Ocular albinism is rare, however just about every cataract surgeon will encounter at least one or two patients with this condition over the course of a career. There are some challenges here including nystagmus and foveal hypoplasia, but there is also a unique ability to visualize structures in the eye that are not normally seen, such as the capsular bag equator. This video is very educational for that reason alone.
At the pre-operative exam we can see that the patient has poliosis of the eyelashes and eyebrows and then the slit lamp examination shows a translucent iris. Some patients have a more robust iris compared to our patient here who has a very delicate iris. A previous case shown here had a less translucent iris, showing that ocular albinism is a spectrum of disease with varying degrees of involvement. For anesthesia, using a retro-bulbar block can help to dampen or eliminate the nystagmus as compared to just topical / intra-cameral anesthesia. For the IOL selection, it may be helpful to use the aniridia-style IOLs which have a smaller optic in the artificially created pupil as we have shown in this case from a few years ago. Finally, as we explained with this prior ocular albinism patient, appropriate patient expectations must be set during the informed consent process.
click to learn the surgical pearls for this case of ocular albinism: