1
|
Chen TH, Chen ZX, Zhang M, Chen JH, Lan LN, Jiang Y. Biometric and Structural Ocular Manifestations of Anterior Megalophthalmos. Front Med (Lausanne) 2022; 9:732452. [PMID: 35665341 PMCID: PMC9160329 DOI: 10.3389/fmed.2022.732452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to examine the biometric ocular manifestations and structural ocular features of anterior megalophthalmos (AM). Methods Fifteen patients with AM (30 eyes) from the Eye & ENT Hospital of Fudan University were included. The age-matched control group consisted of 30 participants (30 eyes) who underwent Pentacam HR and IOLMaster 700 measurements for one normal eye. Data on demographics, biometric manifestations, and genotypes were carefully compared. Results A total of 15 patients with AM and 30 control patients were enrolled. There were no differences in age (37.27 ± 19.1 vs. 31.43 ± 19.69 years, P = 0.249) between these two groups. AM eyes were characterized by premature cataracts (11/30, 36.67%) and zonular weakness with lens subluxation (22/30, 73.33%) compared with the control group. Notably, 20 of the 30 AM eyes (66.67%) had significant posterior iris bowing, and 16 of the 30 AM eyes (53.33%) showed an enlarged ciliary ring on ultrasound biomicroscopy (UBM). Mean corneal curvature was lower in the AM eyes (42.01 ± 2.06 D vs. 43.14 ± 1.38 D, P = 0.023). There was no significant difference in corneal pachymetry and central endothelial cell count between the AM and control groups. Significant differences were found in terms of the anterior chamber and white-to-white (WTW) among the Pentacam HR and IOLMaster 700 in patients with AM (P < 0.05). The difference was 0.53 ± 0.48 mm and 0.36 ± 0.14 mm, respectively (P < 0.001). Conclusion The results of this cohort study conclude the biometric and structural ocular manifestations in Chinese cohorts. Posterior iris bowing (66.67%) and lens subluxation (73.33%) are the most characteristic findings in patients with AM with anatomical abnormalities of megalocornea and a deep anterior chamber, although corneal biometric manifestations of AM included flatter cornea and lower total corneal astigmatism. The knowledge of ocular manifestations of AM is important for diagnosis and preparation for the operation in advance to avoid intraoperative and postoperative complications. Significant differences were found in the anterior chamber and WTW values between the Pentacam HR and IOLMaster 700. Thus, we suggest that various examinations should be carefully considered before determining an AM diagnosis.
Collapse
Affiliation(s)
- Tian-Hui Chen
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital of Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ze-Xu Chen
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital of Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Min Zhang
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital of Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jia-Hui Chen
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital of Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li-Na Lan
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital of Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yongxiang Jiang
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital of Fudan University, Shanghai, China
- Key Laboratory of Myopia of State Health Ministry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Yongxiang Jiang,
| |
Collapse
|
2
|
Ong APC, Zhang J, Vincent AL, McGhee CNJ. Megalocornea, anterior megalophthalmos, keratoglobus and associated anterior segment disorders: A review. Clin Exp Ophthalmol 2021; 49:477-497. [PMID: 34114333 DOI: 10.1111/ceo.13958] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 01/21/2023]
Abstract
Megalocornea and anterior megalophthalmos (megalocornea spectrum) disorders are typically defined by corneal diameter > 12.5 mm in the absence of elevated intraocular pressure. Clinical features overlap with keratoglobus but are distinct from buphthalmos and severe (globus) keratoconus. Megalocornea spectrum disorders and keratoglobus are primarily congenital disorders, often with syndromic associations; both can present with large and thin corneas, creating difficulty in diagnosis, however, only keratoglobus is typically progressive. Molecular genetics provide significant insight into underlying aetiologies. Nonetheless, careful clinical assessment remains intrinsic to diagnosis. Surgical management can be challenging due to the enlarged ciliary ring and weakened zonules in megalocornea spectrum disorders and the extreme corneal thinning of keratoglobus. In this review, the established literature on measurement of corneal diameter, diagnosis of megalocornea, anterior megalophthalmos and keratoglobus, differentiation from severe keratoconus, recent molecular genetics research and key surgical modalities in the management of these rare disorders are outlined and discussed.
Collapse
Affiliation(s)
- Aaron P C Ong
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Southern District Health Board, Dunedin, New Zealand
| | - Jie Zhang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrea L Vincent
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
3
|
Ucar F, Ozcimen M. Can toric IOL rotation be minimized? Toric IOL-Capsular Tension Ring suturing technique and its clinical outcomes. Semin Ophthalmol 2021; 37:158-163. [PMID: 34096458 DOI: 10.1080/08820538.2021.1933545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: In this study, we aimed to evaluate the outcomes of the toric intraocular lens (IOL) and capsular tension ring (CTR) suturing technique in patients with cataract and astigmatism. Methods: Group 1 comprised 37 eyes of 36 patients to whom the CTR-toric IOL complex was co-implanted after the CTR was sutured to the toric IOL haptic. Group 2 comprised 35 eyes of 33 patients in whom the toric IOL and CTR were implanted without suturing. Both groups were compared in terms of preoperative and postoperative astigmatism, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and IOL rotation. Results: The mean rotation degree was 0.54° ± 2.29° in group 1 and 4.28° ± 8.84° in group 2 (p = .01). While there was no significant difference between the postoperative residual astigmatism and the estimated residual astigmatism in group 1, the postoperative residual astigmatism was statistically higher than the estimated residual astigmatism in group 2 (p = .47 and 0.000, respectively). The mean postoperative UCVA was 0.02 ± 0.04 (logMAR) in group 1 and 0.08 ± 0.13 (logMAR) in group 2 (p = .01). Conclusion: The toric IOL and CTR suturing technique provides excellent rotational stability and astigmatism correction.
Collapse
Affiliation(s)
- Fikret Ucar
- Ophthalmology Department, Konyagoz Eye Hospital, Konya, Turkey
| | - Muammer Ozcimen
- Ophthalmology Department, Saglik Bilimleri University Konya Training and Research Hospital, Konya, Turkey
| |
Collapse
|
4
|
Kuo IC. Decentration of a toric intraocular lens implant in a patient with simple megalocornea. Am J Ophthalmol Case Rep 2020; 19:100754. [PMID: 32551399 PMCID: PMC7287240 DOI: 10.1016/j.ajoc.2020.100754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 04/30/2020] [Accepted: 05/20/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe a patient who developed radial displacement of the capsular bag and toric intraocular lens implant within approximately 5 weeks after surgery. Observations A patient underwent uncomplicated cataract extraction and implantation of a toric IOL for 2.5 diopters (D) of preoperative corneal astigmatism. Uncorrected visual acuity (UCVA) on postoperative day 1 was 20/20. Blurriness developed 5 weeks after surgery when UCVA was 20/70 but corrected to 20/20 with 2 D of cylinder in a new axis. The IOL was in the proper axis, but it and the capsular bag were radially displaced. Dilated examination revealed posterior capsular opacification superotemporally, outside the visual axis. The patient's biometry revealed axial myopia and megalocornea (white-to-white measurement of 13.44 mm), suggesting a larger than average capsular bag. Surgery was performed at postoperative week 6 to expand the capsular bag using a capsular tension ring and to re-center the IOL keeping the same axis. The patient recovered UCVA of 20/25 after the IOL was recentered. Conclusions and Importance It is important to review biometry for large white-to-white measurements. Eyes with megalocornea may require capsular tension rings at time of toric IOL implantation so as to maintain IOL centration and good UCVA.
Collapse
Affiliation(s)
- Irene C Kuo
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, 4924 Campbell Blvd. #100, Baltimore, MD, 21236, USA
| |
Collapse
|
5
|
Messina M, Ross AR, Pocobelli G, Said DG, Dua HS. Cataract surgery with intraocular lens implantation in 3 brothers with megalocornea: Long-term follow-up. J Cataract Refract Surg 2018; 44:399-402. [DOI: 10.1016/j.jcrs.2018.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/07/2018] [Accepted: 01/09/2018] [Indexed: 11/28/2022]
|
6
|
Do AT, Holz HA, Cionni RJ. Subluxated cataract lens surgery using sutured segments or rings and implantation of toric intraocular lenses. J Cataract Refract Surg 2016; 42:392-8. [PMID: 27063519 DOI: 10.1016/j.jcrs.2015.10.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the intraoperative performance and postoperative outcomes of toric intraocular lens (IOL) with suture ring implantation in adult patients with subluxated lenses. SETTING Department of Ophthalmology, Kaiser Permanente, Santa Clara, California, and the Eye Institute of Utah, Salt Lake City, Utah, USA. DESIGN Retrospective case review. METHODS Eyes with subluxated cataractous lenses and preoperative corneal astigmatism having toric IOL implantation with a sutured ring or segment were studied. Preoperative and postoperative analyses included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and cylindrical power postoperatively and 3, 6, and 12 months postoperatively. RESULTS Twenty-one eyes of 15 patients were studied. The median follow-up was 14.6 months. The mean CDVA at the final follow-up (0.10 logMAR ± 0.15 [SD]) was significantly improved from the mean preoperative CDVA (0.73 ± 0.40 logMAR). Postoperative cylindrical power was significantly improved in all patients (mean reduction in astigmatism 2.37 ± 1.46 diopters). Patients who required postoperative enhancement had anterior laser capsulotomy for bilateral capsule phimosis (2 eyes), photorefractive keratectomy (1 eye), pupilloplasty (1 eye), and posterior laser capsulotomy (2 eyes). CONCLUSION Cataract removal and implantation of a toric IOL combined with a sutured ring or segment capsule stabilizing device was a safe and efficacious long-term solution for patients with subluxated cataract lenses and corneal astigmatism.
Collapse
Affiliation(s)
- Anna T Do
- From the School of Medicine (Do), Stanford University, Palo Alto, and Kaiser Permanente (Holz), Santa Clara, California; the Eye Institute of Utah (Cionni), Salt Lake City, Utah, USA
| | - Huck A Holz
- From the School of Medicine (Do), Stanford University, Palo Alto, and Kaiser Permanente (Holz), Santa Clara, California; the Eye Institute of Utah (Cionni), Salt Lake City, Utah, USA.
| | - Robert J Cionni
- From the School of Medicine (Do), Stanford University, Palo Alto, and Kaiser Permanente (Holz), Santa Clara, California; the Eye Institute of Utah (Cionni), Salt Lake City, Utah, USA
| |
Collapse
|
7
|
Sagiv O, Sachs D. Rotation stability of a toric intraocular lens with a second capsular tension ring. J Cataract Refract Surg 2015; 41:1098-9. [DOI: 10.1016/j.jcrs.2015.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
|
8
|
Vasavada AR, Nath V, Raj S, Vasavada V, Vasavada S. Technology and Intraocular Lenses to Enhance Cataract Surgery Outcomes-Annual Review (January 2013 to January 2014). Asia Pac J Ophthalmol (Phila) 2014; 3:308-21. [PMID: 26107918 DOI: 10.1097/apo.0000000000000092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This article is aimed to provide a clinical update on recent developments in cataract surgical techniques, with specific focus on femtosecond laser technology. The article also focuses on recent improvements in the technology used in implanting intraocular lenses (IOLs). DESIGN Literature review. METHODS The authors conducted a review of literature available in the last 12 months in the English language using PubMed. The period used to conduct the literature search was from January 1, 2013, to December 31, 2013. The following search terms were used during the PubMed search: phacoemulsification, femtosecond laser, toric IOLs, multifocal IOLs, multifocal toric IOLs, manual small-incision cataract surgery, outcomes, surgically induced astigmatism, rotational stability, trifocal IOLs, laser cataract surgery, safety, and efficacy. RESULTS This review incorporates selected original articles that provide fresh insights and updates on the fields of toric and multifocal IOLs, femtosecond laser cataract surgery, and manual small-incision cataract surgery. Particular attention has been paid to observational, randomized controlled clinical trials, experimental trials, and analyses of larger cohorts with prospective and retrospective study designs. Letters to the editor, unpublished works, and abstracts do not fall under the purview of this review. CONCLUSIONS This review is not designed to be all-inclusive. It highlights and provides insights on literature that is most useful and applicable to practicing ophthalmologists.
Collapse
Affiliation(s)
- Abhay R Vasavada
- From the Iladevi Cataract & IOL Research Center, Raghudeep Eye Hospital, Ahmedabad, India
| | | | | | | | | |
Collapse
|
9
|
Kandar AK. Combined special capsular tension ring and toric IOL implantation for management of post-DALK high regular astigmatism with subluxated traumatic cataract. Indian J Ophthalmol 2014; 62:819-22. [PMID: 25116780 PMCID: PMC4152657 DOI: 10.4103/0301-4738.138294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of 18-year-old male who has undergone phacoemulsification with implantation of toric IOL (AcrySof IQ SN6AT9) after fixation of lens capsule with Cionni's capsular tension ring (CTR) for subluxated traumatic cataract with high astigmatism after deep anterior lamellar keratoplasty (DALK). He underwent right eye DALK for advanced keratoconus four years earlier. He had history of trauma one year later with displaced clear crystalline lens into anterior chamber and graft dehiscence, which was repaired successfully. The graft survived, but patient developed cataract with subluxated lens, for which phacoemulsification with implantation of toric IOL was done. Serial topography showed regular corneal astigmatism of -5.50 diopter (K 1 42.75 D @130°, K 2 48.25 D @40°). At 10-month follow-up, the patient has BCVA 20/30 with + 0.75 DS/- 1.75 DC @ 110°. The capsular bag is quite stable with well-centered IOL. Combination of Cionni's ring with toric IOL could be a good option to manage such complex cases.
Collapse
Affiliation(s)
- Asim Kumar Kandar
- ?Department of Ophthalmology, Vasan Eye Care Hospital, Puducherry, India
| |
Collapse
|
10
|
Scialdone A, De Gaetano F, Monaco G. Visual performance of 2 aspheric toric intraocular lenses: comparative study. J Cataract Refract Surg 2013; 39:906-14. [PMID: 23688877 DOI: 10.1016/j.jcrs.2013.01.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/20/2012] [Accepted: 01/15/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the visual and aberrometric outcomes of 2 aspheric toric intraocular lenses (IOLs). SETTING Fatebenefratelli e Oftalmico Hospital, Milan, Italy. DESIGN Prospective randomized comparative study. METHODS Astigmatic patients had cataract surgery with implantation of an Acrysof SN6AT IOL (Group A) or an AT Torbi 709M IOL (Group B). The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, net refractive astigmatism, spherical equivalent (SE), IOL misalignment, and optical quality were evaluated 3 months postoperatively. RESULTS The study included 72 eyes. No statistically significant difference was found in UDVA, CDVA, residual refractive astigmatism, intraocular or total higher-order aberrations (Z(n,i) (order of aberrations calculated: 3≤n≤8), coma Z(3,±1), or trefoil Z(3,±2). The UDVA was 0.3 logMAR or better in all eyes and 0.1 logMAR or better in 55.5% of eyes in Group A and in 61.1% of eyes in Group B. Considering polar value analysis, 94.4% of eyes in both groups had a refractive astigmatism value within ±0.50 diopter at KP90 (polar value along 90-degree meridian). The SE was closer to emmetropia in Group A (P=.01). Intraocular lens misalignment of less than 5 degrees was present in 61.1% of cases in Group A (maximum 9 degrees) and in 66.6% in Group B (maximum 11 degrees). Spherical aberration Z(4,0) was significantly lower in Group B. CONCLUSIONS Both IOLs had similar clinical effectiveness in term of astigmatism correction, rotational stability, and optical quality. Eyes in Group A appeared significantly nearer to emmetropia, while the IOL in Group B induced significantly less spherical aberration. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
|
11
|
Parra-Colín PDL, Barrientos-Gutierrez T, Mian SI. Axial Length’s Role in Intraocular Lens Power Calculation Error in X-linked Megalocornea: A Case-series Analysis. Ophthalmic Genet 2013; 35:180-3. [DOI: 10.3109/13816810.2013.804099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
12
|
Galvis V, Tello A, Miotto G, Rangel CM. Artisan aphakic lens for cataract surgery in anterior megalophthalmos. Case Rep Ophthalmol 2012; 3:428-33. [PMID: 23341820 PMCID: PMC3551436 DOI: 10.1159/000346074] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A 44-year-old man with anterior megalophthalmos arrived at the clinic presenting a cataract in the right eye. The corneal diameter was 13 mm. Iridodonesis and phacodonesis were evident during slit lamp examination. Anterior chamber depth was 5.89 mm, and the diameter of the capsular bag was approximately 14.45 mm. Due to the large capsular bag, a standard posterior chamber intraocular lens was considered inadequate because of potential instability. Phacoemulsification and an implantation of an iris-claw lens (Artisan for aphakia®, Ophtec) in the posterior chamber were performed with good results. In the fourth postoperative month, uncorrected distance visual acuity was 20/30, and 20/20 was achieved with +0.75 −1.25 × 10°. We consider retropupillary aphakic iris-claw intraocular lenses to be a worthwhile option in these cases of megalophthalmos and cataract, since instability is avoided and the procedure is less challenging than suturing the lens.
Collapse
Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia ; Fundación Oftalmológica de Santander/Clinica Ardila Lulle (FOSCAL), Floridablanca, Colombia ; Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
| | | | | | | |
Collapse
|