Alport Syndrome and Femtosecond Laser Assisted Cataract Surgery


We report the surgical management of a patient with bilateral anterior lenticonus due to Alport syndrome using femtosecond laser-assisted cataract surgery (FLACS) and the Optiwave Refractive Analysis (ORA) system. A 38-year-old man with Alport syndrome presented to our department with visual loss due to anterior lenticonus in both eyes. Adjustments during bilateral FLACS were performed with the software’s calipers to manually delineate the anterior capsulotomy. Multifocal toric intraocular lenses (IOLs) were selected and placed in the posterior chamber with the aid of intraoperative aberrometry. The intended postoperative positioning parameters for the IOL as well as the planned visual acuity and refraction were achieved. The implementation of FLACS and intraoperative wavefront aberrometry is a safe and useful surgical approach for the management of cataract in challenging cases such as patients with anterior lenticonus due to Alport syndrome.


Alport syndrome, Anterior Lenticonus, Cataract Surgery, Femtosecond Laser, Optiwave Refractive Analysis

1. Govan JA. Ocular manifestations of Alport’s syndrome: a hereditary disorder of basement membranes? Br J Ophthalmol 1983;67:493–503.

2. Arnott EJ, Crawfurd MD, Toghill PJ. Anterior lenticonus and Alport’s syndrome. Br J Ophthalmol 1966;50:390–403.

3. Colville DJ, Savige J. Alport syndrome. A review of the ocular manifestations. Ophthalmic Genet 1997;18:161–173.

4. Seymenoğlu G, Baser EF. Ocular manifestations and surgical results in patients with Alport syndrome. J Cataract Refract Surg 2009;35:1302–1306.

5. Xu J-M, Zhang S-S, Zhang Q, Zhou Y-M, Zhu C-H, Ge J, et al. Ocular manifestations of Alport syndrome. Int J Ophthalmol 2010;3:149–151.

6. Savige J, Sheth S, Leys A, Nicholson A, Mack HG, Colville D. Ocular features in Alport syndrome: pathogenesis and clinical significance. Clin J Am Soc Nephrol 2015;10:703–709.

7. Junk AK, Stefani FH, Ludwig K. Bilateral anterior lenticonus: Scheimpflug imaging system documentation and ultrastructural confirmation of Alport syndrome in the lens capsule. Arch Ophthalmol 2000;118:895–897.

8. Izzedine H, Bodaghi B, Launay-Vacher V, Deray G. Eye and kidney: from clinical findings to genetic explanations. J Am Soc Nephrol 2003;14:516–529.

9. Sukhija J, Saini JS, Jain AK. Phacoemulsification and intraocular lens implantation in an Alport’s syndrome patient with bilateral anterior and posterior lenticonus. J Cataract Refract Surg 2003;29:1834–1836.

10. Zare MA, Rajabi MT, Nili-Ahmadabadi M, Oskouee SJ, Moghimi S. Phacoemulsification and intraocular lens implantation in Alport syndrome with anterior lenticonus. J Cataract Refract Surg 2007;33:1127–1130.

11. Gupta A, Ramesh Babu K, Srinivasan R, Mohanty D. Clear lens extraction in Alport syndrome with combined anterior and posterior lenticonus or ruptured anterior lens capsule. J Cataract Refract Surg 2011;37:2075–2078.

12. Ladi JS, Shah NA. Toric multifocal intraocular lens implantation in a case of bilateral anterior and posterior lenticonus in Alport syndrome. Indian J Ophthalmol 2016;64:847–849.

13. Woodcock MG, Lehmann R, Cionni RJ, Breen M, Scott MC. Intraoperative aberrometry versus standard preoperative biometry and a toric IOL calculator for bilateral toric IOL implantation with a femtosecond laser: one-month results. J Cataract Refract Surg 2016;42:817–825.

14. Hatch KM, Woodcock EC, Talamo JH. Intraocular lens power selection and positioning with and without intraoperative aberrometry. J Refract Surg 2015 1;31:237–242.

15. Bayar SA, Pinarci EY, Karabay G, Akman A, Oto S, Yilmaz G. Clear lens phacoemulsification in Alport syndrome: refractive results and electron microscopic analysis of the anterior lens capsule. Eur J Ophthalmol 2014 26;24:345–351.

16. Choi J, Na K, Bae S, Roh G. Anterior lens capsule abnormalities in Alport syndrome. Korean J Ophthalmol 2005;19:84.

17. Agrawal N, Nayak DP, Haripriya A, Bhuwania P. Phacoemulsification with toric IOL implantation in Alport syndrome with anterior lenticonus having spontaneously ruptured anterior capsule. Eur J Ophthalmol 2015;25:78–80.

18. Bellini LP, Brum GS. Cataract surgery in patients with Alport syndrome. Eur J Ophthalmol 2016;26:85.

19. Barnes AC, Roth AS. Femtosecond laser-assisted cataract surgery in anterior lenticonus due to Alport syndrome. Am J Ophthalmol Case Rep 2017;6:64–66.

20. Ecsedy M, Súndor GL, Takúcs ÚI, Krúnitz K, Kiss Z, Kolev K, et al. Femtosecond laser-assisted cataract surgery in Alport syndrome with anterior lenticonus. Eur J Ophthalmol 2015;25:507–511.

21. Boss JD, McDermott M. Capsulorhexis tearing pattern during phacoemulsification in anterior lenticonus due to Alport syndrome. Eur J Ophthalmol 2016 ;26:39–41.

22. Ye Z, Li Z, He S. A meta-analysis comparing postoperative complications and outcomes of femtosecond laserassisted cataract surgery versus conventional phacoemulsification for cataract. J Ophthalmol 2017;2017:3849152.

23. Ewe SY, Abell RG, Vote BJ. Femtosecond laser-assisted versus phacoemulsification for cataract extraction and intraocular lens implantation: clinical outcomes review. Curr Opin Ophthalmol 2018;2:54–60.

24. Day AC, Gore DM, Bunce C, Evans JR. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database Syst Rev 2016;7:CD010735.

25. Grewal DS, Schultz T, Basti S, Dick HB. Femtosecond laser-assisted cataract surgery–current status and future directions. Surv Ophthalmol 2016;61:103–131.