treatments including medication, laser iridotomy, laser gonioplasty, peripheral iridectomy, filtration surgery, and cataract extraction.

Main Results:

• Glaucoma medication showed effectiveness, though miotics occasionally worsened pupillary block.
• Laser iridotomy (83% success) and laser gonioplasty (91.6% success) were effective.
• Peripheral iridectomy had limited success (2/7 eyes).
• Filtration surgery (2/5 eyes achieved tension control) resulted in severe visual loss in 13/15 eyes.
• Cataract extraction improved vision in only 3/6 eyes.

Conclusions:

• Surgical interventions in nanophthalmic eyes carry an extremely high risk of disastrous complications and blindness.
• Medical management and laser therapy are the preferred treatment options for angle-closure glaucoma in nanophthalmos.