Long-term Results of Congenital Cataract Surgery with Primary Intraocular Lens Implantation: A Case-Control Study of Three Age Groups.

Purpose: To analyze the results of ocular refraction at the age of 7 years in children after congenital cataract surgery with intraocular lens (IOL) implantation. Methods: A study of ocular biometric data of 143 eyes who underwent lens aspiration with IOL implantation in unilateral (23 eyes) and bilateral (60 eyes) congenital cataracts was performed. All children were divided into groups according to the age categories at the time of surgery: Group A (0-12 months) - 43 eyes; Group B (12-36 months) - 45 eyes; and Group C (older than 36 months) - 55 eyes. An empirical reduction of the implanted IOL power was performed: an undercorrection of 20% in children aged 0 to 36 months and 10% less in children aged 36 to 60 months. Results: By age 7 years, the mean elongation ± standard deviation (SD) in Group A was 3.93 ± 1.64 mm, 2.13 ± 0.94 mm in Group B, and 0.95 ± 0.76 mm in Group C (18.7%, 9.5%, and 4.1% of the baseline axial length, respectively). There was no significant difference in axial elongation between unilateral and bilateral congenital cataracts (P = 0.32). The mean absolute refraction error (MAE) at last examination was 3.99 ± 2.12 diopter (D), 2.46 ± 1.48 D, and 1.59 ± 1.31 D in Groups A, B, and C, respectively. In infants younger than 7 months of age, by age 7 years, the mean elongation ± SD was 3.27 ± 2.86 mm (25.5%) and MAE was 3.44 ± 2.1 D. The prevalence of preoperative corneal astigmatism of 1.0 D or more was 48.95%, 2.0 D or more was 27.27%, and 3.0 D or more was 5.6%. There was no significant difference in preoperative corneal astigmatism between unilateral (1.62 ± 0.77 D) and bilateral (1.78 ± 0.90 D) congenital cataracts (P = 0.56, 95% confidence interval = -0.50-0.28). Best-corrected visual acuity (BCVA) more than 20/40 was in 53.49%, 55.55%, and 74.54% in Groups A, B, and C, respectively. Conclusions: Although IOL power was calculated in accordance with children's age, at the age of 7 years, there was a different degree of ametropia because of the biometric changes of the growing eye, and a higher rate of ametropia was observed more in the younger age group than in the elder age groups.

Surgical Treatment of Optic Disc Pit Associated with Macular Detachment.

We report a clinical case of a serous macular detachment associated with optic disc pit (ODP), which was successfully treated with vitrectomy and internal limiting membrane (ILM) flap technique. A twenty-four-year-old woman complained of visual loss with duration over 7 months. Upon ophthalmic examination using funduscopy and spectral domain optical coherence tomography (OCT), a serous macular detachment associated with optic disc pit was diagnosed. The patient was successfully treated by 25-gauge pars plana vitrectomy with ILM peeling and placing an autologous ILM flap to cover the optic disc including the ODP. This method of treatment resulted in complete retinal reattachment with best-corrected visual acuity improvement to 20/60 from initial 20/500, and OCT showed a complete retinal attachment. This clinical case suggests that 25-gauge vitrectomy with ILM peeling and an inverted ILM flap can be an effective treatment option for optic disc pit-associated serous macular detachment.

Outcomes of pars plana vitrectomy in three cases of ophthalmomyiasis interna.

Purpose: To report the outcomes of pars plana vitrectomy in three cases of ophthalmomyiasis interna. Observations: Case 1 is a 15-year-old male with a mobile lenticular gray-white larva in the vitreous. Case 2 is a 4-year-old female with a floating larva in the optic axis. Case 3 is an 8-year-old female with a floating larva in the optic axis; however, intraoperatively, the larva was found subretinally. In all cases, 25-gauge pars plana vitrectomy was performed. Conclusions and importance: Ophthalmomyiasis interna is a rare parasitic eye disease that occurs when larvae of flies or gadflies enter the anterior chamber or/and posterior segment. Pars plana vitrectomy is an effective method of dealing with ophthalmomyiasis interna allowing to reach the main goal of treatment: removing the larva and restoring the eye structures. It is necessary to start treatment as soon as possible to prevent complications associated with mechanical injury and the prolonged toxic effect of larval immunogenic materials.

Age at recognition and age at presentation for surgery for congenital and developmental cataract in Kazakhstan.

PURPOSE: To investigate the age at recognition and presentation for surgery for congenital and developmental cataract at Kazakh Eye Research Institute in Kazakhstan. METHODS: A retrospective review of children aged 0-18 years, who presented with congenital and developmental cataract between January 1, 2010 and December 31, 2020. All medical records were reviewed. Gender, age at recognition, age at surgery, laterality, residential location (rural/urban) were recorded. RESULTS: The study population included 897 patients of children presented with congenital and developmental cataract over a 10-year study period, 58% of them were boys and 44.6% were from rural areas. Cataract was bilateral in 621 (69.2%) and unilateral in 276 (30.8%) of patients. Median age at recognition for patients with congenital/developmental cataract was 12 months. Median age at surgery for congenital/developmental cataract was 51 months. Only 14.7% of children underwent surgery within first year of life. The urban citizens underwent surgery earlier than patients from rural areas. The median delay in presentation for surgery was 15 months. CONCLUSION: The average age at cataract surgery in the population of Kazakhstan is much older than in developed countries. It is essential to study barriers that associated with delayed presentation to build strategies to overcome them.Key messagesIt is known that cataract surgery in children early in life provides favourable visual outcome.Children with congenital and developmental cataract in Kazakhstan experience delay in surgical treatment.Children from rural areas undergo cataract surgery later than urban citizens.

Clinical characteristics of congenital and developmental cataract in Kazakhstan.

Purpose: To study and describe clinical characteristics of congenital and developmental cataract at a tertiary eye care facility. Methods: In this retrospective study, 942 children (1311 eyes) presenting with congenital/developmental cataract over a 10-year study period were included. Gender, age at surgery, main presenting complaint, morphologic type of cataract, laterality, family history, and associated findings were recorded. Results: The overall proportion of boys and girls undergoing cataract surgery was approximately equal (P = 0.110). However, in the cases of bilateral cataract, the proportion of boys was larger than girls (P = 0.028). More than half (62.3%) of the patients underwent surgery at the age of >3 years. The main presenting complaint was white pupils, accounting for 48.1% of cases. Total cataract was the most common morphologic type in all age groups. In total, 133 children out of 942 (14.1%) had a positive family history of congenital/developmental cataract. Strabismus and nystagmus were seen in 27.2% and 19.3% of the eyes, respectively. Additional ocular dysmorphology was found in 97 (10.3%) of patients. Coexisting systemic disease was found in 149 (15.8%) cases. Among syndrome-associated cataracts, Down syndrome accounted for the majority of cases. Conclusion: High prevalence of total cataracts as well as frequent association with strabismus and nystagmus are likely to be the consequences of delayed presentation.

Cases of spontaneous reattachment of rhegmatogenous retinal detachment.

Report on clinical cases of spontaneous reattachment of rhegmatogenous retinal detachment (RRD). From 2014 to 2020 we diagnosed four patients with spontaneous reattachment of RRD. We conducted a review of the relevant medical records, focusing on the initial symptoms at presentation, the initial diagnoses, with a further observation of the patients next 3 years. The patients were re-examined 3 years later after cases of spontaneous reattachment of RRD. Three years after a case of spontaneous reattachment of RRD during reexamination in four patients (four eyes), redetachment was not detected. The mentioned clinical cases indicate the possibility of finding new approaches to RRD management.

Granulomatosis with Polyangiitis with Ocular Manifestations.

Granulomatosis with polyangiitis (GPA) is a granulomatous-necrotic systemic vasculitis with a lesion of predominantly the upper and lower respiratory tracts at the onset of the disease (vasculitis, accompanied by granulomatous inflammation), and subsequently renal (glomerulonephritis). In addition, GPA may manifest as inflammation of small arteries and veins. Despite many years of study of this disease, the etiology of GPA remains unknown. The present case is about a 47-year-old female, who had been suffering from necrotizing scleritis, corneal ulcer, and secondary glaucoma in both eyes for 3 months, and she was treated with anti-inflammatory and antimicrobial therapy that showed no effect; the patient's general condition became worse. In the second week of treatment, multiple abscess ruptures exposed the sclera. Sampling of the affected conjunctival tissue and positive HLA B8 haplotype and ANCA (PR3-ANCA) testings make it clear that GPA was the main reason of necrotizing scleritis with inflammation. The targeted treatment of the underlying disease allows to stabilize an inflammation of corneal and scleral lesions.

Vitrectomy without gas tamponade for macular retinoschisis associated with normal-tension glaucoma.

The authors present the case of a patient with normal-tension glaucoma and pit-like maculopathy observed by high-definition optical coherence tomography. Surgical management of macular retinoschisis was associated with improved vision and full resolution of intraretinal fluid and macular detachment. The patient had progressive vision loss over 6 months preoperatively; best corrected visual acuity and high-definition optical coherence tomography changes improved postoperatively. Optic disc pit-like maculopathy can occur in patients with normal-tension glaucoma in the absence of obvious congenital anomalies of the disc. The intraretinal fluid might have migrated from the vitreous cavity through a microhole at the optic disc margin or in the area with the nerve fiber defect. Vitrectomy without gas tamponade might lead to anatomic and functional recovery. Further studies are needed to better understand the pathogenesis of this disease.