ABSTRACT
PURPOSE: To evaluate efficacy, safety, and predictability of sequential Ferrara-type intrastromal corneal ring segments (ICRS) and an extended range of vision intraocular lens (IOL) implantation in patients with keratoconus and cataract. METHODS: This study comprised patients with keratoconus and cataract that had ICRS implantation followed 6 months later by extended range of vision IOL implantation. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and residual refractive errors, analysed using vector analysis, were recorded preoperatively, 6 months after ICRS implantation, and 6 months after IOL implantation, respectively. RESULTS: The study enrolled 17 eyes (11 patients). The mean UDVA (logMAR scale) was 1.15 ± 0.67 preoperatively, 0.88 ± 0.69 six months after ICRS implantation (P = 0.005), and 0.27 ± 0.18 six months after IOL implantation (P < 0.0001). The CDVA changed from 0.26 ± 0.15 (logMAR) before surgery to 0.17 ± 0.08 six months after Ferrara-type ICRS implantation (P = 0.002) and to 0.07 ± 0.06 six months after IOL implantation (P < 0.0001). The spherical equivalent and the refractive cylinder declined steeply after IOL implantation (P < 0.001). The magnitude of depth of focus was 2.60 ± 1.02 D. There were no statistically significant differences in visual acuity for a defocus range from +0.50 D to -0.50 D (P > 0.1). CONCLUSION: Sequential Ferrara-type ICRS and an extended range of vision IOL implantation provided good visual and refractive outcomes, being an effective, safe, and predictable procedure for the treatment of selected cases of patients with keratoconus and cataract. In addition, this approach provides an increase of tolerance to defocus.
ABSTRACT
CASO CLÍNICO: Presentamos el caso de un paciente varón de 4 años de edad, remitido por endotropia congénita con limitación de abducción, tortícolis horizontal con fijación cruzada y escoliosis toraco-lumbar. El análisis genético del gen ROBO3 confirmó el diagnóstico de parálisis de la mirada horizontal y escoliosis progresiva (HGPPS). DISCUSIÓN. La HGPPS es una alteración infrecuente de la motilidad ocular, caracterizada por ausencia de movimientos conjugados horizontales y escoliosis progresiva de inicio precoz. Esta entidad debe ser considerada como parte del diagnóstico diferencial de la endotropia congénita con fijación cruzada e incapacidad de abducción
CASE REPORT: The case is presented on a 4-year-old child with congenital esotropia, limitation of abduction, cross-fixation, and thoracolumbar scoliosis. Genetic testing of ROBO3 gene confirmed the diagnosis of horizontal gaze palsy and scoliosis (HGPSS). DISCUSSION: HGPPS is a rare congenital disorder characterised by absence of conjugate horizontal eye movements and progressive scoliosis developed in childhood and adolescence. We highlight this motility disorder as a part of the differential diagnosis of early childhood esotropia with cross- fixation and limitation of abduction
Subject(s)
Humans , Male , Child, Preschool , Ophthalmoplegia/complications , Ophthalmoplegia , Nystagmus, Pathologic/complications , Ocular Motility Disorders/complications , Ocular Motility Disorders/diagnosis , Diagnosis, Differential , Ophthalmoplegia/congenital , Scoliosis/complications , Scoliosis/diagnosis , Visual Acuity/physiology , Spine , Skull , Ophthalmoplegia/genetics , Ophthalmoplegia/surgery , Oculomotor Nerve Injuries/genetics , Oculomotor Nerve Injuries/surgeryABSTRACT
CASE REPORT: The case is presented on a 4- year-old child with congenital esotropia, limitation of abduction, cross-fixation, and thoracolumbar scoliosis. Genetic testing of ROBO3 gene confirmed the diagnosis of horizontal gaze palsy and scoliosis (HGPSS) DISCUSSION: HGPPS is a rare congenital disorder characterised by absence of conjugate horizontal eye movements and progressive scoliosis developed in childhood and adolescence. We highlight this motility disorder as a part of the differential diagnosis of early childhood esotropia with cross- fixation and limitation of abduction.