Idiopathic tractional corectopia

Unilateral Isolated Congenital Ectopic Pupil (Corectopia) in a Four-Year-Old Child: Case Report and Literature Review

Unilateral corectopia is an exceedingly rare congenital defect where the pupil is displaced from its central position. Usually, it presents with normal visual aperture or associated with other diseases. We describe the first reported case of a left ectopic pupil in a healthy four-year-old boy with normal lens structure and total lack of visual aperture. Reporting such instances contributes to the understanding of this condition and guide future research endeavors. Further studies are needed to reveal the underlying pathophysiology, refine treatment approaches, and assess long-term outcomes.

Corectopia grading: A novel classification system

Objectives: To present and validate the novel grading system for objective classification of corectopia.Subjects and Methods: We evaluated 28 eyes of 28 patients with or without corectopia and validated the grading and classification system for corectopia according to three major criteria: (i) direction, (ii) extent, and (iii) alteration of mydriasis. Intraclass correlation coefficient (ICC) and inter-rater agreement between 7 inexperienced and 1 experienced ophthalmologist against a golden standard (GS) were calculated.Results: The ICC for the 7 inexperienced ophthalmologists regarding the grading of direction and centration of the pupil was 0.83 (95% confidence interval (CI), 0.74 to 0.90; p < .001) and 0.57 (95% CI, 0.43 to 0.72; p < .001), respectively. The inter-rater agreement was the same or almost the same in cases of pupil decentration between the inexperienced, experienced ophthalmologists and the GS (k = 0.82; 95% CI, 0.64-1.00; p < .001). In assessing the direction of pupil displacement, the inter-rater agreement was almost perfect between the inexperienced (k = 0.93; 95% CI, 0.84-1.00; p < .001) and experienced (k = 0.92; 95% CI: 0.82-1.02; p < .001) ophthalmologists and the GS.Conclusion: The first detailed clinical classification is proposed for objective corectopia grading particularly relevant in documenting and assessing progressive disease. It was confirmed to be acceptable for clinical use by inexperienced and experienced ophthalmologists alike.

Combined use of an iris hook and pupil expansion ring for femtosecond laser-assisted cataract surgery in patients with cataracts complicated by insufficient mydriasis and an ectopic pupil

We developed a surgical technique that combines use of an iris hook and a pupil expansion ring in femtosecond laser-assisted cataract surgery complicated by insufficient mydriasis and an ectopic pupil. With this technique, the surgery, including femtosecond laser assistance, phacoemulsification, and intraocular lens implantation, can be accomplished successfully prior to iris repair.

FINANCIAL DISCLOSURE

Dr. Malyugin receives travel grants from Alcon Laboratories, Inc. and Novartis Corp.; he receives royalties from Microsurgical Technology, Inc. None of the other authors has a financial or proprietary interest in any material or method mentioned.

Progressive idiopathic tractional corectopia with iris thinning

A 2-month-old boy presented with an irregular left pupil. Over the course of 3 months, progressive pupil ovalization, corectopia, and ballooning of the thinned superior iris tissue caused obstruction of the visual axis. Because of concern for deprivational amblyopia, a sectoral pupilloplasty and sphincterotomies were performed, restoring pupil shape and clearing the visual axis. On postoperative examinations, the pupil remained round, the visual axis clear, and visual acuity of the left eye improved. Findings and clinical course suggested the diagnosis of idiopathic tractional corectopia, a rare congenital disorder of unknown cause that may lead to isolated unilateral progressive corectopia and visual axis obstruction. Patients should receive regular follow-up examinations.

Congenital pupillary-iris-lens membrane with goniodysgenesis: histopathologic findings in an enucleated eye

A 10-year-old boy with clinically confirmed congenital pupillary-iris-lens membrane with goniodysgenesis underwent light microscopic examination of the enucleated eye. The anterior segment changes consisted of the absence of the iridial pupillary sphincter muscle and dilator muscle processes. Endothelialization and descemetization of the anterior chamber angle and the anterior surface of the iris covered the original eccentric pupillary opening (occlusio pupillae), but grew around the fibrotic edges of the surgically created, patent pseudopupil, probably secondary responses to surgery. The anterior chamber findings in this case establish a localized syndrome that includes absence of the pupillary sphincter and dilator muscle processes. Incomplete development of the iris may be partly attributable to an abnormality of stromal development and inductions by the anterior neuroectodermal layer, together with anomalies of the pupillo-iridial vasculature.

Fundus fluorescein angiographic characterization of diffuse choroidal hemangiomas

PURPOSE

To evaluate the clinical usefulness of fundus fluorescein angiography (FFA) in characterizing diffuse choroidal hemangiomas in Sturge-Weber syndrome.

METHODS

A retrospective case review of children attending a university hospital clinic with a diagnosis of Sturge-Weber syndrome was undertaken. The FFA findings of seven patients who had undergone angiography were reviewed.

RESULTS

FFA confirmed the presence of choroidal hemangioma in each of the seven cases and delineated the extent of the choroidal lesions. No adverse effects of fluorescein injection were encountered.

CONCLUSIONS

FFA is effective in diagnosing and characterizing diffuse choroidal hemangiomas, and may be performed safely in children.

Congenital corectopia (eccentric pupils): a marker for chromosomal and central nervous system abnormality

We present a case series of five children with congenital corectopia without any associated ocular cause: three had chromosomal abnormalities; one a probable prenatal diplegia, and one bilateral perisylvian dysplasia with vermian and midbrain hypoplasia. Bilateral congenital corectopia is an ophthalmic sign that merits chromosomal analysis and neuro-developmental assessment.

Successful treatment of tractional corectopia using 2 mJ of energy with an Nd:YAG laser

Although the Nd:YAG laser is most commonly used to perform posterior capsulotomies after cataract surgery, it has also been used to treat a variety of other anterior segment abnormalities including tractional corectopia, iridocorneal adhesions, persistent pupillary membranes, and posterior synechiae. Numerous reports on the use of the Nd:YAG laser to treat structures in the anterior segment have emphasized the need to use higher pulse energy for pupillary membranes, compared with the lower settings required for posterior capsulotomy. Steinert and Puliafito noted that single pulses of 4 to 12 mJ may be required to treat pupillary membranes "in a manner similar to that of a stonemason chipping at marble" in their description treating a membrane considerably thicker than what we describe. We report the successful treatment of tractional corectopia due to an anterior membrane strand in a child with only 2 mJ of total energy.