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Taiwan Journal of Ophthalmology 2023The crystalline lens is an important structure in the eye that starts to develop as early as the 22 day of gestation, with further differentiation that continues after... (Review)
Review
The crystalline lens is an important structure in the eye that starts to develop as early as the 22 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.
PubMed: 38249493
DOI: 10.4103/tjo.TJO-D-23-00076 -
Current Eye Research Oct 2023To summarize the ophthalmic manifestations of unilateral coronal synostosis patients. (Review)
Review
PURPOSE
To summarize the ophthalmic manifestations of unilateral coronal synostosis patients.
METHODS
We performed a literature search in the electronic database of PubMed, CENTRAL, Cochrane, and Ovid Medline guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement for studies evaluating ophthalmic manifestations of unilateral coronal synostosis.
RESULTS
Unilateral coronal synostosis, also called unicoronal synostosis, may be mistaken for deformational plagiocephaly, an asymmetric skull flattening common in newborns. Characteristic facial features, however, distinguish the two. Ophthalmic manifestations of unilateral coronal synostosis include a "harlequin deformity", anisometropic astigmatism, strabismus, amblyopia, and significant orbital asymmetry. The astigmatism is greater on the side opposite the fused coronal suture. Optic neuropathy is uncommon unless unilateral coronal synostosis accompanies more complex multi-suture craniosynostosis. In many cases, surgical intervention is recommended; without intervention, skull asymmetry and ophthalmic disorders tend to worsen with time. Unilateral coronal synostosis can be managed by early endoscopic stripping of the fused suture and helmeting through a year of age or by fronto-orbital-advancement at approximately 1 year of age. Several studies have demonstrated that anisometropic astigmatism, amblyopia, and severity of strabismus are significantly lower after earlier intervention with endoscopic strip craniectomy and helmeting compared to treatment by fronto-orbital-advancement. It remains unknown whether the earlier timing or the nature of the procedure is responsible for the improved outcomes. As endoscopic strip craniectomy can only be performed in the first few months of life, early recognition of the facial, orbital, eyelid, and ophthalmic characteristics by consultant ophthalmologists enables expeditious referral and optimized ophthalmic outcomes.
CONCLUSION
Timely identification of craniofacial and ophthalmic manifestations of infants with unilateral coronal synostosis is important. Early recognition and prompt endoscopic treatment appears to optimize ocular outcomes.
Topics: Infant, Newborn; Infant; Humans; Amblyopia; Astigmatism; Retrospective Studies; Craniosynostoses; Strabismus
PubMed: 37382098
DOI: 10.1080/02713683.2023.2224536 -
Medicine Oct 2023Adolescent scoliosis is one of the most common surgical disorders of the pediatric spine. With timely detection and early treatment, most scoliotic children can avoid... (Review)
Review
Adolescent scoliosis is one of the most common surgical disorders of the pediatric spine. With timely detection and early treatment, most scoliotic children can avoid major and expensive surgery. Vision problems are also frequently found at an early age and can take a toll on individuals quality of life. However, scoliosis, a severe health hazard to adolescents, is often accompanied by vision problems clinically, including myopia, astigmatism, strabismus, amblyopia, horizontal paralysis, and blindness. And people with genetic defects have a higher probability of suffering both spinal problems and vision problems than those with nongenetic defects. However, many individuals viewed scoliosis and vision problems as 2 irrelevant diseases. This review searched PubMed, China National Knowledge Infrastructure, and Web of Science for studies on adolescent, scoliosis, eye diseases, myopia, strabismus, spinal disorders, and vision problems for almost 3 decades, and thus confirmed the potential relationship between adolescent scoliosis and vision problems.
Topics: Adolescent; Humans; Child; Scoliosis; Quality of Life; Amblyopia; Strabismus; Myopia
PubMed: 37861544
DOI: 10.1097/MD.0000000000035178 -
Taiwan Journal of Ophthalmology 2023Congenital hereditary endothelial dystrophy (CHED) is a rare genetic corneal disorder causing progressive cornea clouding and significant visual impairment. CHED remains... (Review)
Review
Congenital hereditary endothelial dystrophy (CHED) is a rare genetic corneal disorder causing progressive cornea clouding and significant visual impairment. CHED remains a leading indication for pediatric corneal transplantation despite its infrequency, particularly in regions with high consanguinity rates like Southeast Asia. Identifying the Solute Carrier Family 4 Member 11 (SLC4A11) gene as the genetic basis of CHED has led to the discovery of it's various genetic variations. However, a comprehensive understanding of its clinical-genetic correlation, pathophysiology, and optimal management is ongoing. This review aims to consolidate current knowledge about CHED, covering its genetic origins, pathophysiological mechanisms, clinical presentation, and management strategies. Surgical intervention, such as penetrating keratoplasty (PK), Descemet stripping automated endothelial keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK), remains the primary treatment. DSAEK and DMEK offer advantages over PK, including quicker visual recovery, reduced complications, and longer graft survival, especially in the pediatric age group. The timing of surgical interventions depends on disease severity, age at presentation, comorbidities, and visual potential. Elevated oxidative stress in CHED corneal tissue suggests potential benefits from anti-inflammatory drugs to rescue mutated endothelial cells. Considering the limitations of corneal graft surgeries, exploring novel gene-based molecular therapies are essential for future management. Early diagnosis, appropriate surgical interventions, amblyopia control, and genetic counseling for predictive analysis are pivotal for optimizing CHED management. A multidisciplinary approach involving ophthalmologists, researchers, and genetic counselors is essential for precise diagnosis and optimal care for CHED patients.
PubMed: 38249503
DOI: 10.4103/tjo.TJO-D-23-00135 -
European Journal of Ophthalmology Jul 2023Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following... (Review)
Review
Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following cataract surgery. However, the decision to implant a premium IOL in a pediatric patient involves multiple factors affecting the child's visual development and is associated with several dilemmas and surgical challenges. The purpose of this review is to summarize these factors and analyse the influence of each of them on the visual outcomes following premium IOL implantation. A review of literature was conducted using the relevant keywords from various databases until 31 January 2022. All pertinent studies with multifocal or toric IOL implantation in children were reviewed, and relevant articles were studied in detail for age, IOL power calculation, visual outcomes (refractive outcomes, contrast sensitivity and stereopsis) and complications such as dysphotic phenomena and others. A total of 17 relevant studies (10 case series/interventional studies and 7 case reports) on the subject were included. All studies showed a favourable refractive outcome; however, the data available was significantly less. Studies with earlier models of multifocal IOLs showed a higher incidence of IOL decentration and posterior capsule opacification; however, more recent studies with newer IOL models showed much better safety profiles. Toric IOLs showed promising results in all the studies evaluated. Premium IOLs have shown promising results in the pediatric age group. However, their long-term outcomes specifically concerning refractive shift, capsular contraction and role in the management of amblyopia needs to be explored further.
Topics: Adult; Humans; Child; Lens Implantation, Intraocular; Visual Acuity; Lenses, Intraocular; Cataract Extraction; Multifocal Intraocular Lenses; Refraction, Ocular; Astigmatism; Phacoemulsification
PubMed: 36124376
DOI: 10.1177/11206721221126301 -
Frontiers in Neuroscience 2023This perspective article makes the case for evaluating and training peripheral stereopsis, particularly when the central visual field is compromised in one or both eyes....
This perspective article makes the case for evaluating and training peripheral stereopsis, particularly when the central visual field is compromised in one or both eyes. Examples of clinical conditions that preferentially affect the central visual field include macular degeneration, which affects the central macular region in one or both eyes, and amblyopia where the central field is often affected in one eye, but the peripheral field is largely intact. While binocular acuity may be preserved when the monocular central field of one eye is affected, fine stereopsis is compromised because it requires intact vision in corresponding locations in the two eyes. Even in these clinical conditions, recent studies that map stereoacuity at locations across the visual field demonstrate that the periphery supports coarse stereopsis, and that training efforts to use residual stereopsis may have greater benefit if they take this finding into account.
PubMed: 37795187
DOI: 10.3389/fnins.2023.1217993