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Titre	Anterior megalophthalmos cataract: Supporting the ‘bag-in-the-lens’ implant.
Abstract Nr.	1028

But	To describe the challenges associated with cataract surgery in the extreme outlying condition of X-linked anterior megalophthalmos.
Méthodes	This is a report of a rare clinical condition where a patient presented with cataract and a history of anterior megalophthalmos. His best corrected distance visual acuity (BCVA) was 0.6 (Snellen decimal) with a refraction of +2.50DS -1.25DCx10°. Surgery initially followed the standard BIL technique but preoperatively the zonulae proved unstable and capsular support was needed. Two bean-shaped ring segments were used to support a 14.5D BIL (Morcher 89A), one in the capsule and one in the ciliary sulcus.
Résultats	Postoperatively there were two main issues. Firstly the refraction, despite being calculated for emmetropia, resulted in a hypermetropia of +3.00DS. Secondly, at 5 weeks postoperatively one of the bean segments disengaged from the BIL and was loose in the ciliary sulcus. The plan was initially to exchange the BIL and replace the loose ring with a custom-made larger implant. During the surgery however, the zonulae were too unsteady to exchange the lens and only the bean-segment could be replaced. Ultimately the +3.00 refractive error was corrected with glasses.
Conclusion	Cataract surgery in anterior megalophtalmos can be complicated by zonular instability, loss of centration and difficulties in predicting the refractive outcome. When faced with the same issues again we would use larger custom-made beans and place them both in the ciliary sulcus to obtain better lens centration.

Auteur 1

Nom	JANSSEN
Initiales	C

Auteur 2

Nom	Ni Dhubhghaill
Initiales	S

Auteur 3

Nom	Augustinus
Initiales	A

Auteur 4

Nom	Tassignon
Initiales	MJ