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Cataract surgery remains problematic in patients with aniridia

Only a minority of cases will benefit from such procedures

Roibeard O’hEineachain

Posted: Saturday, September 14, 2019

Paolo Nucci

GOOD outcomes are difficult to achieve when performing cataract surgery in eyes with aniridia, said Paolo Nucci MD at the WSPOS Subspecialty Day.

He noted that cataracts typically develop in aniridia in patients at an age when the requirement for good vision is at its greatest, around the age people are learning to drive. However, in his experience, only a minority of cases will benefit from such procedures.

Both conventional phacoemulsification and femtosecond laser-associated cataract surgery (FLACS) are highly problematic in anridia patients due to corneal opacity and weak zonules. In addition, the irregularity of the cornea makes it difficult to achieve a perfect capulorhexis with a femtosecond laser, said Prof Nucci, Director, University Ophthalmology Clinic, of San Giuseppe Hospital in Milan, Italy.

He added that capsular tension rings are not useful in eyes with aniridia because the zonular weakness in eyes with the condition extends the entire perimeter of the capsular bag.

Prof Nucci also emphasised that as yet there is no published research showing any benefit of iris prostheses in eyes with congenital aniridia. The FDA studies that led to their approval involved eyes with traumatic aniridia. The use of the devices in congenital cases is market-driven rather than evidence based, he said.