High hyperopia with papillomacular fold

The Comparison of Soft HydroCone (Toris K) Silicone Hydrogel and Rigid Gas-Permeable Contact Lenses in Patients With Posterior Microphthalmos

OBJECTIVE

To evaluate and compare soft HydroCone (Toris K) silicone hydrogel and rigid gas-permeable contact lenses (RGPCLs) in patients with posterior microphthalmos (PMs), for visual rehabilitation and comfort.

METHODS

The records of 11 patients who were followed up in our hospital with the diagnosis of PM and were fitted with both Toris K and RGPCLs in our contact lens department were reviewed retrospectively. Patient age, gender, axial length (AL), topographic keratometry (K) values and best-corrected visual acuity (BCVA) with both lens types and subjective lens comfort status were recorded.

RESULTS

A total of 22 eyes of 11 patients with a mean age of 20.9±11.1 years were included in the study. The mean AL were 16.01±0.1 and 15.9±0.2 mm in the right and left eyes, respectively. Mean K1 and K2 were 48.6±2.2 and 49.4±2.2 D, respectively. Mean logMAR BCVA of the 22 eyes before contact lens fitting was 0.63±0.56 with spectacle. After Toris K and RGPCLs fitting, mean logMAR BCVA were 0.43±0.20 and 0.35±0.25, respectively. Both lenses provided better visual acuity than spectacles; RGPCLs also provided significantly better visual acuity than HydroCone lens ( P <0.05). Eight of 11 patients (73%) had ocular discomfort with RGPLs, and there was no complaint with Toris K.

CONCLUSIONS

The corneal surfaces are steeper in patients with PMs than in normal population. For that reason, their vision should be rehabilitated by special design keratoconus lenses like Toris K and RGPCLs. Although vision rehabilitation seems better with RGPCLs, these patients prefer Toris K more because of discomfort.

Ocular findings in posterior microphthalmos

AIM

To report a critical case series of six patients with posterior microphthalmos (PM).

METHOD

Complete ophthalmologic examinations of all patients were performed using best-corrected visual acuity (BCVA), cycloplegic refraction, applanation tonometry, slit lamp biomicroscopy of the anterior segment, fundoscopy, A and B mode ultrasonography (USG), keratometry, and optic coherence tomography (OCT).

RESULTS

The most significant clinical characteristics of male patients aged 10-25 years was the presence of shorter posterior segments (mean: 15.27-18.91 mm) accompanying high hyperopia (mean +9.00 - +18.50 diopter) despite the normal anterior segment findings. The BCVA ranged between 20/320 and 40/100. Retinal folds were detected bilaterally on the papillomacular band in all patients. Although neurosensory retina was included in the fold in OCT images, retinal pigment epithelium, choroid, and sclera were not included in the fold. Pigmentary retinopathy was detected in one patient.

CONCLUSION

Despite normal anterior segment, posterior microphthalmos is characterized with high hyperopia, and shorter axial length and bilateral papillomacular retinal fold. Refractive amblyopia, uveal effusion syndrome, retinal detachment and macular hole are complications that can be corrected. Posterior microphthalmos must be kept in mind in patients with a normal anterior segment, and high hyperopia.

High-hyperopia database, part I: clinical characterisation including morphometric (biometric) differentiation of posterior microphthalmos from nanophthalmos

PURPOSE To characterise and differentiate posterior microphthalmos (PM) and nanophthalmos (NO) using morphometric parameters.Patients and methodsConsecutive case database of patients with hyperopia >+7.00 D sphere was analysed retrospectively for clinical and biometric characterisation. Thirty-eight consecutive high-hyperopic subjects (75 eyes) with axial lengths <20.5 mm underwent uniform comprehensive ocular evaluation. Twenty-five subjects were diagnosed as PM and 13 as NO based on the horizontal corneal diameter. Parameters analysed included visual acuity, refraction, horizontal corneal diameter, anterior chamber depth, lens thickness, axial length, fundus changes, and associated ocular pathology.

PRIMARY OUTCOME MEASURES

ocular biometry difference between PM and NO.

SECONDARY OUTCOME MEASURES

differences in associated ocular pathologies between PM and NO.RESULTS Hyperopia ranged from +7 to +17 D and was similar in the two groups. Lens thickness was statistically more in NO than in PM group (4.53±0.75 mm vs 3.82±0.48 mm, P <0.001), whereas anterior chamber depth was more in the PM than in NO group (3.26±0.36 mm, vs 2.59±0.37 mm, P<0.001). NO had higher association with angle-closure glaucoma (66.7% vs 0%) and pigmentary retinopathy (38.5 vs 8.0%) but lesser association with macular folds (0% vs 24%) as compared with PM. NO was associated with poorer visual acuity.CONCLUSION PM and NO have significant differences in lens thickness, anterior chamber depth, prevalence of glaucoma, pigmentary retinopathy, macular pathology, and visual acuity while being similar in hyperopic refraction.

Biometric and molecular characterization of clinically diagnosed posterior microphthalmos

PURPOSE

To biometrically and molecularly characterize clinically diagnosed posterior microphthalmos.

DESIGN

Prospective case series.

METHODS

Twenty-five affected patients from 13 families diagnosed by ophthalmologists experienced with the condition at the King Khaled Eye Specialist Hospital were studied. All participants underwent axial length measurement, keratometry, corneal pachymetry, and candidate gene analysis (MFRP, PRSS56). Main outcome measures were the results of ocular biometry and gene analysis.

RESULTS

All patients (2-47 years of age) had high hyperopia, normal-appearing anterior segments, posterior chamber foreshortening, and characteristic papillomacular folds/wrinkles. For the right eye, mean cycloplegic refraction was +15.09 diopters (D) (range 9.88-18.75). Axial length (mean 16.25 mm [range 14.88-19.88]) had strong inverse correlation (Pearson coefficient -0.88, P < .0001) with corneal power (mean 48.89 D [range 41.91-52.25]) and a positive correlation with corneal diameter (Pearson 0.64, P = .001). Corneal thickness and anterior chamber dimensions were within normal ranges. Left eye data were similar. Nineteen Saudi patients (8/13 families) harbored 4 different homozygous PRSS56 mutations, 1 Indian and 1 Saudi patient harbored 2 different homozygous MFRP mutations, and 4 Saudi patients (3/13 families) had no detectable mutation in either gene. Patients with MFRP mutations were not clinically different from patients with PRSS56 mutations or no identified mutation. Truncating PRSS56 mutations were associated with shorter axial lengths (mean 15.72 mm) than missense PRSS56 mutations (mean 16.37 mm) or no identified mutation (mean 17.57 mm).

CONCLUSIONS

These data define posterior microphthalmos biometrically and reveal that corneal steepening proportional to the degree of axial foreshortening is part of the phenotype. Corneal diameter decreases with decreasing axial length, suggesting posterior microphthalmos and nanophthalmos represent a spectrum of high hyperopia rather than distinct phenotypes. In the Saudi population PRSS56 mutations are the major cause, and in our cohort truncating mutations were associated with a more severe phenotype.

Pervasive ocular anomalies in posterior microphthalmos

BACKGROUND

Posterior microphthalmos is a relatively rare condition that has been reported to coexist with several other ophthalmic conditions. However, to the best of the authors' knowledge, there are no previous reports that have found posterior microphthalmos and refractive, binocular, retinal, and neurologic considerations, along with a possible hereditary component. The following report documents the coexistence of posterior microphthalmos with severe hyperopia, esotropia, macular folds, and optic nerve hypoplasia in a pair of siblings.

CASE REPORT

A 9-year-old Hispanic girl presented for a comprehensive eye examination. Best-corrected visual acuity (VA) was reduced in both eyes with poorer VA in the right eye. Binocular testing found a small angle constant right esotropia (ET). On dilated fundus examination, a peculiar, elevated, dolphin-shaped folding of the macula was identified, the right eye greater than the left eye, that extended toward an anomalous optic nerve head in both eyes (OU), presumed to be a disc hypoplasia. The patient's brother, who also exhibited severe hyperopia and ET, presented with a similar acuity reduction, a nearly identical folded macular appearance, the right eye more so than the left eye, and a probable optic nerve hypoplasia. Pachymetry, ultrasonography, and ocular coherence tomography imaging of both siblings found thickened corneas in the presence of posterior microphthalmos OU and macular folds affecting only the retina, leaving the choroid and sclera unaffected.

CONCLUSIONS

Posterior microphthalmos may exist in the presence of ocular anomalies along with refractive, binocular, retinal, neurologic, and genetic considerations. In this case, optical coherence tomography provided information on the internal morphology of the macular folds, which helped direct the differential diagnosis. The similar presentation among siblings supports a hereditary component that warrants further investigation.

Microphtalmie postérieure bilatérale associée à un pli papillo-maculaire et une forte hypermétropie

Posterior microphthalmos with papillomacular fold is a rare disorder that involves both eyes without other ocular or systemic abnormalities. It is characterized by a short posterior segment with a normal anterior segment. We report the case of a 3.5-year-old boy with high hyperopia. The fundus examination showed bilateral papillomacular fold and ultrasonography confirmed the posterior microphthalmos. We comment on clinical characteristics, pathogenicity, and inheritance modes of this rare congenital disorder.

Posterior segment changes associated with posterior microphthalmos

PURPOSE

To characterize and analyze the posterior segment ocular involvement in patients with posterior microphthalmos.

DESIGN

Retrospective observational case series.

PARTICIPANTS

Eighteen patients (8 sporadic cases and 10 siblings from 5 different families) between the age of 4 and 36 years with posterior microphthalmos.

METHODS

Records of patients with posterior microphthalmos over a 5-year-period were reviewed, including clinical, fundus photographic, fluorescein angiographic, and ultrasonographic findings, and management.

RESULTS

All patients had bilateral foreshortening of the posterior ocular segment (range, 7--11.2 mm) with associated high hyperopia (range, +12.00--+19.00 diopters) and normal or slightly smaller than normal anterior segment dimensions. Visual acuity ranged from 20/200 to 20/40. Inheritance of this syndrome was compatible with an autosomal recessive pattern. Posterior segment changes included bilateral elevated papillomacular retinal fold (13 patients, 72.2%); fine retinal folds (6 patients, 33.3%); chorioretinal folds (11 patients, 61.1%); uveal effusion syndrome (3 patients, 16.7%); pigmentary retinopathy (4 patients, 22.2%), including retinitis punctata albescens in 1 patient; absence or marked reduction of the capillary-free zone (18 patients, 100%); crowded optic discs (18 patients, 100%); and sclerochoroidal thickening on ultrasonography (18 patients, 100%). Two patients with uveal effusion were successfully treated with scleral surgery.

CONCLUSION

A wide variety of congenital or acquired posterior segment changes may be encountered in patients with posterior microphthalmos. Although high hyperopia and elevated papillomacular retinal fold are the main causes of visual impairment, other chorioretinal changes, such as pigmentary retinopathy, chorioretinal folds and uveal effusion syndrome, should be considered as causes of visual disturbance in patients with posterior microphthalmos. Early ultrasonographic diagnosis, close follow-up, and appropriate management are mandatory to improve or maintain visual function in such patients.

Good visual function in posterior microphthalmos

Posterior microphthalmos is a rare condition in which the anterior segment is normal in size and configuration, but the posterior segment is reduced in size; this results in axial hyperopia and retinal folding. Patients have decreased vision that is caused by posterior segment abnormalities, high refractive error, and amblyopia. We present a case of posterior microphthalmos in which retinal function was relatively intact and visual loss was believed to be primarily caused by refractive error and amblyopia. After treatment, the child's visual acuity and school performance improved. This case emphasizes the need for careful examination, refraction, and follow-up for these children because their visual potential may be reasonably good.