[Spontaneous rupture of the anterior lens capsule in Alport syndrome (case study)]. / Samoproizvol'noe vskrytie perednei kapsuly khrustalika pri sindrome Al'porta (klinicheskoe nablyudenie).

Alport syndrome is a hereditary disease characterized by glomerulopathy, manifested by hematuria and/or proteinuria, progressive decline in renal function, often combined with hearing and vision pathology. This article presents a clinical case of spontaneous opening of the anterior lens capsule in a patient with Alport syndrome, accompanied by uveitis and ophthalmic hypertension, and describes the features of the surgical aid and the postoperative period.

Postoperative hyphema due to persistent tunica vasculosa lentis in glaucoma associated with neurofibromatosis-a case report.

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.

A potential role for inflammatory cytokines in a rare late-onset capsular block syndrome: a case report.

BACKGROUND: Late-onset capsule block syndrome (CBS) is a rare complication of cataract phacoemulsification and the implantation of a posterior chamber intraocular lens (PCIOL), which manifests six months to years after surgery. The hallmark of CBS is the formation of an opaque liquid substance between the implanted intraocular lens (IOL) and the posterior capsule. However, its pathogenesis remains unclear. CASE PRESENTATION: A 64-year-old female patient with chronic angle-closure glaucoma (axis length < 21 mm) underwent trabeculectomy surgery combined with phacoemulsification and PCIOL. After a 4-year follow-up, a decline in visual acuity occurred in her right eye due to the location of opaque fluid in the visual axis and distension of the capsular bag. The initial course of action was to release the trapped fluid. Neodymium: yttrium-aluminum-garnet (Nd: YAG) laser capsulotomy could not be employed due to her non-dilating pupil and high extension of the posterior capsule. Subsequently, anterior capsule peeling and anterior segment vitrectomy surgery were performed. The depth of the anterior chamber (ACD), the distance between the face of the retro-IOL and the posterior capsule, the best-corrected visual acuity (BCVA), and the visual quality (VQ) were measured both before and after surgery. Inflammatory cytokine levels in the opaque substances (OS) trapped between the PCIOL and the posterior capsule were assessed using a flow cytometer and compared to normal statistical data in aqueous humor. After surgery, the patient experienced a significant improvement in BCVA and VQ. The distance between the face of the retro-IOL and the posterior capsule was on the verge of disappearing. However, ACD did not differ between pre- and post-operatively. Interleukin-8 (IL-8) and basic fibroblast growth factor (BFGF) concentrations were higher in the OS than in aqueous humor, especially in the former. However, the concentration of vascular cell adhesion molecule (VCAM) in the OS was lower than in aqueous humor. CONCLUSIONS: Anterior segment vitrectomy surgery proved to be a successful treatment for late-onset CBS, presenting a challenging case. In the human lens, inflammatory cytokines originating from the opaque substances may contribute to abnormal metabolism in the sealed area, a consequence of late-onset CBS.

Pigment deposits in the retrolental space of Berger: a rare feature of pigment dispersion syndrome? / Depósitos de pigmento no espaço de Berger: uma característica rara de síndrome de dispersão pigmentar?

ABSTRACT Pigment dispersion syndrome is associated with clinical features such as Krukenberg's spindles, trabecular pigmentation, Scheie's stripe and Zentmayer's ring. Another less common feature of this syndrome is retrolental pigment deposits due to anterior hyaloid detachment or a defect in the Wieger's ligament. We present two cases of pigment deposits on the posterior lens capsule. In both cases, there is bilateral dispersion of pigment throughout the anterior segment. The retrolental deposits are unilateral in the first case and bilateral in the second. Both patients report a history of ocular trauma. This is a possible important clinical sign of pigment dispersion syndrome, rarely described.

RESUMO A síndrome de dispersão pigmentar associa-se a sinais clínicos característicos como fuso de Krukenberg, hiperpigmentação da malha trabecular, linha de Scheie e anel de Zentmeyer. Um sinal menos comum dessa síndrome é o depósito de pigmento posterior ao cristalino, que ocorre por um descolamento da hialoide anterior ou um defeito no ligamento de Wieger. Apresentamos dois casos de depósitos de pigmento posterior à cápsula posterior do cristalino. Em ambos os casos, existia dispersão bilateral de pigmento por todo o segmento anterior. No primeiro caso, os depósitos eram unilaterais e, no segundo, estavam presentes em ambos os olhos. Este pode corresponder a um sinal potencialmente importante da síndrome de dispersão pigmentar, raramente descrito.

Risk factors for posterior capsule rupture in mature cataract surgery: A study of 1302 cases.

Purpose: To identify the risk factors predisposing posterior capsule rupture (PCR) during mature cataract surgery. Methods: A total of 1302 consecutive mature cataract cases were included in this retrospective study. A detailed examination was performed for each patient and risk factors including age, gender, systemic diseases, ocular comorbidities, surgeon, and surgery method were recorded. Cases with PCR during surgery were classified as complicated. Multivariate logistic regression analysis with a generalized estimating equations method was applied for statistical analysis. Results: The overall rate of PCR was 7.30% (n=95 eyes). After adjusting for confounders, factors that remained significant on multivariate analysis were strabismus (odds ratio [OR]: 5.70, 95% confidence interval [CI]: 2.17-14.97; P < 0.001), phacodonesis (OR: 4.62, 95% CI: 2.59-8.22; P < 0.001), history of trauma (OR: 4.46, 95% CI: 1.64-12.12; P = 0.003), surgery method (extracapsular cataract extraction/phacoemulsification) (OR: 2.61, 95% CI: 1.60-4.26; P < 0.001), and pseudoexfoliation (OR: 1.94, 95% CI: 1.20-3.16; P = 0. 007). Conclusion: Strabismus, phacodonesis, history of trauma, extracapsular cataract extraction method, and pseudoexfoliation were found to be important risk factors for developing PCR. Appropriate preoperative and perioperative precautions for these higher-risk cases can reduce complications.

Síndrome de disfunción del cristalino y su intercambio refractivo / Lens Dysfunction Syndrome and its Refractive Exchange

La capacidad de ver bien es una preocupación para todos, especialmente a medida que se envejece. Los cambios en los ojos con el tiempo son inevitables, pero existen opciones de tratamiento para ayudar a tratar los problemas que pueden aparecer en la visión. El síndrome de disfunción del cristalino se caracteriza por englobar algunas de las alteraciones visuales más comunes relacionadas con la edad y que suelen aparecer a partir de los 40 años. La principal causa del síndrome de disfunción del cristalino es el envejecimiento natural de esta estructura ocular. Los síntomas más comunes son visión borrosa, disminución de la sensibilidad a los colores o dificultad y cambios en la visión cercana. El término es poco usado en Cuba por lo que el objetivo fue realizar una revisión sobre el síndrome de disfunción del cristalino y su intercambio refractivo. Existen diferentes opciones de tratamiento, desde gafas hasta el recambio refractivo del cristalino por una lente intraocular, que se usa cada vez a más temprana edad y que gracias al adelanto tecnológico y aumento de la pericia del médico, constituye un tratamiento eficaz en pacientes pregeriátricos(AU)

The ability to see well is a concern for everyone, especially as one ages. Changes in the eyes over time are inevitable, but there are treatment options to help address the problems that can occur in vision. The lens dysfunction syndrome is characterized as encompassing some of the most common age-related visual disorders that usually appear after the age of 40. The main cause of lens dysfunction syndrome is the natural aging of this ocular structure. The most common symptoms are blurred vision, decreased sensitivity to colors or difficulty and changes in near vision. The term is hardly ever used in Cuba, so the objective was to review the crystalline lens dysfunction syndrome and its refractive exchange. There are different treatment options, from glasses to the refractive exchange of the crystalline lens for an intraocular lens, which is used at an increasingly younger age and which, thanks to technological advances and increased medical expertise, is an effective treatment in pregeriatric patients(AU)

Hematoma endocapsular: complicación inusual tras facoemulsificación y esclerectomía profunda no perforante / Endocapsular haematoma: An unusual complication of phacoemulsification and non-penetrating deep sclerectomy

CASO CLÍNICO: Varón de 68 años con catarata y glaucoma primario de ángulo abierto no controlado con máximo tratamiento tópico en ojo derecho, intervenido de cirugía combinada de esclerectomía profunda no perforante y facoemulsificación. No presentó complicaciones intraoperatorias, pero en el postoperatorio inmediato acudió por disminución brusca de agudeza visual tras maniobra de Valsalva; se objetivó en la exploración un hematoma endocapsular. En ausencia de resolución espontánea, a los 3meses se realizó capsulotomía posterior con láser neodomio: YAG con mejoría visual inmediata y óptimo control de la presión intraocular. DISCUSIÓN: Se describe el primer caso de hematoma endocapsular como complicación de cirugía no perforante en glaucoma, manejado eficazmente con capsulotomía YAG

CASE REPORT: A 68-year-old male with a cataract and uncontrolled primary open angle glaucoma with maximal tolerated medication underwent non-penetrating deep sclerectomy combined with phacoemulsification surgery in right eye. There were no complications during the procedure, but shortly after the surgery, he lost visual acuity after a Valsalva manoeuvre due to an endocapsular haematoma. Neodymium:YAG laser posterior capsulotomy was performed for the treatment of an unresolving endocapsular haemorrhage at the third month of the follow-up, with immediate visual improvement and optimal control of intraocular pressure. DISCUSSION: To the best of our knowledge, this is the first reported case of endocapsular haematoma as a complication of non-penetrating glaucoma surgery that has been successfully solved by a YAG capsulotomy

Intra-lenticular caterpillar seta in ophthalmia nodosa.

PURPOSE: To report the clinical course of ophthalmia nodosa with a retained lenticular seta misdiagnosed and treated as non-infectious posterior uveitis for 7 consecutive years. METHODS: Meticulous clinical examination led to discovery of the caterpillar seta embedded in the crystalline lens and the intravitreal setae. RESULTS: Lens-sparing pars plana vitrectomy and removal of free-floating vitreal seta resulted in complete resolution of vitritis and uveitis. CONCLUSION: Embedded seta within a clear lens may remain sequestered, and may be left untouched under close observation, precluding a clear lens extraction in such patients.

Proteomic analysis of aqueous humor from cataract patients with retinitis pigmentosa.

A postcataract surgery complication in patients with retinitis pigmentosa (RP) is lens capsular contraction. To identify potential proteins contributing to this phenomenon, high-performance liquid chromatography/mass spectrometry-based proteomic analysis was conducted with aqueous humor samples collected from 11 patients who underwent cataract surgeries, with four patients diagnosed as RP and cataract (RP group) and the other seven with only senile cataract group. The upregulated proteins in the RP group were enriched in wound response, while downregulated proteins were enriched in cell adhesion and lens crystallins. Receptors of two dramatically upregulated proteins tenascin-C (TNC) and serotransferrin were found expressed in human lens epithelial cells (HLEs). TNC can promote primary HLEs proliferation and cell line HLE-B3 migration. This study indicates aqueous humor proteomic analysis serves as an effective way to unveil the pathogenesis of RP complications. TNC is a potential target of stimulating HLEs proliferation in RP concomitant cataract patients that worth further research.

Ultrastructural and immunofluorescence analysis of anterior lens capsules in autosomal recessive Alport syndrome.

Background: To first report and study the ultrastructural and immunofluorescence abnormalities of the lens anterior capsules in a patient with autosomal recessive Alport syndrome.Methods: Two anterior lens capsules were collected in femtosecond laser-assisted cataract surgeries from a 29-year-old male patient with bilateral lenticonus caused by autosomal recessive Alport syndrome. The left capsule was examined by transmission electron microscopy and the right capsule was serial sectioned and stained with antibodies against the α2, α3, and α4 chains of type Ⅳ collagen. Anterior lens capsules of another two uncomplicated age-related cataract patients were collected and treated in the same way as the control.Results: The novel findings are that the mitochondria in lens epithelial cells in autosomal recessive Alport syndrome patients increased, twisted, and exhibited high electron density. Characteristic ultrastructure changes of capsule thinning, vertical dehiscence, and irregular-shaped lens epithelial cells were also observed in the left anterior lens capsule. Normal reactivity against the α2 chain and decreased reactivity against the α3 and α4 chains were observed in the right anterior lens capsule.Conclusions: The homozygous c.4599 T > G mutation of COL4A4 not only affects the formation of type Ⅳ collagen networks in the extracellular matrix, but also affects the morphology and survival of the lens epithelial cells in the patient with autosomal recessive Alport syndrome. This study is the first report of the ultrastructural and immunofluorescence changes of anterior lens capsules in autosomal recessive Alport syndrome.

Differential optical density of fluid in capsular bag distension syndrome.

Capsular bag distension syndrome (CBDS) is a rare complication of cataract surgery due to collection of fluid behind the intraocular lens (IOL). Nd:Yag laser capsulotomy is commonly performed to release the fluid collection; however, the potential risk of infection and inflammation has led to adaptation of numerous surgical procedures. Clinical examination in an established case of CBDS reveals opalescent fluid behind the IOL with ballooning of the posterior capsule, which has different reflectivity on optical coherence tomography. However, the exact optical properties of this fluid are still unknown. A case of delayed CBDS with induced myopia due to change in IOL position because of fluid collection behind the IOL is presented.

Development of Animal Models for Lens and Corneal Diseases Using N-Methyl-N-Nitrosourea.

Purpose: N-methyl-N-nitrosourea (MNU) is an alkylating toxicant with potent mutagenic ability. This study was designed to induce apoptosis in lens epithelial cells (LECs) and corneal endothelial cells (CECs) via MNU administration. We sought to build ocular disease models of cataract and corneal endothelial decompensation. Methods: MNU was delivered into the intraperitoneal cavities of neonatal rats and the anterior chambers of adult rabbits. The MNU-treated animals were then subjected to a series of functional and morphological analyses at various time points. Results: MNU treatment induced pervasive apoptosis of LECs and CECs. These effects were dose and time dependent. Mature cataracts were found in neonatal rats 3 weeks after MNU treatment. Histological analysis revealed that MNU toxicity induced swelling, vacuolation, and liquefaction in lens fibers of MNU-treated rats. Pentacam examination showed that the average density of rat lens increased significantly after MNU administration. Terminal deoxynucleotidyl transferase-mediated nick end labeling (TUNEL) analysis showed pervasive apoptotic staining in the lenses of MNU-treated rats. In rabbit eyes, intracameral treatment with MNU induced corneal edema and significantly increased central corneal thickness, which peaked at P14. Morphological and immunohistochemical analysis showed that CECs were effectively ablated in the MNU-treated rabbits. The expression of 8-OHdG increased significantly in the cornea of MNU-treated rabbits, compared with vehicle-treated controls. Conclusions: MNU is sufficient to induce ocular cell apoptosis in animal models. These models of MNU-induced cataract and corneal endothelial decompensation represent valuable tools for efforts to develop relevant therapies.

Characterization of Unique Lens Morphology in a Cohort of Children with Familial Exudative Vitreoretinopathy.

Purpose: To characterize the lens morphology and to measure the clinical features of familial exudative vitreoretinopathy (FEVR) in children. Methods: Unique lens changes were observed in a cohort of children with FEVR from March 2015 to November 2017 using slit lamp examination and all the patients underwent cycloplegic refraction, ultrasound A and B, keratometry and fundus fluorescein angiography. Results: Twelve eyes of eight children with FEVR had unique lens changes. The contraction of the posterior capsule caused unique lens changes resulting in myopia in nine eyes of six children and astigmatism in eight eyes of five children. Retinal lesions in the affected eyes were all stage 1 to 2. Six eyes of three patients underwent lensectomy and intraocular lens implantation due to high anisometropia which could not be corrected by conventional optical correction. During lensectomy, the opacification in the posterior capsule was found to be due to the fibrous membrane that protruded into the anterior vitreous and not due to lens opacification. Three patients had bilateral lensectomy, in two of whom significant macular involvement was observed in one eye and in one of whom significant macular involvement was observed in both eyes. After surgery visual acuity (VA) improved obviously in two eyes without significant macular involvement and did not improve in the four eyes which had significant macular involvement. Among the five patients who did not have lensectomy, one patient was lost to follow-up and one patient had VA improved in both eyes without significant macular involvement. The other three patients did not have much change in VA. Conclusions: Clinicians should be aware that when a high myopia or astigmatism does not match the corneal curvature and the length of the eye, one should check carefully the changes of lens and fundus after dilating the pupil, to avoid misdiagnosis and missed diagnosis.

Iris Posterior Synechiae After Descemet Membrane Endothelial Keratoplasty in Asian Eyes: Prevention and Management of Posterior Synechiae.

OBJECTIVES: To evaluate the efficacy of a mydriatic agent for posterior synechiae after phacoemulsification and intraocular lens (IOL) implantation followed by Descemet membrane endothelial keratoplasty (staged DMEK). METHODS: In this prospective study, the outcomes of DMEK with or without mydriasis (0.5% tropicamide and 0.5% phenylephrine hydrochloride [Mydrin-P; Santen, Osaka, Japan]) after the DMEK procedure were analyzed. Patients underwent IOL implantation approximately 4 weeks before DMEK. Six months after DMEK, the iris posterior synechiae severity score was evaluated based on the extent of posterior synechiae affecting the eight areas (45° each) of the pupillary rim (posterior synechiae score; grades 0-8). Best spectacle-corrected visual acuity, central corneal thickness, endothelial cell density, axial length, and the amount of air at the end of the surgery were also evaluated. RESULTS: Fifteen eyes of 15 patients (mydriatic: n=8, control: n=7) were eligible for inclusion. Iris posterior synechiae were detected in all seven eyes (100.0%) in the control group, whereas they were noted in two eyes in the mydriatic group (25%). The mean iris posterior synechiae score was 0.69±1.20 in the mydriatic group and was significantly lower than that in the control group (4.57±0.90; P<0.001). There was no significant difference in other clinical factors. Although the incidence and scores of posterior synechiae in the control group were higher, the incidence was significantly reduced with the use of a mydriatic agent (in the mydriatic group). CONCLUSIONS: Use of a mydriatic agent is an effective measure to prevent postoperative synechiae after DMEK.

Effects of Orally Consumed Rosa damascena Mill. Hydrosol on Hematology, Clinical Chemistry, Lens Enzymatic Activity, and Lens Pathology in Streptozotocin-Induced Diabetic Rats.

Diabetes mellitus is a multisystemic metabolic disorder that may affect the eyes, kidneys, vessels, and heart. Chronic hyperglycemia causes non-enzymatic glycation of proteins and elevation of the polyol pathway resulting in oxidative stress that damages organs. The current study aimed to investigate the dose-dependent effects of orally consumed Rosa damascena Mill. hydrosol on hematology, clinical biochemistry, lens enzymatic activity, and lens pathology in streptozotocin (STZ)-induced diabetic rats. Diabetes was induced into male Sprague-Dawley rats by intraperitoneal administration of STZ (40 mg/kg body weight). Rose hydrosols containing 1515 mg/L and 500 mg/L total volatiles (expressed as citronellol) were introduced to rats orally for 45 days. Consumption of 1515 mg/L volatile containing rose hydrosol successfully ameliorated hematologic, hepatic, and renal functions. Hydrosols also attenuated hyperglycemia and decreased the advanced glycation end-product formation in a dose-dependent manner. Rose hydrosol components significantly increased the lens enzymatic activities of glutathione peroxidase and decreased the activity of aldose reductase to prevent cataractogenesis. Histopathological examinations of rat lenses also indicated that increasing the dose of rose hydrosol had a protective effect on lenses in diabetic conditions. Additionally, in silico modeling of aldose reductase inhibition with rose hydrosol volatiles was carried out for extrapolating the current study to humans. The present results suggest that rose hydrosol exerts significant protective properties in diabetes mellitus and has no toxic effect on all studied systems in healthy test groups.

Assessment of Corneal and Lens Density in Children With Celiac Disease.

PURPOSE: To assess the early changes of corneal and lens density in a pediatric population with celiac disease. METHODS: One hundred one patients were included in this observational and prospective study. Patients with celiac disease formed the celiac disease group. Healthy individuals with no medical history formed the control group. Corneal and lens density were assessed with Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany). RESULTS: The mean lens and corneal density outcomes in all zones did not differ between groups (P > .05 for each). Maximum lens density outcome was significantly higher in the celiac disease group than in the control group (P = .028). The mean corneal density at the peripheral cornea was significantly higher in females than males in the celiac disease group (P < .05 for each). Compliance with a gluten-free diet, body mass index, and histological classification of celiac disease had no significant effect on lens and corneal density in patients with celiac disease (P > .05 for each). CONCLUSIONS: Celiac disease did not affect the mean lens and corneal density in this pediatric population, but higher maximum lens density in patients with celiac disease and higher peripheral corneal density in female patients with celiac disease may indicate early stages of ocular involvement of celiac disease. [J Pediatr Ophthalmol Strabismus. 2019;56(6):402-406.].

Case Series: Late Postoperative Capsular Block Syndrome Causing Reduced Vision Years After Uncomplicated Cataract Surgery.

SIGNIFICANCE: Late postoperative capsular block syndrome is a treatable complication presenting months to years after cataract surgery using continuous curvilinear anterior capsulorhexis and a posterior chamber intraocular lens implantation. Patients may present to optometric practices because of symptom onset significantly after the immediate post-operative period. PURPOSE: The purpose of this study was to describe the defining clinical features, proposed pathophysiology, and treatment of late postoperative capsular block syndrome. Case 1 was a 68-year-old man who presented with a sudden onset of blurry vision in the right eye 2 years after uncomplicated cataract surgery. Clinical examination revealed turbid fluid distending the posterior lens capsule, a 2-D myopic shift, and an absence of intraocular inflammation. Laser posterior capsulotomy successfully released the trapped fluid and reversed the myopic shift without complication. Case 2 was a 67-year-old man who presented with a gradual onset of hazy vision in the right eye 7 years after uncomplicated cataract surgery. Cloudy fluid was observed to be filling the space between the intraocular lens and the posterior lens capsule, and the refractive error was stable. The fluid was liberated and visual function was restored with uncomplicated laser posterior capsulotomy. CONCLUSIONS: Patients with late postoperative capsular block syndrome may present with blurry vision months to years after cataract surgery performed with continuous curvilinear capsulorhexis and posterior capsule intraocular lens implantation. The defining clinical sign is entrapment of turbid fluid between the intraocular lens and the posterior capsule that may result in reduced vision or refractive error shift. Late postoperative capsular block syndrome is distinguishable from other late complications of cataract surgery, including delayed endophthalmitis or phacoantigenic uveitis, by lack of concurrent robust ocular inflammation.