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Correia Barbosa R, Carvalho R. Pediatric Microspherophakia Treatment With Scleral Fixated IOL Using a Z-suture Technique. Cureus 2023; 15:e50445. [PMID: 38222140 PMCID: PMC10785742 DOI: 10.7759/cureus.50445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Microspherophakia constitutes a rare, mostly bilateral anomaly of the crystalline lens, which is characterized by the presence of an increased lens thickness and reduced equatorial diameter. It is frequently associated with lens subluxation, translating into a high degree of variable lenticular myopia and defective accommodation. The purpose of this report is to describe the treatment of a three-year-old female patient with microspherophakia, with the scleral fixation of an intraocular lens using the z-suture technique. A three-year-old female patient with Marfan Syndrome presented with high bilateral myopia and esotropia. Lens subluxation was perceived, and she was proposed for bilateral surgery. Scleral fixation of the intraocular lens was performed using the z-suture technique. During the five-year follow-up period, she maintained a best-corrected visual acuity of 20/20 in both eyes wearing bifocal glasses. Microspherophakia is a rare but impactful condition, frequently related to severe and variable refractive error due to the lens shape and zonule instability. Intraocular lens implantation in the capsular bag is usually impossible, and scleral fixation is a valid alternative. The z-suture technique avoids suture knots and the need for intrascleral flaps, reducing the risk of suture-related complications.
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Affiliation(s)
- Renato Correia Barbosa
- Ophthalmology, Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos (ULSM), Matosinhos, PRT
| | - Rui Carvalho
- Ophthalmology, Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos (ULSM), Matosinhos, PRT
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Bhate M, Motwani D, Murthy SI, Fernandes M. Congenital anomalies of lens shape. Taiwan J Ophthalmol 2023; 13:479-488. [PMID: 38249493 PMCID: PMC10798395 DOI: 10.4103/tjo.tjo-d-23-00076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/01/2023] [Indexed: 01/23/2024] Open
Abstract
The crystalline lens is an important structure in the eye that starts to develop as early as the 22nd day of gestation, with further differentiation that continues after the induction. Congenital anomalies of the lens may involve the size, shape, and position of the lens. They may sometimes be associated with anterior segment dysgenesis or persistence of the tunica vasculosa lentis and hyperplastic vitreous and hyaloid system. Manifestations of anomalies of the lens shape are usually seen in early or late childhood however may sometimes be delayed into adulthood based on the level of visual impairment or the presence or absence of any syndromic associations. While lens coloboma has more often been reported in isolation, the more commonly implicated genes include the PAX6 gene, lenticonus in particular anterior is often part of Alport syndrome with extra-ocular manifestations in the kidneys and hearing abnormalities due to mutations in the alpha 5 chain of the Type IV collagen gene. Recognition of these manifestations and obtaining a genetic diagnosis is an important step in the management. The level of visual impairment and amblyopia dictates the outcomes in patients managed either conservatively with optical correction as well as surgically where deemed necessary. This review discusses the various anomalies of the lens shape with its related genetics and the management involved in these conditions.
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Affiliation(s)
- Manjushree Bhate
- Jasti V Ramanamma Children’s Eye Care Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Divya Motwani
- Jasti V Ramanamma Children’s Eye Care Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I. Murthy
- Cornea Service, The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute Hyderabad, India, The Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
- Cornea Service, The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Merle Fernandes
- Cornea Service, The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute Hyderabad, India, The Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
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Rojananuangnit K, Rojnueangnit K. Microspherophakic Angle Closure Glaucoma in a Patient with Coffin-Siris Syndrome: Case Report. Appl Clin Genet 2023; 16:165-170. [PMID: 37663124 PMCID: PMC10474847 DOI: 10.2147/tacg.s422312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background Bilateral secondary angle closure glaucoma is a presenting symptom of microspherophakia and ectopia lentis. Characterizing the associated syndrome and confirmation by genetic testing can identify associated systemic abnormalities and provide appropriate genetic counseling. Case Presentation A 42-year-old woman with severe intellectual disability presented with light perception visual acuity and glaucoma, with intraocular pressure (IOP) in her right and left eyes of 69 and 70 mmHg, respectively. She underwent two sessions of 270-degree laser diode transscleral cytophotocoagulation treatment at a 6-month interval and was prescribed topical anti-glaucoma medication. Her family noticed a progressive decrease in her vision while on treatment for 2 years. She was diagnosed with apparent Weill-Marchesani syndrome, accompanied by angle closure glaucoma and microspherophakia. Cataract surgery and intraocular lens implantation were successful in both eyes and post-operative IOP was controlled with anti-glaucoma medication but her vision did not improve from severe glaucomatous optic neuropathy. Her underlying syndrome was investigated genetically by whole exome sequencing. Results Sequencing showed a pathogenic variant in ARID1B, c.3955dupC (p.Gln1319Profs*14), diagnostic of Coffin-Siris syndrome. This is the first report of Coffin-Siris syndrome associated with microspherophakia and angle closure glaucoma. Conclusion Bilateral angle closure glaucoma from ectopia lentis in patients with genetic syndromes could be an indicator of microspherophakia in adulthood. Ophthalmological surveillance is important in patients with Coffin-Siris syndrome.
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Affiliation(s)
- Kulawan Rojananuangnit
- Glaucoma Unit, Department of Ophthalmology, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand
| | - Kitiwan Rojnueangnit
- Division of Genetics, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Khan TA, Khan AA, Khan A, Zahid MA, Mehboob MA. Bilateral Anteriorly Displaced Microspherophakia in a Female Child With Marfanoid Habitus. Cureus 2023; 15:e38371. [PMID: 37265880 PMCID: PMC10230448 DOI: 10.7759/cureus.38371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Microspherophakia is a rare congenital anomaly characterized by an abnormally small and spherical crystalline lens, which can be associated with several systemic syndromes. We present an extremely rare case of bilateral anteriorly displaced microspherophakia in a female child with Marfanoid habitus. The patient displayed phenotypic features resembling Marfan syndrome, including tall stature, muscle hypotonia, dolichostenomelia, and increased arm span than body length. However, unlike Marfan syndrome, Marfanoid habitus is not associated with mutations in the fibrillin-1 gene. The association between microspherophakia and Marfanoid habitus is a unique presentation that has not been reported in the literature. This case report aims to increase awareness of microspherophakia as a possible ocular association of Marfanoid habitus.
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Affiliation(s)
- Taimoor A Khan
- Ophthalmology, National University of Medical Sciences (NUMS) Rawalpindi, Rawalpindi, PAK
- Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi, PAK
| | - Ali A Khan
- Ophthalmology, Ayub Medical College, Abbottabad, PAK
| | - Asfandyar Khan
- Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi, PAK
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Jia WN, Wang QY, Niu LL, Chen ZX, Jiang YX. Morphometric assessment of the ciliary body in patients with Marfan syndrome and ectopia lentis: A quantitative study using ultrasound biomicroscopy: Ciliary body morphology in Marfan syndrome and ectopia lentis. Am J Ophthalmol 2023; 251:24-31. [PMID: 36948371 DOI: 10.1016/j.ajo.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE To explore the biometric characteristics of the ciliary body in patients with Marfan syndrome (MFS) and ectopia lentis (EL). DESIGN Cross-sectional study. METHODS Seventy-two consecutive MFS patients with EL and 72 non-disease controls were recruited. Ciliary body biometric parameters such as ciliary muscle cross-sectional area at 2000 μm from the scleral spur (CMA2000), ciliary muscle thickness at 1000 μm from the scleral spur (CMT1000), and maximum ciliary body thickness (CBTmax) were measured from multiple directions with ultrasound biomicroscopy (UBM). The relationship between ciliary body parameters and other ocular characteristics was also evaluated. RESULTS Average CMA2000, CMT1000, and CBTmax were 0.692 ± 0.015 mm2, 0.405 ± 0.010 mm, and 0.855±0.023 mm in MFS eyes, respectively, and were significantly smaller than controls (all p < 0.001). The prevalence of ciliary body thinning was 22.2% in the MFS group versus 0 in controls (p < 0.001); eyes with more severe EL had smaller CMA2000 (p = 0.050), thinner CMT1000 (p = 0.022) and shorter CBTmax (p = 0.015). Patients with microspherophakia (MSP) had even smaller CMA2000 (p = 0.033) and CMT1000 (p = 0.044) than those without MSP. The most common subluxation direction was in the superonasal quadrant (25, 39.7%), which probably correlates with the thinnest CMT1000 in the inferotemporal quadrant (p = 0.005). CONCLUSIONS MFS patients with EL had thinner ciliary muscles, shorter ciliary processes, and a higher prevalence of ciliary body thinning, especially those with MSP. Both the extent and direction of subluxation were associated with ciliary body biometry.
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Affiliation(s)
- Wan-Nan Jia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Qian-Yi Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Ling-Ling Niu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China.
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China.
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Huang J, Nie K, Lv X, Liu Y, Yang G, Fu J, Liu L, Lv H. Abnormal lens thickening in a child with Weill-Marchesani syndrome 4: A 3-year follow-up case report. Front Med (Lausanne) 2023; 9:1021489. [PMID: 36698805 PMCID: PMC9868407 DOI: 10.3389/fmed.2022.1021489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/19/2022] [Indexed: 01/10/2023] Open
Abstract
Background Weill-Marchesani syndrome 4 (WMS4) is caused by ADAMTS17 gene variant and clinical abnormalities including lenticular myopia, ectopia lentis, glaucoma, microspherophakia, brachydactyly, and short stature. Due to free of heart defects and joint stiffness compared with other WMS forms, WMS4 has an insidious onset and is often misdiagnosed as high myopia. We combined multiple imaging biometry and whole-exome sequencing to diagnose a case of WMS4 with a 3-year follow-up. Case presentation An 8-year-old boy presented to our ophthalmology department with progressive myopia for 1 year. He had high myopia in both eyes with normal funds, intraocular pressure, and axial length. Ocular examination revealed thicker lenses (right 4.38 mm, left 4.31 mm) with a smaller equatorial diameter (right 7.33 mm and left 7.17 mm) compared to normal children of the same age. Finger length measurement indicates brachydactyly. Whole-exome sequencing identified compound heterozygous missense variants c.2984G > A (p.Arg995Gln) and c.2254A > G (p.Ile752Val) in the ADAMTS17 gene. During the 3 years of follow-up, the thickness of lenses increased significantly (right 4.49 mm, left 4.48 mm), but the equatorial diameter of the lenses had no significant change (right 7.32 mm, left 7.21 mm). As the equivalent lens power increased, the patient's myopia spherical refractive error rose accordingly. Although the anterior chamber angle remained open during follow-up, the intraocular pressure increased to right 20.4 mmHg and left 19.6 mmHg, Iridodonesis and short stature were present. Conclusion This case report highlights the abnormal thickening of the lens in WMS4 compared to the physiological thinning process during childhood. Comprehensive clinical examinations and genetic testing may improve diagnosis, which allows early therapeutic interventions for complications and better visual outcomes for the patient.
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Affiliation(s)
- Junting Huang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Kailai Nie
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China,Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xinpin Lv
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yuting Liu
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guiqi Yang
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Junjiang Fu
- Key Laboratory of Epigenetics and Oncology, The Research Center for Preclinical Medicine, Southwest Medical University, Luzhou, China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Longqian Liu,
| | - Hongbin Lv
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou, China,Hongbin Lv,
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Chu EA, Cummings A, Sala N, Sala N. Bilateral Subluxation of Microspherophakic Lens in a Child with Cohen Syndrome. J Binocul Vis Ocul Motil 2023; 73:1-3. [PMID: 35917505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cohen Syndrome is a rare autosomal recessive condition characterized by facial abnormalities with or without microcephaly, non-progressive intellectual delay, hypotonia, ophthalmic abnormalities, and neutropenia. Due to its low incidence and variable presentation, much about the disorder, including ophthalmic manifestations, is not fully understood. Here, we present the first documented case of a 5-year-old Amish child with Cohen Syndrome who presented with bilateral subluxation of microspherophakic lenses - rare findings themselves, let alone coexisting in a patient with a rare genetic syndrome. The child underwent bilateral lensectomy and is being managed with aphakic spectacles.
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Affiliation(s)
- Elizabeth A Chu
- Department of Ophthalmology, St. John's Episcopal Hospital, Far Rockaway, New York
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Urkude J, Singh R, Titiyal JS, Sharma N. Kissing microvitreoretinal blade technique: A novel approach for safe and effective endocapsular lens aspiration in microspherophakia. Indian J Ophthalmol 2022; 70:3677-3680. [PMID: 36190071 PMCID: PMC9789857 DOI: 10.4103/ijo.ijo_588_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We herein describe the kissing MVR technique in cases of microspherophakia for safe and effective endocapsular lens aspiration. Microspherophakia is associated with abnormally lax and broken zonules, which pose a great challenge to the operating surgeon, especially while creating the openings in the capsular bag. In this novel technique, simultaneous use of two 23 G MVR blades reduces the above problem associated with the severely mobile lens. Here, one MVR blade stabilizes the capsular bag and, at the same time, provides counter-traction for the opposite MVR blade while puncturing the capsular bag. Furthermore, the creation of openings in the lens at the equator or just posterior to it is beneficial as the capsule is relatively thicker and stronger at this location. This also minimizes the risk of premature extension to the anterior or posterior capsule, thereby avoiding complications like dropped lens matter, vitreous prolapse, and vitreous traction.
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Affiliation(s)
- Jayanand Urkude
- Cornea, Cataract, Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Singh
- Cornea, Cataract, Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Cornea, Cataract, Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Cornea, Cataract, Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,Correspondence to: Prof. Namrata Sharma, Cornea, Cataract and Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi – 110 029, India. E-mail:
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Abstract
Microspherophakia is a rare developmental abnormality of the crystalline lens with a myriad of ocular and systemic associations. Glaucoma is a serious complication associated with this disorder. Early identification of the disease, timely visual rehabilitation, and appropriate management of the lens and glaucoma can help us prevent blindness from this condition. Multidisciplinary care with lifelong follow-up is recommended, as this typically affects the younger population. Current treatment protocols for this condition are mainly based on case reports and retrospective studies with shorter follow-up. Due to the rarity of this disease, designing a large randomized controlled trial to identify the merits and demerits of each management strategy is challenging. With cataract, glaucoma, and vitreoretinal specialists, each having their preferred way of managing microspherophakic lenses, we decided to do a comprehensive review of the existing literature to devise an integrated approach toward effective management of these patients. This review will collate all evidence and provide a very practical decision-making tree for its management.
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Affiliation(s)
| | | | - Neethu Mohan
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
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Pathak-Ray V, Bansal AK, Malhotra V. Combining flanged intrascleral IOL fixation with Glaucoma Surgery: Initial experience. Eur J Ophthalmol 2021; 32:2899-2906. [PMID: 34894793 DOI: 10.1177/11206721211066390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the initial clinical outcomes of combining glaucoma surgery with flanged intrascleral intraocular lens (F-SFIOL) fixation as a single stage procedure. METHODS Retrospective, non-comparative case-series of eyes which underwent combined surgery for glaucoma with F-SFIOL and had at least 6-months of follow-up. A fellowship-trained senior glaucoma surgeon managed all the cases. RESULTS Twelve-eyes of 10 glaucoma patients (8 males, 2 females) underwent F-SFIOL; only 8 of these eyes were combined with a glaucoma procedure. Mean age of patients was 55.1 ± 16.1 years (95%CI [44.4,73.2], median 61 years) and were followed-up for a mean of 21.0 ± 9.5 months, 95% CI [13.1,28.9], median 18 months. F-SFIOL was combined with trabeculectomy ± Mitomycin C in 4 eyes, Ahmed Glaucoma Valve in 3 eyes and needling of a pre-existing bleb in 1. Each eye had controlled intraocular pressure (IOP) at last follow-up (pre-procedure 29.1 ± 13.4 mmHg, 95% CI [17.9, 40.3], median 27 mmHg to 14.5 ± 3.2 mmHg, 95% CI [11.8, 17.1], median 13 mmHg, p = 0.006) and decreased need for number of anti-glaucoma medication (AGM) (pre-procedure 3.7 ± 1.1, 95% CI [2.8,4.6], median 4 to 0.7 ± 0.7, 95% CI [0.1,1.3] median 1, p < 0.001). In all the eyes, best corrected visual acuity (BCVA) was either stable or improved; only 1 eye had astigmatism worse than that pre-existing. In 1 eye IOL was explanted, with an additional procedure to control IOP. No serious long-term complications occurred in any subject. CONCLUSION The initial experience of single-stage F-SFIOL along with glaucoma surgery, both being performed by the same anterior-segment surgeon, is promising, thereby avoiding the cost, specialised skill, and potential complications of a posterior approach. Glaucoma surgery combined with and adapted to suture-less, flap-less, glue-less intra-scleral IOL fixation is hitherto unreported.
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Affiliation(s)
| | - Aashish K Bansal
- Department of Cornea, Cataract and Refractive Surgery, 561100Apollo Hospitals, Hyderabad, India.,Department of Cornea, Cataract and Refractive Surgery, 80579Centre for Sight, Hyderabad, India
| | - Varun Malhotra
- Department of Cornea, Cataract and Refractive Surgery, 80579Centre for Sight, Hyderabad, India
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Lin Z, Zhu M, Deng H. A Pedigree Report of a Rare Case of Weill-Marchesani Syndrome with New Compound Heterozygous LTBP2 Mutations. Risk Manag Healthc Policy 2021; 14:1785-1789. [PMID: 33958902 PMCID: PMC8096439 DOI: 10.2147/rmhp.s307290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Weill–Marchesani syndrome (WMS) is an autosomal inherited connective tissue disease. Clinical manifestations include microspherophakia (MSP), high myopia, ectopia lentis, open-angle glaucoma, short stature, short fingers, joint stiffness, and (occasionally) cardiovascular defects. At present, a total of four pathogenic gene loci related to WMS have been found: ADAMTS10, ADAMTS17, FBN1, and LTBP2. Case Report The patient was a five-year-old girl whose eyesight had become progressively worse for three years before her parents brought her to the hospital. Computer optometry showed high myopia in both eyes, while a slit lamp examination found that the anterior chamber of both eyes was shallow, and the lens was in a state of dislocation (ectopia lentis). An IOLMaster examination revealed that the lens was spherical (MSP), and the lens thickness (LT) was 5.36 mm. Corneal topography showed that the angle kappa was 0.18 mm in the right eye (OD) and 0.30 mm in the left eye (OS). An intraocular pressure (IOP) (OD: 26.5 mmHg, OS: 30.6 mmHg) examination showed that the fundus cup to disc ratio was normal, but secondary glaucoma caused by lens dislocation could be considered. The IOP was maintained within a normal range using antihypertensive drugs. The patient’s younger sister also had a dislocation of MSP. Gene detection showed a heterozygous mutation in the LTBP2 gene [c.3672delC:p.Thr1225fs and c.3542delT:p.Met1181fs], and a diagnosis of WMS-like syndrome was confirmed. Conclusion WMS syndrome is rare, and the mutation of the LTBP2 gene has not been previously recorded in the GnomAD (Genome Aggregation Database) of East Asia. This case report provides some reference for studying the mechanism of WMS and WMS-like syndrome caused by an LTBP2 gene mutation.
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Affiliation(s)
- ZhiHong Lin
- Department of Strabismus & Pediatric Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, The School of Optometry of Shenzhen University, Shenzhen, 518000, Guangdong Province, People's Republic of China
| | - MinJuan Zhu
- Department of Strabismus & Pediatric Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, The School of Optometry of Shenzhen University, Shenzhen, 518000, Guangdong Province, People's Republic of China
| | - HongWei Deng
- Department of Strabismus & Pediatric Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, The School of Optometry of Shenzhen University, Shenzhen, 518000, Guangdong Province, People's Republic of China
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Liu Q, Wang X, Zhang S. Visual quality observation of clear lens extraction by ultrasonic phacoemulsification and intraocular lens implantation in a child with microspherophakia: A case report. Medicine (Baltimore) 2020; 99:e21937. [PMID: 32846863 PMCID: PMC7447390 DOI: 10.1097/md.0000000000021937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Microspherophakia is characterized by a small, spherical crystalline lens with increased sagittal diameter. Because of the uncertainty about the outcome, as well as the complexity of the operation and development of complications, the management and timing of surgical intervention for microspherophakia are still debated. Lens extraction is effective for avoiding the risk of pupillary blockage, but the outcome after operation is controversial. The iTrace (Tracey, USA) report shows the influence of low-order aberrations (LOA) and high-order aberrations (HOA), which may be valuable in predicting postoperative outcome. Our report concerns a child with microspherophakia who underwent lens extraction via the analysis of visual quality by iTrace. PATIENT CONCERNS Our report is on the case of a 7-year-old girl whose parents observed she had to bring her papers and books extremely close to her face to read. On examination, the girl was bilaterally diagnosed microspherophakia with a small tremble lens. The objective refraction was -15.0 diopter of spherical power (DS)/-1.00 diopter of cylindrical power (DC) × 180 right eye (OD) and -12.5 DS/-1.50 DC × 20 left eye (OS). The HOA of OD and OS were high up to 0.926 and 0.659, respectively by iTrace. The visual quality remained terrible after correcting LOA (high myopia and astigmatism). According to iTrace report, the patient would get a good visual quality by extracting the clear lens with HOA from cornea after correcting LOA. The girl's parent opted for surgery on the left eye. DIAGNOSIS Due to the patient's symptoms, examination results, she was diagnosed with microspherophakia. INTERVENTIONS The patient underwent clear lens extraction by ultrasonic phacoemulsification and intraocular lens implantation. OUTCOMES The first day after operation, total HOA was decreased to 0.077. Total LOA was 0.713. Corrected distance visual acuity (CDVA) is 20/20. One week after surgery, HOA was 0.110 and LOA was 0.328. CDVA was 20/25. CDVA was still 20/25 one month after surgery. The total HOA was 0.110 and the LOA was 0.334 by iTrace. LESSONS ITrace not only plays an important role in analyzing potential reasons of undesirable preoperative visual quality but also can predict postoperative outcomes. All these functions are helpful for determining surgical intervention of microspherophakia cases.
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