Endothelial cell study in a case of Werner's syndrome undergoing phacoemulsification and Yettrium-Aluminum-Garnet laser capsulotomy
A 28-year-old female born out of a second-degree consanguineous marriage presented with a gradual onset of decrease in vision in both eyes for 5 years. The patient was alright till the age of 10 years, when she developed skin changes, failure to gain weight, and had oligomenorrhea and irregular menses. She was on treatment for diabetes mellitus, high lipid profile and hypothyroidism, which developed as a consequence of radiotherapy for thyroid enlargement. She was diagnosed as WS and referred for cataract surgery.\nOn systemic examination, she had a short stature (134 cm), weighed 25 kg, looked emaciated, had gray, sparse scalp hair, bird-like facies, hoarse voice, thinned, hyperpigmented skin and lean arms and legs [Fig. and ].\nOn ophthalmic examination, best corrected visual acuity was 20/60, N12 in the right eye (RE) and counting fingers 6 ft, N36 in the left eye (LE). Slit-lamp examination showed nuclear sclerosis grade 2 in the RE and total cataract in the LE. Fundus in the RE appeared normal and LE showed attached retina on ultrasonography. She underwent a clear corneal phacoemulsification with hydrophilic foldable intraocular lens (IOL) implantation in the LE under peribulbar anesthesia.\nSodium hyaluronate 1.4% was used to protect the endothelium. Intraoperatively, a thick posterior capsular calcified plaque was noticed which could not be removed by peeling with a 26 G needle. Primary posterior capsulotomy (PPC) was avoided for the fear of inducing cystoid macular edema (CME). After IOL implantation, the corneal tunnel and side ports were closed with 10/0 nylon suture. Subconjunctival steroids were avoided at the end of surgery. Postoperatively, the patient was started on ketorolac tromethamine ophthalmic solution 0.4% four times daily and gatifloxacin eye drops 0.3% four times daily. The patient was started on a weak steroid (fluorometholone eye drops) twice daily for a week on the 4th postoperative day because of the increased anterior chamber reaction. On subsequent visits, the eye was quiet. At 1 month, the best corrected visual acuity was 20/40 N12. Decrease in vision was attributed to the posterior capsular plaque []. Meanwhile, cataract in the RE progressed to total cataract. She was operated in the RE 6 months after the first cataract surgery with similar precautions. Postoperative best corrected visual acuity was 20/30, N6 in RE. YAG capsulotomy was done 4 months from the date of surgery in LE []. Best corrected visual acuity improved to 20/20 N6 after capsulotomy [].