1/19. The use of contact B mode ultrasound in pediatric ophthalmology.It has been shown that an ultrasound system such as the Bronson-Turner Contact B Mode can be added, fruitfully, to the armamentarium of the individual pediatric ophthalmologist. It can be used quickly and precisely with an ophthalmological training and without patient discomfort or anesthesia no matter what the age. Valuable anterior segment information can be readily gained without a waterbath. Examples are shown of children with opaque media who were found to have congenital cataracts and congenital aphakia, microphthalmos, PHPV, retinal anomalies and ectatic coloboma.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
2/19. Cataract surgery combined with implantation of an artificial iris.We describe 6 patients who presented with cataract or aphakia and absent or nonfunctional irides. The etiologies included congenital aniridia, traumatic iris loss, and chronic mydriasis secondary to recurrent herpetic uveitis. In 5 eyes, a prosthetic iris was successfully implanted in combination with small incision cataract surgery. In 2 eyes, a single-piece iris diaphragm and optical lens was implanted. Artificial irides offer a safe alternative for patients who previously had no viable options for iris reconstruction.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
3/19. In-the-bag secondary intraocular lens implantation in children.BACKGROUND: Surgery for congenital cataracts in early infancy usually includes a primary posterior capsulectomy and an anterior vitrectomy. Initially, most of these infants have aphakia after surgery. Over time, remaining equatorial lens epithelial cells produce new cortical fibers, resulting in a ring of cortex trapped between the lens equator and the fused anterior and posterior capsulectomy edges. A potential space is maintained between the anterior and posterior capsular leaflets. We describe a technique for placing a secondary intraocular lens (IOL) within the capsular bag. patients AND methods: Eight children, ranging in age from 11 months to 14 years, who originally had aphakia after cataract extraction were operated on with the intent to reopen the capsular bag and place an IOL in the bag. RESULTS: Secondary in-the-bag IOL implantation was successfully completed in 7 of 8 children. This was accomplished by reopening the capsular bag 360 degrees at the edge of the fused anterior and posterior capsulectomy remnants, using the previously published vitrectorhexis technique. Residual cortical material was aspirated, and an IOL was placed within the capsular bag. In 1 child, aged 14 years, the capsular bag was reopened, but the lens was placed in the ciliary sulcus because the new anterior capsule edge could not be visualized for 360 degrees . CONCLUSION: Placement of secondary IOLs within the capsular bag can be accomplished successfully for selected patients in the pediatric population. Surgeons operating on infantile cataracts without primary IOL placement can facilitate capsular IOL sequestration later by limiting the anterior and posterior capsulectomy to 4 to 5 mm and performing a generous anterior vitrectomy to help prevent secondary closure of the smaller capsulectomy.- - - - - - - - - - ranking = 2keywords = aphakia (Clic here for more details about this article) |
4/19. Clinical and ultrastructural features of a novel hereditary anterior segment dysgenesis.OBJECTIVE: To describe the clinical, histopathologic, and hereditary features of a novel familial anterior segment dysgenesis. DESIGN: Prospective, observational case series and interventional case report. PARTICIPANTS: Ten individuals from three generations of a single family with iris and corneal abnormalities associated with congenital cataracts. MAIN OUTCOME MEASURES: An ophthalmic evaluation including slit-lamp examination, corneal topography, pachymetry, and specular biomicroscopy of all family members, and histopathologic and ultrastructural evaluation of one excised corneal button. RESULTS: The proband was an 81-year-old man with bilateral aphakia and diffuse corneal haze, and thinning associated with corneal guttae. His pupils were small, mildly eccentric, and difficult to dilate. Pachymeter readings were 335 microm (right eye) and 330 microm (left eye). Topography confirmed advanced steepening of both corneas. light microscopic and transmission electron microscopic examinations of the corneal button revealed an attenuated endothelium with prominent intracellular random aggregates of small-diameter filaments staining positively for cytokeratin. Descemet's membrane was thickened and had marked posterior nodularity. Various-sized polymorphic vacuoles containing layered electron-dense material were present within and between collagen lamellae and within keratocytes throughout the stroma and Bowman's membrane. Secondary bullous changes of the epithelium with thickening of the basement membrane were also observed. The family pedigree demonstrated an autosomal dominant inheritance pattern. CONCLUSIONS: This constellation of autosomal dominantly inherited corneal endothelial and stromal disorder, with congenital cataracts and iris abnormalities, represents a novel anterior segment disorder. Its etiology may involve an abnormal migration of the secondary mesenchyme.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
5/19. Diagnosing glaucoma in pediatric aphakia.BACKGROUND: Cataracts pose a serious threat to the visual system in infants and children, requiring prompt surgical intervention and rehabilitation to optimize visual development. glaucoma is a serious complication following cataract surgery in infants and can lead to loss of vision. early diagnosis of glaucoma, however, can be quite challenging in these patients. case reports: Three cases are presented in which comeal edema was the initial presenting sign that led to the diagnosis of glaucoma during routine contact lens follow-up examinations for pediatric aphakia. CONCLUSION: The contact lens practitioner, during the course of management of aphakic infants and children, should always be suspicious of glaucoma as a complication of cataract surgery, and the presenting sign may be corneal edema.- - - - - - - - - - ranking = 5keywords = aphakia (Clic here for more details about this article) |
6/19. Stereopsis after congenital monocular cataract extraction.Congenital monocular cataract extraction was performed on a 1-day-old baby girl and a hydrophilic contact lens was fitted. A progressive regimen of part-time occlusive therapy was then instituted. Eight years later, the girl has a visual acuity of 20/25 in the operated-on eye and 50 seconds of arc of stereoacuity that has been confirmed by an independent pediatric ophthalmologist. This patient demonstrates the potential for high-grade stereopsis in congenital monocular aphakia.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
7/19. Traumatic lenticele.A 55-year-old woman presented with sudden diminution of vision in her left eye following trauma with her own finger. Examination revealed a firm subconjunctival swelling superiorly with aphakia and hypotony. Lens spike was absent on B-scan. Ultrasonic biomicroscopy showed thickened conjunctiva, a subconjunctival mass lesion with an underlying uveoscleral discontinuity. A surgical repair was performed with successful restoration of globe integrity. This case demonstrates that ultrasonic biomicroscopy may reveal the site and the extent of occult scleral rupture and help in precise surgical planning.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
8/19. Difficult vertical diplopia studied by video-oculography in aphakia after contact lens use. A case report.PURPOSE: To establish the utility of a video-oculography system (3D-VOG) in the diagnosis of a patient with difficult idiopathic vertical diplopia. CASE REPORT: We present a clinical case of an 87 year old female who was operated for glaucoma and cataract with the intracapsular technique in both eyes. She reported vertical diplopia with the use of contact lenses but not while using her aphakia spectacles. A complete ophthalmological study was carried out with special interest in the ocular motility study with 3D-VOG. RESULTS: Besides the hypertropia in lateroversion of the non-fixing eye, the video-oculography showed an incyclotorsion of the hypertropic eye, a fundamental factor for the differential diagnosis between bilateral superior oblique overaction and DVD or dissociated vertical divergence. Such a torsional strabismic deviation is very difficult to detail by other methods and is the important clue for diagnosis. The 3D-VOG made this diagnosis possible. CONCLUSIONS: The occurrence of a vertical diplopia with use of contact lenses, and not with spectacles, is explained by the limitation of ocular gaze movements with the aphakia spectacles which limitation is not found with the use of contact lenses, with diplopia appearing in the more extreme lateroversion possible with the contact lenses. The 3D-VOG system enabled us to analyze torsional movements in lateroversion that allowed the diagnosis of bilateral superior oblique overaction to be made.- - - - - - - - - - ranking = 6keywords = aphakia (Clic here for more details about this article) |
9/19. The correction of unilateral aphakia in children treated for orbital rhabdomyosarcoma.The survival rate of children with localized orbital rhabdomyosarcoma is now greater than 90% 3 years after diagnosis as a result of advances in radiation and chemotherapy. Ninety percent of these children develop cataracts within 1 to 4 years after the completion of radiotherapy. The correction of aphakia in these children is complicated by the concurrent keratoconjunctivitis and dryness associated with radiotherapy. Three patients with a diagnosis of orbital rhabdomyosarcoma underwent treatment for uniocular cataract. Two of the patients were unable to use extended wear contact lenses. Both underwent epikeratophakia with poor results. One patient who had clinically significant ocular drying prior to cataract extraction underwent successful implantation of an intraocular lens as a primary procedure, with excellent visual results. Clinicians should be aware of the difficulties associated with contact lens wear and epikeratophakia tissue lenses in children who have had high doses of radiation for orbital rhabdomyosarcoma. Such patients are probably best served by primary intraocular lens implantation or by preservation of the posterior capsule at the time of cataract extraction to allow secondary lens implantation if contact lens wear is unsuccessful.- - - - - - - - - - ranking = 5keywords = aphakia (Clic here for more details about this article) |
10/19. epikeratophakia after ocular trauma.Five patients with long-standing monocular traumatic aphakia and contact lens intolerance underwent epikeratophakia. This procedure was chosen to rehabilitate the visual function in those eyes that exhibited distorted anterior segment anatomy after trauma. Three of the patients had corneal scars associated with their old perforation wounds, and all of them had undergone an intracapsular cataract extraction soon after their original injuries. Best-corrected visual acuity was 20/50 or better in all cases before surgery. Postoperative best-corrected visual acuity improved to within two lines of the best-corrected preoperative visual acuity, after a minimum follow-up period of six months. No intraoperative complications were noted. One cornea developed late-onset partial scarring of the interface in the area of the original scar, but the process arrested spontaneously.- - - - - - - - - - ranking = 1keywords = aphakia (Clic here for more details about this article) |
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