Medical Care
Medical care for patients with megalocornea includes correction of refractive error and thorough evaluation for findings of anterior megalophthalmos. Also, routine examination for the development of cataracts and glaucoma is necessary.
Surgical Care
Surgical amelioration of glaucoma and cataract is performed when necessary.
Cataract is common with megalocornea, and the cataract surgery is difficult. The zonules supporting the lens capsule surrounding the cataract are often weak. Weakened zonules make it more difficult to support an artificial intraocular lens (IOL). This leads to increased surgical complications, such as vitreous loss and loss of lens material to the back of the eye during cataract surgery. [4, 5, 6]
The large size of the anterior segment makes IOL selection difficult as standard IOLs are too small. A standard lens will often not work. Oetting and Newsom at the University of Iowa reported on the use of a special IOL called the Artisan lens (see the image below) that clips onto the iris. [7]
Because this IOL clips onto the iris rather than fitting into the angle, it allows for a safe and stable placement, even with the large anterior segment. Basti and colleagues reported using suture based iris fixation to allow placement of a standard IOL in these large eyes. [8]
Consultations
Pediatric developmental specialist consultation is always indicated to evaluate for the many associated systemic conditions. These include albinism, Down syndrome, Marfan syndrome, Alport syndrome, craniosynostosis, and many others.
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Central mosaic dystrophy sometimes noted in megalocornea.
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Megalocornea.
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Megalocornea patient with Artisan lens.
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B-scan ultrasound showing a large flat iris.
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Aphakic megalocornea patient with 15 mm white to white.
