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NR. 3(I)/2004
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Relative anterior
microphthalmus (RAM): Morphometrical analysis and its
implications for cataract and glaucoma surgery
Hans E. Völcker, Gerd U. Auffarth
Department of Ophthalmology,
Ruprecht-Karls-University of Heidelberg |
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| Summary: |
Purpose: To
evaluate morphometrical data and risk factors for
cataract surgery in patients with relative anterior
microphthalmus (RAM). RAM is defined as eyes with
horizontal corneal diameters £ 11mm, axial length of >20
mm without any malformation.
Patients and Methods: Sixty two patients with
RAM, who underwent cataract surgery, were examined for
anterior chamber (AC) depth, lens thickness, total axial
length (TAL) and refraction. Associated ocular pathology
(such as glaucoma, previous surgical interventions,
etc.) was recorded. In addition a matched pairs analysis
concerning the anatomical features was performed with a
group of 17 patients with RAM and 17 patients (controls)
that matched the RAM group in terms of axial length, age
and gender but showed corneal diameters >11 mm.
Results: Anatomical parameters in RAM showed an
average corneal diameter of 10.7±0.34 mm, AC-depth of
2.20±0.49 mm and average lens thickness of 5.05± 0.45 mm.
Fifty five percent of patients revealed myopic
refraction. There was a high incidence of glaucoma
(77.4%), cornea guttata (45.2%) and Pseudoexfoliation
syndrome (16.1%) in the RAM-group. Sixty percent of
patients had undergone previous glaucoma surgery.
Matched pairs analysis showed significant differences
between RAM and controls in terms of AC-depth (p=0.029)
but no difference in lens thickness (p=0.12). After
cataract surgery 51.2% of patients achieved visual
acuity of >20/40, 69.8% of >20/50. Temporary corneal
edema (54.8%) and cilio-lenticular block (11.6%) were
the most important complications after cataract surgery.
Conclusions: Relative anterior microphthalmus can
be characterized in terms of morphometrical data as eyes
with corneal diameters £11 mm and anterior chamber
depths of 2 mm. The small anterior segment, especially
the shallow anterior chamber, is responsible for the
high incidence of glaucoma and postoperative
complications after cataract surgery. Identifying these
patients prior to surgery helps the cataract surgeon to
be prepared for potential problems. |
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| Key words: |
Ram, microphthalmus,
anterior chamber depth, lens thickness, total axial
lenght. |
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