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Phacoemulsification in nanophthalmos
Microphthalmia and Microphthalmia: A Complete Guide to Small Eyes and Their Treatment
What is the microphthalmia? And the nanalmos? These ophthalmic conditions involve abnormally small eyes, presenting unique challenges in their diagnosis and treatment. Understanding these differences is key to effectively addressing these complex conditions. eye diseases.
Microphthalmia vs. Nasalmia: Understanding the Difference
The microphthalmia is the general term for any eye that is significantly smaller than normal. The nanalmos It is a specific form of microphthalmia, which not only involves a reduced size of the eye, but also additional features such as:
- Microcornea: Cornea (the clear front part of the eye) smaller than usual.
- High hyperopia: A significant refractive error where the eye is too “short.”
It is important to note that All nanalmos is microphthalmia, but not all microphthalmia is nanalmos.
Challenges in Cataract Surgery for Nanophthalmic Eyes
One of the biggest challenges in the treatment of nanalmos and microphthalmia is the cataract surgery. He precise calculation of the intraocular lens (IOL) it is complicated in such small eyes due to their atypical anatomy.
- IOL Formulas: Traditional formulas, such as the SRK/T, may be less accurate. Studies have shown that the haigis' formula may offer better results in nanophthalmic eyes.
- Treatment Options:
- Implant the highest power IOL available and correct residual hyperopia with glasses.
- Use LIOs «Piggyback»: Implant two lenses one on top of the other to achieve the desired power.
Surgical Risks and Complications in Small Eyes
Surgery on nanophthalmic and microphthalmic eyes is delicate and carries a high risk of complications, including:
- Uveal effusion: Accumulation of fluid between the choroid and the sclera.
- Choroidal hemorrhage: Bleeding into the choroid, a vascular layer of the eye.
- Angle closure glaucoma: More common in these eyes, a laser peripheral iridotomy before surgery to prevent it.
Causes and Genetics of Nanalmos and Microphthalmia
In many cases, the exact cause of nanalmos and microphthalmia remains unknown (sporadic cases). However, Genetics plays a fundamental role. Por ejemplo, el Kennerknecht-AFI syndrome, characterized by short stature, dense bones, and short hair, is a clear example of genetic influence. If both parents are carriers of a genetic mutation, there's a chance their children will inherit the condition.
The family history are a crucial factor in the diagnosis and understanding of these conditions.
Diagnosis and Evaluation of the Patient with Small Eyes
Beyond genetics, specialists perform a comprehensive evaluation that includes:
- Medical record detailed.
- Visual acuity and intraocular pressure.
- A thorough examination of the ocular structure.
- Use of specialized equipment such as IOLMaster to obtain accurate biometric measurements of the eye.
Comprehensive Treatment and Quality of Life
Treatment for nanalmos and microphthalmia is individualized based on severity and complications:
- Vision correction: Glasses or contact lenses.
- Glaucoma control: Medications to regulate intraocular pressure.
- The surgery it is not always the first option; each case is evaluated individually.
Although perfect vision is not always achieved without glasses, cataract surgery with high-power IOLs can significantly reduce dependence on thick glasses, improving vision quality of life of the patients.
Advances and Future of Therapies for Small Eyes
The field of ophthalmology is advancing rapidly, offering new hope for the management of microphthalmia and napalmos:
- More accurate IOL formulas: New formulas are being developed for IOL calculation in small eyes.
- Custom IOLs: Different types of IOLs are being investigated, including multifocal IOLs and customized IOLs, often with the help of Artificial Intelligence (AI) to improve accuracy.
- Gene therapy: It could revolutionize treatment by correcting underlying genetic causes.
Specialized Surgical Techniques for Nanophthalmic Eyes
Operating on small eyes requires great precision and experience:
- Pars plana vitrectomy: Important to reduce intraocular pressure and the risk of uveal effusion.
- Anterior vitrectomy: To deepen the anterior chamber and facilitate IOL implantation.
- Laser peripheral iridotomy: Preventive procedure for angle closure glaucoma.
- Suborbital blocks: To temporarily immobilize the eye during surgery.
- Hydrosocionoidovitrectomy: A more complex technique for specific cases.
IOL Selection and Orbital Expansion in Specific Cases
The choice of IOL in nanalmos is crucial:
- Precise measurements: Essential, especially axial length and corneal curvature.
- IOL Considerations: Power can be undercorrected, especially in children, and multifocal IOLs are being explored.
- Implantation techniques: Given the small capsular bag, techniques such as optic capture or scleral fixation are used.
In severe cases of microphthalmia, the orbital expansion it is essential to stimulate bone growth and improve the adaptation of ocular prostheses, as well as the aesthetic appearance. A common technique is the expansive bone orbitotomy with inflatable balloon.
Multidisciplinary Approach: The Key to Success
Comprehensive management of nanalmos and microphthalmia requires a multidisciplinary approachOphthalmologists, geneticists, maxillofacial surgeons, and other specialists work together to provide the best personalized care to each patient.
Nanophthalmia and microphthalmia are complex conditions, but advances in surgical techniques, IOL calculations, and technology are dramatically improving treatment options and patient quality of life. Continued research, especially in genetics and new technologies, offers immense hope for future improvements in the management of these conditions.
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