Intraocular Lens Dislocation into the Anterior Chamber because of Repeated Eye-Poking in a Patient with Leber's Congenital Amaurosis

Unintended placement of intraocular lens haptics in the sulcus and its association with posterior capsular opacification in pseudophakic post-mortem eyes

OBJECTIVE

To assess the prevalence of unintended placement of intraocular lens (IOL) haptics in the sulcus and its association with posterior capsular opacification (PCO).

DESIGN

Cross-sectional study.

PARTICIPANTS

428 post-mortem pseudophakic human eyes.

METHODS

Eyes were obtained from the Lions Gift of Sight and imaged in Miyake-Apple view (MAV). IOL haptic placement (bag-bag, bag-sulcus, sulcus-sulcus) was determined from the MAV images. IOL-capsular bag complexes were extracted and analyzed via Automated Detector Opacification Software to quantify PCO and Soemmering's Ring (SR). SR distribution was categorized as focal, diffuse, or none. Mean differences in PCO and SR between haptic groups were assessed via Welch's t-test. Odds ratios were used to compare the risk of SR distribution patterns between both haptic groups. Sex, clinical history (diabetes, smoking, hypertension, glaucoma, cancer, age-related macular degeneration [AMD], hypercholesterolemia, cardiovascular disease), and IOL model and specifications were collected.

RESULTS

20 eyes (4.67%) had unintended sulcus placement of haptics. Mean PCO (p = 0.0367) and SR (p = 0.0414) were significantly higher in sulcus eyes. Sulcus eyes were significantly more at risk of focal SR distribution (OR 8.715; p < 0.0001) and significantly less at risk of diffuse SR distribution (OR 0.168; p = .0007). Sulcus eyes had significantly higher frequencies of glaucoma (p < 0.0001) and AMD (p = 0.0023) on clinical history.

CONCLUSIONS

This study demonstrates that unintended sulcus placement of IOL haptics may be associated with an increased risk of PCO and SR formation. This study offers clinical signs of sulcus haptic placement that may prompt physicians to seek earlier appropriate intervention.

Predictors of Receiving Keratoplasty for Keratoconus

PURPOSE

To identify sociodemographic factors and comorbid conditions associated with receiving keratoplasty for keratoconus (KCN).

DESIGN

Retrospective, cross-sectional study.

METHODS

Health records of KCN patients <65 years of age from 2011 to 2018 were obtained from the IBM MarketScan Database. A multivariable model adjusted for potential confounders was used to examine factors associated with the risk of receiving keratoplasty.

RESULTS

Of 42,086 total patients with KCN identified, 1282 (3.0%) patients had keratoplasty to treat KCN. In the fully adjusted analysis, female sex (odds ratio [OR] 0.87 [95% confidence interval {CI} 0.78-0.98]) and living in metropolitan areas (OR 0.75 [95% CI 0.63-0.90]) were associated with lower odds of receiving keratoplasty. Compared with individuals 10 to 19 years of age, those 20 to 29 years of age (OR 1.77 [95% CI 1.31-2.41]) and 30 to 39 years of age (OR 1.61 [95% CI 1.19-2.17]) were more likely to have keratoplasty, while individuals in the older age groups (50-64 years of age) did not show statistically significant associations. Conditions associated with higher odds of receiving keratoplasty were corneal hydrops (OR 4.87 [95% CI 4.07-5.82]), Leber congenital amaurosis (OR 2.41 [95% CI 1.02-5.71]), sleep apnea (OR 1.46 [95% CI 1.25-1.71]), diabetes mellitus (OR 1.32 [95% CI 1.13-1.54]), and depression (OR 1.22 [95% CI 1.03-1.44]). Conditions associated with lower odds were previous contact lens usage (OR 0.61 [95% CI 0.50-0.74]) and a history of glaucoma (OR 0.60 [95% CI 0.49-0.73]).

CONCLUSIONS

This analysis of a large sample of patients with KCN reveals previously unidentified risk factors associated with receiving keratoplasty including Leber congenital amaurosis, depression, and diabetes. Future research should examine if young patients with these conditions may benefit from more frequent follow-up and/or early crosslinking to reduce the need for subsequent keratoplasty.

Late Nontraumatic Anterior Dislocation of Intraocular Lens with Complete Capsular Phimosis in Retinitis Pigmentosa

Intraocular lens (IOL) dislocation is an unusual but serious complication after cataract surgery. We are here to report a rare case which is nontraumatic IOL dislocated and prolapsed into the anterior chamber in a retinitis pigmentosa (RP) patient. Zonular weakness and capsular contraction are considered to be the main contributing factors of IOL dislocation in RP patients. Patients at risk should be recognized and managed accordingly intraoperatively or postoperatively.

Intraperitoneal chromophore injections delay early-onset and rapid retinal cone degeneration in a mouse model of Leber congenital amaurosis

Highly expressed in the retinal pigment epithelium (RPE), the RPE-specific 65-kDa (RPE65) enzyme is indispensable to generate 11-cis-retinal (11cRAL), a chromophore for rhodopsin and cone photopigments. RPE65 deficiency can lead to Leber congenital amaurosis type 2 (LCA2), in which the isomerization of photobleached all-trans-retinal into photosensitive 11cRAL is blocked, ultimately causing severe retinal dysfunction and degeneration. The related mouse models, which are constructed through gene knockout or caused by spontaneous mutations, morphologically present with early-onset and rapid retinal cone cells degeneration, including loss of short-wavelength-sensitive cone opsins (S-opsins) and mislocalization of medium-wavelength-sensitive cone opsins (M-opsins). Studies have shown that routine Rpe65 gene replacement therapy, mediated by an adeno-associated virus (AAV) vector, can restore RPE65 protein. However, AAV transfection and Rpe65 transgene expression require at least one to two weeks, and the treatment cannot fully block the early-onset cone degeneration. To determine the feasibility of delaying cone degeneration before gene therapy, we investigated the impact of 11cRAL treatment in an early-age LCA2 retinal degeneration 12 (rd12) mouse model. Similar to human patients, the mouse model carries a spontaneous mutation in the Rpe65 gene, which results in disrupted endogenous 11cRAL regeneration. We found that RPE65 deficiency did not notably affect rodent retinal vessels. Under red light illumination, the rd12 mice were intraperitoneally injected with exogenous 11cRAL from postnatal day (P) 14 to P21. Three days after the last injection, a notable recovery of retinal function was observed using scotopic and photopic electroretinograms. Using optical coherence tomography and histological analyses of the deficient retinas, we found changes in the thickness of the photoreceptor outer segment (OS); this change could be rescued by early 11cRAL treatment. In addition, the treatment notably preserved M- and S-opsins, both of which maintained appropriate localization inside cone cells, as shown by the wild-type mice. In contrast, the age-matched untreated rd12 mice were characterized by retinal S-opsin loss and M-opsin mislocalization from the photoreceptor OS to the inner segment, outer nuclear layer, or outer plexiform layer. Notably, 11cRAL treatment could not maintain retinal function for a long time. Ten days after the last injection, the rod and M-cone electroretinograms significantly decreased, and S-cone responses almost extinguished. Our findings suggest that early 11cRAL treatment is useful for restoring retinal function and rescuing morphology in the rd12 mouse model, and the early-onset and rapid cone degeneration can be delayed before gene therapy.