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Mansour AM, López-Guajardo L, Özdek Ş, Popov I, Parodi Battaglia M. Surgical Approaches to Serous Retinal Detachment With Retina-Lens Touch in Eyes With Nanophthalmos. JOURNAL OF VITREORETINAL DISEASES 2024; 8:173-180. [PMID: 38465360 PMCID: PMC10924594 DOI: 10.1177/24741264231220157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose:To describe the visual outcomes and problems that resulted from surgical treatment of nanophthalmic complete retinal detachment (RD) with retina-lens contact. Methods: A multicenter retrospective case series with deep sclerectomy as a treatment was performed. Results: Five cases had extensive deep sclerectomies, 3 with intended drainage of subretinal fluid (SRF). The RD resolved 1 week postoperatively in 4 cases and within 1 month in 1 case. The visual acuity improved from light perception to a median of 20/100. Three cases had longstanding lens touch beyond 1 year and improved VA to 20/100, 20/150, and hand motions, respectively. Complications included focal lens dialysis in 2 cases (passive drainage of SRF) and lens or intraocular lens dislocation in 1 case each (active drainage of SRF). Ultrasound biomicroscopy and anterior optical coherence tomography showed a very narrow angle and short zonules. Conclusions: Deep sclerectomy results in good anatomic and functional improvements in advanced cases of nanophthalmos exudative detachment, which is often considered to be incurable.
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Affiliation(s)
- Ahmad M. Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
- Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
| | | | - Şengül Özdek
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Ivajlo Popov
- Department of Ophthalmology, Comenius University, Bratislava, Slovakia
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Niazi S, Dhubhghaill SN, Doroodgar F, Gatzioufas Z, Dehghan MH. Insight into small eyes: a practical description from phenotypes presentations to the management. Int J Ophthalmol 2024; 17:380-391. [PMID: 38371260 PMCID: PMC10827624 DOI: 10.18240/ijo.2024.02.23] [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: 02/09/2023] [Accepted: 11/29/2023] [Indexed: 02/20/2024] Open
Abstract
This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search. The definition can be related to a number of special phenotypes. In the more challenging cases of complex microphthalmos, relative anterior microphthalmos, and nanophthalmos, the surgeon can approach these cases more safely if they have a deep understanding of the anatomical variations and ideal formulae for intraocular lens computation and knows how to avoid intra- and post-operative complications. In this article, we review the criteria by which we recognize and describe pre-, intra-, and post-operative considerations, as well as discuss the ideal intraocular lenses for microphthalmos, given the intricate varieties of small eye phenotypes.
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Affiliation(s)
- Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Sorcha Ní Dhubhghaill
- Antwerp University Hospital, Edegem 2650, Belgium
- Faculty of Health Sciences, Antwerp University, Antwerpen 2000, Edegem, Belgium
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran 1416753955, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran 16666, Iran
| | | | - Mohammad Hossein Dehghan
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran 16666, Iran
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Conway MP, Stephenson KAJ, Zhu J, Dockery A, Burke T, Turner J, Le FT, O’Byrne JJ, Keegan DJ. The Role of the Ophthalmic Genetics Multidisciplinary Team in the Management of Inherited Retinal Degenerations-A Case-Based Review. Life (Basel) 2024; 14:107. [PMID: 38255722 PMCID: PMC10817299 DOI: 10.3390/life14010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Inherited retinal degenertions are rare conditions which may have a dramatic impact on the daily life of those affected and how they interact with their environment. Coordination of clinical services via an ophthalmic genetics multidisciplinary team (OG-MDT) allows better efficiency of time and resources to reach diagnoses and facilitate patient needs. (2) Methods: This clinical case series was conducted by a retrospective review of patient records for patients enrolled in the Target 5000 programme and managed by the OG-MDT, at the Mater Hospital Dublin, Ireland (n = 865) (3) Results: Herein we describe clinical cases and how the use of the OG-MDT optimizes care for isolated and syndromic IRD pedigrees. (4) Conclusions: this paper demonstrates the benefits of an OG-MDT to patients with IRDs resulting in the holistic resolution of complex and syndromic cases. Furthermore, we demonstrate that this format can be adopted/developed by similar centres around the world, bringing with it the myriad benefits.
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Affiliation(s)
- Marcus P. Conway
- Mater Clinical Ophthalmic Genetics Unit, Mater Misericordiae University Hospital, D07 AX57 Dublin, Ireland (D.J.K.)
| | - Kirk A. J. Stephenson
- Mater Clinical Ophthalmic Genetics Unit, Mater Misericordiae University Hospital, D07 AX57 Dublin, Ireland (D.J.K.)
| | - Julia Zhu
- Mater Clinical Ophthalmic Genetics Unit, Mater Misericordiae University Hospital, D07 AX57 Dublin, Ireland (D.J.K.)
| | - Adrian Dockery
- Mater Clinical Ophthalmic Genetics Unit, Mater Misericordiae University Hospital, D07 AX57 Dublin, Ireland (D.J.K.)
| | - Tomas Burke
- Mater Clinical Ophthalmic Genetics Unit, Mater Misericordiae University Hospital, D07 AX57 Dublin, Ireland (D.J.K.)
| | - Jacqueline Turner
- Mater Clinical Ophthalmic Genetics Unit, Mater Misericordiae University Hospital, D07 AX57 Dublin, Ireland (D.J.K.)
| | - Francois Thai Le
- Eye Clinic Liasson Officer, Vision Ireland, Mater Misericordiae University Hospital, D07 AX57 Dublin, Ireland;
| | - James J. O’Byrne
- Mater Clinical Ophthalmic Genetics Unit, Mater Misericordiae University Hospital, D07 AX57 Dublin, Ireland (D.J.K.)
| | - David J. Keegan
- Mater Clinical Ophthalmic Genetics Unit, Mater Misericordiae University Hospital, D07 AX57 Dublin, Ireland (D.J.K.)
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Levinger N, Erdinest N, London N, Levinger E, Goldfeather Ben Zaken S, Barequet D, Barequet I, Achiron A, Levinger S. Femtosecond LASER-Assisted Double Intraocular Lens Exchange in Nanophthalmic Eyes. Case Rep Ophthalmol 2024; 15:143-149. [PMID: 38348443 PMCID: PMC10861217 DOI: 10.1159/000536190] [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: 06/27/2023] [Accepted: 01/01/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Though patients with nanophthalmos frequently endure decreased quality of vision with contact lenses or spectacles, refractive surgery is generally an inadequate alternative due to the associated high refractive error. A refractive lens exchange (RLE) is an alternative option but is technically challenging, requiring accuracy in biometry measurements and procedures. Case Presentation This case discusses a 27-year-old female with nanophthalmos (axial lengths 17.6 mm and 17.4 mm, right and left eyes, respectively) who underwent a femtosecond laser-assisted (FLA) RLE with simultaneous implantation of a monofocal and a Sulcoflex trifocal (Rayner, Britain) lens in each eye. Preoperative cycloplegic refraction was +11.50/-0.75 × 145 and +12.00/-1.00 × 35 in the RE and LE, respectively. Best-corrected visual acuity (BCVA) at distance and near in the RE and LE was 6/7.5 and J1, 6/8.5 and J2, respectively. Uncorrected visual acuity (UCVA) was >6/120 and >J14 for each eye. FLA RLE was performed in the RE, then in the LE 2 weeks later. In each eye, a monofocal (44.0 D, RE, and LE) and a Sulcoflex trifocal lens (both implants, Rayner, Britain) were implanted in one procedure. Distance and near UCVA measured 6 weeks post-op RE and 1-month post-op LE at 6/8.5 and J1 in the RE, 6/10 and J1 in the LE. The RE and LE refraction and BCVA were +0.50/-1.00 × 115, 6/7.5, and plano/-1.00 × 55, 6/8.5, respectively. The post-op outcomes were uneventful. Conclusion A single procedure concurrently implanting a monofocal and Sulcoflex trifocal intraocular lens in nanophthalmic eyes resulted in an excellent UCVA. This procedure can be considered esthetic and reconstructive as it significantly improves patient appearance and function.
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Affiliation(s)
- Nadav Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - Nir Erdinest
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
| | | | - Eliya Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shalhevet Goldfeather Ben Zaken
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Dana Barequet
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Irit Barequet
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Asaf Achiron
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shmuel Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
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Kenny PI, Kozhaya K, Truong P, Weikert MP, Wang L, Hill WE, Koch DD. Efficacy of segmented axial length and artificial intelligence approaches to intraocular lens power calculation in short eyes. J Cataract Refract Surg 2023; 49:697-703. [PMID: 36940190 DOI: 10.1097/j.jcrs.0000000000001185] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/14/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE In short eyes, to compare the predictive accuracy of newer intraocular lens (IOL) power calculation formulas using traditional and segmented axial length (AL) measurements. SETTING Cullen Eye Institute, Baylor College of Medicine, Houston, Texas and East Valley Ophthalmology, Mesa, Arizona. DESIGN Multi-center retrospective case series. METHODS Measurements from an optical biometer were collected in eyes with AL <22 mm. IOL power calculations were performed with 15 formulas using 2 AL values: (1) machine-reported traditional AL (Td-AL) and (2) segmented AL calculated with the Cooke-modified AL nomogram (CMAL). 1 AL method and 7 formulas were selected for pairwise analysis of mean absolute error (MAE) and root mean square absolute error (RMSAE). RESULTS The study comprised 278 eyes. Compared with the Td-AL, the CMAL produced hyperopic shifts without differences in RMSAE. The ZEISS AI IOL Calculator (ZEISS AI), K6, Kane, Hill-RBF, Pearl-DGS, EVO, and Barrett Universal II (Barrett) formulas with Td-AL were compared pairwise. The ZEISS AI demonstrated smaller MAE and RMSAE than the Barrett, Pearl-DGS, and Kane. K6 had a smaller RMSAE than the Barrett formula. In 73 eyes with shallow anterior chamber depth, the ZEISS AI and Kane had a smaller RMSAE than the Barrett. CONCLUSIONS ZEISS AI outperformed Barrett, Pearl-DGS, and Kane. The K6 formula outperformed some formulas in selected parameters. Across all formulas, use of a segmented AL did not improve refractive predictions.
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Affiliation(s)
- Peter I Kenny
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas (Kenny, Kozhaya, Truong, Weikert, Wang, Koch); East Valley Ophthalmology, Mesa, Arizona (Hill)
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Stopyra W. Analysis of accuracy of twelve intraocular lens power calculation formulas for eyes with axial hyperopia. Saudi J Ophthalmol 2023; 37:125-130. [PMID: 37492218 PMCID: PMC10365256 DOI: 10.4103/sjopt.sjopt_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/28/2022] [Accepted: 11/16/2022] [Indexed: 07/27/2023] Open
Abstract
PURPOSE The purpose was to compare twelve intraocular lens power calculation formulas for eyes smaller than 22.0 mm in terms of absolute error (AE), the percentage of postoperative emmetropia, and agreement interval in Bland-Altman analysis. METHODS The data of hyperopic patients who underwent uneventful phacoemulsification between January 2016 and July 2021 were reviewed. Intraocular lens power was calculated using Holladay 1, SRK/T, Hoffer Q, Holladay 2, Haigis, Barrett Universal II, Hill-RBF, Ladas, Kane, Emmetropia Verifying Optical (EVO), Pearl-DGS, and K6 formulas. Three months after phacoemulsification, refraction was measured, and the mean AE was calculated. The percentage of patients with full visual acuity (VA) without any correction, with ± 0.25D, ±0.5D, ±0.75D, and limits of agreement for each formula was established. RESULTS Seventy-two patients, whose ocular axial length (AL) ranged between 20.02 mm and 21.98 mm, were included. The Kane formula achieved the lowest mean AE of 0.09 ± 0.09 just before EVO (0.12 ± 0.09), Hill-RBF (0.17 ± 0.12), and Hoffer Q formulas (0.19 ± 0.16). In addition, with the Kane formula, the percentage of patients with full VA without any correction (80.6%) was the highest ahead of EVO and Hoffer Q formulas (51.5% and 50.0%, respectively). Finally, Kane, EVO, and Hill-RBF obtained the lowest agreement interval (0.4923, 0.5815, and 0.7740, respectively). CONCLUSION The Kane formula is recommended for intraocular lens power calculation for eyeballs with the AL smaller than 22.0 mm. The EVO formula gives very promising results in regarding the accuracy of intraocular lens power for hyperopic eyes.
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Cataract surgery in adult eyes with short axial length. Curr Opin Ophthalmol 2023; 34:84-93. [PMID: 36373749 DOI: 10.1097/icu.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW Cataract surgery in eyes of patients with short axial length (AL) can be technically challenging and is associated with a high risk of intra- and postoperative complications. Several technical and surgical strategies have been proposed to optimize the visual outcome and decrease the rate of surgical complications and it is important to understand their applications in these cases. RECENT FINDINGS Traditional intraocular lens (IOL) measurement formulas in eyes with short AL have reduced reliability. Novel formulas such as the Kane formula provide a better refractive prediction. Surgery can be difficult in short eyes due to the crowdedness of the anterior chamber (AC) and the associated scleral abnormalities increasing the risk of uveal effusion. Surgical techniques such as prophylactic scleral incisions, limited pars plana anterior vitrectomy, and modified hydrodissection, have been shown to facilitate surgery in extremely short eyes and decrease the rate of operative complications. Although cataract surgery improves vision in these cases, short AL and shallow AC have been associated with worse visual outcomes. SUMMARY Newer 4 th generation IOL formulas have improved the refractive outcomes of cataract surgery in eyes with short AL. There are multiple evolving surgical strategies for optimizing surgery in these eyes. However, studies on the surgical and visual outcomes of cataract surgery in eyes with short AL are limited by their design and sample size. With further research and continued clinical experiences, we hope to develop evidence-based algorithms for the management of these complex cases.
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O’Connell A, Zhu J, Stephenson KA, Whelan L, Dockery A, Turner J, O’Byrne JJ, Farrar GJ, Keegan D. MFRP-Associated Retinopathy and Nanophthalmos in Two Irish Probands: A Case Report. Case Rep Ophthalmol 2022; 13:1015-1023. [PMID: 36605040 PMCID: PMC9808125 DOI: 10.1159/000527260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/17/2022] [Indexed: 12/23/2022] Open
Abstract
The conjunction of nanophthalmos (NO) and retinitis pigmentosa (RP) provides challenges to effective clinical management while narrowing the genetic spectrum for targeted molecular diagnostics. This case study describes two not knowingly related adult cases of MFRP-associated retinopathy and nanophthalmos (MARN). Structural features including short axial lengths (mean 16.4 mm), steep keratometry (mean 49.98 D), adult-onset signs, and symptoms of retinal dystrophy and acquired disease (i.e., cataract, angle-closure glaucoma) were evident in both cases. Pathogenic variants in the MFRP gene impair both prenatal eye growth and childhood emmetropization while also leading to RPE/outer retinal degeneration in 75% of cases. We discuss the "small-eye" phenotype spectrum and associated defining characteristics, molecular mechanisms with particular focus on MFRP-associated NO with RP features (MARN), the spectrum of visual morbidities (e.g., extreme refractive error, amblyopia, cystoid macular lesions, early cataract) and the challenges of their treatment/surgical management.
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Affiliation(s)
- Ann O’Connell
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julia Zhu
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kirk A.J. Stephenson
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Laura Whelan
- The School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
| | - Adrian Dockery
- Next Generation Sequencing Laboratory, Pathology Department, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jacqueline Turner
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - James J. O’Byrne
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - G. Jane Farrar
- The School of Genetics and Microbiology, Trinity College Dublin, Dublin, Ireland
| | - David Keegan
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, Dublin, Ireland
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