Megalocornea, iris desinsertion and crystalline luxation in congenital glaucoma

Purpose To present a case report of a patient with congenital glaucoma and megalocornea, who suffer iris desinsertion and crystalline luxation during adulthood. Methods We present a 46-year-old male with bilateral congenital glaucoma treated with bilateral goniotomy in pediatric age and right eye (RE) blind after a traumatism. He refered visual acuity (VA) loss in his left eye (LE). The visual acuity was light perception in RE and count fingers at 50 cm in LE. Ophthalmological exams evidenced asymmetric bilateral buphthalmos. The LE shows 21 mm of diameter corneal, transparent cornea, severe iridodonesis, 360o iris desinsertion, afaquia, and 22 mmHg of intraocular pressure by applanation tonometry. This eye was treated with dorzolamide and timolol maleate. Posterior luxation of the crystalline was found in the ophthalmic ultrasound. Results A +14 diopters lens provided the best corrected visual performance achievable of 0.05 with LE. Non-invasive treatment was selected in order to avoid surgery complications. Conclusion Ophthalmologists should to monitor intraocular pressure and corneal diameter in patients with congenital glaucoma because increase in corneal diameter is a biomarker of progression of glaucoma. In these patients, interdisciplinary valuation of systemic and ophthalmological findings should be performed.