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Mitra A, Choudhury S, Sar S, Das N, Chaudhury D. Complete detachment of the Schwalbe's line in a case of Axenfeld-Reiger anomaly - A rare presentation. Indian J Ophthalmol 2022; 70:2648-2650. [PMID: 35791187 PMCID: PMC9426130 DOI: 10.4103/ijo.ijo_2291_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Arijit Mitra
- Disha Eye Hospitals Pvt. Ltd., Barrackpore, Kolkata, West Bengal, India
| | - Sumit Choudhury
- Disha Eye Hospitals Pvt. Ltd., Barrackpore, Kolkata, West Bengal, India
| | - Suchanda Sar
- Disha Eye Hospitals Pvt. Ltd., Barrackpore, Kolkata, West Bengal, India
| | - Nibedita Das
- Disha Eye Hospitals Pvt. Ltd., Barrackpore, Kolkata, West Bengal, India
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Mahalingam K, Singh A, Gupta V, Gupta S. Hyperproliferative embryotoxon simulating double cornea. BMJ Case Rep 2021; 14:e246960. [PMID: 34937757 PMCID: PMC8704954 DOI: 10.1136/bcr-2021-246960] [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] [Accepted: 11/23/2021] [Indexed: 11/04/2022] Open
Abstract
Posterior embryotoxon, an anteriorly displaced Schwalbe's line, is the most common feature of Axenfeld Rieger syndrome. We report a case of Axenfeld anomaly with unusual corneal manifestation, that is, a fairly symmetric, hyperproliferated posterior embryotoxon mimicking double cornea as well as a double pupil.
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Affiliation(s)
- Karthikeyan Mahalingam
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Abhishek Singh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Viney Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shikha Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Ong APC, Zhang J, Vincent AL, McGhee CNJ. Megalocornea, anterior megalophthalmos, keratoglobus and associated anterior segment disorders: A review. Clin Exp Ophthalmol 2021; 49:477-497. [PMID: 34114333 DOI: 10.1111/ceo.13958] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 01/21/2023]
Abstract
Megalocornea and anterior megalophthalmos (megalocornea spectrum) disorders are typically defined by corneal diameter > 12.5 mm in the absence of elevated intraocular pressure. Clinical features overlap with keratoglobus but are distinct from buphthalmos and severe (globus) keratoconus. Megalocornea spectrum disorders and keratoglobus are primarily congenital disorders, often with syndromic associations; both can present with large and thin corneas, creating difficulty in diagnosis, however, only keratoglobus is typically progressive. Molecular genetics provide significant insight into underlying aetiologies. Nonetheless, careful clinical assessment remains intrinsic to diagnosis. Surgical management can be challenging due to the enlarged ciliary ring and weakened zonules in megalocornea spectrum disorders and the extreme corneal thinning of keratoglobus. In this review, the established literature on measurement of corneal diameter, diagnosis of megalocornea, anterior megalophthalmos and keratoglobus, differentiation from severe keratoconus, recent molecular genetics research and key surgical modalities in the management of these rare disorders are outlined and discussed.
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Affiliation(s)
- Aaron P C Ong
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Southern District Health Board, Dunedin, New Zealand
| | - Jie Zhang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrea L Vincent
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Koc M, Kosekahya P, Inanc M, Tekin K. Corneal crosslinking in a case with Axenfeld-Rieger syndrome and unilateral pellucid marginal degeneration. Ther Adv Ophthalmol 2019; 11:2515841418822288. [PMID: 30729234 PMCID: PMC6350116 DOI: 10.1177/2515841418822288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022] Open
Abstract
A 31-year-old male patient presented with the complaint of progressive vision loss in his left eye. Slit-lamp examination showed posterior embryotoxon, iris hypoplasia, and iridocorneal adhesion in both eyes, corectopia in the right, and peripheral inferior thinning and ectasia in the left eye. Corneal topography showed slightly asymmetric bowtie pattern in the right eye and crab-claw pattern in the left eye. Topographic examination was compared with his previous topography. The comparison showed 1.6-D steepening of maximum keratometry (Kmax) and 22-µm decrease of thinnest corneal pachymetry. Corneal crosslinking treatment was performed on the left eye. At the postoperative 28-month follow-up visit, Kmax decreased from 54.1 to 53.0 D and corrected distance visual acuity improved to 20/20 with scleral lens. This is the first reported a case with Axenfeld–Rieger syndrome and pellucid marginal degeneration association. We suggest that corneal crosslinking can be useful for management of pellucid marginal degeneration and longer follow-up might be needed in order to corroborate the effectiveness of the corneal crosslinking procedure.
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Affiliation(s)
- Mustafa Koc
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pinar Kosekahya
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
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Abstract
RATIONALE Axenfeld-Rieger syndrome (ARS) is a rare autosomal dominant disorder with ocular anterior segment dysgenesis and systemic anomalies. PATIENT CONCERNS A 28-year-old Chinese Han female was referred to Beijing Tongren Eye Center for progressive decrease of the visual acuity on her right eye in the past month. DIAGNOSES The patient was diagnosed as ARS with retinal detachment based on series of ophthalmic examinations performed. INTERVENTIONS A pars plana vitrectomy was performed to manage the retinal detachment. OUTCOMES Her best-corrected visual acuity was slightly improved after surgery. LESSONS ARS is a developmental defect of ocular anterior segment with various clinical manifestations which might cause misdiagnosis.
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Affiliation(s)
- Wei Song
- Department of Ophthalmology, Jiaxing Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Jiaxing, Zhejiang Province
| | - Xiaodan Hu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Dongcheng District, Beijing, China
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Síndrome de Axenfeld-Rieger: Hallazgos clínicos, ecográficos y en ultrabiomicroscopia. REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Radhakrishnan OK, Pahuja K, Patel K, Chandna S. OLOGEN(®) implant in the management of glaucoma in an unusual case of Axenfeld-Rieger syndrome. Oman J Ophthalmol 2014; 7:90-2. [PMID: 25136237 PMCID: PMC4134556 DOI: 10.4103/0974-620x.137170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report an unusual case of Axenfeld–Rieger Syndrome with secondary glaucoma managed with Ologen® implant. A 35-year-old male presented with complaints of decreased vision in both eyes of 22 years duration. His best corrected visual acuity (BCVA) was no perception of light in right eye and 20/30 in left eye. Gonioscopy revealed anterior insertion of iris into trabecular meshwork, prominent iris processes and broad-based synechiae with prominent Schwalbe's line along the angle circumference with cord-like structures taking its origin at the level of Schwalbe's line in both eyes. Fundus examination revealed total glaucomatous optic atrophy in right eye with 0.9:1 cup disc ratio with bipolar notch in left eye. Humphrey visual field analysis showed superior and inferior arcuate scotoma in left eye. Intraocular pressure measured by Goldman applanation tonometry was 30 mmHg and 26 mmHg in right and left eye, respectively. After an unsuccessful medical management, he underwent trabeculectomy with Ologen® implant under local anesthesia in his left eye. Postoperatively, at the end of one year, intraocular pressure (IOP) in his left eye was controlled without medication. This case highlights the management of secondary angle closure glaucoma in Axenfeld–Rieger syndrome with Ologen® implant.
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Affiliation(s)
- O K Radhakrishnan
- Department of Ophthalmology, Padmashree Dr. D. Y. Patil University Pimpri, Pune, Maharashtra, India
| | - Kishore Pahuja
- Natasha Eyecare and Research Centre, Sai Saheb Bldg. Pimple Saudagar, Pune, Maharashtra, India
| | - Khevna Patel
- Department of Ophthalmology, Padmashree Dr. D. Y. Patil University Pimpri, Pune, Maharashtra, India
| | - Sunaina Chandna
- Department of Ophthalmology, Padmashree Dr. D. Y. Patil University Pimpri, Pune, Maharashtra, India
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Parikh RS, Parikh SR, Debashish B, Harsha BL, Thomas R. Unusual presentation in Axenfeld-Rieger syndrome. Indian J Ophthalmol 2011; 59:312-4. [PMID: 21666320 PMCID: PMC3129760 DOI: 10.4103/0301-4738.82003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report an unusual presentation of a case of Axenfeld-Rieger (A-R) syndrome. A 14-year-old male presented with gradual dimness of vision for 1 year and redness of left eye for 3 days. The patient had megalocornea with Haab's striae in the right eye and posterior embryotoxon in both the eyes. In the left eye, there was a white cord-like structure traversing the anterior chamber with adhesions to iris tissue along its course. On two antiglaucoma medications, his intraocular pressure (IOP) was 22 mm Hg in the right eye and 18 mm Hg in the left eye. Gonioscopy revealed a cord-like structure originating at the level of Schwalbe's line. He underwent right eye trabeculectomy with mitomycin-C. This case highlights a rare presentation of a strange cord-like structure, a rare presentation of A-R syndrome.
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Affiliation(s)
- Rajul S Parikh
- Department of Glaucoma and Clinical Research, Bombay City Eye Institute and Research Centre, Mumbai, India.
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