Aniridia Associated with Lens Coloboma and Secondary Glaucoma Treated with Transcorneal Argon Laser Ciliary Body Photocoagulation: A Case Report
Our patient was an 18-year-old female affected by congenital AN associated with palpebral ptosis and lens coloboma with an existing cataract (fig. ), but without systemic association (AN-1) []. The absence of a macular reflex (foveal hypoplasia) with yellowish deposits in the retinal periphery was also observed. Since the age of 5, the patient had been treated with timolol 0.05% to control the IOP of both eyes. Her best-corrected visual acuity was 20/400 in both eyes. The IOP, determined by Goldmann tonometry, was 33 mm Hg OD and 23 mm Hg OS, and corneal central thickness was 674 μm OD and 637 μm OS (Orbscan II; Bausch & Lomb, Rochester, N.Y., USA). The patient underwent pars plana cataract extraction, with both lens and capsule removed, and anterior 20G vitrectomy without intraocular lens (IOL) implantation in the right eye. After surgery, the IOP was well controlled by timolol 0.5%. However, 20 days later, the IOP began to exceed 26 mm Hg, although it was not appreciable at the slit lamp evaluation. We therefore decided to add latanoprost 0.005%. Forty-five days after surgery, the IOP continued to increase, reaching values up to 35 mm Hg. These IOP values were constant, although maximal ocular hypotensive therapy was added (brimonidine tartrate 0.2%, dorzolamide hydrochloride 2% drops and 250 mg acetazolamide tablets, twice daily). For this reason, we decided to perform transcorneal ciliary body photocoagulation. The procedure was performed with a solid-state 532-nm laser (Lumenis Novus® SpectraTM). The inferior temporal quadrant was treated first (80 spots, diameter 100 μm, 250 mW, 0.3 s), and after 1 month, the inferior nasal quadrant was treated (103 spots, diameter 100 μm, 250 mW, 0.3 s). The power of the laser was regulated to obtain whitening at the head of the ciliary processes. Microbubbles and pigment release were observed at times during treatment.