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Koshiishi Y, Nagata M, Matsushima H, Ito S, Suzuki S, Matsumoto H, Okayasu A, Senoo T. Unilateral lifebuoy cataract: A case report. Medicine (Baltimore) 2024; 103:e39359. [PMID: 39151503 PMCID: PMC11332702 DOI: 10.1097/md.0000000000039359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
RATIONALE Lifebuoy cataract is a rare congenital condition characterized by lens thinning. Due to its rarity, detailed treatment reports and standardized surgical approaches are limited. This study aims to enhance the current body of knowledge by presenting comprehensive case reports and describing surgical techniques for the treatment of lifebuoy cataracts. PATIENT CONCERNS A 14-year-old boy was diagnosed with a congenital cataract in his right eye at the age of 9, which was left untreated. The patient visited our hospital due to progressive visual impairment. DIAGNOSES The visual acuity of the right eye was counting fingers at 30 cm. The uncorrected visual acuity of the left eye was 20/100, whereas the best corrected visual acuity was 20/20. The intraocular pressures were 18 mm Hg (left eye) and 20 mm Hg (right eye). Slit-lamp microscopy revealed central calcification of the lens capsule in the right eye and slightly opaque cortical tissue in the periphery, with no observable lens nucleus. Anterior segment optical coherence tomography (CASIA2, TOMEY, Nagoya, Japan) of the right eye showed fused anterior and posterior capsules and an absence of the lens nucleus, leading to a diagnosis of lifebuoy cataract. INTERVENTIONS Cataract surgery was performed on the right eye. Following a 2.4-mm sclerocorneal incision and trypan blue staining, continuous curvilinear capsulorrhexis was performed around the central opacity. The surrounding cortex was removed using irrigation and aspiration, while a viscoelastic agent was injected between the central calcified membrane and the posterior capsule. The membranous tissue was carefully peeled away and removed using forceps. Despite residual posterior capsular opacification, posterior capsulotomy was not performed due to concerns about vitreous prolapse. The intraocular lens was fixed within the capsule. Ten days post-surgery, the remaining posterior capsular opacification was treated with neodymium-doped yttrium aluminum garnet laser capsulotomy. OUTCOMES The uncorrected visual acuity and best corrected visual acuity of the right eye improved to 20/100 and 20/50, respectively. LESSONS This case report demonstrates a successful surgical approach for a lifebuoy cataract, highlighting its unique morphology and the need for careful, specialized techniques. These findings aim to guide ophthalmologists in managing this rare condition, potentially improving patient care.
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Affiliation(s)
- Yuka Koshiishi
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Mayumi Nagata
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Hiroyuki Matsushima
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Sakae Ito
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Shigenari Suzuki
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Haruka Matsumoto
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Akihiko Okayasu
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Tadashi Senoo
- Department of Ophthalmology, Dokkyo Medical University Hospital, Tochigi, Japan
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Zhang XF, Li XX, Xin C, Kline B, Kang MT, Li M, Qiao LY, Wang NL. Refractive Lens Exchange Surgery in Early-Onset High Myopia Patients With Partial Cataract. Front Med (Lausanne) 2022; 9:739197. [PMID: 35492336 PMCID: PMC9051036 DOI: 10.3389/fmed.2022.739197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose By reporting clinical characteristics and retinal image quality before and after refractive lens replacement surgery in early-onset high myopia (eoHM) patients presenting with partial cataract, we emphasized the need for an objective way to grade the severity of partial cataracts. Methods This retrospective, consecutive case series included six Chinese patients (nine eyes). Analysis of previous medical records, visual acuity, optometry, retinal image quality, and axial length (AXL) before surgery and after surgery was performed. Results Five females and one male (nine eyes) with a mean (± SD) age of 11.6 ± 7.9 years (range: 4–25 years) were included in this study. The preoperative spherical power ranged from −7.5 to −42 D. The mean follow-up time was 36 months (range: 24–48 months). Phacoemulsification was followed by in-the-bag implantation of intraocular lens. For patients who were under 6 years old, posterior capsulotomy + anterior vitrectomy were performed simultaneously. All surgeries were uneventful and no postoperative complications occurred during the entire follow-up period. All patients’ uncorrected visual acuity improved by ≥2 lines postoperatively(Snellen acuity). LogMAR best-corrected visual acuity was improved at 24-month (P = 0.042) and endpoint (P = 0.046) follow-ups. Modulation transfer function cutoff frequency (MTFcutoff) and objective scatter index (OSI) was significantly improved at 12-month (P = 0.025, P = 0.038), 24-month (P = 0.005, P = 0.007) and endpoint (P = 0.005, P = 0.008) follow-ups. Postoperative AXL remained stable during 2–4 year follow-ups (P > 0.05). Conclusion Refractive lens replacement surgery is safe and effective for improving functional vision in eoHM patients presenting with partial cataract. Retinal image quality could provide a useful and objective way to facilitate partial cataract severity evaluation and surgery decision making.
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Affiliation(s)
- Xi-Fang Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiao-Xia Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Chen Xin
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Brad Kline
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
| | - Meng-Tian Kang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Meng Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Li-Ya Qiao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- *Correspondence: Li-Ya Qiao,
| | - Ning-Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Age norms for grating acuity and contrast sensitivity in children using eye tracking technology. Int Ophthalmol 2021; 42:747-756. [PMID: 34622374 DOI: 10.1007/s10792-021-02040-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
KEY MESSAGES Visual acuity is the most used method to assess visual function in children. Contrast sensitivity complements the information provided for visual acuity, but it is not commonly used in clinical practice. Digital devices are increasingly used as a method to evaluate visual function, due to multiple advantages. Testing with these devices can improve the evaluation of visual development in children from a few months of age. Visual acuity and contrast sensitivity tests, using eye tracking technology, are able to measure visual function in children across a wide range of ages, objectively, quickly and without need of an experienced examiner. PURPOSE To report age-normative values for grating visual acuity and contrast sensitivity in healthy children using a digital device with eye tracking technology and to validate the grating acuity test. METHODS In the first project of the study, we examined healthy children aged between 6 months and 7 years with normal ophthalmological assessment. Grating visual acuity (VA) and contrast sensitivity (CS) were assessed using a preferential gaze paradigm with a DIVE (Device for an Integral Visual Examination) assisted with eye tracking technology to provide age norms. For the validation project, we compared LEA grating test (LGT) with DIVE VA in a group of children aged between 6 months and 4 years with normal and abnormal visual development. RESULTS Fifty-seven children (2.86 ± 1.55 years) were examined with DIVE VA test and 44 successfully completed DIVE CS test (3.06 ± 1.41 years). Both, VA and CS values increased with age, mainly along the first two years of life. Sixty-nine patients (1.34 ± 0.61 years) were included in the DIVE VA test validation. The mean difference between LGT and DIVE VA was - 1.05 ± 4.54 cpd with 95% limits of agreement (LoA) of - 9.95-7.84 cpd. Agreement between the two tests was higher in children younger than 1 year with a mean difference of - 0.19 ± 4.02 cpd. CONCLUSIONS DIVE is an automatic, objective and reliable tool to assess several visual function parameters in children, and it has good agreement with classical VA tests, especially for the first stage of life.
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Mayer DL, Taylor CP, Kran BS. A New Contrast Sensitivity Test for Pediatric Patients: Feasibility and Inter-Examiner Reliability in Ocular Disorders and Cerebral Visual Impairment. Transl Vis Sci Technol 2020; 9:30. [PMID: 32879786 PMCID: PMC7442875 DOI: 10.1167/tvst.9.9.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 05/12/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Assess feasibility and interexaminer reliability of a new test of contrast sensitivity (CS) for pediatric populations. Methods The Double Happy (DH) measures CS using a method similar to the Teller Acuity Cards. The schematic DH face is 16 degrees in diameter with features of 0.3 c/d and a channel frequency of 0.8 c/d. DH log10 CS is in 0.15 log unit steps, 0.05 to 2.1. Participants were 43 unselected patients, ages 2 to 18 years: 23 were diagnosed with ocular disorders only; 20 were diagnosed with cerebral visual impairment (CVI). Two examiners measured DH log10 CS. Visual acuity (VA) was also measured. Results All 43 participants were tested for binocular DH log10CS. Cohen's kappa values for interexaminer reliability were fair. The between examiner ICC was +0.92 (P < 0.001). The mean difference between examiners was near zero, and the 95% CI was −0.44 to 0.45 log10CS. DH log10CS was near normal in the ocular disorder group and reduced in the CVI group. VA was reduced in both groups. DH log10 CS and VA were correlated (r = −0.65). DH log10 CS was a marginally better predictor of diagnosis than VA. Conclusions DH log10CS test was successful in a diverse pediatric population diagnosed with ocular disorders or CVI. Interexaminer reliability was comparable to that of adults tested previously using the same stimuli and methods. Both CS and VA are reduced in CVI. Translational Relevance CS and VA both should be tested in pediatric clinical populations, especially in those at risk of CVI.
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Affiliation(s)
- D Luisa Mayer
- New England College of Optometry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, Boston, MA, USA
| | | | - Barry S Kran
- New England College of Optometry, Boston, MA, USA
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Shuai L, Leilei Z, Wen W, Shu W, Gangsheng L, Yinglong L, Guoke Y, Xinrong C, Hong L, Rongfeng L. Binocular treatment in adult amblyopia is based on parvocellular or magnocellular pathway. Eur J Ophthalmol 2019; 30:658-667. [PMID: 31014078 DOI: 10.1177/1120672119841216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Amblyopia is speculated to be an untreatable disease in the patient, who is beyond the critical period of vision; however, currently, it is treatable in adults. PURPOSE This study aimed to elucidate whether the treatment is useful in both anisometropic amblyopia and strabismic amblyopia. In addition, the differences were detected between anisometropic amblyopia and strabismic amblyopia after the same perceptual treatment and whether the suppression in anisometropic amblyopia or strabismic amblyopia could be decreased before and after the treatment. METHODS A binocular perceptual learning was applied for the treatment, the suppression was measured, and the patients were followed up for 2 months after training. Anisometropic amblyopia and strabismic amblyopia groups were subjected to the assessment of stereo, visual acuity, contrast sensitivity, and suppression before and after the training. RESULTS After 6 weeks of "Diploma Gabor Orientation Coherence" training, in the anisometropic amblyopia group, the outcomes of visual acuity (t = 3.114, p = 0.026) and contrast sensitivity (t = 7.786, p = 0.001) were increased significantly. While in the strabismic amblyopia group, the outcomes of stereo (t = 2.987, p = 0.040) and contrast sensitivity (t = 3.638, p = 0.022) were increased significantly. CONCLUSION After Diploma Gabor Orientation Coherence training in the same frequency and in the same duration, the anisometropic amblyopia group got an improvement in visual acuity, but the strabismic amblyopia group got an improvement in stereo. As there are evidences to show that anisometropic amblyopia and strabismic amblyopia were injured in different pathways, we think the diverse results might come from the different pathway injury in anisometropic amblyopia and strabismic amblyopia.
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Affiliation(s)
- Liu Shuai
- Anhui Medical University, Hefei, China.,Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Zou Leilei
- Fudan University, Shanghai, China.,Department of Ophthalmology, EENT Hospital Affiliate to Fudan University, Shanghai, China
| | - Wen Wen
- Fudan University, Shanghai, China.,Department of Ophthalmology, EENT Hospital Affiliate to Fudan University, Shanghai, China
| | - Wang Shu
- Fudan University, Shanghai, China.,Department of Ophthalmology, EENT Hospital Affiliate to Fudan University, Shanghai, China
| | - Liu Gangsheng
- Anhui Medical University, Hefei, China.,Department of Ophthalmology, Hefei First People's Hospital, Anhui, China
| | - Li Yinglong
- Anhui Medical University, Hefei, China.,Department of Ophthalmology, Hefei First People's Hospital, Anhui, China
| | - Yang Guoke
- Anhui Medical University, Hefei, China.,Department of Ophthalmology, Hefei First People's Hospital, Anhui, China
| | - Chang Xinrong
- Anhui Medical University, Hefei, China.,Department of Ophthalmology, Hefei First People's Hospital, Anhui, China
| | - Liu Hong
- Fudan University, Shanghai, China.,Department of Ophthalmology, EENT Hospital Affiliate to Fudan University, Shanghai, China
| | - Liao Rongfeng
- Anhui Medical University, Hefei, China.,Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Anhui, China
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Abstract
Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract.
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Affiliation(s)
- Anagha Medsinge
- Pediatric Ophthalmology, Strabismus, and Adult Motility, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, (UPMC), Pittsburgh, PA, USA ; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ken K Nischal
- Pediatric Ophthalmology, Strabismus, and Adult Motility, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, (UPMC), Pittsburgh, PA, USA ; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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