Ocular and Systemic Findings in Adults with Uveal Coloboma

Congenital bilateral coloboma of iris and choroid accompanied by unilateral multiple primary pigmented iris cysts: A case report

INTRODUCTION AND IMPORTANCE

Congenital iris and choroidal coloboma is a congenital ocular developmental anomaly, most occur in both eyes, which may exist in isolation or be accompanied by systemic developmental abnormalities. Herein, we report a case of congenital bilateral coloboma of iris and choroid accompanied by unilateral multiple primary pigmented iris cysts. The selection of treatment methods for iris cysts has always been a challenge for ophthalmologists. Especially for primary iris pigment epithelial cysts without clinical symptoms, no particular intervention measures are required. Which in turn helps ophthalmologists to make clinical decisions in real-world practice.

CASE PRESENTATION

A 16-year-old boy presented to the ophthalmology clinic with a history of poor eyesight in both eyes since childhood. The pupils of both eyes were pear shaped, and there was a pigmented iris cyst about 1.5 mm × 2 mm at 6-7 o'clock pupillary margin of the left eye on slit-lamp examination. A large fan-shaped coloboma of choroid in both eyes respectively, involving the optic nerve and macular area on fundus examination. Ultrasound biomicroscopy revealed three cysts with hyperreflective walls and clear hyporeflective lumen in the left eye, one located on the anterior surface of the iris and the other two located on the posterior surface of the iris. Above all, he had no history of surgery, trauma, infection, tumor or medication. Therefore, primary pigmented iris epithelial cysts were diagnosed. Given that the patient was asymptomatic, with no impact on visual function, his cysts were monitored. After 2 years follow-up, the cysts remained stable.

CLINICAL DISCUSSION

Iris cysts, whether primary or secondary, are a diagnostic and a treatment challenge. Primary iris cysts are mostly present in the iridociliary sulcus and the ciliary crown, often asymptomatic, with a few located forward or larger, manifested as local protrusions around the iris. This patient had no history of ocular surgery or trauma, therefore, combining clinical manifestations and imaging examination results, primary pigmented iris epithelial cysts were diagnosed. For this patient, on the one hand, the surgical risk was high, and iris cysts probably recur after surgery, and there might be no improvement in postoperative visual acuity. On the other hand, the patient's fundus was poor and his family's economic conditions were not good. In addition, the iris cysts of this patient remained stable after 2 years of observation, therefore, no treatment was taken.

CONCLUSION

Ophthalmologists should be aware of this rare but distinctive presentation, especially in patients without symptoms. Prompt diagnosis and treatment are pivotal in ensuring favorable outcomes and preventing further ocular complications in individuals affected by these uveal anomalies.

Genetics of the anterior segment dysgenesis

The anterior segment dysgeneses are a broad group of heterogeneous disorders characterized by developmental abnormalities of the anterior segment of the eye, including primary congenital aphakia, Peters sequence, aniridia, and Axenfeld-Rieger spectrum. These conditions can have overlapping phenotypes and both genotypic and phenotypic heterogeneity. This article provides a strategy for both phenotyping and then genotyping using a targeted stepwise approach.

A Trial of Intranasal Corticosteroids to Treat Childhood OSA Syndrome

BACKGROUND

Intranasal corticosteroids (INCS) are frequently used to treat OSA syndrome (OSAS) in children. However, their efficacy has not been rigorously tested.

RESEARCH QUESTION

Do INCS result in improved OSAS symptoms, polysomnography findings, behavior, and quality of life compared with placebo?

STUDY DESIGN AND METHODS

In this randomized, double-blind, placebo-controlled trial, children with OSAS aged 5 to 12 years (N = 134) were randomized 2:1 to receive 3 months of INCS or placebo. Children in the INCS arm were then re-randomized to receive 9 months of INCS or placebo. Polysomnography, symptoms, and neurobehavioral findings were measured at baseline, 3 months, and 12 months. The primary outcome was change in obstructive apnea hypopnea index (OAHI) at 3 months, available for 122 children. The secondary outcome was OAHI change at 12 months, available for 70 children.

RESULTS

Median (interquartile range) age and OAHI at baseline for the entire group were 7.9 (6.3 to 9.9) years and 5.8 (3.6 to 9.7) events per hour. OAHI changes at 3 months (-1.72 [-3.91 to 1.92] events per hour) and 12 months (-1.2 [-4.22 to 1.71] events per hour) were not different between the two groups (P = not significant). OSAS symptoms and neurobehavioral results did not differ between the INCS and placebo groups at 3 and 12 months. The 38 children who received INCS for 12 months reported a significant OAHI decrease from 7.2 (3.62 to 9.88) events per hour to 3.7 (1.56 to 6.4) events per hour (P = .039).

INTERPRETATION

In children with OSAS, treatment with INCS did not result in significant polysomnography, neurobehavioral, or symptom changes at 3 and 12 months of treatment. Twelve months of INCS treatment resulted in a statistically significant but not clinically relevant OAHI reduction.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NCT02180672; URL: www.

CLINICALTRIALS

gov.

Clinical and Demographic Profile of Uveal Coloboma: A hospital-based Study of 14,371 eyes of 9557 Indian Patients

OBJECTIVE

To describe the demographics and clinical profile of uveal coloboma in patients presenting to a multi-tier ophthalmology hospital network in India.

DESIGN

Cross- sectional hospital -based study.

METHODS

This cross-sectional hospital-based study included 2,817,766 new patients presenting between August 2010 and May 2021. Patients with a clinical diagnosis of uveal coloboma in at least one eye were included as cases. The data were collected using an electronic medical record system.

RESULTS

Overall, 9,557 (0.34%) patients were diagnosed with uveal coloboma. Just over half of the patients were male (51.82%) and had bilateral (50.37%) affliction. The most common age group at presentation was during the second decade of life with 2,198 (23%) patients. The overall prevalence was higher in patients from a lower socio-economic status (0.53%) and presenting from the rural geography (0.39%). The most common type was retino-choroidal coloboma in 8,049 (84.22%) patients followed by iris coloboma in 2,129 (22.28%) patients. The most common Ida Mann classification in the eyes with retino-choroidal coloboma was type 4 in 7,049 (57.23%) eyes followed by type 2 in 3,685 (29.92%) eyes. In the 14,371 eyes, 5,696 (39.64%) eyes had a visual impairment of blindness (>20/400) followed by mild or no visual impairment (<20/70) in 2,875 (20.01%) eyes. In the 2,228 (15.5%) eyes that required a surgical/ laser intervention, cataract surgery was performed in 951 (6.62%) eyes, vitreo-retinal surgery in 661 (4.6%) eyes followed by laser photocoagulation in 357 (2.48%) eyes.

CONCLUSION

Uveal Coloboma is more common in males, is predominantly bilateral in the population studied. It is more commonly found in patients from lower socio-economic strata and from a rural background. The most common type is retino-choroidal coloboma and over a third of the eyes are affected with blindness.

Embryonic Development of the Orbit

The embryonic and fetal development of the orbit comprises a series of sequential events, starting with the fertilization of the ovum and extending until birth. Most of the publications dealing with orbital morphogenesis describe the sequential development of each germinal layer, the ectoderm with its neuroectoderm derivative and the mesoderm. This approach provides a clear understanding of the mode of development of each layer but does not give the reader a general picture of the structure of the orbit within any specified time frame. In order to enhance our understanding of the developmental anatomy of the orbit, the authors have summarized the recent developments in orbital morphogenesis, a temporally precise and morphogenetically intricate process. Understanding this multidimensional process of development in prenatal life, identifying and linking signaling cascades, as well as the regulatory genes linked to existing diseases, may pave the way for advanced molecular diagnostic testing, developing minimally invasive interventions, and the use of progenitor/stem cell and even regenerative therapy.