Challenges in the Management of a Unique Case of Bilateral Nanophthalmic Glaucoma

To report a case of bilateral nanophthalmic glaucoma with choroidal detachment: its medical and surgical management. Methods: A 64-year-old male patient, having high hypermetropia with senile immature cataracts in both eyes, presented in our outpatient department. He had a shallow anterior chamber with raised intraocular pressure in both eyes. Gonioscopy showed narrow angles. The central fundus in the right eye could not be visualized due to a hazy view, due to a significant cataract, and in the left eye was normal. Axial length in both eyes was 15.2 mm, bringing us to the diagnosis of bilateral nanophthalmic glaucoma with senile immature cataract. The patient was then started on antiglaucoma medication, and laser peripheral iridotomy (LPI) was done in both eyes. On the follow-up visit, his intraocular pressure was maintained with antiglaucoma medications, and peripheral iridotomies were patent, but he was noted to have developed choroidal detachment in both eyes. Considering the significant cataract, requiring extraction and intraocular lens implantation, a decision was made to do a scleral window in both eyes. Scleral window surgery was then done in both eyes, following which the choroidal effusion decreased. The patient underwent cataract surgery in his right eye 3 months post- scleral window, which was uneventful. Results: Following the scleral window and cataract surgeries, intraocular pressure remained stable in both eyes, with the patient enjoying good vision postoperatively. Conclusion: A comprehensive evaluation of nanophthalmic eyes is essential; an optimal clinical outcome can be obtained through timely medical and surgical care.