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Bhate M, Motwani D, Murthy SI, Fernandes M. Congenital anomalies of lens shape. Taiwan J Ophthalmol 2023; 13:479-488. [PMID: 38249493 PMCID: PMC10798395 DOI: 10.4103/tjo.tjo-d-23-00076] [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: 06/05/2023] [Accepted: 08/01/2023] [Indexed: 01/23/2024] Open
Abstract
The crystalline lens is an important structure in the eye that starts to develop as early as the 22nd day of gestation, with further differentiation that continues after the induction. Congenital anomalies of the lens may involve the size, shape, and position of the lens. They may sometimes be associated with anterior segment dysgenesis or persistence of the tunica vasculosa lentis and hyperplastic vitreous and hyaloid system. Manifestations of anomalies of the lens shape are usually seen in early or late childhood however may sometimes be delayed into adulthood based on the level of visual impairment or the presence or absence of any syndromic associations. While lens coloboma has more often been reported in isolation, the more commonly implicated genes include the PAX6 gene, lenticonus in particular anterior is often part of Alport syndrome with extra-ocular manifestations in the kidneys and hearing abnormalities due to mutations in the alpha 5 chain of the Type IV collagen gene. Recognition of these manifestations and obtaining a genetic diagnosis is an important step in the management. The level of visual impairment and amblyopia dictates the outcomes in patients managed either conservatively with optical correction as well as surgically where deemed necessary. This review discusses the various anomalies of the lens shape with its related genetics and the management involved in these conditions.
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Affiliation(s)
- Manjushree Bhate
- Jasti V Ramanamma Children’s Eye Care Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Divya Motwani
- Jasti V Ramanamma Children’s Eye Care Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I. Murthy
- Cornea Service, The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute Hyderabad, India, The Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
- Cornea Service, The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Merle Fernandes
- Cornea Service, The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute Hyderabad, India, The Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
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Saroya AS, Saroya S, Morya AK. Commentary: Innovation is the key to manage complications in rare ocular conditions like spherophakia. Indian J Ophthalmol 2023; 71:2493-2494. [PMID: 37322668 PMCID: PMC10418006 DOI: 10.4103/ijo.ijo_144_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Affiliation(s)
- Arnav Singh Saroya
- Cataract, Cornea and Refractive Surgery Dr. Agarwals Eye Hospital, Chennai, Tamil Nadu, India
| | - Shaina Saroya
- Vitreo – Retina Surgery Dr. Agarwals Eye Hospital, Chennai, Tamil Nadu, India
| | - Arvind Kumar Morya
- Cataract, Glaucoma, Refractive, Squint, Paediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences Bibinagar Hyderabad Telangana, India
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Burugupally K, Senthil S, Parameshwarappa DC, Ali H, Balakrishnan D, Garudadri C. Outcomes of lensectomy with glued intraocular lens and factors associated with failure in eyes with spherophakia and glaucoma. Indian J Ophthalmol 2023; 71:2487-2492. [PMID: 37322667 PMCID: PMC10417956 DOI: 10.4103/ijo.ijo_1866_22] [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: 07/30/2022] [Revised: 12/04/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023] Open
Abstract
Purpose To evaluate the outcomes of lensectomy with a glued intraocular lens (IOL) in spherophakic eyes with secondary glaucoma and assess factors associated with failure. Methods We prospectively evaluated outcomes of lensectomy with glued IOL in 19 eyes with spherophakia and secondary glaucoma (intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage) between 2016 and 2018. The vision, refractive error, IOP, antiglaucoma medications (AGMs), optic disc changes, need for glaucoma surgery, and complications were assessed. Success was defined as complete when IOP was ≥5 and ≤21 mmHg without AGMs; qualified success as similar IOP with up to 3 AGM; the need for >3AGM/additional surgery for IOP control was considered a failure. Results Preoperatively, the median (interquartile range: IQR) age was 18 (13.5-30) years. IOP was 16 (14-22.5) mmHg on a median of 3 (2,3) AGMs. Median postoperative follow up was 27.7 months (11.9, 39.7). Postsurgery, most patients achieved emmetropia, with significantly decreased refractive error from a median spherical equivalent of -12.5D to + 0.5D, P < 0.0002. The complete success probability was 47% (95% confidence intervals (CIs): 29-76%) at 3 months and was 21% (8 - 50%) at 1 year and 3 years. The qualified success probability was 93% (82-100%) at 1 year, which reduced to 79% (60-100%) in 3 years. None of the eyes had any retinal complications. The higher number of preoperative AGM was found to be a significant risk factor (p < 0.02) for the failure of complete success. Conclusion One-third of the eyes had IOP control without the need for AGM postlensectomy with glued IOL. Surgery resulted in significant improvement in visual acuity. The higher number of preoperative AGM was associated with poor glaucoma control after glued IOL surgery.
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Affiliation(s)
- Keerthi Burugupally
- VST Glaucoma Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- VST Glaucoma Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Deepika C Parameshwarappa
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Hasnat Ali
- Center for Biostatistcs and Epidemiology, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Khan TA, Khan AA, Khan A, Zahid MA, Mehboob MA. Bilateral Anteriorly Displaced Microspherophakia in a Female Child With Marfanoid Habitus. Cureus 2023; 15:e38371. [PMID: 37265880 PMCID: PMC10230448 DOI: 10.7759/cureus.38371] [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] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Microspherophakia is a rare congenital anomaly characterized by an abnormally small and spherical crystalline lens, which can be associated with several systemic syndromes. We present an extremely rare case of bilateral anteriorly displaced microspherophakia in a female child with Marfanoid habitus. The patient displayed phenotypic features resembling Marfan syndrome, including tall stature, muscle hypotonia, dolichostenomelia, and increased arm span than body length. However, unlike Marfan syndrome, Marfanoid habitus is not associated with mutations in the fibrillin-1 gene. The association between microspherophakia and Marfanoid habitus is a unique presentation that has not been reported in the literature. This case report aims to increase awareness of microspherophakia as a possible ocular association of Marfanoid habitus.
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Affiliation(s)
- Taimoor A Khan
- Ophthalmology, National University of Medical Sciences (NUMS) Rawalpindi, Rawalpindi, PAK
- Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi, PAK
| | - Ali A Khan
- Ophthalmology, Ayub Medical College, Abbottabad, PAK
| | - Asfandyar Khan
- Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi, PAK
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Chattannavar G, Mohamed A, Malgi V, Kekunnaya R. Visual outcomes and safety profile of intraocular lens implantation versus aphakia in children with microspherophakia with no subluxation. BMJ Open Ophthalmol 2023. [PMCID: PMC9835943 DOI: 10.1136/bmjophth-2022-001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective To study the visual, refractive and surgical outcomes of intraocular lens (IOL) implantation versus aphakia in children with microspherophakia. Design Retrospective, comparative, non-randomised interventional study. Methods All consecutive children with microspherophakia who satisfied the inclusion criteria were included. The eyes that underwent in-the-bag IOL implantation and those that were left aphakic were included in groups A and B, respectively. The postoperative visual outcomes, IOL stability and complications during the follow-up period were studied. Results 22 eyes (13 patients, male 76%), of which 12 eyes were in group A and 10 eyes in group B. The mean±SE of age at surgery was 9.4±1.4 and 7.3±0.9 years in group A and group B, respectively (p value 0.18). The mean follow-up of group A was 0.9±0.4 years (median 0.5 years; Q1 0.04, Q3 2.16) and group B was 1.3±0.9 years (median 0.147 years; Q1 0.08, Q3 0.39) (p value 0.76). All the baseline biometric variables including best-corrected visual acuity (BCVA) were comparable in each group. The final BCVA in logMAR adjusted for follow-up was comparable in both group A (0.29±0.06) and group B (0.52±0.09) (p value 0.06). Mean predictive error of IOL power in microspherophakia was 0.17±0.43. The most common complication in group A was visual axis opacification of two eyes (16.7%, 95% CI 2.9% to 49.1%), of which one eye (8.3%, 95% CI 0.4% to 40.2%) needed membranectomy. Vitreous in anterior chamber was the most common complication in group B, seen in two eyes (20%, 95% CI 3.5% to 55.8%), of which one eye (10%, 95% CI 0.5% to 45.9%) underwent YAG laser vitreolysis. The survival analysis (p value 0.18) was comparable in each group. Conclusion In-the-bag IOL is an option, which can be considered in selected cases of microspherophakia in developing nations where regular follow-up and economic constraints are a major concern.
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Affiliation(s)
- Goura Chattannavar
- Pediatric and Neuro-ophthalmology Services, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | | | - Vishwesh Malgi
- Pediatric and Neuro-ophthalmology Services, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Ramesh Kekunnaya
- Pediatric and Neuro-ophthalmology Services, Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
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Scleral rupture during retinal detachment repair with primary scleral buckle and cryoretinopexy in a patient with microspherophakia. Am J Ophthalmol Case Rep 2022; 28:101746. [PMID: 36393910 PMCID: PMC9650018 DOI: 10.1016/j.ajoc.2022.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The purpose of this report is to describe a case of a patient with microspherophakia (MSP) who had a scleral rupture during a retinal detachment (RD) repair with primary scleral buckle and cryoretinopexy. Observations A 48-year-old woman with MSP presented with six days of expanding loss of vision and photopsias. Examination revealed a superior retinal detachment involving the macula associated with two superior retinal tears. The patient underwent successful placement of a segmental buckle. During cryoretinopexy treatment of the tears, a 4 mm full-thickness scleral rupture occurred. The sclera was immediately closed with interrupted 8-0 nylon sutures and reinforced with a processed pericardium allograft. Subsequent combined phacoemulsification with capsulectomy, zonulectomy, and pars plana vitrectomy with retinal reattachment was performed nine days post buckle placement. Conclusions and importance This case illustrates that a patient with MSP, even observed in the absence of a genetic syndrome or familial condition, may be at increased risk of scleral rupture during RD repair. Though future investigations are necessary to confirm this association, surgeons should take a conservative approach by having a high clinical suspicion for compromised scleral integrity in patients with MSP and proceeding with caution in procedures that may pose a risk of scleral rupture. A pericardium allograft can be an effective adjunct for scleral rupture repair.
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Al-Rajhi AA, Almazyad EM. Early lens aspiration with posterior chamber intraocular lens and capsular tension ring in microspherophakia to avoid lens-induced complications. Saudi J Ophthalmol 2022; 36:163-170. [PMID: 36211322 PMCID: PMC9535905 DOI: 10.4103/sjopt.sjopt_231_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report the surgical outcome of early lens aspiration, posterior chamber intraocular lens (PC IOL), and capsular tension ring (CTR) in a case series of microspherophakia (MSP) and secondary glaucoma. METHODS Case series of 18 eyes of MSP cases presented with lenticular myopia and secondary glaucoma that underwent early lens aspiration, PC IOL and CTR by one ophthalmologist. Baseline, long-term postoperative outcomes and complications were documented. RESULTS All cases underwent successful surgery with lens aspiration PC IOL implantation and CTR insertion without intraoperative complications. One of the 18 cases was a delayed referral which had broad anterior synechiae and following lens aspiration developed corneal decompensation. In one eye, CTR implantation was not possible hence, lens aspiration with scleral fixation (SF) of 3 piece IOL was performed (excluded from the analysis). Overall there was an improvement in visual acuity (from 0.3 ± 0.1 to 0.2 ± 0.2 LogMar, P = 0.006), intraocular pressure (IOP), and most notably, deepening of the anterior chamber. Some cases required subsequent glaucoma surgery to control IOP. After a long duration of follow-up, all cases had stable capsular lens complex and no capsular phimosis. CONCLUSION Early Lens aspiration with CTR and PCIOL alone in MSP with lens subluxation has a significant impact on the patient's quality of vision, deepening the anterior chamber and preventing complications or poor outcomes. In addition, good capsular-lens complex stability and absence of capsular phimosis or phacodonesis on long-term follow-up were obtained.
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Affiliation(s)
- Ali A. Al-Rajhi
- Department of Cornea and External Disease, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Specialized Experts Center, Riyadh, Saudi Arabia,Address for correspondence: Prof. Ali Al Rajhi, Department of Cornea and External Disease, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. E-mail:
| | - Enmar M. Almazyad
- Department of Cornea and External Disease, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Venkataraman P, Haripriya A, Mohan N, Rajendran A. A systematic approach to the management of microspherophakia. Indian J Ophthalmol 2022; 70:2262-2271. [PMID: 35791105 PMCID: PMC9426104 DOI: 10.4103/ijo.ijo_2888_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Microspherophakia is a rare developmental abnormality of the crystalline lens with a myriad of ocular and systemic associations. Glaucoma is a serious complication associated with this disorder. Early identification of the disease, timely visual rehabilitation, and appropriate management of the lens and glaucoma can help us prevent blindness from this condition. Multidisciplinary care with lifelong follow-up is recommended, as this typically affects the younger population. Current treatment protocols for this condition are mainly based on case reports and retrospective studies with shorter follow-up. Due to the rarity of this disease, designing a large randomized controlled trial to identify the merits and demerits of each management strategy is challenging. With cataract, glaucoma, and vitreoretinal specialists, each having their preferred way of managing microspherophakic lenses, we decided to do a comprehensive review of the existing literature to devise an integrated approach toward effective management of these patients. This review will collate all evidence and provide a very practical decision-making tree for its management.
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Affiliation(s)
| | | | - Neethu Mohan
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
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Factors Related to Visual Outcomes after Lens Surgery in Isolated Microspherophakia. J Ophthalmol 2022; 2022:9089203. [PMID: 35721227 PMCID: PMC9201369 DOI: 10.1155/2022/9089203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the main factors influencing visual performance after lens subluxation surgery in subjects with isolated MSP. Design. Retrospective study. Methods. In this study, 38 eyes of subjects with isolated MSP (microspherophakia) were included and divided into two groups based on preoperative IOP (intraocular pressure), IOP <21 mmHg, or IOP ≧21 mmHg. Phacoemulsification and scleral-fixated modified capsular tension ring implantation were performed with or without goniosynechialysis according to the IOP. Some ocular biometric parameters, such as corneal curvature, corneal pachymetry, endothelial cell count (ECC), anterior chamber depth (ACD), and axial length, were evaluated. The best-corrected visual acuity (BCVA) and IOP of these subjects were measured before the surgery and during <1 month and 3- to 6-month postoperative follow-ups. Results. Compared with the high IOP group, the normal IOP group was significantly younger and had better preoperative BCVA, a higher ECC, deeper ACD, a lower postoperative IOP, and flatter total corneal refractive power K1. The multivariable analysis revealed that preoperative ACD (b = −0.113, t = −2.070,
) and preoperative BCVA (b = 0.153, t = 2.562,
) were significantly associated with postoperative BCVA at 3–6 months. A preoperative ACD of 1.86 mm was found to be the optimal cut-off point for 3- to 6-month postoperative BCVA of ≧20/63 (≤0.52 logMAR). Conclusions. In addition to the effect of normal IOP, better preoperative BCVA and deeper ACD also correlated with better visual outcomes after lens surgery. Preoperative ACD served as a warning for isolated MSP subjects, especially for the risk of irreversible loss of postoperative vision. This trial is registered with “ChiCTR2000039132.”
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Chen ZX, Zhao ZN, Sun Y, Jia WN, Zheng JL, Chen JH, Chen TH, Lan LN, Jiang YX. Phacoemulsification Combined With Supra-Capsular and Scleral-Fixated Intraocular Lens Implantation in Microspherophakia: A Retrospective Comparative Study. Front Med (Lausanne) 2022; 9:869539. [PMID: 35492301 PMCID: PMC9047048 DOI: 10.3389/fmed.2022.869539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/23/2022] [Indexed: 01/19/2023] Open
Abstract
BackgroundMicrospherophakia (MSP) is a rare ocular condition, the lens surgery of which is complicated by both insufficient zonules and undersized capsule.MethodsThis study included MSP eyes managed with phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens implantation (SCSF-IOL) and made the comparison with those treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL).ResultsA total of 20 MSP patients underwent SCSF-IOL, and 17 patients received MCTR-IOL. The postoperative best corrected visual acuity was significantly improved in both groups (P < 0.001), but no difference was found between the groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd:YAG laser posterior capsulotomy was performed 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment and one eye (5.00%) had a decentered capsule opening. Posterior capsule opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up.ConclusionsSCSF-IOL is a viable option for managing MSP and is comparable with the MCTR-IOL. Nd:YAG laser posterior capsulotomy was necessary to prevent residual capsule complications after the SCSF-IOL procedure.
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Affiliation(s)
- Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Zhen-Nan Zhao
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yang Sun
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wan-Nan Jia
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Lei Zheng
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Tian-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Li-Na Lan
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- *Correspondence: Yong-Xiang Jiang
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Chen ZX, Jia WN, Jiang YX. Lens Biometry in Congenital Lens Deformities: A Swept-Source Anterior Segment OCT Analysis. Front Med (Lausanne) 2021; 8:774640. [PMID: 34988093 PMCID: PMC8720848 DOI: 10.3389/fmed.2021.774640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/22/2021] [Indexed: 12/22/2022] Open
Abstract
Aims: To investigate the lens biometric parameters in congenital lens deformities, using a novel technique of swept-source anterior segment optical coherence tomography (SS-ASOCT). Methods: This prospective study included patients with microspherophakia (MSP), coloboma lentis (CL), and posterior lenticonus (PL). For this cohort, 360-degree high-resolution lens images were obtained using the latest SS-ASOCT (CASIA2, Tomey Corp, Nagoya, Japan). The lens biometric parameters were calculated by the CASIA2 built-in software for anterior lens radius (ALR), posterior lens radius (PLR), anteroposterior distance (APD), anterior chamber depth (ACD), equatorial diameter (Eq Dia), rear projection length (RPL), and maximum diameter of the lesion (MDL). Results: This study included two eyes each with MSP and CL and one eye with PL. The lens of MSP was spherical and posteriorly dislocated, with decreased ALR and PLR, Eq Dia, but increased APD. In patients with CL, the coloboma was isolated, bilateral, inferior, and located toward the maldeveloped ciliary body. High astigmatism was mainly lenticular, and this was calculated by the ALR and PLR. Regarding the site of coloboma, a significant decrease in ALR was observed, while the PLR and APD were not affected. The PL eyes had a cone-shaped protrusion of the posterior lens surface with a subtle cataractous region around the apex. An extremely high posterior surface curvature was observed with a mean PLR of 1.67 mm. The RPL and MDL were about 1.80 and 0.4 mm, respectively, which were homogenous at different sections. Conclusions: The CASIA2 is a valuable option for in vivo crystalline lens measurement for congenital lens deformities, enabling the accurate diagnosis and providing illuminating insights into the pathogenesis of MSP, CL, and PL
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Affiliation(s)
- Ze-xu Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wan-Nan Jia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- *Correspondence: Yong-Xiang Jiang
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Xu M, Li K, He W. Compound heterozygous mutations in the LTBP2 gene associated with microspherophakia in a Chinese patient: a case report and literature review. BMC Med Genomics 2021; 14:227. [PMID: 34535142 PMCID: PMC8449461 DOI: 10.1186/s12920-021-01080-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Microspherophakia (MSP, OMIM 251,750) is a rare inherited autosomal recessive eye disorder characterized by small spherically shaped lens. Several studies have indicated that the transforming growth factor-beta (TGF-beta) binding proteins(LTBP2) gene mutation is the predominant cause of MSP. In our study, novel compound heterozygous mutations in the LTBP2 gene associated with MSP were reported, which was different from previous reported homozygous mutations. CASE PRESENTATION The proband was an 18-year-old male in Western China with bilateral MSP, accompanied by ectopia lentis, secondary glaucoma and blindness in both eyes. In our hospital, he received bilateral lens resection and trabeculectomy combined with peripheral iridotomy. Using next-generation sequencing (NGS)-based gene panel tests, we identified pathogenic mutations in the peripheral blood DNA sample from the proband: c.3614_3618dupCTGGC (exon24, NM_000428) and c.2819G > A (exon18, NM_000428). The presence of the novel compound heterozygous mutations in the LTBP2 gene was linked with the development of MSP. Sanger sequencing confirmed the existence of one of the two variants in each parent respectively. CONCLUSION Our results demonstrated a rare case of MSP phenotype associated with novel compound heterozygous mutations in the LTBP2 gene using NGS technology.
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Affiliation(s)
- Manhua Xu
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China
- Affiliated Hospital of Southwest Medical University, No.25, Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan Province, China
| | - Kaiming Li
- Affiliated Hospital of Southwest Medical University, No.25, Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan Province, China
| | - Weimin He
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China.
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Nivean M, Nivean DP, Raja R. An innovative alternative for spherophakia. GMS OPHTHALMOLOGY CASES 2021; 11:Doc07. [PMID: 33928004 PMCID: PMC8051592 DOI: 10.3205/oc000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: The aim of this case report is to report a new aphakic intraocular lens (IOL) that can be used for spherophakia. Methods: This is a single case report wherein the authors elaborate the technique of inserting the new IOL design in patients with spherophakia. Results: This new IOL design is very stable and is very promising in our follow-up of 6 months. Conclusion: The CM T-flex IOL can be a simple and alternate option for correcting aphakia.
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Affiliation(s)
| | - Devi Pratheeba Nivean
- M. N. Eye Hospital, Chennai, India,*To whom correspondence should be addressed: Devi Pratheeba Nivean, M. N. Eye Hospital, 781 Thiruvottiyur High Rd, Sanjeevarayanpet, Tondiarpet, Chennai, Tamil Nadu 600021, India, E-mail:
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Abstract
As a rare congenital disease, microspherophakia (MSP) is characterized by small and spherically shaped crystalline lenses. The common complications of MSP include secondary glaucoma and crystalline lens dislocation or subluxation. Patients with MSP often show high lenticular myopia. The special morphological characteristics and complex complications bring challenges to the treatment of patients with MSP. Although there are some studies on MSP, most are case reports. In this article, the morphological characteristics, complications, genetic diagnosis, and treatment of MSP were systematically reviewed, providing valuable insight into the clinical diagnosis and treatment of this disease.
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Singh SR, Yangzes S, Ram J. The golden ring. Oman J Ophthalmol 2019; 12:141. [PMID: 31198305 PMCID: PMC6561042 DOI: 10.4103/ojo.ojo_172_2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Simar Rajan Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonam Yangzes
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Khokhar S, Pillay G, Sen S, Agarwal E. Clinical spectrum and surgical outcomes in spherophakia: a prospective interventional study. Eye (Lond) 2017; 32:527-536. [PMID: 29099498 DOI: 10.1038/eye.2017.229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 08/17/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo study the varied clinical presentations of patients with spherophakia, their management using surgical methods, and the clinical outcomes.Patients and methodsA prospective interventional study of 13 patients of spherophakia who presented to us from January 2014 and were followed up over the course of their treatment, and the data were documented for analysis.ResultsIn all, 26 eyes of 13 patients were reviewed and the median age of presentation was 12±12.05 years. All patients had a bilateral presentation with 22 eyes having lenticular myopia with a mean refractive error of -11.5±12.945 DS. Ten eyes presented with glaucoma of which six had raised intraocular pressure (IOP) >21 mm Hg. A total of 23 eyes underwent lens extraction for dislocation/subluxation. Lens extraction helped lower overall IOP. Refractive rehabilitation was done with ACIOL, posterior chamber intraocular lens (PCIOL) with capsular tension ring, and scleral-fixated intraocular lens (SFIOL) in respective cases with ACIOLs being the most commonly used option.ConclusionsSpherophakia is a rare condition, which exhibits a varying degree of lenticular myopia, glaucoma, and subluxation of the crystalline lens. Lensectomy with proper rehabilitation using ACIOL, PCIOL, or SFIOL is a method of managing subluxation and unacceptable myopia. Lensectomy may also be a viable option of controlling glaucoma alongside medications and glaucoma surgery for the management of glaucoma in such cases.
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Affiliation(s)
- S Khokhar
- Cataract and Refractive Surgery Services, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - G Pillay
- Cataract and Refractive Surgery Services, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - S Sen
- Cataract and Refractive Surgery Services, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - E Agarwal
- Cataract and Refractive Surgery Services, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Rao DP, John PJ, Ali MH, Kekunnaya R, Jalali S, Garudadri CS, Senthil S. Outcomes of lensectomy and risk factors for failure in spherophakic eyes with secondary glaucoma. Br J Ophthalmol 2017; 102:790-795. [PMID: 28928265 DOI: 10.1136/bjophthalmol-2017-310861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To report the outcomes of lensectomy in spherophakic eyes with subluxated or dislocated crystalline lenses and secondary glaucoma. METHODS Lensectomy was performed in 52 eyes, 36 eyes with lens subluxation and 16 eyes with lens dislocation with secondary glaucoma from 1991 to 2016. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage. Complete success was defined as IOP ≥5 and ≤21 mm Hg without antiglaucoma medications (AGMs) or surgery, and eyes needing oral AGM or surgical intervention for IOP control or those with complication causing loss of light perception were considered failure. RESULTS Median (IQR) age at lensectomy was 12 (6-18) years, and median spherical equivalent was -14.5D (-23.7to -13). Median follow-up was 30.6 (5.4-103.4) months. Median logMAR (logarithm of minimal angle of resolution) visual acuity improved from 0.95 (0.6-1.8) to 0.4 (0.2-1.3) after lensectomy (p=0.01). Median IOP decreased from 22 mm Hg (17-31) to 14 mm Hg (11-19) at final follow-up (p=0.01). Median number of AGM decreased from 2 (2-3) to 1 (0-2) at final follow-up (p<0.0001), and glaucoma surgery was needed in four eyes (7.7% eyes). Complete success probability was 69% at 1 year and 51% at 5 years. Younger age (<6 years), higher presenting IOP (>32 mm Hg) and larger cup to disc ratio at presentation were found to be significant risk factors for failure. CONCLUSION Lensectomy was effective in controlling IOP in close to half of all eyes with spherophakia and secondary glaucoma, 40% eyes needed AGM and only 7.7% eyes needed glaucoma surgery for IOP control. In this cohort, younger age, higher IOP and larger cup to disc ratio at presentation were risk factors for poor glaucoma control after lensectomy.
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Affiliation(s)
- Divya P Rao
- VST Centre for Glaucoma, L V Prasad Eye Institute, Hyderabad, India
| | - Praveen J John
- VST Centre for Glaucoma, L V Prasad Eye Institute, Hyderabad, India
| | - Mohammed Hasnat Ali
- Department of Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute, Hyderabad, India
| | - Ramesh Kekunnaya
- Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Subhadra Jalali
- Srimathi Kanuri Santhamma Vitreoretinal Services, L V Prasad Eye Institute, Hyderabad, India
| | | | - Sirisha Senthil
- VST Centre for Glaucoma, L V Prasad Eye Institute, Hyderabad, India
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Rajamani M, Kawali A, Vijayalakshmi P, Puthuran GV. Response to ‘Role of miotics and cycloplegics in angle closure’. Eye (Lond) 2015; 29:1515-6. [DOI: 10.1038/eye.2015.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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