Journal of Clinical and Experimental Ophthalmology
Open Access
ISSN: 2155-9570
ISSN: 2155-9570
Milan Rai
Om Parkash Eye Institute, India
Scientific Tracks Abstracts: Clin Exp Ophthalmol
Nanophthalmos is a rare genetic disease characterized by the abnormally small eyes secondary to compromised
growth inducing high degree of hypermetropia.It is very often associated with primary angle closure glaucoma,
uveal effusion, absence of foveal pit, shallow anterior chamber, diffuse macular thickening ,rudimentary foveal
avascular zone, scleral collagen fibers abnormalities etc. It may be present with familial or sporadic disorder with
autosomal-dominant or recessive inheritance. Five genes and two loci have been implicated in familial forms. The
five genes are MFRP, TMEM9, PRSS56, BEST1 and CRB1.The refractive error can be corrected by the spectacles as
well as with contact lens despite having their few limitations. However due to high power, optical aberrations are
associated with the use of spectacle is comparatively more than aberrations associated with the contact lens. Usually
the total dioptric power of eye is about 60D.However, in this case the total power of the optical system of eye is almost
73D in both eyes even if the power of crystalline lens is not considered when RGP is fitted.
Case Presentation: A 26 years old patient came to our OPD for LASIK opinion. His Chief complaints were redness,
itching and watering since last 2 days. He had no history of ocular and systemic illness . He used spectacle for the
time when he was 5 years old and continued the same spectacle till he became 12 years old .At the age of 12, his
spectacle prescription became+13.00DS (OD) and +13.50 (OS) .He continued the same spectacle for 6 years. At
the age of 18,he began to use soft contact lens for 2 years and since last 6 years he had been using the spectacle of
+15.00DS(OD) and +16.00DS(OS).The visual acuities with PGP were 6/18 in both eyes. The dry acceptance were
+15.25DS/-0.25DC*180 and +15.50DS/-0.50DC *140 in right and left eye respectively with visual acuity of 6/12 in
both eyes. The slit lamp examination was done .Mild swelling on upper eyelid, few SPKs on nasal side of cornea and
mild congestion on conjunctiva were seen through slit lamp examination in right eye. However, anterior segment of
left eye was within normal limit. Antibiotic and lubricant eye drops were prescribed for 3 days.
Follow Up After 3 Days: Non-Contact Tonometry values were 11 mmHg(OD) and 13mmHg(OS). The cycloplegic
refraction was done using Tropicamide. The cycloplegic refraction revealed +18.00DS (OD) and +18.50 DS (OS).The
visual acuity of each eye was same i.e.6/12. The fundus exam showed hypermetropic fundus with absence of foveal
pit in both eyes. However peripheral retinal was ok.The patient was called for follow up after 2 days.
Follow Up After 2 Days: The Dry acceptance values were +16.50DS (OD) and +16.50DS/-0.50DC*140 (OS).
The Near Vision was N12 at 30cm (OU). The biometry was done using IOL MASTER 700. The axial lengths were
15.18mm(OD) and 15.24mm (OS).The central Anterior chamber depth were 2.93mm(OD) and 2.89mm(OS).The
lens thickness is considerably less in right eye (1.39mm) but in left eye it was 2.30mm.Central Corneal Thickness were
497 micrometer (OD) and 499micrometer (OS).The keratometric values were 49.94Dat 0 and 50.30D at 90 in right
eye and 49.84D at 119 and 50.14 D at 29 in left eye. The gonioscopy revealed that none of the angle structure were
visible indicating the close to zero angle grading. The anterior segment OCT (angular) was done which confirmed
the gonioscopy findings. The patient was advised for all glaucoma work up but he denied. The patient was called for
follow up after 2 days.
Follow Up After 2 Days: The patient came to Contact lens unit. The best corrected visual acuities with RGP contact
lens (FP90,blue tinted with lenticular design) were 6/12 in both eyes. The Base curves of Contact were 6.75(OD) and 6.80(OS) with total diameter of 9.8mm.The final powers of contact lens with best corrected Visual acuity of
6/12 in both eyes were +21.50DS (OD) and +22.00DS(OS).There was sufficient corneal coverage by the lens with
well centration with lid fit. The overall fitting of contact lens was visually, optically and mechanically optimal. . The
patient was called for follow up after 1 week.
Follow Up After 1 Week: The patient was comfortable with the contact lens. The contact lens was well centered with
sufficient corneal coverage. The visual acuities with contact lens were 6/12 in both eyes.
Discussion: Due to natural increase in size of the crystalline lens inside the small eye ball in patients with
nanophthalmos, there is always a high risk of developing chronic angle closure painless glaucoma in middle age.
The central Anterior Chamber Depth is not informative in nanophthalmic eyes regarding glaucomatous changes.
Peripheral ACD is of utmost importance. Retinal changes include the macular hypoplasia, ocular cystinosis, retinal
cysts, retinal detachment, cystoid macular oedema and pseudopapilloedema etc. The hyperopic eye is due to short
axial length (15-20)mm .Nanophthalmos occurs very often bilaterally. The contact lens has widely increased the field
of view and its reduced weight in comparison to the thick lens has increased its use especially while using for high
refractive error correction.
Milan Rai works at Dr. Om Parkash Eye Institute PVT LTD and Dr Om Parkash eye institute.He is working as an Intern Optometrist.
E-mail: raimilan054@gmail.com