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Abstract
PURPOSE To study the safety of phacoemulsification in eyes with long anterior zonules (LAZs). SETTING Institute. DESIGN Retrospective interventional case series. METHODS All patients with clinically proven LAZs who had undergone phacoemulsification by a single surgeon from January 2014 to December 2018 were included. All cases of LAZs with cataract extraction by procedures other than phacoemulsification or combined with any other ocular surgery were excluded. Sixty-five eyes of 52 patients were analyzed. Phacoemulsification with capsulorhexis that involves sacrificing the LAZs was performed. The primary outcome measures were the incidence of capsulorhexis extension or the need to rescue intraoperatively and the rate of intraoperative complications. Secondary outcomes assessed were the percentage of eyes within ±0.5 diopters (D) and ±1 D of the target refraction. RESULTS Sixty-five eyes (52 patients) were analyzed; the mean age of patients was 67.3 ± 7.4 years. The successful completion of an adequately sized capsulorhexis without extension or rescue was seen in 100% of cases. The incidence of intraoperative complications was 1.5% (posterior capsular rupture in 1 eye). The mean postoperative corrected distance visual acuity was 0.05 ± 0.1 (logarithm of the minimum angle of resolution) at a mean of 26.8 ± 7.6 days. The mean spherical equivalent was -0.15 ± 0.7 D. Eyes within ±0.5 D and ±1.00 D of the target refraction were 77% and 94%, respectively. CONCLUSIONS Phacoemulsification in eyes with LAZs can be safely performed through an adequately sized capsulorhexis by sacrificing, ie, cutting or breaking, the anteriorly inserted zonules 360 degrees without significant intraoperative complications.
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Ksiazek S, Jones WB, Bassnett S, Roberts DK. Capsulorhexis challenge with long anterior lens zonules. Am J Ophthalmol Case Rep 2020; 19:100756. [PMID: 32529119 PMCID: PMC7276380 DOI: 10.1016/j.ajoc.2020.100756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Susan Ksiazek
- University of Chicago Pritzker School of Medicine, Department of Ophthalmology and Visual Science, DCAM Eye Center, 5758, South Maryland, Chicago, IL, USA
- Corresponding author. Marshfield Clinic Wausau Eye Center, 2727 Plaza Drive, Wausau, WI, 54401, USA.
| | - Wendell B. Jones
- Washington University School of Medicine, Department of Ophthalmology and Visual Sciences, 660 South Euclid, St. Louis, MO, USA
| | - Steven Bassnett
- Washington University School of Medicine, Department of Ophthalmology and Visual Sciences, 660 South Euclid, St. Louis, MO, USA
| | - Daniel K. Roberts
- Illinois Eye Institute, Department of Clinical Education, Illinois College of Optometry, 3241, S. Michigan Ave, Chicago, IL, USA
- University of Illinois at Chicago, Department of Epidemiology and Biostatistics, 1603, West Taylor, Chicago, IL, USA
- University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences, 1855, West Taylor, Chicago, IL, USA
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Newman TL, Roberts DK, Morettin CE, McMahon JM, Roberts MF. Krukenberg's Spindles Strongly Suggest Long Anterior Zonule Associated Pigment Dispersion Mechanism in Older Patients. Invest Ophthalmol Vis Sci 2020; 61:8. [PMID: 32634206 PMCID: PMC7425699 DOI: 10.1167/iovs.61.8.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to further investigate factors associated with Krukenberg’s spindle (KS) presence in a primary eye care setting. Methods As part of a larger investigation, several practitioners in an academic eye care facility in Chicago, IL, USA evaluated patients for the long anterior zonule (LAZ) trait during 2011 to 2018, and data were collected on ocular/systemic health, lifestyle, and demographic variables, including the presence of a KS. Multivariate regression was used to assess relationships to KS presence. Results Analysis included 3501 subjects with mean age of 51 ± 15 years (18–98 years; 65% women; and 84% African American). Among the right eyes, 57 (1.6%) had a KS, with this group having a mean age of 62 ± 13 years (25–86 years; 75% women; and 82% African American). There were 120 subjects (3.4%) with right eye LAZ, with mean age of 64 ± 11 years (36–91 years; 77% women; and 92% African American). There were 19 of 57 (33.3%) KS eyes that also had LAZ. Controlling for other factors, variables with the strongest relationship to KS presence were the LAZ trait (odds ratio [OR] = 12.2, 95% confidence interval [CI] = 6.5 to 22.8, P < 0.0001) and advancing age (OR = 1.3 per decade, 95% CI = 1.3 to 1.9, P < 0.0001). Conclusions In the population studied, KS presence had its strongest relationship to the LAZ trait and advancing age. The KS-LAZ relationship may not be well-known, but these data strongly suggest that pigment dispersion signs, such as a KS, should prompt the clinician to consider the LAZ trait as a potential etiology, especially because LAZ is associated with higher IOP and possibly glaucoma.
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Papastavrou VT, Borooah S, O'Brien JM, Ray-Chaudhuri N, Dhillon B, Vieira RV, Browning AC. Cataract surgery in patients with late-onset retinal degeneration. J Cataract Refract Surg 2019; 43:1036-1043. [PMID: 28917403 DOI: 10.1016/j.jcrs.2017.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/27/2017] [Accepted: 05/21/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To review the outcomes in a series of patients with long anterior lens zonular fibers associated with late-onset retinal degeneration who had phacoemulsification cataract surgery. SETTING Newcastle Eye Centre, Newcastle upon Tyne, United Kingdom. DESIGN Retrospective case series. METHODS Inclusion criteria were patients with genetically confirmed late-onset retinal degeneration requiring cataract surgery. Perioperative data relating to surgery were collected. In addition, the corrected distance visual acuity (CDVA) and retinal imaging data were recorded. Selected lens capsules were examined using immunohistochemistry or scanning electron microscopy (SEM). RESULTS Eleven eyes of 7 patients were included. The long anterior lens zonular fibers made capsulorhexis challenging; however, it was completed safely in all cases. There were no intraoperative or postoperative issues with lens stability. The CDVA improved postoperatively in those cases with intact foveal photoreceptors and retinal pigment epithelium. Over the longer term, the CDVA slowly declined because of progressive atrophy of the macula. Most patients noticed a subjective improvement in vision, even those with advanced disease at baseline. Immunohistochemistry showed that the C1QTNF5 protein was expressed within the lens capsule epithelial cells, although SEM of the long anterior lens zonular fibers showed them to be smaller in diameter than normal anterior lens zonular fibers and to be composed of a helix of fibers. CONCLUSIONS In this small series of patients with late-onset retinal degeneration, cataract surgery was successfully performed without long-term complications involving intraocular lens stability. The objective improvement in CDVA seemed to be limited to patients with good foveal photoreceptor architecture.
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Affiliation(s)
- Vasileios T Papastavrou
- From the Newcastle Eye Centre (Papastavrou, O'Brien, Ray-Chaudhuri, Browning), Royal Victoria Infirmary, the Institute of Genetic Medicine (Browning), International Centre for Life and the Institute of Health and Society (Vieira), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, and the Department of Ophthalmology (Borooah, Dhillon), Princess Alexandra Eye Pavilion, Edinburgh, Scotland, United Kingdom
| | - Shyamanga Borooah
- From the Newcastle Eye Centre (Papastavrou, O'Brien, Ray-Chaudhuri, Browning), Royal Victoria Infirmary, the Institute of Genetic Medicine (Browning), International Centre for Life and the Institute of Health and Society (Vieira), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, and the Department of Ophthalmology (Borooah, Dhillon), Princess Alexandra Eye Pavilion, Edinburgh, Scotland, United Kingdom
| | - Jill M O'Brien
- From the Newcastle Eye Centre (Papastavrou, O'Brien, Ray-Chaudhuri, Browning), Royal Victoria Infirmary, the Institute of Genetic Medicine (Browning), International Centre for Life and the Institute of Health and Society (Vieira), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, and the Department of Ophthalmology (Borooah, Dhillon), Princess Alexandra Eye Pavilion, Edinburgh, Scotland, United Kingdom
| | - Neeta Ray-Chaudhuri
- From the Newcastle Eye Centre (Papastavrou, O'Brien, Ray-Chaudhuri, Browning), Royal Victoria Infirmary, the Institute of Genetic Medicine (Browning), International Centre for Life and the Institute of Health and Society (Vieira), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, and the Department of Ophthalmology (Borooah, Dhillon), Princess Alexandra Eye Pavilion, Edinburgh, Scotland, United Kingdom
| | - Baljean Dhillon
- From the Newcastle Eye Centre (Papastavrou, O'Brien, Ray-Chaudhuri, Browning), Royal Victoria Infirmary, the Institute of Genetic Medicine (Browning), International Centre for Life and the Institute of Health and Society (Vieira), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, and the Department of Ophthalmology (Borooah, Dhillon), Princess Alexandra Eye Pavilion, Edinburgh, Scotland, United Kingdom
| | - Rute V Vieira
- From the Newcastle Eye Centre (Papastavrou, O'Brien, Ray-Chaudhuri, Browning), Royal Victoria Infirmary, the Institute of Genetic Medicine (Browning), International Centre for Life and the Institute of Health and Society (Vieira), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, and the Department of Ophthalmology (Borooah, Dhillon), Princess Alexandra Eye Pavilion, Edinburgh, Scotland, United Kingdom
| | - Andrew C Browning
- From the Newcastle Eye Centre (Papastavrou, O'Brien, Ray-Chaudhuri, Browning), Royal Victoria Infirmary, the Institute of Genetic Medicine (Browning), International Centre for Life and the Institute of Health and Society (Vieira), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, and the Department of Ophthalmology (Borooah, Dhillon), Princess Alexandra Eye Pavilion, Edinburgh, Scotland, United Kingdom.
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Roberts DK, Newman TL, Roberts MF, Teitelbaum BA, Winters JE. Long Anterior Lens Zonules and Intraocular Pressure. Invest Ophthalmol Vis Sci 2019; 59:2015-2023. [PMID: 29677364 PMCID: PMC5907516 DOI: 10.1167/iovs.17-23705] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To investigate the relation between intraocular pressure (IOP) and the idiopathic long anterior zonule (LAZ) trait. Methods Patients presenting for primary eye care were examined for LAZ, identified as radially oriented zonular fibers with central extension >1.0 mm beyond the normal anterior lens insertion zone (estimated via slit lamp beam length). Ocular, systemic health, and lifestyle data were collected via comprehensive exam and questionnaire. Multivariate regression was used to assess the relationship between IOP (Goldmann) and LAZ. Results There were 2169 non-LAZ and 129 LAZ subjects (mean age: 49.8 ± 15.0 vs. 62.6 ± 10.2 years; 63.6% vs. 76.0% female; 83.2% vs. 91.5% African American). Right eyes with >trace LAZ (n = 59 of 110) had higher unadjusted mean IOP than control eyes (16.4 ± 3.3 vs. 15.0 ± 3.3 mm Hg, P = 0.005), and with control for numerous factors, LAZ eyes had an average IOP of approximately 1.3 ± 0.4 mm Hg higher (P = 0.003) than non-LAZ eyes. Final model covariates included sex (P = 0.001); spherical-equivalent refractive error (D; P < 0.0001); body mass index (kg/m2; P < 0.001); presence of diabetes (P < 0.001); having >high school education (P < 0.001); systolic blood pressure (mm Hg; P < 0.0001); being an ever smoker (P = 0.006); and having history of any site cancer (P = 0.01). Conclusions The LAZ trait, with potential prevalence near 2%, was associated with a higher IOP. This observation is consistent with the hypothesis that the trait is a marker for underlying mechanisms that elevate glaucoma risk.
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Affiliation(s)
- Daniel K Roberts
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, Illinois, United States.,University of Illinois at Chicago, School of Medicine, Department of Ophthalmology and Visual Sciences, Chicago, Illinois, United States.,University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics, Chicago, Illinois, United States
| | - Tricia L Newman
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, Illinois, United States
| | - Mary Flynn Roberts
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, Illinois, United States
| | - Bruce A Teitelbaum
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, Illinois, United States
| | - Janis E Winters
- Illinois Eye Institute, Illinois College of Optometry, Department of Clinical Education, Chicago, Illinois, United States
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Abstract
PURPOSE To investigate presence of remnants of the tunica vasculosa lentis, a possible indication of anterior segment dysgenesis, in subjects with the long anterior zonule (LAZ) trait. METHODS Retroillumination photographs of the pupil region had been collected in earlier study of the LAZ trait in African Americans. Secondary image analysis was performed to assess the frequency of intact persistent pupillary membrane iris strands (PPMIS). RESULTS The analysis included 148 subjects, comprised of 74 LAZ subjects (median age=70 y; range, 50 to 91 y; 64 females) and 74 controls (68 y; 50 to 83 y; 64 females). While controlling for age and sex, analysis showed that LAZ subjects were 3.1 times more likely than controls (odds ratio=3.1; 95% confidence interval, 1.4-6.7; P=0.004) to exhibit PPMIS in at least one of their eyes. CONCLUSION The LAZ trait, which is being studied as a potential risk factor for glaucoma, was associated with presence of PPMIS in our study population.
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Anterior Chamber Depth, Lens Thickness, and Related Measures in African American Females With Long Anterior Zonules: A Matched Study With Control for Refractive Error. J Glaucoma 2014; 25:45-8. [PMID: 25093521 DOI: 10.1097/ijg.0000000000000085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate anterior chamber depth (ACD), lens thickness (LT), vitreous body length (VBL), and axial length (AL) in African American females with long anterior zonules (LAZ) while controlling for refractive error. METHODS The eyes of 50 African American females with LAZ were compared with 50 controls matched with age, race, sex, and refractive error. Central ACD, LT, VBL, and AL measurements were obtained in a masked manner using a-scan ultrasonography. RESULTS LAZ cases had a mean age±SD of 67.1±7.6 years (range, 52 to 85 y) and a mean refractive error of +1.85±1.41 D (-1.75 to +4.75 D). Parameters were similar for controls. Mean ACD for cases was 2.45±0.34 mm and 2.57±0.38 mm for controls. Mean LT for cases was 4.94±0.43 mm and 4.83±0.45 mm for controls. Mean VBL for cases was 15.00±0.72 mm and 15.17±0.76 mm for controls. Mean AL for cases was 22.39±0.82 mm and 22.57±0.76 mm for controls. Using multiple logistic regression to control for any residual differences in age and refractive error, no significant differences were present between LAZ eyes and control eyes relative to the a-scan variables (P>0.1). CONCLUSIONS When refractive error was controlled for, this group of African American females with LAZ did not exhibit clinically significant differences in ACD, LT, VBL, and AL as compared with controls.
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Roberts DK, Yang Y, Wilensky JT. Cataract surgery in African Americans with long anterior lens zonules. Clin Exp Ophthalmol 2014; 42:898-900. [DOI: 10.1111/ceo.12341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel K Roberts
- Illinois Eye Institute, Department of Clinical Education; Illinois College of Optometry; Chicago Illinois USA
- Department of Epidemiology and Biostatistics; University of Illinois at Chicago; Chicago Illinois USA
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
| | - Yongyi Yang
- Department of Electrical and Computer Engineering; Illinois Institute of Technology; Chicago Illinois USA
| | - Jacob T Wilensky
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois USA
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Chen SDM, Glover N, Patel CK. Trypan blue staining of anteriorly placed zonules in patients with pigment dispersion. J Cataract Refract Surg 2004; 30:2462-3; author reply 2463. [PMID: 15617897 DOI: 10.1016/j.jcrs.2004.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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