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Infantile Aphakia and Successful Fitting of Pediatric Contact Lenses; a Case Presentation Authors: Virji N, Patel A, Libassi D
Infantile aphakia and successful fitting of pediatric contact lenses; a case presentation Authors: Virji N, Patel A, Libassi D An eleven month old male presents with bilateral aphakia secondary to congenital cataracts. The patient is currently successfully wearing B&L Silsoft Pediatric contact lenses, with good prognosis for vision in both eyes. I. Case History -Patient demographics: African American male, DOB 8/18/2009 -Chief complaint: patient presents with bilateral aphakia secondary to bilateral congenital cataract extraction -Ocular, medical history: S/P CE with anterior vitrectomy OD 09/22/2009, followed by OS 09/29/09. (+) squinting, rubs eyes, light sensitivity -Medications: none -Other salient information: patient has been seen by SUNY Contact Lens clinic since 2 months old, 10/14/2009 II. Pertinent findings -Clinical: Keratometry readings 41.00/41.25 @ 005 OD, 38.50/41.00 @ 046 Axial length, immeasurable Horizontal corneal diameter 8mm OD/OS Fundus exam WNL OU -Others: surgical dates: successful CE OU, September 2009 III. Differential diagnosis -Primary/leading: Idiopathic -Others: Posterior lenticonus, persistent hyperplastic primary vitreous, anterior segment dysgenesis, and posterior pole tumors, trauma, intrauterine infection (rubella), maternal hypoglycemia, trisomy (eg, Down, Edward, and Patau syndromes), myotonic dystrophy, infectious diseases (eg, toxoplasmosis, rubella, cytomegalovirus, and herpes simplex [TORCH]), and prematurity. (5) IV. Diagnosis and discussion -Elaborate on the condition: Bilateral infantile cataracts are one of the major treatable causes of visual impairment in children. (2) Hubel and Weisel’s research on the critical period of visual development determined that if infantile cataracts are removed within the critical period and appropriate correction is worn, vision is greatly improved. -
Intraocular Lenses and Spectacle Correction
MEDICAL POLICY POLICY TITLE INTRAOCULAR LENSES, SPECTACLE CORRECTION AND IRIS PROSTHESIS POLICY NUMBER MP-6.058 Original Issue Date (Created): 6/2/2020 Most Recent Review Date (Revised): 6/9/2020 Effective Date: 2/1/2021 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY I. POLICY Intraocular Lens Implant (IOL) Initial IOL Implant A standard monofocal intraocular lens (IOL) implant is medically necessary when the eye’s natural lens is absent including the following: Following cataract extraction Trauma to the eye which has damaged the lens Congenital cataract Congenital aphakia Lens subluxation/displacement A standard monofocal intraocular lens (IOL) implant is medically necessary for anisometropia of 3 diopters or greater, and uncorrectable vision with the use of glasses or contact lenses. Premium intraocular lens implants including but not limited to the following are not medically necessary for any indication, including aphakia, because each is intended to reduce the need for reading glasses. Presbyopia correcting IOL (e.g., Array® Model SA40, ReZoom™, AcrySof® ReStor®, TECNIS® Multifocal IOL, Tecnis Symfony and Tecnis SymfonyToric, TRULIGN, Toric IO, Crystalens Aspheric Optic™) Astigmatism correcting IOL (e.g., AcrySof IQ Toric IOL (Alcon) and Tecnis Toric Aspheric IOL) Phakic IOL (e.g., ARTISAN®, STAAR Visian ICL™) Replacement IOLs MEDICAL POLICY POLICY TITLE INTRAOCULAR LENSES, SPECTACLE CORRECTION AND IRIS PROSTHESIS POLICY NUMBER -
Insertion of Aqueous Shunt in Pedicatric Glaucoma
1/29/2018 Challenges of Insertion of Aqueous shunt in paediatric glaucoma Ahmed Elkarmouty MD, FRCS Moorfields Eye Hospital London, UK Classification • Primary Childhood Glaucoma • A- Primary Congenital Glaucoma (PCG) 1: 10,000–18,000 • B- Juvenile Open Angle Glaucoma (JOAG) (5-35 ys,)1 : 50,000. • Secondary Childhood Glaucoma • A- Glaucoma associated with non-acquired ocular anomalies • B- Glaucoma associated with non- acquired systemic disease or syndrome • C- Glaucoma associated with acquired condition • D- Glaucoma following Cataract surgery 1 1/29/2018 Glaucoma associated with non- acquired ocular anomalies • Conditions with predominantly ocular anomalies present at birth which may or may not be associated with systemic signs • Axenfeld Reiger anomaly • Peters anomaly • Ectropion Uvae • Congenital iris hypolplasia • Aniridia • Oculodermal melanocytosis • Posterior polymorphous dystrophy • Microphthalmos • Microcornea • Ectopia Lentis ( et pupillae) • Persistent foetus vasculopathy Glaucoma associated with non- acquired systemic disease or syndrome predominantly associated with known syndrome, systemic anomalies present at birth which may be associated with ocular signs • Down Syndrome • Connective tissue disorder: Marfan syndrome, Weill- Marchesiani syndrome, Stickler syndrome • Metabolic disorder : Homocystenuria, lowe syndrome, Mucoploysacchroidoses • Phacomatoses: Neurofibromatoses, Sturge Weber, Klipple-Trenaunay- weber syndrome, Rubenstein Taybi • Congenital Rubella 2 1/29/2018 Glaucoma associated with acquired condition Conditions -
Expanding the Phenotypic Spectrum of PAX6 Mutations: from Congenital Cataracts to Nystagmus
G C A T T A C G G C A T genes Article Expanding the Phenotypic Spectrum of PAX6 Mutations: From Congenital Cataracts to Nystagmus Maria Nieves-Moreno 1,* , Susana Noval 1 , Jesus Peralta 1, María Palomares-Bralo 2 , Angela del Pozo 3 , Sixto Garcia-Miñaur 4, Fernando Santos-Simarro 4 and Elena Vallespin 5 1 Department of Ophthalmology, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] (S.N.); [email protected] (J.P.) 2 Department of Molecular Developmental Disorders, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] 3 Department of Bioinformatics, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] 4 Department of Clinical Genetics, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] (S.G.-M.); [email protected] (F.S.-S.) 5 Department of Molecular Ophthalmology, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] * Correspondence: [email protected] Abstract: Background: Congenital aniridia is a complex ocular disorder, usually associated with severe visual impairment, generally caused by mutations on the PAX6 gene. The clinical phenotype of PAX6 mutations is highly variable, making the genotype–phenotype correlations difficult to establish. Methods: we describe the phenotype of eight patients from seven unrelated families Citation: Nieves-Moreno, M.; Noval, with confirmed mutations in PAX6, and very different clinical manifestations. -
Feasibility and Outcome of Descemet Membrane Endothelial Keratoplasty in Complex Anterior Segment and Vitreous Disease
CLINICAL SCIENCE Feasibility and Outcome of Descemet Membrane Endothelial Keratoplasty in Complex Anterior Segment and Vitreous Disease Julia M. Weller, MD, Theofilos Tourtas, MD, and Friedrich E. Kruse, MD escemet membrane endothelial keratoplasty (DMEK), Purpose: Descemet membrane endothelial keratoplasty (DMEK) is Da technique for posterior lamellar keratoplasty, involves becoming the method of choice for treating Fuchs endothelial a graft consisting only of the thin Descemet membrane with dystrophy and pseudophakic bullous keratopathy. We investigated adherent corneal endothelial cells. Introduced in 2006 by whether DMEK can serve as a routine procedure in endothelial Melles et al,1 DMEK is becoming more popular as several decompensation even in complex preoperative situations. studies show its superiority to Descemet stripping automated Methods: Of a total of 1184 DMEK surgeries, 24 consecutive eyes endothelial keratoplasty (DSAEK), regarding visual function 2,3 with endothelial decompensation and complex preoperative situa- and the time of visual rehabilitation after DMEK. However, tions were retrospectively analyzed and divided into 5 groups: group because DMEK grafts are thinner than DSAEK grafts, it is fi 1: irido-corneo-endothelial syndrome (n = 3), group 2: aphakia, more dif cult to handle them and typically takes surgeons subluxated posterior chamber intraocular lens or anterior chamber longer to learn. intraocular lens (n = 6), group 3: DMEK after trabeculectomy (n = In difficult situations, most surgeons prefer DSAEK or 4), group 4: DMEK with simultaneous intravitreal injection (n = 6), penetrating keratoplasty to DMEK because of its possible and group 5: DMEK after vitrectomy (n = 5). Main outcome intraoperative complications. For example, if corneal edema 4 parameters were best-corrected visual acuity, central corneal thick- is advanced, Ham et al recommend performing DSAEK first ness, endothelial cell density, rebubbling rate, and graft failure rate. -
Glaucoma-Related Adverse Events in the Infant Aphakia Treatment Study 1-Year Results
CLINICAL SCIENCES ONLINE FIRST Glaucoma-Related Adverse Events in the Infant Aphakia Treatment Study 1-Year Results Allen D. Beck, MD; Sharon F. Freedman, MD; Michael J. Lynn, MS; Erick Bothun, MD; Daniel E. Neely, MD; Scott R. Lambert, MD; for the Infant Aphakia Treatment Study Group Objectives: To report the incidence of glaucoma and glau- sistent fetal vasculature and 1.6 times higher for each coma suspects in the IATS, and to evaluate risk factors for month of age younger at cataract surgery. the development of a glaucoma-related adverse event in patients in the IATS in the first year of follow-up. Conclusions: Modern surgical techniques do not elimi- nate the early development of glaucoma following con- Methods: A total of 114 infants between 1 and 6 months genital cataract surgery with or without an intraocular of age with a unilateral congenital cataract were as- lens implant. Younger patients with or without persis- signed to undergo cataract surgery either with or with- tent fetal vasculature seem more likely to develop a glau- out an intraocular lens implant. Standardized defini- coma-related adverse event in the first year of follow- tions of glaucoma and glaucoma suspect were created and up. Vigilance for the early development of glaucoma is used in the IATS. needed following congenital cataract surgery, especially when surgery is performed during early infancy or for a Results: Of these 114 patients, 10 (9%) developed glau- child with persistent fetal vasculature. Five-year fol- coma and 4 (4%) had glaucoma suspect, for a total of 14 low-up data for the IATS will likely reveal more glaucoma- patients (12%) with a glaucoma-related adverse event in related adverse events. -
Journal of Ophthalmology & Clinical Research
ISSN: 2573-9573 Case Report Journal of Ophthalmology & Clinical Research Bilateral Congenital Ectropion Uveae, Anterior Segment Dysgenesis and Aniridia with Microspherophakic Congenital Cataracts and RubeosisIridis Rao Muhammad Arif Khan* and Ashal Kaiser Pal *Corresponding author Rao Muhammad Arif Khan, MCPS, FCPS, FPO, FACS, Pediatric Ophthalmologist, King Edward Medical University, Al-Awali Street, Taif Road, Makkah, Saudi Arabia, Pediatric Ophthalmologist, King Edward Medical University, Tel: 00966560479694; E-mail: [email protected] Makkah, Saudi Arabia Submitted: 02 Apr 2018; Accepted: 12 Apr 2018; Published: 19 Apr 2018 Abstract In recent times, multiple eye diseases have been seen associated with an increase in the rate of Demodex infestation as a possible cause, but in the particular case of dry eye syndrome in patients treated with platelet-rich plasma, this increase in mite may be relevant to guide a more adequate treatment focusing on the elimination of the mite in conjunction with the recovery of the ocular ecology. The demodex mite is a commensal parasite that lives in hair follicles, sebaceous glands and meibomian, which in a high rate of infestation can generate alterations in the ocular area. Performing an adequate diagnosis for the detection of the mite and treatment for its eradication can be effective for the recovery of the normal physiology of the tear film that constitutes a cause of dry eye. Introduction Congenital ectropion uvea is a rare ocular manifestation of neural crest syndrome [1]. It is a non-progressive anomaly characterized by presence of iris pigment epithelium on anterior surface of iris from the pigment ruff [2]. Congenital glaucoma is its common association [3-8]. -
Lid and Lash Conditions
Perth Veterinary Ophthalmology Lid and Lash Conditions Eyelid Diseases The most common eyelid diseases are entropion, ectropion and facial droop. Entropion Entropion means a turning in of the lids. This is a common complaint in young dogs but can sometimes affect older dogs and cats as well. Most cases in young dogs affect the lower lids, but the upper lid can become affected in later life in some breeds such as Cocker Spaniels and Bloodhounds. Entropion Some breeds such as Shar Peis, Chows, Rottweillers and Mastiffs can have very complex entropion leading to defects in both upper and lower lids. A Shar Pei with severe upper and lower lid entropion Entropion is painful and can be potentially blinding. The rolling in of the lid leads to hair coming into contact with the cornea, leading to pain, ulceration and scarring (which can affect vision). In severe cases this can even lead to perforation of the eye. There are many causes of entropion. It can be primary or secondary to other problems affecting the lids (such as ectopic cilia, distichiasis etc. - see below). Some possible causes include the lid being too long, the lid being too tight, instability of the lateral canthus (outer cornea of the eyelids), misdirection of the lateral canthal tendon, brachycephalic anatomy (big eyes and short nose - e.g. Pekingese, Pugs, Shih Tsus, Persian cats etc.), diamond eye defects, loose or too much skin, facial droop etc. Often these cases are referred to a veterinary ophthalmologist for proper assessment and treatment to provide the best outcome. Entropion requires surgical correction. -
Visual Management of Aphakia with Concomitant Severe Corneal Irregularity by Mini-Scleral Design Contact Lenses
HOSTED BY Available online at www.sciencedirect.com ScienceDirect Journal of Current Ophthalmology 28 (2016) 27e31 http://www.journals.elsevier.com/journal-of-current-ophthalmology Original research Visual management of aphakia with concomitant severe corneal irregularity by mini-scleral design contact lenses Fateme Alipur, Seyedeh Simindokht Hosseini* Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran Received 30 October 2015; accepted 28 January 2016 Available online 30 March 2016 Abstract Purpose: To evaluate visual results, comfort of use, safety, and efficacy of mini scleral contact lenses in optical management in patients with traumatic aphakia and severe concomitant irido-corneal injury. Methods: In a case series, eight eyes with post traumatic aphakia and severe concomitant irido-corneal injury that were evaluated at the Contact Lens Clinic of Farabi Eye Hospital, Tehran, Iran for contact lens fitting and could not be corrected with conventional corneal RGP contact lenses were fitted with miniscleral contact lenses. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and BCVA (Best corrected visual acuity) with miniscleral lens were recorded. Slit lamp examination, comfortable daily wearing time, and any contact lens-related complication were documented in each follow-up visit. Results: The mean UCVA and BSCVA of the cases was >2.7 and 0.41 LogMAR, respectively (BSCVA could not be assessed in one case due to severe corneal irregularity). The mean final BCVA with the miniscleral lens was 0.05 LogMAR (range from 0.4 to À0.04 LogMAR). The mean follow-up period was 14.6 months. The mean comfortable daily wearing time (CDWT) was 11.6 h, ranging from 8 to 16 h. -
Ocular Colobomaâ
Eye (2021) 35:2086–2109 https://doi.org/10.1038/s41433-021-01501-5 REVIEW ARTICLE Ocular coloboma—a comprehensive review for the clinician 1,2,3 4 5 5 6 1,2,3,7 Gopal Lingam ● Alok C. Sen ● Vijaya Lingam ● Muna Bhende ● Tapas Ranjan Padhi ● Su Xinyi Received: 7 November 2020 / Revised: 9 February 2021 / Accepted: 1 March 2021 / Published online: 21 March 2021 © The Author(s) 2021. This article is published with open access Abstract Typical ocular coloboma is caused by defective closure of the embryonal fissure. The occurrence of coloboma can be sporadic, hereditary (known or unknown gene defects) or associated with chromosomal abnormalities. Ocular colobomata are more often associated with systemic abnormalities when caused by chromosomal abnormalities. The ocular manifestations vary widely. At one extreme, the eye is hardly recognisable and non-functional—having been compressed by an orbital cyst, while at the other, one finds minimalistic involvement that hardly affects the structure and function of the eye. In the fundus, the variability involves the size of the coloboma (anteroposterior and transverse extent) and the involvement of the optic disc and fovea. The visual acuity is affected when coloboma involves disc and fovea, or is complicated by occurrence of retinal detachment, choroidal neovascular membrane, cataract, amblyopia due to uncorrected refractive errors, etc. While the basic birth anomaly cannot be corrected, most of the complications listed above are correctable to a great 1234567890();,: 1234567890();,: extent. Current day surgical management of coloboma-related retinal detachments has evolved to yield consistently good results. Cataract surgery in these eyes can pose a challenge due to a combination of microphthalmos and relatively hard lenses, resulting in increased risk of intra-operative complications. -
Clinical Manifestations of Congenital Aniridia
Clinical Manifestations of Congenital Aniridia Bhupesh Singh, MD; Ashik Mohamed, MBBS, M Tech; Sunita Chaurasia, MD; Muralidhar Ramappa, MD; Anil Kumar Mandal, MD; Subhadra Jalali, MD; Virender S. Sangwan, MD ABSTRACT Purpose: To study the various clinical manifestations as- were subluxation, coloboma, posterior lenticonus, and sociated with congenital aniridia in an Indian population. microspherophakia. Corneal involvement of varying degrees was seen in 157 of 262 (59.9%) eyes, glaucoma Methods: In this retrospective, consecutive, observa- was identified in 95 of 262 (36.3%) eyes, and foveal hy- tional case series, all patients with the diagnosis of con- poplasia could be assessed in 230 of 262 (87.7%) eyes. genital aniridia seen at the institute from January 2005 Median age when glaucoma and cataract were noted to December 2010 were reviewed. In all patients, the was 7 and 14 years, respectively. None of the patients demographic profile, visual acuity, and associated sys- had Wilm’s tumor. temic and ocular manifestations were studied. Conclusions: Congenital aniridia was commonly as- Results: The study included 262 eyes of 131 patients sociated with classically described ocular features. with congenital aniridia. Median patient age at the time However, systemic associations were characteristically of initial visit was 8 years (range: 1 day to 73 years). Most absent in this population. Notably, cataract and glau- cases were sporadic and none of the patients had par- coma were seen at an early age. This warrants a careful ents afflicted with aniridia. The most common anterior evaluation and periodic follow-up in these patients for segment abnormality identified was lenticular changes. -
Retinitis Pigmentosa Associated with Ectopia Lentis
CLINICOPATHOLOGIC REPORTS, CASE REPORTS, AND SMALL CASE SERIES SECTION EDITOR: W. RICHARD GREEN, MD tion of the oil progressing through the In January 2001, glaucoma sur- Silicone Oil Egressing tube and histopathologic analysis of gery was needed to control elevated Through an Inferiorly the orbital tissue surrounding the ex- intraocular pressure (IOP). The eye Implanted Ahmed Valve truded silicone oil. was aphakic and had total traumatic aniridia. An Ahmed valve was im- Silicone oil use as an adjunct to com- Report of a Case. A 69-year-old white planted inferonasally in an attempt plicated vitreoretinal surgery is be- man lost his left eye to trauma at age to avoid the silicone oil bubble coming more frequent. Refractory 12 years. In September 2000, blunt (Figure 1 and Figure 2). The pa- glaucoma in these patients is com- trauma resulted in a lacerated eye- tient’s IOP responded well initially mon. Isolated reports have men- brow, scleral rupture, uveal prolapse, but rose subsequently to 30 mm Hg. tioned the possibility of silicone oil extrusion of his crystalline lens, reti- A bubble of silicone oil was wrap- migrating and/or obstructing the nal detachment, and suprachoroidal ping the tip of the tube (Figure 3). tube in the anterior chamber of Mol- hemorrhage in his right eye. A limited Silicone oil could be seen migrating teno implants (IOP, Costa Mesa, anterior chamber washout was per- through the Ahmed tube (Figure 4 Calif).1,2 This report describes a case formed at the time of the primary re- and Figure 5) and the bleb over the of intraocular silicone oil egressing pair.