Phacoemulsification for secondary glaucoma in nanophthalmos: A case report

Management of secondary glaucoma in nanophthalmos remains challenging, particularly in patients with markedly reduced axial length. This case report describes a patient with nanophthalmos, secondary glaucoma, and extreme axial shortening who was successfully treated with phacoemulsification and goniosynechialysis. A 50-year-old woman presented to our hospital with right eye pain and headache. Slit-lamp examination revealed shallow anterior chambers bilaterally. The intraocular pressure (IOP) in the right eye was 11 mmHg despite treatment with brinzolamide, 2% pilocarpine, timolol, and mannitol. Gonioscopy demonstrated partial angle synechiae, and axial lengths were measured at 14.53 mm in the right eye and 14.50 mm in the left eye. The patient was diagnosed with nanophthalmos, secondary glaucoma, and amblyopia. Phacoemulsification and goniosynechialysis were performed on the right eye, while laser peripheral iridotomy was performed on the left eye. Postoperatively, the anterior chamber of the right eye deepened and IOP stabilized immediately. However, IOP in the left eye increased 1 month later, prompting phacoemulsification, which resulted in rapid normalization of IOP and deepening of the anterior chamber. Two months after surgery, macular edema developed in the right eye. Intravitreal ranibizumab injection was administered, with subsequent resolution of edema. At 16 months postsurgery, IOP remained stable at 14 mmHg in the right eye and 12 mmHg in the left eye, with no recurrence of anterior chamber shallowing. Phacoemulsification combined with goniosynechialysis may represent a viable treatment option for patients with nanophthalmos and acute secondary glaucoma.