| 본문 : We hereby present a case of using retropupillary iris claw intraocular lens after cataract extraction in a relative nanophthalmic malignant glaucoma patient. A 56-year old female patient was being followed-up for several years with recurrent angle closure attack in her right eye. 9 years ago, the patient received argon laser peripheral iridotomy(ALPI) on her both eyes. After that, the patient used 2% pilocarpine once a day and her intra-ocular pressure(IOP) was maintained at about 10~16mmHg. But 3 months prior to the visit, IOP in her right eye was increased to 52mmHg and she complained of severe headache and visual discomfort. Examination revealed intact ALPI site, but lens diameter from anterior to posterior surface was increased and her axial length was 20.64mm with A-scan. Also, lens-iris diaphragm had been moved forward. She received mannitol intravenously (mannitolization), stopped applying pilocarpine and started using cyclopentolate 3 times a day. However, recurrent angle closure attacks became more severe; thus cataract extraction combined with 25G pars plana vitrectomy and capsulectomy were planned. There was a possibility that nanophthalmos including relative nanophthalmos, would progress to an aqueous misdirection syndrome(malignant glaucoma) after cataract surgery. Therefore we performed cataract extraction, trans pars plana vitrectomy(TPPV), capsulectomy and fixation of retropupillary iris claw intraocular lens(posterior fixated Artisan® lens). As a result, IOP was maintained at about 12~15mmHg and the visual acuity was 18/20 without glasses at 2 months after surgery. In relative nanophthalmic angle closure patients, one-step surgery of cataract extraction with posterior iris claw lens can be an effective way to prevent malignant glaucoma and acquire good visual quality, as compared to sequential surgery of cataract extraction followed by TPPV and secondary IOL implantation. |