ABSTRACT
An 8-month-old girl referred from her pediatrician with a diagnosis of neurofibromatosis type 1 (NF1) presented with an enlarged cloudy cornea of the left eye and a swollen left side of the face. Her left eye had intraocular pressure (IOP) of 21 mm Hg, corneal diameter of 16 mm, ectropion uvea, cup:disk ratio of 0.9, axial length of 28.06 mm, and S-shaped upper lid deformity. Uneventful combined trabeculotomy-trabeculectomy with mitomycin C was performed. On postoperative day 1, there was a new total hyphema that persisted for 2 weeks. An anterior chamber washout was performed, revealing the source of bleeding to be a persistent tunica vasculosa lentis along the zonules of the lens. Viscotamponade was performed, and the corneal wounds were closed, with the ocular tension slightly elevated. Bleeding did not recur for the following 5 months, and IOP was controlled until final follow-up.
Subject(s)
Hyphema , Intraocular Pressure , Neurofibromatosis 1 , Trabeculectomy , Humans , Female , Hyphema/etiology , Hyphema/diagnosis , Intraocular Pressure/physiology , Neurofibromatosis 1/complications , Neurofibromatosis 1/diagnosis , Infant , Glaucoma/etiology , Glaucoma/surgery , Glaucoma/diagnosis , Lens, Crystalline/surgery , Postoperative Complications , Mitomycin/administration & dosage , Mitomycin/therapeutic use , Lens Diseases/diagnosis , Lens Diseases/etiology , Lens Diseases/surgery , Embryonic Structures , Retinal Vessels/embryologyABSTRACT
PURPOSE: To report on the changes in the natural crystalline lens in primary congenital glaucoma (PCG) eyes that had undergone previous combined angle-filtering surgery with antimetabolites. SETTINGS: The pediatric ophthalmology unit of the ophthalmology department of Alexandria Main University Hospital. DESIGN: A retrospective chart review. METHODS: A retrospective chart review of patients presenting with and operated (by combined angle-filtering surgery with antimetabolites) for PCG in the period from 2005 to 2018. Any lens pathology was noted as well as the management and the outcome. RESULTS: The records of 422 children (613 eyes) were reviewed. Lens pathology was noted in 54 (8.8%) eyes. Abnormalities in lens clarity (cataract) were detected in 31 (56%) eyes, and abnormalities in lens position (subluxation) were detected in 24 (44%) eyes. Management options included observation (in 28 eyes), lensectomy for aphakia (in 14 eyes), lensectomy with in the bag intraocular lens (IOL) implantation (in 11 eyes), and lensectomy with iris-fixated IOL (in 1 eye). Elevation of intraocular pressure (IOP) occurred in only 4 eyes (of 26 operated eyes, 15.3%) after lens extraction. CONCLUSIONS: Changes in the natural crystalline lens clarity and/or position occurred in 8.8% (54 of 613) of PCG eyes operated by combined angle-filtering surgery with antimetabolites. Lens extraction was a relatively safe procedure with only 15% (4 of 26) of eyes suffering an elevation of IOP after lens extraction.
Subject(s)
Cataract Extraction , Cataract , Filtering Surgery , Glaucoma , Lens, Crystalline , Lenses, Intraocular , Child , Glaucoma/etiology , Glaucoma/surgery , Humans , Intraocular Pressure , Lens Implantation, Intraocular , Retrospective Studies , Visual AcuityABSTRACT
Anophthalmia or microphthalmia (A/M), characterized by absent or small eye, can be unilateral or bilateral and represent developmental anomalies due to the mutations in several genes. Recently, mutations in aldehyde dehydrogenase family 1, member A3 (ALDH1A3) also known as retinaldehyde dehydrogenase 3, have been reported to cause A/M. Here, we screened a cohort of 75 patients with A/M and showed that mutations in ALDH1A3 occurred in six families. Based on this series, we estimate that mutations in ALDH1A3 represent a major cause of A/M in consanguineous families, and may be responsible for approximately 10% of the cases. Screening of this gene should be performed in a first line of investigation, together with SOX2.
