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Journal of Cataract and Refractive... Dec 2022Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast... (Review)
Review
Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented.
Topics: Humans; Aphakia; Lens, Crystalline; Lenses, Intraocular; Cataract Extraction; Cataract
PubMed: 36449676
DOI: 10.1097/j.jcrs.0000000000000954 -
Journal of AAPOS : the Official... Feb 2022To describe the natural history, management, and visual outcome in children with congenital primary aphakia (CPA).
PURPOSE
To describe the natural history, management, and visual outcome in children with congenital primary aphakia (CPA).
METHODS
This is a multicenter retrospective consecutive case series from five academic centers in England and North America.
RESULTS
A total of 27 eyes of 14 patients were included (male:female, 1.7:1). Thirteen patients had bilateral CPA, and 1 patient had unilateral CPA. Mean age at diagnosis was 18 months (median, 21; range, 0.5-144). Of 11 patients who underwent genetic testing, 9 had FOXE3 pathogenic variants. In all patients, visual acuity at presentation was not better than fixing and following light. Typical findings included silvery appearance of the cornea with vascularization (96%), glaucoma (81%), iridocorneal adhesions (74%), optic nerve coloboma (55%), abnormal vitreous (33%), retinal detachment (30%), and aniridia with hypoplasia of ciliary body (19%). Surgical interventions in select patients included penetrating keratoplasty (PKP), glaucoma drainage device implantation, and cyclophotocoagulation (CPC).
CONCLUSIONS
Eyes with corneal ectasia and a silvery appearance of the cornea with vascularization should alert the physician to the possibility of CPA. Glaucoma causes globe enlargement and may increase the risk of corneal perforation, but glaucoma is often refractory to medical treatment, and the threshold for surgical treatment should be low. PKP outcomes are very poor.
Topics: Aphakia; Child; Female; Follow-Up Studies; Humans; Intraocular Pressure; Keratoplasty, Penetrating; Male; Retrospective Studies; Treatment Outcome
PubMed: 35051625
DOI: 10.1016/j.jaapos.2021.09.008 -
In Vivo (Athens, Greece)Senile cataract is the leading cause of severe vision loss and blindness worldwide, affecting approximately 20 million people. Anterior chamber intraocular lens (AC... (Review)
Review
Senile cataract is the leading cause of severe vision loss and blindness worldwide, affecting approximately 20 million people. Anterior chamber intraocular lens (AC IOLs) remain a surgical option for visual rehabilitation required after surgical extraction of the cataract lens. Relevant publications in the PUBMED database were searched for articles regarding the types, visual outcomes and the complications followed the surgical implantation of AC IOLs. AC IOLs, which can be iris- (iris-claw) or angle-supported, increase visual acuity in most patients. However, complications, such as raised intraocular pressure, hyphaema, distorted pupil shape, iris pigment precipitates, endothelial cell loss, corneal oedema, neovascular glaucoma, retinal detachment and cystoid macular oedema, can unfavorably affect the surgical outcome. Although AC IOLs have been found to improve the visual acuity of patients with cataract, they have been also implicated in several complications.
Topics: Anterior Chamber; Aphakia; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Treatment Outcome; Visual Acuity
PubMed: 27815455
DOI: 10.21873/invivo.10988 -
Journal of AAPOS : the Official... Dec 2022To describe the presentation and treatment outcomes of a cohort of children with primary aphakia (PA).
PURPOSE
To describe the presentation and treatment outcomes of a cohort of children with primary aphakia (PA).
METHODS
Clinical photographs and ultrasound biomicroscopy (UBM) images of children presenting with sclerocornea and undetermined anterior segment dysgenesis between July 2017 and December 2020 were reviewed retrospectively. Children who had no crystalline lens visible on UBM were included.
RESULTS
A total of 124 UBM images were captured for 124 children with cloudy corneas. Twelve children were identified with congenital primary aphakia: 5 had bilateral buphthalmos, 2 had buphthalmos in one eye and microphthalmos in the other, and 5 had bilateral sclerocornea-microphthalmia complex. All patients had a peculiar silvery-blue corneal appearance, with fine vascularization on the corneal surface. The overall corneal thickness was 409.1 ± 8.7 μm. The intraocular pressure (IOP) in eyes with glaucoma was 24.5 ± 7.3 mm Hg; in microphthalmic eyes, 11.4 ± 3.4 mm Hg (P <0.001). The raised IOP was treated with limited trans-scleral cyclophotocoagulation under transillumination and topical antiglaucoma medications. Children with glaucoma gained ambulatory vision with spectacles.
CONCLUSIONS
Congenital primary aphakia has a characteristic clinical appearance and may present as buphthalmos or microphthalmos, depending on the extent of dysgenesis. Incisional surgery may result in phthisis because of ciliary body dysgenesis and unpredictable aqueous production.
Topics: Child; Humans; Microphthalmos; Hydrophthalmos; Retrospective Studies; Aphakia; Intraocular Pressure; Glaucoma
PubMed: 36183996
DOI: 10.1016/j.jaapos.2022.07.012 -
Ophthalmology Sep 2018To review the published literature to assess the visual outcomes and adverse events associated with the 2 most commonly used contact lenses for treating aphakia in... (Review)
Review
PURPOSE
To review the published literature to assess the visual outcomes and adverse events associated with the 2 most commonly used contact lenses for treating aphakia in children: silicone elastomer (SE) and rigid gas permeable (RGP).
METHODS
Literature searches were last conducted in January 2018 in the PubMed, Cochrane Library, and ClinicalTrials.gov databases with no date or language restrictions. These combined searches yielded 167 citations, 27 of which were reviewed in full text. Of these, 10 articles were deemed appropriate for inclusion in this assessment and subsequently assigned a level of evidence rating by the panel methodologist.
RESULTS
The literature search identified 4 level II studies and 6 level III studies. There were insufficient data to compare visual outcomes for eyes treated using SE lenses versus RGP lenses. Silicone elastomer lenses have the advantage that they can be worn on an extended-wear basis, but they were associated with more adverse events than RGP lenses. These adverse events included microbial keratitis, corneal infiltrates, corneal edema, corneal scars, lenses adhering to the cornea, superficial punctate keratopathy, lid swelling, and conjunctival hyperemia. The lens replacement rate was approximately 50% higher for RGP lenses in the only study that directly compared SE and RGP lenses.
CONCLUSIONS
Limited evidence was found in the literature on this topic. Silicone elastomer and RGP contact lenses were found to be effective for treating aphakia in children. Silicone elastomer lenses are easier to fit and may be worn on an extended-wear basis. Rigid gas permeable lenses must be removed every night and require a more customized fit, but they are associated with fewer adverse events. The choice of which lens a practitioner prescribes should be based on the particular needs of each patient.
Topics: Academies and Institutes; Aphakia; Child; Contact Lenses; Humans; Ophthalmology; United States
PubMed: 29631901
DOI: 10.1016/j.ophtha.2018.03.014 -
Ophthalmologica. Journal International... 2011Phacoemulsification with an intraocular lens implant is a safe and effective means of correction of visual loss from cataract. The high frequency of this procedure world... (Review)
Review
Phacoemulsification with an intraocular lens implant is a safe and effective means of correction of visual loss from cataract. The high frequency of this procedure world wide means inevitable direct surgical complications will be numerous even though infrequent. The approach to correcting aphakia following complicated cataract surgery is dependent on multiple factors including the degree to which the capsular bag is intact and the type of intraocular lens that has been inserted. We discuss several approaches and strategies for managing dropped intraocular lenses, the correction of aphakia and the safety and long-term results of anterior chamber intraocular lens placement.
Topics: Anterior Chamber; Aphakia; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Prosthesis Failure; Suture Techniques; Vitrectomy
PubMed: 21778780
DOI: 10.1159/000328210 -
Indian Journal of Ophthalmology Mar 2022To describe the clinical spectrum and management of glaucoma in congenital aphakia.
PURPOSE
To describe the clinical spectrum and management of glaucoma in congenital aphakia.
METHODS
The demographics and clinical spectrum of eyes with congenital aphakia with and without glaucoma were compared, and management outcomes of congenital aphakia cases with glaucoma were studied retrospectively between April 2000 and June 2020.
RESULTS
There were a total of 168 eyes (84 subjects) with a diagnosis of congenital aphakia, of which 29 eyes of 18 subjects were diagnosed with glaucoma. Corneal opacity was the presenting complaint in 26/29 eyes with glaucoma and 139/139 eyes without glaucoma. The (interquartile range (IQR)) horizontal corneal diameterwas 10.5mm (IQR, 9.0-12.5) and 8mm (IQR, 5-10) in eyes with and without glaucoma (P = 0.01), respectively. The median (IQR) axial length was 17.5mm (IQR, 13.5-19.5) and 15mm (IQR, 14-16) mm in eyes with and without glaucoma (P = 0.03), respectively. Nineteen eyes with glaucoma had adequate intraocular pressure (IOP) control with one medication. Three eyes underwent transscleral diode cyclophotocoagulation and maintained IOP without medications. Three eyes underwent trabeculectomy and trabeculotomy, trabeculectomy followed by penetrating keratoplasty, and trabeculectomy, respectively, of which two eyes became phthisical. At the last follow-up, the median (IQR) IOP was 14 mm Hg (IQR, 14-17) Hg. The median(IQR) follow-up duration was 4.53 months (IQR, 2.03- 48.06).
CONCLUSION
One-fifth of the eyes with congenital aphakia had secondary developmental glaucoma. The corneal diameter and axial lengths were higher in the eyes with glaucoma compared to eyes without glaucoma. Medical management is the preferred short-term mode of IOP control. Transscleral cyclophotocoagulation may be preferred over surgical intervention.
Topics: Aphakia; Ciliary Body; Follow-Up Studies; Glaucoma; Humans; Intraocular Pressure; Retrospective Studies; Trabeculectomy; Treatment Outcome
PubMed: 35225525
DOI: 10.4103/ijo.IJO_1782_21 -
Cornea Sep 2018To describe 2 sporadic Mexican patients having congenital bilateral, total sclerocornea, aphakia, and microphthalmia associated with novel mutations in the FOXE3 gene. (Review)
Review
PURPOSE
To describe 2 sporadic Mexican patients having congenital bilateral, total sclerocornea, aphakia, and microphthalmia associated with novel mutations in the FOXE3 gene.
METHODS
Two affected individuals with congenital bilateral, total sclerocornea, aphakia, and microphthalmia underwent detailed examinations including slit-lamp examination, visual acuity, and intraocular pressure measurements. Ocular ultrasonography and ultrasound biomicroscopy were performed. Genomic DNA was isolated from blood leukocytes in each subject, and molecular analysis of the FOXE3 gene was performed. For cosegregation analysis, presumable pathogenic variants were tested by Sanger sequencing in parental DNA.
RESULTS
Molecular screening of FOXE3 was performed in 2 cases with congenital bilateral, total sclerocornea, aphakia, and microphthalmia. In patient 1, genetic analysis demonstrated a novel homozygous c.291C>G (p.Ile97Met) FOXE3 pathogenic variant. In patient 2, compound heterozygosity for the novel c.387C>G (p.Phe129Leu) transversion and for the previously reported c.244A>G (p.Met82Val) transition, was recognized.
CONCLUSIONS
The sclerocornea-microphthalmia-aphakia complex is a severe malformative ocular phenotype resulting from mutations in the FOXE3 transcription factor. To date, patients from at least 14 families with this uncommon ocular disorder have been described. The identification of 2 novel pathogenic variants in our patients expands the mutational spectrum in FOXE3-related congenital eye disorders. In addition, we performed a review of the clinical and genotypic characteristics of all published patients carrying biallelic FOXE3 mutations.
Topics: Aphakia; Child; Consanguinity; Cornea; Corneal Diseases; DNA Mutational Analysis; Female; Forkhead Transcription Factors; Genotype; Heterozygote; Humans; Infant, Newborn; Male; Microphthalmos; Microscopy, Acoustic; Mutation; Polymerase Chain Reaction
PubMed: 29878917
DOI: 10.1097/ICO.0000000000001655 -
Turkish Journal of Ophthalmology Apr 2024Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision.... (Review)
Review
Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision. Therefore, early cataract surgery and effective multifaceted treatment of the resulting aphakia in the early stages of life are of great value for the management of vision development. Among the treatment models, contact lenses (CL) have an important place in infancy and early childhood up to the age of 2 years. Although good visual gains were not considered very likely, especially in unilateral aphakia, important steps have been taken in the treatment of pediatric aphakia thanks to the surgical techniques developed over time and the increasing experience with optical correction systems, especially CLs. This review examines current developments in the types of CL used in pediatric aphakia, their application features, comparison with other optical systems, the features of amblyopia treatment in the presence of CL, and the results obtained with family compliance to CL wear and occlusion therapy in the light of existing studies.
Topics: Humans; Contact Lenses; Aphakia, Postcataract; Visual Acuity; Infant; Child, Preschool; Cataract; Cataract Extraction; Amblyopia; Aphakia; Child; Infant, Newborn
PubMed: 38645732
DOI: 10.4274/tjo.galenos.2023.56252 -
Journal of Pediatric Ophthalmology and... 1997
Topics: Anterior Eye Segment; Aphakia; Eye; Humans; Lens, Crystalline; Neural Crest
PubMed: 9253731
DOI: 10.3928/0191-3913-19970701-04