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Nihalani BR, VanderVeen DK. Timing of Diagnosis and Treatment of Glaucoma following Infantile Cataract Surgery. Ophthalmol Glaucoma 2024; 7:290-297. [PMID: 38104771 DOI: 10.1016/j.ogla.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To report timing of diagnosis and treatment of glaucoma following cataract surgery (GFCS) in a large cohort of infants undergoing cataract surgery at a tertiary care center. STUDY DESIGN Cross-sectional study. PARTICIPANTS All consecutive infants that underwent cataract surgery over a 30-year period from January 1991 to December 2021 were included if they had at least 1 year follow-up. METHODS The data collection included age at time of cataract surgery, presence of associated ocular or systemic conditions, age at diagnosis of GFCS, and treatment required to control GFCS. Glaucoma diagnosis required intraocular pressure (IOP) > 21 mmHg on > 2 visits with glaucomatous optic nerve head changes and/or visual field changes, or in young children, other anatomic changes such as corneal enlargement or haze or accelerated axial elongation and myopic shift. MAIN OUTCOME MEASURES The incidence of GFCS was calculated. Linear regression was performed to assess the effect of age at time of cataract surgery. Analysis of risk factors and treatment modalities was performed using univariate and multivariate analysis. RESULTS Three hundred eighty-three eyes (260 patients) were analyzed. Median age at surgery was 52 days and median follow-up, 8 years. Glaucoma following cataract surgery was noted in 27% (104/383 eyes; median age at surgery, 45 days; median follow-up, 13 years.) Young age at surgery (< 3 months) was the greatest risk factor (P = 0.001) but the incidence was similar for infants operated in the first, second, or third month of life (25%, 36%, 40%, respectively, P = 0.4). Microcornea (41%, P < 0.0001), poorly dilating pupils (25%, P = 0.001), persistent fetal vasculature (PFV, 13%; P = 0.8), or anterior segment dysgenesis (3%, P = 0.02) were considered as additional risk factors. Surgical intervention was needed for 73% (24/33) eyes with early-onset GFCS compared with 14% (10/71) eyes with later-later onset GFCS (P < 0.0001). Medical treatment was effective in 86% with later-onset GFCS (P = 0.006). CONCLUSIONS The incidence of GFCS was 27%, and timing of diagnosis occurred in a bimodal fashion. Early-onset GFCS usually requires surgical intervention; medical treatment is effective for later-onset GFCS. Cataract surgery within the first 3 months of life, microcornea, and poorly dilating pupils were major risk factors. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Bharti R Nihalani
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Zhao Y, Zhao Q, Zhang H, Zhang Z, Wang D, Li Z, Ding X, Zhao Y. Characteristic cytokine profile of the aqueous humor in eyes with congenital cataract and pre-existing posterior capsule dysfunction. Front Med (Lausanne) 2024; 11:1301588. [PMID: 38435385 PMCID: PMC10904641 DOI: 10.3389/fmed.2024.1301588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Objectives To investigate the characteristic cytokine profile of the aqueous humor in eyes with congenital cataract and pre-existing posterior capsule dysfunction (PCD). Methods In this cross-sectional study, the enrolled eyes with congenital cataract and PCD were included in the PCD group, while those with an intact posterior capsule were included in the control group. Demographic data and biometric parameters were recorded. The levels of 17 inflammatory factors in the aqueous humor collected from the enrolled eyes were detected using Luminex xMAP technology, and intergroup differences in the collected data were analyzed. Results The PCD group comprised 41 eyes from 31 patients with congenital cataract and PCD, whereas the control group comprised 42 eyes from 27 patients with congenital cataract and an intact posterior capsule. Lens thickness was significantly thinner in the PCD group than in the control group. However, the levels of monocyte chemoattractant protein-1 (MCP-1), transforming growth factor-β2 (TGF-β2), and vascular endothelial growth factor (VEGF) were significantly higher in the PCD group than in the control group. Multivariate logistic regression confirmed that lens thickness and TGF-β2 level were independent risk factors for PCD. Conclusion A thinner lens thickness in eyes with congenital cataract and PCD could serve as a biometric feature of these eyes. The higher levels of MCP-1, TGF-β2, and VEGF in eyes with PCD indicated a change in their intraocular inflammatory microenvironment, which possibly led to cataract progression. Lens thickness and TGF-β2 level are independent risk factors for PCD.
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Affiliation(s)
- Yinying Zhao
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Qihui Zhao
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Hongfang Zhang
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Zhewen Zhang
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Dandan Wang
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Zhangliang Li
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Xixia Ding
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yune Zhao
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
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Al Otaibi A, AlShamrani M, Alarfaj G, Alsalman B, Neyaz HA, Alkatan HM. Successful removal of a congenital fibrovascular pupillary membrane in 2 cases with variable age at presentation and sparing of the crystalline lens. Int J Surg Case Rep 2023; 108:108452. [PMID: 37406531 PMCID: PMC10382844 DOI: 10.1016/j.ijscr.2023.108452] [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: 05/21/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Congenital fibrovascular pupillary membranes (CFPMs) represent a rare poorly understood condition that has been sporadically reported in the literature. The presence of such a membrane can cause pupillary block and further complications, therefore must be properly diagnosed and managed. CASE PRESENTATION We are presenting the successful treatment of 2 cases with CFPM. The first patient presented 2-days after birth with an absent red reflex and had a less complicated clinical course. The second presented at a later age of 5-months and was referred as a case of congenital cataract. This baby had associated pupillary block glaucoma. Each of these cases was managed surgically by membrane peeling with sparing of the lens, which was found to be clear in the second case. DISCUSSION Even though CFPM has been rarely reported, it should be correctly identified since it can progress with the development of glaucoma and lens changes. The etiology of CFPM is not well understood but might be related to the presence of ectopic iris tissue, which was suspected as an etiology in our second case. Several techniques have been described to remove the membrane, and occasionally this might necessitate removal of the lens. We described successful removal of CFPM in 2 cases without affecting the crystalline lens. CONCLUSION General Ophthalmologists and Pediatricians should be aware of CFPM, especially when dealing with an absent or dull red reflex in a newborn. Referral for definitive diagnosis and treatment is essential to preserve vision.
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Affiliation(s)
- Abdullah Al Otaibi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed AlShamrani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ghufran Alarfaj
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Budoor Alsalman
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hanan A Neyaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Sand MK, Cholidis S, Kristianslund O, Drolsum L. Primary intraocular lens implantation in infants with unilateral congenital cataract operated before 12 weeks of age. Acta Ophthalmol 2022; 100:526-533. [PMID: 35411695 DOI: 10.1111/aos.15155] [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: 12/08/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to report visual outcome and safety after cataract surgery with primary intraocular lens implantation before 12 weeks of age. METHODS Infants with visually significant unilateral congenital cataract having primary IOL implantation in the capsular bag before 12 weeks of age in 2007-2016 were enrolled for a prospective study examination in 2017. The medical records were also reviewed. RESULTS In total, 23 patients with a median age at cataract surgery of 32 days (range, 12-75 days) were included. Seventeen (74%) eyes had persistent foetal vasculature (PFV). After a median follow-up of 6.3 years (range, 1.4-10.9 years), the corrected distance visual acuity was 0.8 logMAR (range, 3.0-0.1 logMAR). All, except one eye, required surgery for visual axis opacification (VAO), with a median of two (range 0-5) additional surgical procedures. Four (17%) eyes developed secondary glaucoma. CONCLUSION Cataract surgery with primary IOL implantation before 12 weeks of age resulted in a high number of VAO operations, and the visual outcome varied considerably, showing the range in outcome for this challenging patient group. Co-existent PFV in these young patients was common. The incidence of secondary glaucoma was similar to other studies, despite the young age at surgery, high percentage of PFV and number of surgical procedures for VAO.
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Affiliation(s)
- Mari Kathrine Sand
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Symira Cholidis
- Department of Ophthalmology Oslo University Hospital Oslo Norway
| | - Olav Kristianslund
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Liv Drolsum
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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Thomas DM, Kannabiran C, Balasubramanian D. Identification of Key Genes and Pathways in Persistent Hyperplastic Primary Vitreous of the Eye Using Bioinformatic Analysis. Front Med (Lausanne) 2021; 8:690594. [PMID: 34485332 PMCID: PMC8409525 DOI: 10.3389/fmed.2021.690594] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The failure of the embryonic hyaloid vascular system to regress naturally causes persistent hyperplastic primary vitreous (PHPV), a congenital eye disease. PHPVs molecular pathway, candidate genes, and drug targets are unknown. The current paper describes a comprehensive analysis using bioinformatics to identify the key genes and molecular pathways associated with PHPV, and to evaluate potential therapeutic agents for disease management. Methods: The genes associated with PHPV were identified using the pubmed2ensembl text mining platform. GeneCodis was employed to evaluate the Gene Ontology (GO) biological process terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Search Tool for the Retrieval of Interacting Genes (STRING) constructed a protein-protein interaction (PPI) network from the text mining genes (TMGs) in Cytoscape. The significant modules were clustered using Molecular Complex Detection (MCODE), and the GO and KEGG analysis for the hub genes were analyzed with the Database of Annotation, Visualization and Integrated Discovery (DAVID) tool. ClueGO, CluePedia, and ShinyGo were used to illustrate the functions and pathways of the clustered hub genes in a significant module. The Drug-Gene Interaction database (DGIdb) was used to evaluate drug-gene interactions of the hub genes to identify potential PHPV drug candidates. Results: A total of 50 genes associated with PHPV were identified. Overall, 35 enriched GO terms and 15 KEGG pathways were discovered by the gene functional enrichment analysis. Two gene modules were obtained from the PPI network constructed with 31 nodes with 42 edges using MCODE. We selected 14 hub genes as core candidate genes: TP53, VEGFA, SMAD2, CDKN2A, FOXC, FZD4, LRP5, KDR, FZD5, PAX6, MYCN, NDP, PITX2, and PAX2, primarily associated with camera-type eye morphogenesis, pancreatic cancer, the apoptotic process involved in morphogenesis, and the VEGF receptor signaling pathway. We discovered that 26 Food and Drug Administration (FDA)-approved drugs could target 7 of the 14 hub genes. Conclusions: In conclusion, the results revealed a total of 14 potential genes, 4 major pathways, 7 drug gene targets, and 26 candidate drugs that could provide the basis of novel targeted therapies for targeted treatment and management of PHPV.
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Affiliation(s)
- Derin M Thomas
- Kallam Anji Reddy Molecular Genetics Laboratory, Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Chitra Kannabiran
- Kallam Anji Reddy Molecular Genetics Laboratory, Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - D Balasubramanian
- Kallam Anji Reddy Molecular Genetics Laboratory, Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
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Petrou P, Giannopoulou K, Papakonstantinou E, Karamaounas A, Kandarakis S, Georgalas I. Episodes of monocular blurring of vision during breastfeeding. Am J Ophthalmol Case Rep 2020; 20:100976. [PMID: 33145455 PMCID: PMC7595879 DOI: 10.1016/j.ajoc.2020.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To describe the occurrence of visual loss secondary to dispersion of cells deriving from an iris strand during pupil dilation in a 35-year-old woman. Observations A 35-year-old woman presented complaining of blurring in the Left Eye 15–30 minutes following breastfeeding at night hours. On clinical examination, the uncorrected visual acuity was 20/20 in both eyes and slit-lamp examination demonstrated cells in the anterior chamber (26–50 cells in field/3+ SUN working group grading) whereas the examination of the right eye was unremarkable. Dilated examination revealed a thin pigmented strand of iris in the Left Eye spanning from one edge of the iris to the other (1st to 8th h). This strand was connected at a single point to the anterior capsule of the lens and from the point of connection red blood cells flowed in a linear configuration that ended at the lower part of the anterior chamber. Conclusions and importance In this case report a patient with persistent pupillary membrane in the form of an individual iris strand connected to the anterior lens capsule presented with episodes of monocular vision loss. This occurred due to red blood cell dispersion from the iris strand during mesopic light conditions and pupil dilation while breastfeeding. To the best of our knowledge, this is the first report in the literature.
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Affiliation(s)
- Petros Petrou
- First Opthhalmology Department, "G.Gennimatas" Hospital, National and Kapodistrian University of Athens, Greece
| | - Kelly Giannopoulou
- First Opthhalmology Department, "G.Gennimatas" Hospital, National and Kapodistrian University of Athens, Greece
| | - Evangelia Papakonstantinou
- First Opthhalmology Department, "G.Gennimatas" Hospital, National and Kapodistrian University of Athens, Greece
| | - Aristotelis Karamaounas
- First Opthhalmology Department, "G.Gennimatas" Hospital, National and Kapodistrian University of Athens, Greece
| | - Stylianos Kandarakis
- First Opthhalmology Department, "G.Gennimatas" Hospital, National and Kapodistrian University of Athens, Greece
| | - Ilias Georgalas
- First Opthhalmology Department, "G.Gennimatas" Hospital, National and Kapodistrian University of Athens, Greece
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Surgical outcomes of cataract surgery in anterior and combined persistent fetal vasculature using a novel surgical technique: a single center, prospective study. Graefes Arch Clin Exp Ophthalmol 2020; 259:213-221. [PMID: 32803327 DOI: 10.1007/s00417-020-04883-6] [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: 02/05/2020] [Revised: 07/05/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To study the complications and surgical outcomes of cataract surgery in patients of persistent fetal vasculature (PFV) with cataract. METHODS In this prospective study, phacoaspiration with/without intraocular lens implantation (IOL) was done in 20 children (mean age 14.2 months) with unilateral cataract with anterior (n = 6) or combined (n = 14) PFV. The rentrolental vascularized membrane was cauterized and dissected circumferentially, followed by cauterization and resection of the PFV stalk. The outcome measures included fixation preference using the CSM (central, steady, maintained) method and intraoperative and postoperative complications in an 18-month follow-up. The difference in outcomes of anterior and combined PFV, as well as aphakic and pseudophakic eyes, was studied. RESULTS CSM fixation was seen in 16 patients after 18 months. The intraocular lens was implanted in 16 eyes and 4 eyes with combined PFV were left aphakic. None of our patients had intraoperative bleeding. Visual axis obscuration was the major complication seen, requiring membranectomy in 8 children. Pupilloplasty was required with membranectomy in one eye. None of our patients developed glaucoma or retinal detachment. CONCLUSION Timely surgical intervention and aggressive amblyopia therapy led to good visual results in our study. Poor prognosis was seen in combined PFV, aphakia, and microphthalmia.
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Gajjar DU, Vasavada AR, Patel P, Praveen MR, Shah SR. Evaluation of collagen derived antiangiogenic factors and matrix metalloproteinases in anterior lens epithelial cells of pediatric eyes with persistent fetal vasculature. Indian J Ophthalmol 2020; 67:1618-1622. [PMID: 31546493 PMCID: PMC6786169 DOI: 10.4103/ijo.ijo_185_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To measure levels of collagen-derived antiangiogenic factors (arresten, canstatin, tumstatin, endostatin) and matrix metalloproteinases (MMP-2 and MMP-9) in anterior lens epithelial cells (LECs) and anterior capsules of children with cataract and persistent fetal vasculature (PFV) as cases and cataract without PFV as controls. Methods: Anterior capsules harboring LECs were collected from pediatric cataract patients with (n = 13) and without PFV (n = 13) during surgery. Samples were immediately subjected to RNA extraction and cDNA preparation. Quantitative real time PCR was performed to determine the mRNA levels of antiangiogenic factors and matrix metalloproteinases. GAPDH (Glyceraldehyde 3-Phosphate Dehydrogenase) and β Actin were used as the housekeeping control. The mRNA levels were expressed as a ratio, using the delta-delta method for comparing the relative expression results between controls and cases. The non-parametric Mann-Whitney U test was applied for statistical evaluation. P values < 0.05 were statistically significant. Results: The relative mRNA levels of arresten, canstatin, tumstatin, endostatin, MMP-2 and MMP-9 in cases were 6.20E-03 ± 0.003, 1.49E-01 ± 0.02, 1.70E-01 ± 0.007, 3.20E-03 ± 0.003, 1.11E-03 ± 0.0009 and 3.72E-04 ± 0.0001. The mRNA levels of arresten was 1.6 times lower (P = 0.01) while mRNA levels of MMP-2, tumstatin and canstatin were 4, 2.5, and 2.3 times higher in cases than in controls. No change was observed in mRNA levels of MMP-9 and endostatin (P = 0.82). Conclusion: A significant difference in the levels of arresten, canstatin, tumstatin, and MMP-2 was found in LECs with PFV.
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Clinical Characteristics and Surgical Safety in Congenital Cataract Eyes with Three Pathological Types of Posterior Capsule Abnormalities. J Ophthalmol 2020; 2020:6958051. [PMID: 32280529 PMCID: PMC7125490 DOI: 10.1155/2020/6958051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To observe the clinical characteristics of 3 pathological types of posterior capsule abnormalities (PCAs) in congenital cataracts (CCs) and evaluate the surgical safety in these eyes. Methods This study involved 239 children (367 eyes) with CC who underwent cataract surgery at the Eye Hospital of Wenzhou Medical University. All surgery videos were collected for detailed reviews. Intraoperative and postoperative complications (within 3 months) were all recorded. Results The 3 pathological types of PCAs, namely, persistent fetal vasculature (PFV), posterior capsule defect (PCD), and posterior lenticonus (PLC), presented in 129 (35.1%) CC eyes, while 238 (64.9%) eyes were recorded as CC without PCA. The percentages of PFV, PCD, and PLC were 10.9%, 26.7%, and 5.4% in CC eyes (n = 367), respectively. The most common concomitant of PFV eyes was PCD (42.5%), and PFV was the most frequent (17.3%) one in PCD eyes. PLC was only associated with PFV (15%) and PCD (50%). The occurrence rates of surgical complications ranged from 0 to 5.4%, and no statistical difference was found between the eyes with and without PCA (all P > 0.05). Conclusions PFV, PCD, and PLC play a very important role in the CCs. The effect of fetal vessels in PFV eyes might be an abnormally strong attachment on the posterior capsule, leading to PLC and PCD. Even in PCA patients, severe surgical complication can also be avoided with well-designed and skilled operation. This trial is registered with NCT03905044 at http://ClinicalTrials.gov.
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Incidence and Risk Factors for Glaucoma Development After Bilateral Congenital Cataract Surgery in Microphthalmic Eyes. Am J Ophthalmol 2019; 208:265-272. [PMID: 31449792 DOI: 10.1016/j.ajo.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate the long-term incidence and risk of glaucoma after bilateral congenital cataract surgery in microphthalmic eyes. DESIGN Retrospective, observational case series. METHODS Subjects: Children with microphthalmic eyes who had undergone surgery for bilateral congenital cataract within 6 months of birth and been followed up for at least 5 years. PROCEDURES Review of medical records at our institution. MAIN OUTCOME MEASURES Probability of an eye's developing glaucoma after bilateral congenital cataract surgery and associated risk factors. RESULTS Thirty-eight eyes of 19 children with bilateral congenital cataract were included. The mean age at surgery was 3.2 ± 1.7 months, and the mean follow-up duration was 7.79 ± 2.61 years. After cataract surgery, 11 eyes (29.0%) developed glaucoma at the age of 4.0 ± 1.4 years. Three of these eyes underwent Ahmed glaucoma valve implantation surgery. The probability of an eye's developing glaucoma was estimated to be 32.0% by 10 years after surgery. In a multivariate analysis, axial length was significantly associated with glaucoma development (odds ratio = 0.364, P = .025). Age at the time of cataract surgery, corneal diameter, and aphakia did not affect the risk of glaucoma (P > .10). Eyes without glaucoma had a better final visual outcome than those with glaucoma (0.75 ± 0.60 and 1.47 ± 1.10 logMAR, respectively, P = .049). CONCLUSIONS The long-term cumulative risk of postoperative glaucoma development was 32.0% by 10 years after bilateral congenital cataract surgery. Because the risk of developing glaucoma persists for several years after surgery, careful monitoring and control of intraocular pressure is needed to preserve vision in such patients.
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Molecular genetics of congenital cataracts. Exp Eye Res 2019; 191:107872. [PMID: 31770519 DOI: 10.1016/j.exer.2019.107872] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022]
Abstract
Congenital cataracts, the most common cause of visual impairment and blindness in children worldwide, have diverse etiologies. According to statistics analysis, about one quarter of congenital cataracts caused by genetic defects. Various mutations of more than one hundred genes have been identified in hereditary cataracts so far. In this review, we briefly summarize recent developments about the genetics, molecular mechanisms, and treatments of congenital cataracts. The studies of these pathogenic mutations and molecular genetics is making it possible for us to comprehend the underlying mechanisms of cataractogenesis and providing new insights into the preventive, diagnostic and therapeutic approaches of cataracts.
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Li Z, Chang P, Wang D, Zhao Y, Hu M, Ding X, Yu L, Zhao Y. Morphological and biometric features of preexisting posterior capsule defect in congenital cataract. J Cataract Refract Surg 2019; 44:871-877. [PMID: 30055693 DOI: 10.1016/j.jcrs.2018.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/15/2018] [Accepted: 05/04/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the diagnostic signs and biometric characteristics of preexisting posterior capsule defects in congenital cataract. SETTING Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China. DESIGN Retrospective case series. METHODS Eyes with congenital cataract were reviewed and divided into a preexisting posterior capsule defect group (study group) and a control group with intact posterior capsules. Diagnostic signs were summarized on agreement of 3 ophthalmologists after they reviewed surgical videos. The biometric parameters, including central corneal thickness, anterior chamber depth, lens thickness, vitreous chamber depth, axial length, mean keratometry, corneal astigmatism, corneal diameter, and intraocular pressure, were compared between groups. The predictors of preexisting posterior capsule defect were determined using univariate and multivariate analyses. RESULTS The study comprised 81 eyes (53 patients). The diagnostic signs of preexisting posterior capsule defect included posterior capsule plaque with a well-demarcated margin, gray granules and vacuoles, and heterogeneous nuclear opacity (more dense in the posterior). The lens was significantly thinner in the study group than in the control group (P < .001). The corneal diameter was significantly smaller in the study group (P = .015 horizontal and P = .005 vertical). Multivariate analysis identified lens thickness as an independent predictor (odds ratio, 0.731; 95% confidence interval, 0.621-0.860; P < .001). CONCLUSIONS For preexisting posterior capsule defect, lens thickness was a valuable predictor and the presence of characteristic morphology was an important indicator. The cornea configuration suggests the need for further study of the role of genetic mutation.
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Affiliation(s)
- Zhangliang Li
- From the School of Optometry and Ophthalmology, Wenzhou Medical University and the Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China
| | - Pingjun Chang
- From the School of Optometry and Ophthalmology, Wenzhou Medical University and the Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China
| | - Dandan Wang
- From the School of Optometry and Ophthalmology, Wenzhou Medical University and the Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China
| | - Yinying Zhao
- From the School of Optometry and Ophthalmology, Wenzhou Medical University and the Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China
| | - Man Hu
- From the School of Optometry and Ophthalmology, Wenzhou Medical University and the Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China
| | - Xixia Ding
- From the School of Optometry and Ophthalmology, Wenzhou Medical University and the Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China
| | - Liuqing Yu
- From the School of Optometry and Ophthalmology, Wenzhou Medical University and the Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China
| | - Yune Zhao
- From the School of Optometry and Ophthalmology, Wenzhou Medical University and the Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
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Khokhar S, Dhull C. Commentary: Understanding angiogenic factors in pathogenesis of persistent fetal vasculature. Indian J Ophthalmol 2019; 67:1622-1623. [PMID: 31546494 PMCID: PMC6786143 DOI: 10.4103/ijo.ijo_1156_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sudarshan Khokhar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Chirakshi Dhull
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Louison S, Blanc J, Pallot C, Alassane S, Praudel A, Bron AM, Creuzot-Garcher C. Visual outcomes and complications of congenital cataract surgery. J Fr Ophtalmol 2019; 42:368-374. [DOI: 10.1016/j.jfo.2018.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 10/27/2022]
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Warren N, Trivedi RH, Wilson ME. Persistent Fetal Vasculature With Elongated Ciliary Processes in Children. Am J Ophthalmol 2019; 198:25-29. [PMID: 30267698 DOI: 10.1016/j.ajo.2018.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Outcomes and reoperation rates in infants with unilateral persistent fetal vasculature (PFV) with elongated or stretched ciliary processes have not been extensively studied and were excluded from the Infant Aphakia Treatment Study (IATS). The purpose of this study is to analyze the preoperative measurements, reoperation rates, and complications after surgery in unilateral anterior PFV with stretched processes. DESIGN Retrospective case series. METHODS Inclusion criteria consisted of unilateral cataract surgery prior to 7 months of age and anterior PFV with elongated ciliary processes. Eyes with posterior retinal involvement and less than 6 months of follow-up were excluded. All patients underwent lensectomy, posterior capsulectomy, and vitrectomy. RESULTS Eleven eyes of 11 patients were included. Patients had a mean age at surgery of 2.4 ± 1.4 months. Average follow-up was 4.5 ± 3.7years. Globe axial lengths were 18.6 ± 1.9 mm. Ten patients (91%) were initially left aphakic. Three patients (27%) later received a secondary intraocular lens (IOL), and 1 patient underwent an IOL exchange. Six out of 10 (60%) aphakic patients developed visual axis opacification. One aphakic patient required topical therapy for glaucoma. One additional patient developed neovascular glaucoma and retinal detachment. The eye was subsequently enucleated. Three patients underwent strabismus surgery. Two patients underwent pupilloplasty. Two patients (18.2%) had a final visual acuity better than 20/200. CONCLUSION Eyes operated for PFV with elongated ciliary processes are unlikely to have a final visual acuity greater than 20/200 and many will need additional surgery. Postoperative visual axis opacification occurred in 60% and glaucoma developed in 18%.
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Fu Z, Löfqvist CA, Liegl R, Wang Z, Sun Y, Gong Y, Liu CH, Meng SS, Burnim SB, Arellano I, Chouinard MT, Duran R, Poblete A, Cho SS, Akula JD, Kinter M, Ley D, Pupp IH, Talukdar S, Hellström A, Smith LE. Photoreceptor glucose metabolism determines normal retinal vascular growth. EMBO Mol Med 2019; 10:76-90. [PMID: 29180355 PMCID: PMC5760850 DOI: 10.15252/emmm.201707966] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The neural cells and factors determining normal vascular growth are not well defined even though vision‐threatening neovessel growth, a major cause of blindness in retinopathy of prematurity (ROP) (and diabetic retinopathy), is driven by delayed normal vascular growth. We here examined whether hyperglycemia and low adiponectin (APN) levels delayed normal retinal vascularization, driven primarily by dysregulated photoreceptor metabolism. In premature infants, low APN levels correlated with hyperglycemia and delayed retinal vascular formation. Experimentally in a neonatal mouse model of postnatal hyperglycemia modeling early ROP, hyperglycemia caused photoreceptor dysfunction and delayed neurovascular maturation associated with changes in the APN pathway; recombinant mouse APN or APN receptor agonist AdipoRon treatment normalized vascular growth. APN deficiency decreased retinal mitochondrial metabolic enzyme levels particularly in photoreceptors, suppressed retinal vascular development, and decreased photoreceptor platelet‐derived growth factor (Pdgfb). APN pathway activation reversed these effects. Blockade of mitochondrial respiration abolished AdipoRon‐induced Pdgfb increase in photoreceptors. Photoreceptor knockdown of Pdgfb delayed retinal vascular formation. Stimulation of the APN pathway might prevent hyperglycemia‐associated retinal abnormalities and suppress phase I ROP in premature infants.
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Affiliation(s)
- Zhongjie Fu
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chatarina A Löfqvist
- Section for Ophthalmology, Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Raffael Liegl
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhongxiao Wang
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ye Sun
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yan Gong
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chi-Hsiu Liu
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven S Meng
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel B Burnim
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ivana Arellano
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Rubi Duran
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Poblete
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steve S Cho
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - James D Akula
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Kinter
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - David Ley
- Pediatrics, Department of Clinical Sciences, Skåne University Hospital and University of Lund, Lund, Sweden
| | - Ingrid Hansen Pupp
- Pediatrics, Department of Clinical Sciences, Skåne University Hospital and University of Lund, Lund, Sweden
| | | | - Ann Hellström
- Section for Ophthalmology, Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Lois Eh Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Van Looveren J, Van Gerwen V, Timmermans JP, Tassignon MJ. Immunohistochemical characteristics of the vitreolenticular interface in congenital unilateral posterior cataract. J Cataract Refract Surg 2018; 42:1037-45. [PMID: 27492103 DOI: 10.1016/j.jcrs.2016.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/14/2016] [Accepted: 04/15/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To gain insight into the histology of the vitreolenticular interface in congenital unilateral posterior cataract. SETTING Antwerp University Hospital, Department of Ophthalmology, Edegem, and the University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium. DESIGN Prospective case study. METHODS Samples of the posterior lens capsule of patients with congenital posterior cataract (including opaque plaque on the anterior and adhesion to the vitreous on the posterior surface) were collected during the posterior capsulorhexis procedure. Staining for collagen types II and IV was performed using indirect immunohistochemistry. Results were compared with those of control posterior lens capsules of 3 children and 3 adults. RESULTS Samples were collected from 3 patients. All posterior lens capsules contained collagen type IV. Samples from congenital posterior cataract patients all showed a narrow band of collagen type II on the outer surface, indicating strong adherence of the anterior hyaloid membrane to the center of the posterior lens capsule. Surprisingly, collagen type II was also found in the posterior capsule plaques. Collagen type II was not found in any control posterior lens capsule. CONCLUSION The adherence of collagen type II to the center of the posterior lens capsule histologically supports the hypothesis that this subgroup of congenital cataract hints at an abnormality at the vitreolenticular interface. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Jan Van Looveren
- From the Department of Ophthalmology (Van Looveren, Tassignon), Antwerp University Hospital, Edegem, and the Faculty of Medicine and Health Sciences (Van Looveren, Van Gerwen, Tassignon) and the Faculty of Pharmaceutical, Biomedical and Veterinary Sciences (Timmermans), Laboratory of Cell Biology & Histology and Core Facility for Biomedical Microscopic Imaging, University of Antwerp, Antwerp, Belgium.
| | - Veerle Van Gerwen
- From the Department of Ophthalmology (Van Looveren, Tassignon), Antwerp University Hospital, Edegem, and the Faculty of Medicine and Health Sciences (Van Looveren, Van Gerwen, Tassignon) and the Faculty of Pharmaceutical, Biomedical and Veterinary Sciences (Timmermans), Laboratory of Cell Biology & Histology and Core Facility for Biomedical Microscopic Imaging, University of Antwerp, Antwerp, Belgium
| | - Jean-Pierre Timmermans
- From the Department of Ophthalmology (Van Looveren, Tassignon), Antwerp University Hospital, Edegem, and the Faculty of Medicine and Health Sciences (Van Looveren, Van Gerwen, Tassignon) and the Faculty of Pharmaceutical, Biomedical and Veterinary Sciences (Timmermans), Laboratory of Cell Biology & Histology and Core Facility for Biomedical Microscopic Imaging, University of Antwerp, Antwerp, Belgium
| | - Marie-José Tassignon
- From the Department of Ophthalmology (Van Looveren, Tassignon), Antwerp University Hospital, Edegem, and the Faculty of Medicine and Health Sciences (Van Looveren, Van Gerwen, Tassignon) and the Faculty of Pharmaceutical, Biomedical and Veterinary Sciences (Timmermans), Laboratory of Cell Biology & Histology and Core Facility for Biomedical Microscopic Imaging, University of Antwerp, Antwerp, Belgium
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Khokhar S, Jose CP, Sihota R, Midha N. Unilateral Congenital Cataract: Clinical Profile and Presentation. J Pediatr Ophthalmol Strabismus 2018; 55:107-112. [PMID: 29131913 DOI: 10.3928/01913913-20170703-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 06/02/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the clinical profile and presentation of children with unilateral cataract. METHODS In this hospital-based, observational, cross-sectional study, patients 15 years of age or younger who presented with unilateral cataract were recruited. Cases of cataract secondary to causes such as trauma or uveitis were excluded. Age at detection and presentation, distance from the treatment center, presenting complaints, cataract morphology, and biometry were noted for each case. RESULTS A total of 76 patients were recruited. Most patients presented with complaints of leukocoria. Persistent fetal vasculature accounted for 27.6% of cases and was the most common identifiable cause of cataract in this study. Subsequently, patients were divided into two groups: no persistent fetal vasculature (control) and persistent fetal vasculature. A male predominance was noted in both groups. The mean age at detection was 27.58 ± 37.02 and 6.17 ± 8.42 months and the mean age at presentation was 55.613 ± 45.21 and 14.83 ± 17.75 months in the control and persistent fetal vasculature groups, respectively. In the persistent fetal vasculature group, a significant difference was noted in the axial length, keratometry, and corneal diameter between the affected and normal eyes (P = .027, .00176, and .0114, respectively). In the control group, this difference was observed only in keratometry readings (P = .0464). The mean distance traveled by patients to reach the treatment center was 211 km. CONCLUSIONS Persistent fetal vasculature is an important and less identified cause of unilateral cataract. A significant delay is noted in the detection and presentation of unilateral cataract. [J Pediatr Ophthalmol Strabismus. 2018;55(2):107-112.].
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Zahavi A, Weinberger D, Snir M, Ron Y. Management of severe persistent fetal vasculature: case series and review of the literature. Int Ophthalmol 2018; 39:579-587. [DOI: 10.1007/s10792-018-0855-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/01/2018] [Indexed: 11/30/2022]
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Bronshtein M, Gabbay-Benziv R, Gover A, Gilboa Y, Bardin R. Prenatal Sonographic Abnormal Appearances of the Fetal Hyaloid Artery: From Normal Variants to Pathology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1935-1941. [PMID: 28480545 DOI: 10.1002/jum.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/13/2016] [Indexed: 06/07/2023]
Abstract
This is a case series on the abnormal sonographic appearance and outcome of the fetal hyaloid artery (HA) detected during between 1987 and 2015 at one medical center. Fifteen cases were detected during fetal anatomy scans, usually performed at 14 to 16 weeks' gestation. Three other cases were diagnosed following referral for a second opinion. In nine fetuses, the HA regressed normally throughout pregnancy. Of them, eight neonates had normal outcomes and one had cataract at the same eye. All nine other cases ended with adverse outcomes. Failure of the HA to regress in the third trimester appears to be an indicator of congenital blindness.
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Affiliation(s)
- Moshe Bronshtein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel, and Faculty of Social Welfare and Health Sciences Haifa University, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayala Gover
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yinon Gilboa
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Bardin
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Vasavada AR, Vasavada V. Current Status of IOL implantation in pediatric eyes: an update. Expert Rev Med Devices 2017; 14:1-9. [PMID: 28042714 DOI: 10.1080/17434440.2016.1271706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/09/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Pediatric cataracts are a huge problem worldwide, and with improving techniques and technology, the surgical treatment and postoperative visual rehabilitation are improving. Despite intraocular lenses(IOLs) being the standard of care for adult cataract surgery, this issue is still somewhat controversial, particularly in young children and infants due to lack of unequivocal evidence. This review therefore summarises the findings from recent studies on the aspect of IOL implantation in pediatric eyes. Areas covered: An extensive literature search was undertaken for published articles on congenital/developmental pediatric cataracts, and IOL implantation, where literature pertinent to traumatic and subluxated cataracts was not included in the review. Pubmed was used for literature search, and keywords entered were : pediatric, cataract surgery, intraocular lens, persistent fetal vasculature, outcomes, complications, visual performance with intraocular lenses. Expert commentary: Recent literature supports IOL implantation in most cases of congenital / developmental pediatric cataracts, and it seems like the way forward. However, the jury is still out on IOL implantation in infants, particularly in bilateral cataracts. Thus, surgeons must be extremely cautious in planning primary IOL implantation in infant eyes, and if they do perform IOL implantation, rigorous followup is mandatory.
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Affiliation(s)
- Abhay R Vasavada
- a Iladevi Cataract & IOL Research Centre, Raghudeep Eye Hospital , Ahmedabad , India
| | - Vaishali Vasavada
- a Iladevi Cataract & IOL Research Centre, Raghudeep Eye Hospital , Ahmedabad , India
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Congenital cataract associated with persistent fetal vasculature: findings from IoLunder2. Eye (Lond) 2016; 30:1204-9. [PMID: 27472205 DOI: 10.1038/eye.2016.159] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/23/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeTo describe the frequency, characteristics, and treatment outcome of persistent fetal vasculature (PFV) in children undergoing surgery for congenital and infantile cataract in the first 2 years of life.Patients and methodsObservational population-based cohort study with case identification through active surveillance and standardised data collection via a national clinical network, the British Isles Congenital Cataract Interest Group (BCCIG).ResultsThe IoLunder2 cohort comprises 246 children undergoing surgery for bilateral and unilateral congenital and infantile cataract in the first 2 years of life. A total of 58/246 (24%) children had PFV (%): overall, 46/95 (46%) with unilateral cataract, and 12/141 (8%) with bilateral disease. Anterior segment vascular remnants were more common in bilateral than unilateral disease (75 vs 11%, P=0.01). At 1 year after surgery, 20% of children with bilateral PFV and 24% with unilateral had achieved normal vision for age within the operated eye. The prevalence of post-operative glaucoma was 9% (of children with bilateral disease) and 4% (unilateral).ConclusionPFV is significantly more common than previously reported, and outcomes are comparable to that for congenital and infantile cataract overall.
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Somma AT, Moura CMC, Lange RR, Medeiros RS, Montiani‐Ferreira F. Congenital cataract associated with persistent hyperplastic primary vitreous and persistent tunica vasculosa lentis in a sambar deer (Rusa unicolor) - clinical, ultrasonographic, and histological findings. Clin Case Rep 2016; 4:636-42. [PMID: 27386118 PMCID: PMC4929795 DOI: 10.1002/ccr3.500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/08/2015] [Accepted: 12/30/2015] [Indexed: 11/24/2022] Open
Abstract
Ultrasonography suggested the diagnosis of cataract associated with persistent fetal intraocular vasculature in a 26-day-old sambar deer. The deer was ill and died despite intense critical care. Globes were removed. Histological characteristics of persistent fetal vasculature and secondary cataract are reported expanding the knowledge of ophthalmic disorders in wild ungulates.
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Affiliation(s)
- André Tavares Somma
- Departamento de Medicina VeterináriaUniversidade Federal do Paraná (UFPR)Rua dos Funcionários 154080035‐050CuritibaPRBrazil
| | | | - Rogério Ribas Lange
- Departamento de Medicina VeterináriaUniversidade Federal do Paraná (UFPR)Rua dos Funcionários 154080035‐050CuritibaPRBrazil
| | - Renan Schiebel Medeiros
- Departamento de Medicina VeterináriaUniversidade Federal do Paraná (UFPR)Rua dos Funcionários 154080035‐050CuritibaPRBrazil
| | - Fabiano Montiani‐Ferreira
- Departamento de Medicina VeterináriaUniversidade Federal do Paraná (UFPR)Rua dos Funcionários 154080035‐050CuritibaPRBrazil
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Congenital cataract surgery without intraocular lens implantation in persistent fetal vasculature syndrome: Long-term clinical and functional results. J Cataract Refract Surg 2016; 42:759-67. [DOI: 10.1016/j.jcrs.2016.02.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 11/22/2022]
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Waiswol M, Ejzenbaum F, Wu DC, Kagohara E, Reggi JRDA. Congenital fibrovascular pupillary membrane. EINSTEIN-SAO PAULO 2015; 13:163-4. [PMID: 25993083 PMCID: PMC4946823 DOI: 10.1590/s1679-45082015ai2850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 12/27/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mauro Waiswol
- Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Fábio Ejzenbaum
- Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Davi Chen Wu
- Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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Jakobiec FA, Rai R, Rashid A, Kanoff J, Mukai S. Dystrophic hyaloid artery remnants and other abnormalities in a buphthalmic eye with retinoblastoma. Surv Ophthalmol 2014; 59:636-42. [PMID: 25233827 DOI: 10.1016/j.survophthal.2014.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/07/2014] [Accepted: 05/22/2014] [Indexed: 11/17/2022]
Abstract
Partial persistence of the hyaloid artery unaccompanied by hyperplastic primary vitreous has not been previously reported in association with retinoblastoma. We describe an 18-month-old child with such a finding who had a retinoblastoma that was undifferentiated, extensively necrotic, heavily calcified, and completely filled the eyeball. The enucleated globe harbored a nonperfused, fossilized remnant of the hyaloid artery due to DNA/calcium deposition in the vascular wall. This structure inserted into a lenticular, extracapsular, fibrous plaque corresponding to a Mittendorf dot. The tumor had induced a placoid cataractous lens, obliterated the anterior and posterior chambers, caused glaucoma leading to buphthalmos, and extended into the optic nerve and extraocularly to involve the orbit. We conclude that the retinoblastoma arose early in ocular morphogenesis, at around 4 months gestation, when the programmed involution of the hyaloid artery begins. This process would typically end at 7-8 months gestation, but was aborted by the tumor. The patient died 6 weeks after surgery without receiving further treatment because of the parents' resistance.
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Affiliation(s)
- Frederick A Jakobiec
- Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ruju Rai
- Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Alia Rashid
- Department of Ophthalmology, David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin Kanoff
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Shizuo Mukai
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Matsuo T. Intraocular lens implantation in unilateral congenital cataract with minimal levels of persistent fetal vasculature in the first 18 months of life. SPRINGERPLUS 2014; 3:361. [PMID: 25061553 PMCID: PMC4108679 DOI: 10.1186/2193-1801-3-361] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 11/25/2022]
Abstract
Purpose To describe the incidence of unilateral congenital cataract associated with minimal (ultrasonically undetectable) levels of persistent fetal vasculature in the first 18 months of the life and to report surgical methods for intraocular lens implantation, using 25-gauge vitrectomy system. Methods Retrospective review was made on 16 consecutive patients with bilateral or unilateral congenital cataract in the first 18 months of the life who underwent surgery at Okayama University Hospital after the introduction of the 25-gauge vitrectomy system from October 2005 to March 2013. As the standard of care at this hospital in the study period, intraocular lenses were not implanted in children with bilateral cataract while intraocular lenses were implanted in those with unilateral cataract. Results Ten children with bilateral cataract underwent lensectomy in both eyes with a 25-gauge vitreous cutter under irrigation with a 25-gauge infusion cannula, inserted from two side ports at the corneal limbus. Six children with unilateral cataract underwent intraocular lens implantation and posterior capsulotomy after lens aspiration from limbal side ports. No patient showed vitreous abnormalities on ultrasound examinations before the surgery. At the surgery, all 10 children with bilateral cataract showed no additional abnormalities. In contrast, 3 children with unilateral cataract at the age younger than 12 months showed white fibrous tissue in the anterior vitreous integrated with the posterior lens capsule while the other 3 children with unilateral cataract at the age from 12 to 18 months did not have vitreous abnormalities. The fibrous tissue was cut together in the process of posterior capsulotomy from a 25-gauge trocar inserted at 1.5 mm posterior from the corneal limbus. Conclusions Unilateral congenital cataract in the first 12 months of the life has a high incidence for the association with anterior type of persistent fetal vasculature which could not be detected by preoperative ultrasound examinations. Intraocular lens implantation was technically feasible in unilateral cataract with or without minimal levels of persistent fetal vasculature in the first 18 months of the life.
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Affiliation(s)
- Toshihiko Matsuo
- Department of Ophthalmology, Okayama University Medical School and Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Okayama City, 700-8558 Japan
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Chen G, Ma J, Shatos MA, Chen H, Cyr D, Lashkari K. Application of human persistent fetal vasculature neural progenitors for transplantation in the inner retina. Cell Transplant 2013; 21:2621-34. [PMID: 23317920 DOI: 10.3727/096368912x647153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Persistent fetal vasculature (PFV) is a potentially serious developmental anomaly in human eyes, which results from a failure of the primary vitreous and the hyaloid vascular systems to regress during development. Recent findings from our laboratory indicate that fibrovascular membranes harvested from subjects with PFV contain neural progenitor cells (herein called NPPFV cells). Our studies on successful isolation, culture, and characterization of NPPFV cells have shown that they highly express neuronal progenitor markers (nestin, Pax6, and Ki67) as well as retinal neuronal markers (β-III-tubulin and Brn3a). In the presence of retinoic acid and neurotrophins, these cells acquire a neural morphological appearance in vitro, including a round soma and extensive neurites, and express mature neuronal markers (β-III-tubulin and NF200). Further experiments, including real-time qRT-PCR to quantify characteristic gene expression profiles of these cells and Ca(2+) imaging to evaluate the response to stimulation with different neurotransmitters, indicate that NPPFV cells may resemble a more advanced stage of retinal development and show more differentiation toward inner retinal neurons rather than photoreceptors. To explore the potential of inner retinal transplantation, NPPFV cells were transplanted intravitreally into the eyes of adult C57BL/6 mice. Engrafted NPPFV cells survived well in the intraocular environment in presence of rapamycin and some cells migrated into the inner nuclear layer of the retina 1 week posttransplantation. Three weeks after transplantation, NPPFV cells were observed to migrate and integrate in the inner retina. In response to daily intraperitoneal injections of retinoic acid, a portion of transplanted NPPFV cells exhibited retinal ganglion cell-like morphology and expressed mature neuronal markers (β-III-tubulin and synaptophysin). These findings indicate that fibrovascular membranes from human PFV harbor a population of neuronal progenitors that may be potential candidates for cell-based therapy for degenerative diseases of the inner retina.
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Affiliation(s)
- Guochun Chen
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
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Laaks D, Freeman N. Congenital iris ectropion uveae presenting with glaucoma in infancy. J AAPOS 2013; 17:214-6. [PMID: 23522945 DOI: 10.1016/j.jaapos.2012.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/15/2012] [Accepted: 11/16/2012] [Indexed: 10/27/2022]
Abstract
A healthy 5-month-old boy presented with a sporadic unilateral right-sided sectorial ectropion uveae, anterior insertion of the iris root, increased IOP, and glaucomatous disk changes. The absence of other additional ocular anomalies and the appearance of the angle led to a diagnosis of congenital iris ectropion syndrome. IOPs became refractory to maximal topical therapy, and trabeculotomy surgery was performed. The patient has since been stabilized on topical agents.
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Affiliation(s)
- Debbie Laaks
- Division of Ophthalmology, Department of Surgical Sciences, Faculty of Health Sciences, University of Stellenbosch, South Africa.
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While B, Mudhar HS, Chan J. Lens particle glaucoma secondary to untreated
congenital cataract and persistent fetal vasculature. Eur J Ophthalmol 2012; 23:0. [PMID: 23097093 DOI: 10.5301/ejo.5000201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 11/20/2022]
Abstract
Purpose. To present a case of lens particle glaucoma in a child with an untreated unilateral congenital cataract and persistent fetal vasculature (PFV) and to discuss the implications for the management of unilateral congenital cataract.
Methods. A 4-year-old boy presented with a unilateral congenital cataract affecting the right eye. Examination revealed a cataract and PFV. Intraocular pressure (IOP) measured 18 mmHg right, 14 mmHg left, and he was managed conservatively. Nine months later, he attended clinic with a painful right eye. He had quiet anterior and posterior segments but free lens particles in the anterior vitreous and an IOP of 12 mmHg. Over 4 weeks, the IOP rose to 23 mmHg and the patient underwent vitreolensectomy.
Results. The affected eye has at no point become inflamed but macrophages laden with lens proteins were identified during histopathologic analysis of the vitreous. The proposed mechanism in this case is that the PFV weakened the posterior capsule leading to its rupture. The resultant macrophages then caused mechanical obstruction of aqueous outflow through the trabecular meshwork.
Conclusions. Lens particle glaucoma secondary to posterior capsular rupture is a rare form of lens-induced glaucoma. It is common practice to manage conservatively those patients who present late with unilateral congenital cataract. This case highlights the need for vigilant follow-up of these patients to enable lens-induced glaucoma to be detected at an early stage.
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Affiliation(s)
- Benjamin While
- Department of Ophthalmology, The Royal Hallamshire Hospital, Sheffield - UK
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Eballé AO, Ellong A, Koki G, Nanfack NC, Dohvoma VA, Mvogo CE. Eye malformations in Cameroonian children: a clinical survey. Clin Ophthalmol 2012; 6:1607-11. [PMID: 23055685 PMCID: PMC3468283 DOI: 10.2147/opth.s36475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
SUMMARY The aim of this work was to describe the clinical aspects of eye malformations observed at the ophthalmology unit of the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital. PATIENTS AND METHODS We carried out a retrospective study of all malformations of the eye and its adnexae observed among children aged 0-5 years who were seen at the ophthalmology unit from January 2003 to December 2009. RESULTS Out of the 2254 children who were examined, 150 (6.65%) presented eye malformations. The mean age was 14.40 ± 4 months. Eye malformations were diagnosed in 71.66% of cases during the first year of life. The most frequent malformations were congenital lacrimal duct obstruction (66.66%), congenital cataract (10.9%), congenital glaucoma (10.9%), microphthalmos (5.03%), and congenital ptosis (3.77%). CONCLUSION Eye malformations among children can lead to visual impairment and are a cause for discomfort to children and parents. Therefore, systematic postnatal screening is recommended to enable early management.
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Affiliation(s)
- André Omgbwa Eballé
- Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital, Yaoundé, Cameroon ; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
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Morrison DG, Lambert SR, Wilson ME. Posterior capsular plaque in bilateral congenital cataracts. J AAPOS 2012; 16:17-20. [PMID: 22244507 DOI: 10.1016/j.jaapos.2011.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/30/2011] [Accepted: 08/31/2011] [Indexed: 01/24/2023]
Abstract
BACKGROUND Many cases of unilateral congenital cataract have an associated posterior capsular plaque. Observations such as this have led to the hypothesis that posterior capsular plaque is caused by persistent fetal vasculature, generally a unilateral condition, even if no obvious hyaloid remnant is visible. We investigated the incidence of posterior capsular plaque associated with bilateral congenital cataracts. METHODS Children with bilateral congenital cataracts were identified from three surgical practices. Children were included if lensectomies were performed prior to age 7 months. Surgical videos were evaluated for cataract morphology. RESULTS Fourteen children with bilateral cataracts were identified. Surgical videos were available for 24 eyes. Five eyes (21%) had evidence of persistent hyaloid remnants. Of the remaining 19 eyes, cataracts were categorized as nuclear in 10 cases, nuclear with cortical extension in 6 cases, and posterior cortical in 3 cases. Evidence of posterior capsular plaque was seen in seven cases (37%) on video review. CONCLUSIONS Video review revealed a much lower incidence of posterior capsular plaque in eyes with bilateral congenital cataracts compared to unilateral congenital cataracts, lending presumptive evidence to the hypothesis that most unilateral lens opacities arise from persistent fetal vasculature.
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Lambert SR, Buckley EG, Lenhart PD, Zhang Q, Grossniklaus HE. Congenital fibrovascular pupillary membranes: clinical and histopathologic findings. Ophthalmology 2011; 119:634-41. [PMID: 22197437 DOI: 10.1016/j.ophtha.2011.08.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 08/24/2011] [Accepted: 08/26/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To report the clinical and histopathologic findings associated with congenital fibrovascular pupillary membranes. DESIGN Case series. PARTICIPANTS Seven infants were included, 6 with a unilateral congenital pupillary membrane and 1 with classic persistent fetal vasculature (PFV). METHODS Patients underwent a membranectomy, pupilloplasty, or lensectomy. Histopathologic examination was performed on the excised membranes. MAIN OUTCOME MEASURES Visual acuity and pupil size. RESULTS Four of the 6 patients with a unilateral congenital pupillary membrane had 1 or more recurrences after a membranectomy and pupilloplasty. The most recent pupil size ranged from 2 to 5 mm in the affected eye. When last tested, the vision in the affected eye was excellent in 4 of the 6 patients. The 2 patients without recurrences of the pupillary membranes underwent multiple iris sphincterotomies at the time of the initial surgery. Histopathologic examination of 2 primary pupillary membranes showed fibrovascular tissue that did not stain for neuron-specific enolase. Smooth muscle actin was only present in vascular walls. In contrast, histopathology of a recurrent pupillary membrane revealed collagenized fibrovascular tissue that was immunoreactive for smooth muscle actin. Finally, histopathology of the retrolenticular membrane excised from an infant with classic PFV was similar to the latter aside from hypercellularity. CONCLUSIONS Congenital fibrovascular pupillary membranes in infants are likely a variant of PFV that may recur if incompletely excised. The risk of these membranes recurring may be reduced by excising as much as the membrane as possible and enlarging the pupil with iris sphincterotomies. A lensectomy should be avoided if possible.
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Affiliation(s)
- Scott R Lambert
- Department of Ophthalmology, Emory University, Atlanta, Georgia 30322, USA.
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Wilson ME, Trivedi RH, Morrison DG, Lambert SR, Buckley EG, Plager DA, Lynn MJ. The Infant Aphakia Treatment Study: evaluation of cataract morphology in eyes with monocular cataracts. J AAPOS 2011; 15:421-6. [PMID: 22108352 PMCID: PMC3345197 DOI: 10.1016/j.jaapos.2011.05.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/26/2011] [Accepted: 05/12/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a video-documented assessment of cataract type in the eyes of patients with monocular infantile cataract who were enrolled in the Infant Aphakia Treatment Study. METHODS The Infant Aphakia Treatment Study is a randomized clinical trial in which the investigators compared intraocular lens (IOL) versus contact lens correction in 114 infants, aged 28 days to <7 months. A total of 83 videos were available for morphological analysis of cataract. Three examiners reviewed all surgical recordings and agreed on the cataract characteristics by using a score sheet to record the lens layer or configuration of the opacity. RESULTS Nuclear cataract was present in 45 of 83 eyes (54%). Posterior capsule plaque was observed in 73 eyes (88%). All eyes with fetal nuclear cataract had associated posterior capsule plaque. Cortical cataract without nuclear involvement was seen in 21 eyes (25%). Posterior bowing of the posterior capsule was noted in 4 eyes (5%). Evidence of persistent fetal vasculature (PFV) was present in 18 eyes (22%). PFV was the only finding in 5 eyes but was also seen in combination with nuclear (7 eyes) and cortical cataracts (6 eyes). The entire lens was white in 3 eyes (4%), whereas the lens was partially resorbed in 7 (8%) eyes. Anterior capsule fibrosis was noted in 5 eyes with advanced cataract (1 with total cataract, 4 with partially resorbed lens). CONCLUSIONS Nuclear opacities were common, but many different cataract types presented in infancy. PFV occurred in isolation or in association with cataract. Posterior capsule plaque was frequently noted, especially when a nuclear cataract was present.
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Affiliation(s)
- M Edward Wilson
- Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA.
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Morrison DG, Wilson ME, Trivedi RH, Lambert SR, Lynn MJ. Infant Aphakia Treatment Study: effects of persistent fetal vasculature on outcome at 1 year of age. J AAPOS 2011; 15:427-31. [PMID: 22108353 PMCID: PMC3223380 DOI: 10.1016/j.jaapos.2011.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/24/2011] [Accepted: 06/01/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND The Infant Aphakia Treatment Study is a randomized trial that compares the treatment of unilateral congenital cataract with primary intraocular lens (IOL) implantation versus aphakic contact lens (CLs). The purpose of this study was to compare the outcomes for infants with lens opacity associated with persistent fetal vasculature (PFV) to those without. METHODS Retrospective subgroup analysis of grating visual acuity at 1 year of age and adverse events up to 1 year after surgery in eyes identified intraoperatively as having evidence of mild PFV from the IATS. RESULTS Of 83 infants, 18 (22%: 11 CL, 7 IOL) had PFV. Median logMAR visual acuity was 0.88 for patients with PFV and 0.80 for patients without PFV (P = 0.46). One or more adverse events up to 1 year after surgery occurred in 12 infants (67%) with PFV and 30 infants (46%) without PFV (P = 0.18). The incidence of adverse events was significantly greater in patients with PFV compared with patients without PFV in the CL group (55% vs 20%, P = 0.049) but not in the IOL group (86% vs 71%, P = 0.65), possibly because all children receiving IOLs had greater rates of adverse events when compared with aphakic children (73% vs 29%, P < 0.001). CONCLUSIONS Aphakic infants with mild PFV treated with CL had a greater incidence of adverse events after lensectomy compared with children with other forms of unilateral congenital cataract; nevertheless, similar visual outcomes at 1 year after surgery were obtained.
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Acquired central corneal thickness increase following removal of childhood cataracts. Am J Ophthalmol 2011; 151:434-41.e1. [PMID: 21236412 DOI: 10.1016/j.ajo.2010.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 09/16/2010] [Accepted: 09/18/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate central corneal thickness (CCT) in children with congenital/developmental cataracts before and after cataract removal, to correlate CCT with corneal diameters before cataract surgery in this same group, and to evaluate CCT over time in a separate group of children who were already aphakic or pseudophakic at study entry. DESIGN Longitudinal study. METHODS Children with cataract (Group 1, with pre-cataract-removal CCT) and aphakia/pseudophakia (Group 2, presenting after cataract removal) were included. CCT measurements were performed using ultrasound pachymetry. Normal fellow eyes of unilaterally affected cases served as controls. In bilateral cases, right eyes were used for analyses. RESULTS Group 1 comprised 66 children. Before cataract surgery, unilateral cases (n = 31) showed similar CCT and strong association between the affected and fellow eyes (552.0 ± 32.9 μm vs 550.9 ± 40.4 μm, respectively; r(2) = 0.71, P = .0001). After cataract surgery, affected eyes (n = 13) showed mean CCT increase of 29.7 ± 43.1 μm (P = .03) while fellow eyes remained unchanged. Similarly, before cataract surgery, bilateral cases (n = 35) showed similar CCT between the right and left eyes. After cataract surgery, mean CCT increase was 27.4 ± 39.4 μm for first operated eyes of bilateral cases (n = 17, P = .01). Group 2 comprised 50 aphakic/pseudophakic children lacking pre-cataract-removal CCT. CCT was higher in eyes with glaucoma vs those without, at both first and last measurements (ΔCCT 58.9 ± 27.0 μm at first examination, P = .034, and 56.4 ± 27.1 μm at last examination, P = .043, respectively). There was no statistically significant CCT change over the study interval (median 28 months) for either Group 2 eyes with or those without glaucoma. CONCLUSIONS CCT in children with cataracts increases after cataract surgery while the fellow eye remains stable. This increase seems to occur early after surgery, likely remaining stable thereafter, though glaucoma can accentuate the increase.
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Zhang ZD, Shen LJ, Qu J. Congenital membranous cataract associated with persistent fetal vasculature. Int J Ophthalmol 2010; 3:370-1. [PMID: 22553597 DOI: 10.3980/j.issn.2222-3959.2010.04.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 11/08/2010] [Indexed: 11/02/2022] Open
Abstract
A 15-year-old boy underwent phacoemulsification for a membranous cataract during which the presence of anterior persistent hyaloid artery and elongated ciliary processes were discovered. A posterior capsulorhexis was performed and the anterior part of the persistent hyaloid artery stalk was resected together with the posterior capsule. A foldable intraocular lens was implanted and the optic was captured in the posterior capsulorhexis margin. This is an unusual case of congenital membranous cataract associated with malformations of persistent fetal vasculature and elongated ciliary processes.
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Affiliation(s)
- Zong-Duan Zhang
- Eye Hospital of Wenzhou Medical College, Wenzhou 325027, Zhejiang Province, China
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Persistent fetal vasculature and spontaneous hyphema in a patient with Klippel-Trénaunay-Weber syndrome. J AAPOS 2010; 14:190-2. [PMID: 20451865 DOI: 10.1016/j.jaapos.2009.12.157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 12/01/2009] [Accepted: 12/02/2009] [Indexed: 11/23/2022]
Abstract
Klippel-Trénaunay-Weber syndrome is characterized by the triad of capillary malformations (usually port-wine stains), varicose veins or venous malformations of unusual distribution, and soft-tissue or bony hypertrophy of an extremity. The syndrome can be diagnosed on the basis of 2 of these 3 features. In the atypical form of the syndrome, capillary malformations may be absent. Recognition is possible during infancy or early childhood, and evaluation and treatment is important to minimize morbidity. We describe the case of an 11-year-old girl who presented with hyphema after a Valsalva maneuver and was found to have persistent fetal vasculature in the affected eye. She had systemic features of Klippel-Trénaunay-Weber syndrome. Magnetic resonance imaging, magnetic resonance angiography, and magnetic resonance venography scans of the brain and orbits were normal. Magnetic resonance imaging scan of the left hypertrophied lower limb revealed venous malformations leading to soft-tissue hypertrophy. To our knowledge, this is the first case of persistent fetal vasculature and hyphema in a patient with Klippel-Trénaunay-Weber syndrome.
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Lee EJ, Padilla M, Merwine DK, Grzywacz NM. Developmental regulation of the morphology of mouse retinal horizontal cells by visual experience. Eur J Neurosci 2008; 27:1423-31. [DOI: 10.1111/j.1460-9568.2008.06122.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Temtamy SA, Aglan MS, Ashour AM, Zaki MS. Adams-Oliver syndrome: further evidence of an autosomal recessive variant. Clin Dysmorphol 2007; 16:141-149. [PMID: 17551326 DOI: 10.1097/mcd.0b013e3280f9df22] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adams-Oliver syndrome is characterized by aplasia cutis congenita and variable degrees of terminal transverse limb defects. Other associated anomalies were described in the syndrome. Most described cases follow an autosomal dominant pattern of inheritance. Sporadic and autosomal recessive cases, however, were reported. In this study, we report on three Egyptian patients with Adams-Oliver syndrome from three different families. The parents were normal and consanguineous in all three families. There was history of similarly affected sibs for two cases. These findings denote autosomal recessive inheritance. The reported cases had typical skull and limb anomalies with cutis marmorata telangiectatica congenita. We observed additional rare manifestations in the form of microcephaly, psychomotor retardation, epilepsy, eye anomalies and atrophic skin lesions. MRI of the brain in one of the studied cases revealed retrocerebellar cyst and mild asymmetrical cerebellar hypoplasia, which to our knowledge, were not previously reported in Adams-Oliver syndrome. The results of this study provide further evidence of clinical and genetic heterogeneity and support the presence of autosomal recessive variant of Adams-Oliver syndrome.
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Affiliation(s)
- Samia A Temtamy
- Clinical Genetics Department, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
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Roche O, Keita Sylla F, Beby F, Orssaud C, Dufier JL. Persistance et hyperplasie du vitré primitif. J Fr Ophtalmol 2007; 30:647-57. [PMID: 17646755 DOI: 10.1016/s0181-5512(07)89674-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The persistence of the fetal vascular system is a rare ocular malformation whose origin remains unknown. It comprises a group of complex ocular malformations from which the various clinical forms have a heterogeneous functional prognosis. The diagnosis depends on a precise and complete examination of the child's eye, often under general anesthesia. Various clinical forms can be found together, ranging from the tiny form with no visual repercussion or ocular or systemic anomaly associated with the major forms involving the totality of the ocular structures and systemic syndromes. A systematic general pediatric examination is therefore recommended. The treatment is adapted individually for early and specific surgical and medical treatment. In the event of intervention, the induced aphakia will be corrected in one procedure with an implantation, generally sutured with the sclera, or at the time of a second intervention after the wearing of glasses or a contact lens. However, the complications can sometimes lead to rapid phthisis bulbi. Whatever solution is chosen, the final functional result has progressed thanks to early diagnosis, the surgical techniques suggested, even if implantation continues to be debated. Amblyopia must be treated for the entire sensitive period. However, despite good rehabilitation, the average functional prognosis remains disappointing, probably because of the overall ocular malformation.
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Affiliation(s)
- O Roche
- Service d'ophtalmologie, Hôpital Necker-Enfants Malades, Paris, France
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Mitchell CA, Rutland CS, Walker M, Nasir M, Foss AJE, Stewart C, Gerhardt H, Konerding MA, Risau W, Drexler HCA. Unique vascular phenotypes following over-expression of individual VEGFA isoforms from the developing lens. Angiogenesis 2006; 9:209-24. [PMID: 17109192 DOI: 10.1007/s10456-006-9056-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 10/13/2006] [Indexed: 01/13/2023]
Abstract
Formation of a correctly organised vasculature and subsequently embryonic survival is critically dependent on the dosage and site-specific expression of VEGF. Murine VEGF exists in three common isoforms (viz. 120, 164 and 188 amino acids) having different organ specific distribution levels. Gene knock-in studies show that expression of any of the individual isoforms of VEGF extends survival until birth, although each is associated with distinct organ-specific abnormalities. Comparison of the effects of VEGF isoform expression is complicated by the general lethality of mis-expression, in addition to cumulative effects of adjacent tissues from the inappropriately patterned vasculature. Here we investigate the effects of over-expression of individual VEGFA isoforms from the lens-specific alphaA-Crystallin promoter and characterise their effects on the vessel morphology of the hyaloid and developing retinal vasculature. Since the hyaloid vasculature is an anatomically distinct, transient vasculature of the eye, comprising 3 cell types (endothelium, pericytes and macrophages) it is possible to more readily interpret the role of individual VEGF-A isoforms in vascular pattern formation in this model. The severity of the vascular phenotype, characterised by a hyperplastic hyaloid at E13.5 and subsequently retinal vascular patterning and ocular defects, is most severe in transgenics over-expressing the more diffusible forms of VEGFA (120 and 164), whereas in VEGFA(188) transgenics the hyaloid vascular defects partially resolve post-natally. The results of this study indicate that individual isoforms of VEGFA induce distinct vascular phenotypes in the eye during embryonic development and that their relative doses provide instructive cues for vascular patterning.
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Affiliation(s)
- Christopher A Mitchell
- Department of Obstetrics and Gynaecology, University of Nottingham, City Hospital, Hucknall Rd, Nottingham, NG5 1PB, UK
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Abstract
The treatment of pediatric cataracts is rapidly evolving, and the visual prognosis for infants and children with cataracts is improving, due in part to earlier surgery, increased frequency of intraocular lens (IOL) implantation, more effective amblyopia therapy following surgery, and better forms of optical correction. A surgeon treating a child with a cataract is faced with An assortment of therapeutic dilemmas such as whether an IOL should be implanted, whether foldable lenses are appropriate, and whether the posterior capsule should be opened during surgery. Although the surgery can be technically difficult in small and unforgiving eyes, it is often the easy part as treatment decisions and results have lifelong implications. The visual system, which is immature at birth, has a latent period of approximately 6 weeks before it becomes sensitive to deprivation, and binocular vision first appears at approximately 3 months of age. It is therefore imperative that infants with visually significant congenital cataracts receive prompt treatment during the sensitive periods to decrease the risk of developing amblyopia or binocular abnormalities. An ideal time for early surgical intervention resulting in few complications and maximal visual outcome has not been identified with certainty. Perhaps the greatest overall change in the approach to the surgical treatment of pediatric cataracts has been the adaptation of techniques used in adult cataract surgery. This article focuses on the methods currently used in the management of pediatric cataracts.
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Affiliation(s)
- Brian J Forbes
- The Childrens Hospital of Philadelphia, Division of Ophthalmology, Philadelphia, Pennsylvania 19104, USA
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