Abstract：
OBJECTIVE: Cataract surgery in microphthalmic eyes is challenging due to anatomical restraints, hard bulky nucleus. This series aims to evaluate the safety and efficacy of couching of intraocular lens in irido-fundal coloboma with microphthalmos.
METHODS: Tertiary care centre in South India.
METHODS: Retrospective non-comparative study in eyes with irido-fundal coloboma, corneal diameter < 7 mm and brown cataract. Visual acuity less than 6/60 in other eye.
METHODS: Anterior chamber entry made, zonules broken and lens dislocated into the vitreous cavity in a controlled manner. Baseline Clinico-demographic details, corrected distance visual acuity (CDVA), Intra-ocular pressure (IOP), corneal diameter, axial length, lens status and post-surgery CDVA, IOP and complications recorded and followed up for atleast 6 months.
RESULTS: Fifteen eyes of 15 subjects were evaluated with a mean age 49.4 ± 10.9 years. At baseline, mean IOP 14.5 ± 3.8 mmHg, mean axial length 19.3 ± 0.5 mm, mean corneal diameter was 6.5 ± 0.34 mm and CDVA 2 logMAR which improved to 1.5 logMAR at 3 months (p value 0.002). Transient spike in IOP in 33.3% subjects was medically managed with no significant difference in IOP (p > 0.05) at baseline (14.5 ± 3.8 mmHg), 3 months post-surgery (16 ± 2.8 mmHg) and 6 months post-surgery (14.9 ± 2.5 mmHg). One patient underwent re-couching. No other major complications were noted.
CONCLUSIONS: Couching of cataractous lens is an effective and safe method in microphthalmic eyes with irido-fundal coloboma as last resort procedure, where no other surgical procedure may work. It provides an ambulatory gain of visual acuity in previously non-ambulatory subjects. Corneal measurements help in determining the subset of patients where couching offers viable option.
METHODS: Tertiary care centre in South India.
METHODS: Retrospective non-comparative study in eyes with irido-fundal coloboma, corneal diameter < 7 mm and brown cataract. Visual acuity less than 6/60 in other eye.
METHODS: Anterior chamber entry made, zonules broken and lens dislocated into the vitreous cavity in a controlled manner. Baseline Clinico-demographic details, corrected distance visual acuity (CDVA), Intra-ocular pressure (IOP), corneal diameter, axial length, lens status and post-surgery CDVA, IOP and complications recorded and followed up for atleast 6 months.
RESULTS: Fifteen eyes of 15 subjects were evaluated with a mean age 49.4 ± 10.9 years. At baseline, mean IOP 14.5 ± 3.8 mmHg, mean axial length 19.3 ± 0.5 mm, mean corneal diameter was 6.5 ± 0.34 mm and CDVA 2 logMAR which improved to 1.5 logMAR at 3 months (p value 0.002). Transient spike in IOP in 33.3% subjects was medically managed with no significant difference in IOP (p > 0.05) at baseline (14.5 ± 3.8 mmHg), 3 months post-surgery (16 ± 2.8 mmHg) and 6 months post-surgery (14.9 ± 2.5 mmHg). One patient underwent re-couching. No other major complications were noted.
CONCLUSIONS: Couching of cataractous lens is an effective and safe method in microphthalmic eyes with irido-fundal coloboma as last resort procedure, where no other surgical procedure may work. It provides an ambulatory gain of visual acuity in previously non-ambulatory subjects. Corneal measurements help in determining the subset of patients where couching offers viable option.
摘要：
目的：由于解剖学限制，小眼白内障手术具有挑战性，坚硬笨重的核。本系列旨在评估人工晶状体在虹膜底突合并小眼中的安全性和有效性。
方法：印度南部的三级护理中心。
方法：回顾性非对照研究，角膜直径<7毫米和棕色白内障。其他眼视力小于6/60。
方法：前房进入，小带破裂，晶状体以受控方式脱位进入玻璃体腔。基线临床人口统计详细信息，矫正视力（CDVA），眼内压(IOP),角膜直径,轴向长度,晶状体状态和术后CDVA，记录眼压及并发症,随访至少6个月。
结果：对15名受试者的15只眼进行评估，平均年龄为49.4±10.9岁。在基线,平均眼压14.5±3.8mmHg，平均轴向长度19.3±0.5mm，平均角膜直径为6.5±0.34mm，CDVA2logMAR在3个月时改善为1.5logMAR（p值0.002）。33.3％受试者的眼压瞬时峰值在基线（14.5±3.8mmHg）时没有显着差异（p>0.05），术后3个月（16±2.8mmHg）和术后6个月（14.9±2.5mmHg）。一名患者接受了重新卧床。未发现其他重大并发症。
结论：白内障晶状体Couching是一种有效和安全的方法，适用于虹膜底缺损作为最后手段的微眼科，没有其他外科手术可以工作。它在以前的非走动受试者中提供了视觉敏锐度的走动增益。角膜测量有助于确定沙发提供可行选择的患者子集。
方法：印度南部的三级护理中心。
方法：回顾性非对照研究，角膜直径<7毫米和棕色白内障。其他眼视力小于6/60。
方法：前房进入，小带破裂，晶状体以受控方式脱位进入玻璃体腔。基线临床人口统计详细信息，矫正视力（CDVA），眼内压(IOP),角膜直径,轴向长度,晶状体状态和术后CDVA，记录眼压及并发症,随访至少6个月。
结果：对15名受试者的15只眼进行评估，平均年龄为49.4±10.9岁。在基线,平均眼压14.5±3.8mmHg，平均轴向长度19.3±0.5mm，平均角膜直径为6.5±0.34mm，CDVA2logMAR在3个月时改善为1.5logMAR（p值0.002）。33.3％受试者的眼压瞬时峰值在基线（14.5±3.8mmHg）时没有显着差异（p>0.05），术后3个月（16±2.8mmHg）和术后6个月（14.9±2.5mmHg）。一名患者接受了重新卧床。未发现其他重大并发症。
结论：白内障晶状体Couching是一种有效和安全的方法，适用于虹膜底缺损作为最后手段的微眼科，没有其他外科手术可以工作。它在以前的非走动受试者中提供了视觉敏锐度的走动增益。角膜测量有助于确定沙发提供可行选择的患者子集。
