Clear Lens Extraction for Visual Rehabilitation in a Functionally One-Eyed Patient with Congenital Nystagmus and High Myopia

Abstract

A young adult male with congenital nystagmus and high myopia presented with long-standing visual impairment. The right eye was functionally blind with hand movements, vision, large-angle exotropia, and congenital nystagmus. The left eye was the only seeing eye, with best-corrected visual acuity of 6/60 despite optimal spectacle correction. Ocular examination revealed a clear crystalline lens, myopic retinal changes, and no evidence of myopic choroidal neovascular membrane or treatable peripheral retinal pathology. After extensive counselling regarding the risks and guarded prognosis of surgery in the only seeing eye, clear lens extraction with posterior chamber intraocular lens implantation was performed. Postoperatively, best-corrected visual acuity improved to 6/9 (partial) with marked improvement in functional vision, while nystagmus persisted. This case highlights the role of clear lens extraction as a refractive option in carefully selected, functionally one-eyed patients with congenital nystagmus and high myopia.