Cataract surgery in 79 patients with relative anterior microphthalmus (RAM): A review on anatomy, associated pathology and complications

Background: Naumann has coined the term relative anterior microphthalmus (R AM) for eyes with a dysproportional small anterior segment but no further m alformation. Those eyes are characterized by corneal diameters of <11 mm an d total axial length of >20 mm. Patients and Methods: To evaluate and define morphometrical data and risk f actors for cataract surgery in patients with relative anterior microphthalm us (RAM) 112 cataract operations of 79 patients with RAM were analysed. Ass ociated ocular pathology (such as glaucoma, previous surgical interventions , etc.) and complications of cataract surgery were recorded. Results: Average corneal diameter was 10.7+/-0.34 mm, AC-depth was 2.20+/-0 .49 and average lens thickness 5.05+/-0.45 mm. Fifty five percent of the pa tient revealed myopic refraction. There was a high incidence of glaucoma (7 7%), cornea guttata (46.6%) and Pseudoexfoliation syndrome (16%) in the RAM -group. Sixty percent of patients previously underwent glaucoma surgery. Af ter cataract surgery 51.2% of patients achieved a visual acuity of >0.5; 69 .8% >0.4. The IOP was preoperatively 16.5+/-5.8 mm Hg (with 1.3+/-1.4 antig laucomatous drugs). Postoperatively IOP dropped significantly to 13.6+/-3.2 mm Hg (with significant reduction of treatment (0,6+/-1,0) (p<0.01). The a nterior chamber depth deepened from 2.42+/-0.47 mm to 3.33+/-0.72 mm. Conclusions: The special anatomical situation in RAM is responsible for the high incidence of glaucoma and postoperative complications after cataract surgery. Cataract surgery helps not only to restore vision but also facilit ates handling and regulation of intraocular pressure.