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Jia WN, Chen ZX, Wang YL, Shen X, Chen XY, Chen TH, Sun Y, Liu Y, Song LH, Huo QY, Jiang YX. Genotype Associated with Visual Prognosis in Patients with Congenital Ectopia Lentis following Lens Surgery: a Prospective Cohort Study. Am J Ophthalmol 2024:S0002-9394(24)00355-6. [PMID: 39121940 DOI: 10.1016/j.ajo.2024.08.002] [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: 04/09/2024] [Revised: 08/01/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE To investigate the relationship between visual prognosis and genotype in patients undergoing lens surgery for congenital ectopia lentis (EL). DESIGN Prospective clinical cohort study. METHODS Patients with congenital EL who underwent lens removal and intraocular lens implantation received panel-based next-generation sequencing. Patients were grouped into children and adolescents/adults based on the age at surgery. The visual prognosis, including best-corrected visual acuity (BCVA) and amblyopia, was stratified into short-term and medium to long-term. RESULTS This study included 329 probands with congenital EL, with a median age at lens surgery of 7.00 years (interquartile range [IQR] = 5.00, 12.50 years). Children with the non-FBN1 mutation exhibited inferior medium to long-term postoperative BCVA [0.26 (IQR: 0.14, 0.33) vs. 0.15 (IQR: 0.10, 0.22), P = 0.034] and a higher prevalence of amblyopia (44.4% vs. 16.8%, P = 0.012) compared to those with FBN1 mutation. Multivariable analysis showed that genotype (FBN1 vs. non-FBN1 mutation) was significantly associated with medium to long-term postoperative BCVA (b = -0.128, 95% CI -0.214 to -0.042, P = 0.004) and amblyopia (OR = 0.20, 95% CI 0.05 to 0.78, P = 0.020) in children. Further classification of FBN1 genotype did not yield significant correlations with visual prognosis. However, no significant correlation was observed between genotype and short-term visual prognosis in the children. Children with less severe EL (OR = 0.13, 95% CI 0.02 to 0.85, P = 0.033) had lower risks of amblyopia in the short-term follow-up. For adolescent and adult patients with congenital EL, those with poor preoperative BCVA and long axial length should be informed of suboptimal visual prognosis. CONCLUSIONS Genotype significantly influences the medium to long-term visual prognosis in children with congenital EL. Genotype, along with pre-operative BCVA, may assist in establishing reasonable expectations for patients regarding their visual outcomes after the lens surgery.
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Affiliation(s)
- Wan-Nan Jia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Ya-Lei Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Xin Shen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Xin-Yao Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Tian-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Yang Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Yan Liu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Ling-Hao Song
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Qiu-Yi Huo
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China.
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Chen Z, Jia W, Chen T, Shen X, Wang Y, Sun Y, Jiang Y. Safety and efficacy of capsular tension ring and capsular hook implantation for managing ectopia lentis in Marfan syndrome: real-world study. J Cataract Refract Surg 2024; 50:698-706. [PMID: 38409756 DOI: 10.1097/j.jcrs.0000000000001434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of capsular tension ring and capsular hook (CTR-CH) implantation in Marfan syndrome (MFS) patients with ectopia lentis (EL). SETTING Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN Retrospective propensity score-matched cohort study. METHODS This study included patients with MFS who had in-the-bag intraocular lens (IOL) implantation assisted by CTR-CH or modified CTR (MCTR). The safety analysis focused on the resurgery rate. The efficacy analysis compared the corrected distance visual acuity (CDVA) and the incidence of laser capsulotomy after propensity score matching (PSM). RESULTS This study encompassed 148 eyes that had the CTR-CH procedure and 162 eyes that received MCTR implantation. In the CTR-CH group, the median age at the time of surgery was 5 years, with a mean follow-up duration of 1.81 ± 0.4 years. 5 eyes (3.38%) required a second surgery because of retinal detachment (2, 1.35%), IOL decentration (2, 1.35%), and CH dislocation (1, 0.68%). The resurgery rate was comparable with that of the MCTR group ( P = .486). After PSM, a total of 108 eyes were recruited in each group. Postoperative CDVA was significantly improved in both groups (both P < .001), but comparable between the groups ( P = .057). The posterior capsular opacification took place earlier ( P = .046) while the anterior capsular opacification required laser capsulotomy at a later stage ( P = .037) compared with the MCTR group. CONCLUSIONS The CTR-CH procedure was a feasible, safe, and efficient approach for managing EL in patients with MFS.
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Affiliation(s)
- Zexu Chen
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China (Z. Chen, Jia, T. Chen, Shen, Wang, Sun, Jiang); NHC Key Laboratory of Myopia, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China (Z. Chen, Jia, T. Chen, Shen, Wang, Sun, Jiang); Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China (Z. Chen, Jia, T. Chen, Shen, Wang, Sun, Jiang)
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Chen ZX, Jia WN, Ma Y, Chen TH, Hong JH, Sun Y, Liu Y, Song LH, Jiang YX. Predicting axial length in patients with Marfan syndrome and ectopia lentis after modified capsular tension ring and intraocular lens implantation. J Cataract Refract Surg 2023; 49:571-577. [PMID: 36745849 DOI: 10.1097/j.jcrs.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To predict the growth of axial length (AL) in patients with Marfan syndrome (MFS) and ectopia lentis (EL). SETTING Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN Consecutive retrospective case series. METHODS Eyes were evaluated that had modified capsular tension ring and intraocular lens (IOL) implantation. The rate of AL growth (RALG) was calculated using AL divided by log10-transformed age. A multivariate linear regression model of RALG was developed after validation. RESULTS 128 patients with MFS and EL were enrolled with a median follow-up duration of about 3 years. RALG was independent of age between 3 years and 15 years old ( P = .799) and decreased to 0 thereafter ( P = .878). Preoperative AL was associated with RALG in patients under 15 years old ( P = .003). Beta values for the final model of RALG were as below: intercept (-9.794) and preoperative AL (0.664). The postoperative AL was predicted as: postAL = preAL + RALG × log 10 ([postAge + 0.6]/[preAge + 0.6]). The mean prediction error was -0.003 (95% CI, -0.386 to 0.3791) mm and the mean absolute percentage error was 1.93% (95% CI, 0.73% to 3.14%). A Python-based calculator was developed to use the predicted AL in selecting IOL power and setting undercorrection. CONCLUSIONS The AL growth of patients with MFS followed a logarithmic pattern and ceased at about age 15. A prediction model of postoperative AL was established for individual MFS patients between 3 and 15 years old, which could potentially optimize the IOL power selection.
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Affiliation(s)
- Ze-Xu Chen
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China (Z.-X. Chen, Jia, Ma, T.-H. Chen, Sun, Liu, Song, Jiang); NHC Key Laboratory of Myopia, Fudan University; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China (Z.-X. Chen, Jia, Ma, T.-H. Chen, Sun, Liu, Song, Jiang); Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China (Z.-X. Chen, Jia, Ma, T.-H. Chen, Sun, Liu, Song, Jiang); School of Computer Science, Fudan University Shanghai, China (Hong)
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Chen ZX, Jia WN, Sun Y, Chen TH, Zhao ZN, Lan LN, Liu Y, Song LH, Jiang YX. Biallelic ADAMTSL4 variants in a Chinese cohort of congenital ectopia lentis: Implications for genotype-phenotype relationships. Hum Mutat 2022; 43:2141-2152. [PMID: 36208099 DOI: 10.1002/humu.24483] [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: 04/19/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 01/25/2023]
Abstract
ADAMTSL4 variants are one of the common causes of congenital ectopia lentis (EL), reported ocular comorbidities of which include iris anomalies, cataract, and glaucoma. However, a genotype-phenotype correlation has not been established. Potentially pathogenic ADAMTSL4 variants were screened from a Chinese cohort of congenital EL using panel-based next-generation sequencing followed by multiple bioinformatics analyses. The genotype-phenotype correlation was assessed via a systematic review of ADAMTSL4 variants within our data and those from the literature. A total of 12 variants of ADAMTSL4, including seven frameshift variants, one nonsense variant, two splicing variants, and two missense variants, were found in nine probands. Combing genetic and clinical information from 72 probands in the literature revealed 37 ADAMTSL4 variants known to cause EL, and the ethnic difference was prominent. The lens was inclined to dislocate inferior temporally (22, 27.16%), while the pupil was always located oppositely (9, 81.82%). Several anterior segments anomalies were identified, including ectopia pupillae (15, 18.52%), persistent pupillary membrane (9, 11.10%), poor pupil dilation (4, 30.8%), cataract (13, 24.10%), and glaucoma (8, 13.33%). Genotype-phenotype analysis revealed that truncation variants had higher risks of combined iris anomalies, including either ectopia pupillae or a persistent pupillary membrane (p = 0.007). The data from this study not only extend our knowledge of the ADAMTSL4 variant spectrum but also suggest that deleterious variants of ADAMTSL4 might be associated with severe ocular phenotypes.
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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
| | - Yang Sun
- 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
| | - Tian-Hui 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
| | - Zhen-Nan Zhao
- 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
| | - Li-Na Lan
- 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
| | - Yan Liu
- 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
| | - Ling-Hao Song
- 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
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Li JT, Chen ZX, Chen XJ, Jiang YX. Mutation analysis of SUOX in isolated sulfite oxidase deficiency with ectopia lentis as the presenting feature: insights into genotype-phenotype correlation. Orphanet J Rare Dis 2022; 17:392. [PMID: 36303223 PMCID: PMC9615255 DOI: 10.1186/s13023-022-02544-x] [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: 06/14/2022] [Revised: 07/25/2022] [Accepted: 10/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Isolated sulfite oxidase deficiency (ISOD) caused by sulfite oxidase gene (SUOX) mutations is a rare neurometabolic disease associated with ectopia lentis (EL). However, few genotype–phenotype correlations have been established yet. Methods Potentially pathogenic SUOX mutations were screened from a Chinese cohort of congenital EL using panel-based next-generation sequencing and analyzed with multiple bioinformatics tools. The genotype–phenotype correlations were evaluated via a systematic review of SUOX mutations within our data and from the literature. Results A novel paternal missense mutation, c.205G > C (p.A69P), and a recurrent maternal nonsense mutation, c.1200 C > G (p.Y400*), of SUOX were identified in a 4-year-old boy from 312 probands. The biochemical assays manifested elevated urine sulfite and S-sulfocysteine accompanied by decreased homocysteine in the blood. The patient had bilateral EL and normal fundus, yet minimal neurological involvement and normal brain structure. Molecular modeling simulation revealed the p.A69P mutant had an unstable structure but an unchanged affinity for sulfite, while the truncated p.Y400* mutant showed decreased binding capacity. Genotype–phenotype analysis demonstrated patients with biallelic missense mutations had milder symptoms (P = 0.023), later age of onset (P < 0.001), and a higher incidence of regression (P = 0.017) than other genotypes. No correlations were found regarding EL and other neurological symptoms. Conclusion The data from this study not only enrich the known mutation spectrum of SUOX but also suggest that missense mutations are associated with mild and atypical symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02544-x.
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Affiliation(s)
- Jia-Tong Li
- Department of Neurology, Huashan Hospital and Institute of Neurology, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, 200031, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, 200031, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, 200031, Shanghai, China
| | - Xiang-Jun Chen
- Department of Neurology, Huashan Hospital and Institute of Neurology, Fudan University, Shanghai, China. .,National Center for Neurological Disorders, Shanghai, China. .,Human Phenome Institute, Fudan University, Shanghai, China.
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, 200031, Shanghai, China. .,Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, 200031, Shanghai, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, 200031, Shanghai, China.
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Zou C, Zhang T, Wang X, Zhuang H, Jiang R. Treatment of long-term endophthalmitis developing after intraocular lens implantation in children: a retrospective study. BMC Ophthalmol 2022; 22:301. [PMID: 35820855 PMCID: PMC9277780 DOI: 10.1186/s12886-022-02519-3] [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: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background To discussed the risk factor and the management of vitrectomy for long-term endophthalmitis developing after intraocular lens (IOL) implantation in children. Methods We retrospectively investigated the clinical characteristics and surgical outcomes of long-term endophthalmitis developing after IOL implantation in children. Results Four eyes of four children were included in the study. The mean time to endophthalmitis development after IOL implantation was 3.0 ± 0.8 years. The corneal or scleral sutures may have been caused the infection. All 4 patients underwent vitrectomy and received intravitreal antibiotics with or without IOL removal. At the last follow-up, the outcomes were satisfactory; the fundus was clear, the retina remained attached, the visual acuity improved, and there were no severe complications. Conclusions The use of scleral sutures and the exposure of conceal sutures may induce the onset of long-term endophthalmitis after IOL implantation. Complete vitrectomy and appropriate use of antibiotics are effective in the treatment of long-term endophthalmitis developing after IOL implantation in children.
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Affiliation(s)
- Chen Zou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Xin Wang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Hong Zhuang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83# Fenyang Road, Shanghai, China.
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Gao X, Zhu W, Tian J, Sun X, Ni Z, Yuan G, Zhang J. Outcomes of Transscleral Two-Point Fixation Versus Closed Continuous-Loop Four-Point Fixation of Intraocular Lens in Subluxated Lens Secondary to Marfan Syndrome. Ophthalmol Ther 2022; 11:1493-1502. [PMID: 35590126 PMCID: PMC9253219 DOI: 10.1007/s40123-022-00519-6] [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: 03/20/2022] [Accepted: 04/29/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction To compare the outcome of two different transscleral fixation approaches for posterior chamber intraocular lens (IOL) implantation, a two-point fixation of the Sensar (Allergan) or CZ70BD (Alcon) IOL and a four-point fixation of the Akreos Adapt (Bausch & Lomb) foldable IOL, for treatment of subluxated lenses in Marfan syndrome (MFS). Methods Fifty-three eyes of 33 consecutive patients with subluxated lenses secondary to MFS were studied. Eighteen patients with MFS (30 eyes) received two-point fixation of the Sensar (16 patients, 26 eyes) or CZ70BD (2 patients, 4 eyes) IOL, and 15 patients with MFS (23 eyes) received four-point fixation of the Akreos Adapt IOL. Preoperative and postoperative ophthalmologic examinations were performed. A primary outcome measure of postoperative complication was studied. Results The mean preoperative best corrected visual acuity (BCVA) in the two-point group was 0.68 ± 0.38 logarithm of the minimum angle of resolution (logMAR), and it improved to 0.30 ± 0.32 logMAR at the final follow-up (p < 0.05). The mean preoperative BCVA in the four-point group was 0.68 ± 0.45 logMAR, and it improved to 0.28 ± 0.28 logMAR at the final follow-up (p < 0.05). The BCVA results did not differ significantly between groups. The intraocular pressure was increased at the final follow-up in the two-point group (p < 0.05). Transscleral two-point fixation of IOL has relatively high incidences of pupillary capture of the IOL. Conclusion The closed continuous-loop transscleral four-point fixation of the Akreos Adapt foldable IOL is more suitable than two-point fixation of a two-haptic IOL in treating subluxated lenses due to MFS.
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Affiliation(s)
- Xiang Gao
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, Shandong Province, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China.,School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Wenting Zhu
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, Shandong Province, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China
| | - Jingyi Tian
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, Shandong Province, China.,School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Xiaolei Sun
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, Shandong Province, China.,School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Ziyi Ni
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Gongqiang Yuan
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, Shandong Province, China. .,School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
| | - Jingjing Zhang
- Eye Hospital of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, Shandong Province, China. .,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Qingdao, Shandong Province, China. .,School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
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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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Zhang M, Chen Z, Chen T, Sun X, Jiang Y. Cysteine Substitution and Calcium-Binding Mutations in FBN1 cbEGF-Like Domains Are Associated With Severe Ocular Involvement in Patients With Congenital Ectopia Lentis. Front Cell Dev Biol 2022; 9:816397. [PMID: 35237611 PMCID: PMC8882981 DOI: 10.3389/fcell.2021.816397] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: To investigate the clinical manifestations of congenital ectopia lentis (CEL) in patients with fibrillin (FBN1) calcium-binding epidermal growth factor (cbEGF)-like mutations. Design: Retrospective cohort study. Methods: Consecutive 68 CEL probands with FBN1 cbEGF-like mutations were recruited, mostly comprising Marfan syndrome (MFS) patients. Patients were classified into the cysteine group (n = 43), calcium (Ca2+)-binding group (n = 13) or the others (n = 12) according to their genotypes. Ocular biometrics, morbidities and visual performance were compared among different mutation groups. Linear regression was used to evaluate the risk factors for axial length (AL) elongation. Results: With age-adjustment, cysteine substitution and Ca2+-binding mutations positively contributed to AL elongation (standardized coefficient: 0.410 and 0.367, p = 0.008 and 0.017, respectively). In addition, cataract formation was more frequently detected in patients with Ca2+-binding mutations (observed n = 3, expected n = 1.0; p = 0.036). Patients with cysteine substitutions had the poorest preoperative visual acuity among the three groups (p = 0.012) and did not recover as well as other patients. More MFS diagnoses were made in patients with cysteine substitutions (observed n = 16, expected n = 12.6), while ectopia lentis syndrome was detected more often in patients with cbEGF-like mutations out of the functional regions (observed n = 6, expected n = 2.5; p = 0.023). Conclusion: Compared with patients with cbEGF-like mutations out of functional regions, patients with cysteine substitutions or Ca2+-binding mutations had longer ALs with age adjustment, poorer ocular involvement, visual performance, and systematic manifestations.
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Affiliation(s)
- Min Zhang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zexu Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Tianhui Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongxiang Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
- *Correspondence: Yongxiang Jiang,
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