Cataract Membrane Research Articles

The contextuality of the Qur'an in detecting diseases (Study of the interpretation of eye diseases of Prophet Ya'qub in Surah Yusuf verse 84 perspective of eye health)

Qur'an Chapter Yusuf verse 84 tells about the sore eye of Prophet Ya'qub. It is told that he had sore eye with an indication of white discoloration of his eyes due to deep sadness. In this verse, the Qur'an only speaks of the nature and cause of the illness, without mentioning the type of illness yet. Based on this background, this thesis presents research on the eye disease of Prophet Ya'qub in the perspective of eye health study. The research method applied in the study is qualitative method. Whereas, The documentation techniques from library sources in the form of 12 books of tafsir muktabar along with other supporting books for data collection techniques. Then the interpretation analysis theory that is applied is tahli>li> interpretation. The results of the study found that there are six opinions of tafsir scholars in interpreting the type of eye disease of Prophet Ya'qub. The six are: blindness, low vision, flooding of tears (Nasolacrimal duct obstruction), thin white membrane (cataract), dry eye, and glaucoma. There are two principles which become the standard in the object of this research, namely the indication of the white color in the eyes of Prophet Ya'qub and sadness as a causative factor. According to the study of eye health, by paying attention to these two indications, the author further strengthens the opinion that the eye disease which plagued the Prophet Ya'qub leads to cataract eye disease. Because cataracts are a disease which clearly gives a white effect on the eye. As for the other diseases, there is less visible characteristic of the white effect on the eye. Furthermore, the main cause of cataracts is excess sugar in the body (Diabetes Mellitus). Diabetes mellitus often occurs due to stress or protracted sadness. Thus, the author's strong assumption in giving the conclusion that the eye disease experienced by the Prophet Ya'qub is leading to cataract eye disease

Impact of topographic hot spots on the refractive outcomes of combined DMEK and cataract surgery.

To compare the refractive results of combined Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery in eyes with Fuchs endothelial corneal dystrophy (FECD) with and without topographic hot spots. "Villa Igea" Hospital, Forlì, Italy. Interventional case series. 57 eyes of 52 patients with FECD undergoing combined DMEK, cataract surgery, and monofocal intraocular lens (IOL) implantation were included in this single-center study. Patients were classified based on the presence or absence of topographic hot spots on the preoperative axial power map. Prediction error (PE) was calculated as the postoperative manifest spherical equivalent (SE) refraction minus the SE predicted refraction. 6 months postoperatively, mean PE was +0.79 ± 1.12 diopters (D). In eyes with hot spots, mean keratometry (K), K flat, and K steep significantly decreased after surgery (all P < .05), whereas no significant changes were observed in eyes without hot spots (all P > .05). Eyes with hot spots showed a significantly more hyperopic PE than eyes without hot spots (+1.13 ± 1.23 vs +0.40 ± 0.86 D; P = .013). Combined DMEK and cataract surgery can result in a hyperopic refractive surprise. The presence of topographic hot spots before surgery is associated with a higher hyperopic shift.

Mutation screening in autosomal dominant congenital cataract families from North India.

Congenital cataract an opacity of the eye lens is present at birth and results in visual impairment during early childhood. If left untreated, it can lead to permanent blindness. Its prevalence is ten times higher in developing countries like India. Thus, we aimed to investigate the underlying genetic defects in three autosomal dominant congenital cataract (ADCC) families from North India. Detailed family histories were collected, pedigrees drawn followed by slit-lamp examination and lens photography. Mutation screening was performed in the candidate genes for crystallins, connexins, and membrane proteins by Sanger sequencing. Pathogenicity of novel variant was assessed bioinformatically. In an ADCC (CC-3006) family with bilateral membranous cataract and microcornea, a novel change (c.1114C>T;p.P372S) in GJA3 has been detected. In other two ADCC families affected with subcapsular (CC-286) and shrunken membranous hypermature cataract (CC-3014), a nonsense mutation (c.463C>T;p.Q155X) in CRYβB2 and a frameshift deletion (c.590_591delAG;p.E197VfsX22) in CRYβA1/A3 respectively, are observed. These variants segregated completely with the phenotypes in respective families and were absent in their unaffected family members and unrelated controls (testedfor novel variant in GJA3). Earlier p.Q155X (CRYβB2) and p.E197VfsX22 (CRYβA1/A3) are reported with entirely different phenotypes. Thus, findings in present study expand the mutation spectrum and phenotypic heterogeneity linked with GJA3, CRYβB2, and CRYβA1/A3 for congenital cataracts. Identifying underlying genetic defects is essential for disease management and appropriate genetic counseling.

Choroidal structural changes following vitrectomy performed with phacoemulsification in unilateral idiopathic epiretinal membrane

BackgroundThis study aims to determine the influence of vitrectomy combined with macular epiretinal membrane dissection and internal limiting membrane (ILM) peeling and phacoemulsification on choroidal vasculature in patients with unilateral idiopathic epiretinal membrane (IERM) and concurrent cataract using optical coherence tomography (OCT).MethodsThis retrospective study included 26 eyes of 26 patients (8 males and 18 females) with unilateral IERM without vitreomacular traction (VMT) (group 1) and the patients’ fellow eyes (n = 26, group 2). Three-port 25-G pars plana vitrectomy (PPV) combined with macular epiretinal membrane dissection and ILM peeling and phacoemulsification was performed on all patients. The comprehensive ophthalmologic examinations of all patients involved OCT measurements at every visit before and after surgery, and the choroidal thickness (CT), central macular thickness (CMT) and choroidal vascularity index (CVI) were calculated.ResultsThe mean age of the IERM patients was 66.58 ± 7.06 years. Postoperatively, best corrected visual acuity (BCVA) was significantly greater than baseline (P = 0.023). The CVI of the IERM eyes was significantly lower (P < 0.01) than that of the fellow eyes at baseline. The subfoveal CT in the IERM eyes was lower than that in the fellow eyes (P = 0.023), but there was, no significant difference in the average CT between the two groups at baseline (P = 0.071). In eyes with IERM, the CVI significantly increased at 1 week, 1 month (P < 0.001), and 3 months (P = 0.049) postoperatively, the subfoveal CT was markedly thickened 1 month after surgery (P = 0.001), the temporal 3 mm and nasal CT significantly increased at 1 week and 1 month postoperatively (P = 0.041, P = 0.022 for temporal 3 mm; P < 0.001, P = 0.047 for nasal 1.5 mm; P = 0.01, P = 0.001 for nasal 3 mm), and only the temporal 3 mm CT increased significantly at 3 months postoperatively (P = 0.017). The baseline CMT of the IERM eyes was significantly thicker than that of the fellow eyes (P < 0.001). CMT significantly decreased at 3 months postoperatively in IERM eyes(P = 0.033).ConclusionsThe increase in the CVI in the IERM eyes without VMT after combined PPV with ILM peeling and phacoemulsification persists for at least 3 months.

IOL Power Calculation in Eyes Undergoing Combined Descemet Membrane Endothelial Keratoplasty and Cataract Surgery.

To assess the accuracy of different corneal powers for intraocular (IOL) power calculation in combined Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery and investigate whether preoperative parameters correlate to the prediction error (PE). This prospective case series involved patients with Fuchs endothelial dystrophy receiving combined DMEK and cataract surgery. Preoperatively, patients underwent optical biometry and anterior segment OCT (AS-OCT). AS-OCT measurements were repeated 6 months postoperatively, when final refraction was assessed. The PE was calculated using the preoperative average keratometry (Kave) measured by the optical biometer and User Group for Laser Interference Biometry (ULIB) constants. It was also calculated, after constant optimization, using the preoperative Kave from both devices and the total corneal power (TCP) measured by AS-OCT, as well as the postoperative Kave and TCP measured by AS-OCT. ULIB constants resulted in the highest hyperopic PE (P < .0001). Constant optimization improved the results, because the PE was zeroed out and the absolute PEs decreased. No significant difference was found among the Barrett Universal II, Emmetropia Verifying Optical 2.0, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas. Further improvement was achieved with the postoperative Kave and TCP, although the accuracy remained moderate. The PE based on preoperative corneal measurements was correlated to the amount of corneal flattening; the latter could be predicted by multiple linear regression accounting for anterior and posterior corneal radii (P = .0002) and was correlated to the preoperative anterior/posterior ratio. Constant optimization is beneficial for combined DMEK and phacoemulsification. Predicting postoperative corneal flattening may improve the results of IOL power accuracy. [J Refract Surg. 2022;38(7):435-442.].

Bilateral congenital membranous cataracts due to Glucosaminyl (N-Acetyl) Transferase 2 (GCNT2) mutation: Life-saving genetic analysis.

Bilateral congenital membranous cataracts due to Glucosaminyl (N-Acetyl) Transferase 2 (GCNT2) mutation: Life-saving genetic analysis.

Comparison of Face-down Positioning Durations Following Silicone Oil Tamponade.

To analyze the rate and timing of retinal redetachments and other complications following pars plana vitrectomy for retinal detachment repair with silicone oil tamponade and the effect of face-down positioning duration on these endpoints. A retrospective study was performed on patients with retinal detachment repair via pars plana vitrectomy with silicone oil tamponade between 2015 and 2020. Surgery was performed by 10 physicians associated with a private retina practice in Cleveland, Ohio. Duration of postoperative face-down positioning was noted and patients were grouped by short (≤6 days) or long (≥7 days) durations. Outcome variables were retinal re-detachment, epiretinal membrane formation, cataract formation, and other complications. Timing and frequency of outcomes were noted and statistical analysis was performed. The study was composed of 227 eyes. The mean age of patients was 62.09±13.65 years with 143 (63.00%) male and 84 (37.00%) female. Of the initial detachments, 63 (27.88%) were macula-on and 163 (72.12%) were macula-off. Overall, 128 (56.39%) patients were given instructions for face-down positioning for 6 days or less and 99 (43.61%) patients for 7 days or more. Retinal redetachment was seen in 42.19% of patients with face-down positioning ≤6 days and 29.29% of patients with face-down positioning ≥7 days (P = .045). No significant difference was found in epiretinal membrane formation or cataract formation (P >.05). There was a lower rate of redetachment in patients who kept a face-down position for ≥7 days compared with ≤6 days. Further study to determine causality between duration of postoperative face-down positioning and retinal redetachment is recommended. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:285-292.].

Prevalence of Cystoid Macular Edema After Cataract Surgery in Eyes with Previous Macular Surgery.

ObjectiveTo determine the prevalence and risk factors for cystoid macular edema (CME) after cataract surgery in eyes that have previously undergone macular surgery.Study Design and MethodsRetrospective consecutive interventional case series. Patient medical records and Spectral Domain Optical Coherence Tomography (SD-OCT) were reviewed for eyes that underwent vitrectomy for full thickness macular hole (FTMH), lamellar macular hole (LMH) or epiretinal membrane (ERM) and subsequent cataract surgery at a large private retina practice between 2016 and 2018.ResultsAround 9.1% of eyes (22/243) developed CME post cataract surgery. The mean time from macular surgery to cataract surgery was 273 days (range: 87–797) in eyes with CME and 289 days (range: 22–897) in eyes without CME (p = 0.67). There was no difference in final visual acuity between eyes with CME (20/40, logMAR 0.312) and without CME (20/30, logMAR 0.206) (p = 0.101). Compared with patients with FTMH or LMH, patients with epiretinal membrane were more likely to develop post cataract CME (OR = 2.97, p = 0.031, Chi square test).ConclusionIn eyes with history of macular surgery, the prevalence of post cataract surgery CME was around 9.1%. The development of CME is not dependent on timing of cataract surgery but is more common in eyes with history of epiretinal membrane.

Refractive accuracy and visual outcomes after combined descemet membrane endothelial keratoplasty and cataract surgery: A French multicentric study

Descemet membrane endothelial keratoplasty (DMEK) combined with cataract extraction and intraocular lens insertion (new triple procedure) limits postoperative refractive errors. The objective of this study was to assess refractive accuracy after DMEK combined with cataract extraction and intraocular lens implantation. Four university hospitals (Rouen, Paris, Reims, Grenoble). This retrospective multicenter study included patients with symptomatic corneal endothelial decompensation and cataract. The primary outcome was the difference between the target spherical equivalent and postoperative refraction at months 2 and 6. Secondary outcomes were visual acuity, keratometry, pachymetry and endothelial cell density. A total of 130 eyes of 111 patients (mean age 66.2 years) were included (94% with Fuchs' endothelial dystrophy). For a mean refractive target set at -0.50 (±0.57) D, the mean (95% CI) refractive error was hyperopia of +0.49 (0.314; 0.664) D at 2 months and +0.46 (0.299; 0.619) D at 6 months. Best corrected distance visual acuity was improved in all patients: from 0.49 (±0.3) logMAR to 0.14 (±0.14) logMAR at 2 months and 0.05 (±0.1) logMAR at 6 months. Mean corneal thickness decreased from 621.6 (±37.6) μm to 515.2 (±42.6) μm at 2 months and 539.0 (±39.0) μm at 6 months. Good refractive accuracy was obtained after the new triple procedure with DMEK. Hyperopic shift is common after triple procedures, and its persistence should be evaluated in future studies in order to anticipate a change in its value to optimize intraocular lens power calculation.

A novel mutation of LIM2 causes autosomal dominant membranous cataract in a Chinese family.

To identify mutations in the genes of a four-generation Chinese family with congenital membranous cataracts and investigate the morphologic changes and possible functional damage underlying the role of the mutant gene. Whole exome analysis of thirteen members of a four-generation pedigree affected with congenital membranous cataracts was performed; co-segregation analysis of identified variants was validated by Sanger sequencing. All members underwent detailed physical and complete eye examinations. The physical changes caused by the mutation were analyzed in silico through homology modeling. The lens fiber block from a patient was observed under a scanning electron microscope (SEM). Cell membrane proteins and cytoplasmic proteins from the human lenses donated by one patient with cataract in this family and from the dislocated lens resulted from the penetrating ocular trauma of a patient unrelated with this family were extracted, and the expression and localization of MP20 and Cx46 were detected by Western blot (WB) assay in these proteins. A novel LIM2 heterozygous mutation (c.388C>T, p.R130C) was identified with congenital membranous cataracts inherited by an autosomal dominant (AD) pattern. Nystagmus and amblyopia were observed in all patients of this family, and exotropia and long axial length were observed in most patients. A/B ultrasound scan and ultrasound biomicroscopy revealed obvious thin crystalline lenses from 1.7 to 2.7 mm in central thickness in all cataract eyes. The bioinformatic analysis showed that the mutation was deleterious to the physiological function of LIM2-encoded MP20. Furthermore, by SEM, ultrastructure of the cataract nucleus showed that lens fiber cells (LFCs) remained morphologic characteristics of immature fiber cells, including flap cell surface with straight edges and lacking normal ball-and-socket joint boundaries, which implied that the differentiation of LFCs might be inhibited. Accumulation of MP20 and Cx46 in the cytoplasm was observed in the cytoplasm of the LFCs in human cataract lens. We identify a novel heterozygous LIM2 (c.388C>T, p.R130C) mutation inherited by an AD pattern. This LIM2 mutation causes the abnormal sub-localization of MP20 and Cx46 in LFCs resulting in membranous cataracts.

The novel mutation P36R in LRP5L contributes to congenital membranous cataract via inhibition of laminin γ1 and c-MAF.

The present study investigated a pathogenic mutation and its mechanism on membranous cataract in a congenital membranous cataract family. An autosomal dominant four-generation Chinese congenital membranous cataract family was recruited and whole-exome sequencing was performed to screen for sequence variants. Candidate variants were validated using polymerase chain reaction and Sanger sequencing. Wild-type and mutant low-density lipoprotein receptor-related protein 5-like (LRP5L) plasmids were constructed and transfected into human lens epithelial cells (HLE B-3) and human anterior lens capsules. The cell lysates, nuclear and cytoplasmic proteins, and basement membrane components of HLE B-3 cells were harvested. LRP5L and laminin γ1 were knocked down in HLE B-3 cells using specific small-interfering RNA. The protein expression levels of LRP5L, laminin γ1, and c-MAF were detected using immunoblotting and immunofluorescence. We identified a novel suspected pathogenic mutation in LRP5L (c.107C > G, p.P36R) in the congenital membranous cataract family. This mutation was absent in 300 normal controls and 300 age-related cataract patients. Bioinformatics analysis with PolyPhen-2 and SIFT suggested that LRP5L-P36R was pathogenic. LRP5L upregulated laminin γ1 expression in the cytoplasmic proteins of HLE B-3 cells and human anterior lens capsules, and LRP5L-P36R inhibited the effects of LRP5L. LRP5L upregulated c-MAF expression in the nucleus and cytoplasm of HLE B-3 cells, and LRP5L-P36R inhibited c-MAF expression via inhibition of laminin γ1. Our study identified a novel gene, LRP5L, associated with congenital membranous cataract, and its mutant LRP5L-P36R contributed to membranous cataract development via inhibition of laminin γ1 and c-MAF.

One-year follow-up evaluation of combined phacovitrectomy for idiopathic epiretinal membrane.

To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens (IOL) implantation in patients with severe idiopathic epiretinal membrane (iERM) and concurrent cataract. A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane (ERM) peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured preoperatively and at 1, 3, 6mo and 1y postoperatively. Temporal changes and bivariate correlations of these parameters were analyzed. Mean logMAR BCVA improved and CFT decreased significantly (P<0.001) until 6mo after surgery. Correlation analysis revealed a positive correlation between preoperative and postoperative logMAR BCVA (r=0.716, P<0.001 at 1mo, r=0.417, P=0.014 at 3mo, r=0.359, P=0.037 at 6mo, and r=0.369, P=0.032 at 12mo post-op respectively), but preoperative CFT was neither associated with postoperative CFT nor with postoperative logMAR BCVA. There was a positive correlation between CFT and logMAR BCVA at 1mo (r=0.346, P=0.045), 6mo (r=0.347, P=0.045), and 12mo (r=0.342, P=0.048) post-operatively. The intra- and postoperative complications were relatively mild, and the incidences were generally low. For severe iERM patients with significant visual symptoms, combined phacovitrectomy with membrane peeling and IOL implantation is safe and effective in improving BCVA and decreasing CFT. Early surgery in selected patients may help preserving better visual function.

LRP5L-P36R Attenuating Matrix Metalloproteinase 9 Biological Function May Contribute to the Development of Cataract

Background: Congenital cataract is the leading cause of childhood blindness. Membranous cataract is a rare congenital cataract and the mechanism has not been understood. This study aimed to investigate the pathogenic mutation and its mechanism on the development of cataract in a four-generation Chinese congenital membranous cataract family. Methods: Whole exome sequencing was performed to validate the pathogenic mutation in a Chinese congenital membranous cataract family. Wild-type and mutant LDL receptor related protein 5 like (LRP5L) plasmids were transfected into human lens epithelial cells (HLE B-3). Reverse transcription-PCR, quantitative real-time PCR, and immunoblotting were used to investigate the contributions of mutant LRP5L to development of cataract. Tube formation and spheroid sprouting assays were used to evaluate the contributions of LRP5L to angiogenesis. Findings: We found a novel suspected pathogenic mutation in LRP5L (c.107C>G, p.P36R) in a Chinese congenital membranous cataract family. In HLE B-3, LRP5L and LRP5L-P36R increase matrix metalloproteinase 9 (MMP9) expressions by cooperation with MMP9. However, LRP5L may promote angiogenesis by increasing active MMP9, while LRP5L-P36R may inhibit angiogenesis via downregulating active MMP9 and laminin γ1. Exogenous transforming growth factor beta-1 recombinant protein could promote LRP5L expressions in HLE B-3 cells. Interpretation: Our data indicated that LRP5L-P36R may contribute to the development of cataract via attenuating biological function of MMP9. This study enriches our knowledge on LRP5L and its mutant, LRP5L-P36R, and will benefit the studies on pathogenesis of congenital membranous cataract. Funding Statement: This study was supported by the Heilongjiang Provincial Natural Science Foundation of China (H2017028); the Nature Science Foundation of China (81470618); and the Natural Science Foundation of Heilongjiang Province of China (H2016038 and H2016007). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This study was approved by the Internal Review Board of Harbin Medical University and all the experiments were conducted in accordance with Declaration of Helsinki Principles. Written informed consents were obtained from all the participants or their guardians.

Avoiding Hyperopic Surprises After Descemet Membrane Endothelial Keratoplasty in Fuchs Dystrophy Eyes by Assessing Corneal Shape

It is unclear which patients unexpectedly have a hyperopic refractive outcome after combined Descemet membrane endothelial keratoplasty and cataract surgery (triple DMEK). We assessed how corneal shape predicts hyperopia after triple DMEK. Retrospective cohort study. Patients with Fuchs endothelial corneal dystrophy (FECD) with Scheimpflug examinations before uncomplicated triple DMEK at a tertiary referral center were included. The arithmetic error was calculated (stable postoperative refraction minus predicted refraction). Using multinomial logistic regression, risk ratios of >+0.5 diopter (D) hyperopic and > 0.5 D myopic arithmetic errors were calculated. In 112 eyes, the median predicted refraction was-0.43 D (interquartile range [IQR],-0.47 to-0.17) with an achieved refraction of-0.63 to 0.56 (IQR). The arithmetic error was 0.34 D (IQR,-0.22 to 0.81). A hyperopic arithmetic error was present in 46% of eyes. FECD eyes with an oblate posterior cornea (Q value >0) had a 3.0 times higher risk of hyperopic shift after triple DMEK (95% confidence interval [CI], 1.3-7.0; P= .011), compared to spherical or prolate corneas (Q value ≤ 0). In eyes with posterior Q > 0, the mean prediction error was+0.50 D higher than in eyes with negative Q values (95% CI, 0.19-0.82; P= .002), independent of corneal thickness. Hyperopic surprises after triple DMEK particularly occur in corneas that are flatter centrally than the periphery because of edematous changes (oblate posterior profile). Eyes with a positive Q value on Scheimpflug imaging should be considered for additional power at the intraocular lens level.

THE EVALUATION OF THE TYPES OF FIXATION OF INTRAOCULAR LENSES DURING LENSECTOMY IN THE CHILDREN PRESENTING WITH MARFAN’S SYNDROME

Aim. The objective of the present study was to evaluate the results of lensectomy in the combination with intraocular lens implantation including various types of their fixation in the children presenting with Marfan’s syndrome. Materials and methods. The study included 16 children presenting with Marfan’s syndrome and congenital cataract (31 eyes) at the age from 3 to 16 (mean 9.8+-4.1) years treated in the Excimer Eye Centre during a period from 2003 to 2015. The best corrected visual acuity (BCVA) prior to the surgical treatment was estimated at 0.1-0.4 (0.32+-0.16). All the patients underwent early phacoemulsification of the cataract in the combination with the intraocular lens implantation after the standard ophthalmological examination. Various types of intraocular lens implants were applied, namely AcrySof SN 60AT (n=2), SN60WF (n=3), MA60AC (n=19), MA60BM (n=2), and toric SN60T5 (n=3). The choice of the method for the intraocular Implant fixation depended on the degree of lens ectopia, the capsule characteristics, and the age of the patient. Results. Three main types of lens fixation were identified, viz. the mixed type (n-5), intracapsular (n-15) and intrascleral (n= 11) types. The BCVA measured within 12-36 months after the surgical intervention: was 0.4-1.0 (0.78+-0.26). The dislocation of the implanted intraocular lens was documented in 10 children, including all the three cases in the group with the mixed type of fixation without suturing and two cases of membranous cataract. Lens dislocation developed in 6 eyes of the patients with the Intracapsular localization of the intraocular lens and in 7 other eyes of the children comprising this group. Secondary lens reposition was required in a single patient who had undergone intrascleral lens fixation. No cases of uveitis, retinal detachment, macular oedema, and other complications were documented. Conclusion. In all the cases of lensectomy in the combination with the intraocular lens implantation in the children presenting with Marfan’s syndrome, the well apparent improvement of the visual functions and reduction of the severity of ambliopathy have been achieved. The lowest frequency of postoperative complications and the best functional outcome of the surgical treatment were documented in the group of the children with the intrascleral fixation of the intraocular lens implants. However, further studies involving a large sample of the patients are needed to obtain the statistically significant data for the evaluation of the long-term outcomes of the surgical treatment of the children presenting with Marfan’s syndrome and the choice of the optimal method for the fixation of the intraocular lens implants.

One Step Operation of the Persistent Pupillary Membrane Removal and Cataract Operation: A Case Report

One Step Operation of the Persistent Pupillary Membrane Removal and Cataract Operation: A Case Report

Clinical Characteristics and Surgical Procedures for Children with Congenital Membranous Cataract.

Objective In a group case series, the clinical characteristics of congenital membranous cataract in children were studied to establish a system of classification and determine the surgical method suited for each type. Methods Children (18 eyes) with congenital membranous cataract were examined by slit lamp, ultrasound biomicroscopy, and operating microscopy to classify cataracts. The clinical characteristics of congenital membranous cataract and its feature related to the surgical method were analyzed. Results Five major types of congenital membranous cataracts were classified. All of the surgeries were successful. Anterior and posterior capsulorhexis was performed using Klöti RF capsulotomy tips. The capsular flap was removed, and anterior vitrectomy was performed using a vitrectomy cutter. Postoperative complications included posterior capsule opacification in 16.7% of the patients. Conclusion Ultrasound biomicroscopy was used successfully to classify congenital membranous cataracts prior to surgery. Anterior and posterior capsulorhexis was performed using Klöti RF capsulotomy tips, and capsulectomy was performed using a vitrectomy cutter. These were effective techniques and should be considered for congenital membranous cataract removal surgery. This trial is registered with registration number chiCTR-OOC-17010913.

Image features of lens opacity in pediatric cataracts using ultrasound biomicroscopy

To study lens opacity in pediatric cataract images captured using ultrasound biomicroscopy (UBM). The medical records of patients operated on from September 2012 to October 2013 were reviewed retrospectively. Prior to surgery, patients were placed in the supine position under sedation with oral chloral hydrate for UBM imaging. Lens morphology was evaluated by UBM examination with a 50MHz probe that was equipped with a water bag instead of the standard plastic shell. UBM images were compared to images captured from intraoperative videos. UBM examination was performed in 50 patients (including 10 infants) aged 2months to 6years. The UBM ecographic images showed features specific to pediatric cataract lenses. These features were used to define 2 types of anterior capsule of the lens, 4 types of cortex and nucleus of the lens, 3 types of posterior capsule of the lens, and membranous cataracts. Capsule morphology and the cortex density of pediatric cataracts could be evaluated before surgery using UBM imaging. Adoption of this technique could provide useful preoperative information to surgeons.

The Clinical Spectrum and a New Theory of Pathogenesis of True Exfoliation Syndrome

To describe the clinical spectrum and a new theory of pathogenesis of true exfoliation syndrome. Cross-sectional and prospective, observational case series. Consecutive patients with characteristic peeling of the anterior lens capsule. After maximal mydriasis, slit-lamp biomicroscopy, and photography, imaging of the anterior capsule and zonules was performed. The condition was classified into 4 clinical stages: annular anterior capsule thickening with a distinct splitting margin (stage 1), an inward detached crescentic flap lying on the anterior lens (stage 2), a floating and folding translucent membrane behind the iris (stage 3), and a broad membrane within the pupil (stage 4). Serial photography was performed at each 3-month follow-up visit. Ultrastructural examination of dislocated lenses and excised anterior capsules was performed. Detached membrane morphologic features, zonular defects, pigment deposition, glaucoma, phacodonesis, and cataract. We enrolled 259 patients (424 eyes). Ages ranged from 52 to 97 years (mean age, 75.2±7.1 years). Eleven patients were associated with trauma (n= 1) or intense heat (n= 10), whereas 248 were idiopathic. Two hundred ten patients were followed up every 3 months, with a mean follow-up of 9.6±6.1 months (range, 3-50 months). The detachment started along the anterior zonular insertions in association with zonular disruption. It progressed centrally to higher stages, manifesting a spectrum of disease. Several stages coexisted in a single eye. At the final visit, including 49 patients who were examined once, there were 70, 87, 85, and 17 patients in stages 1, 2, 3, and 4, respectively. All stages shared common histologic findings consisting of diffuse capsular lamellar separation and anterior zonular disruption. All developed cataract. Pigment deposition on the membrane was present in 178 patients (68.7%). Twenty-six patients (10%) had spontaneous phacodonesis. Eighteen eyes (4.2%) demonstrated secondary delamination. Capsular lamellar separation and anterior zonular disruption are characteristic findings. Aging, heat exposure, and trauma are risk factors. Initial capsular splits occur along the insertions of disrupted anterior zonules. The peeling progresses centrally in association with iris movement and aqueous flow. A second detachment can occur.

Epithelial-Mesenchymal Transition (EMT)-Related Cytokines in the Aqueous Humor of Phakic and Pseudophakic Fuchs' Dystrophy Eyes.

The present study aimed to analyze the expression of epithelial-mesenchymal transition (EMT)-related cytokines in the aqueous humor of phakic and pseudophakic Fuchs' endothelial corneal dystrophy (FECD) eyes and their correlation to FECD severity. Aqueous humor samples from phakic FECD eyes (FECDph, n = 9), from pseudophakic FECD eyes more than 1 year after cataract surgery (FECDpsph, n = 13), and from cataract controls without FECD (Controlcat, n = 28) were obtained during Descemet membrane endothelial keratoplasty (DMEK) or cataract surgery. Expression of EMT-related cytokines (TGF-β1, TGF-β2, TGF-β3, MCP-1, BFGF, TNF-α, IL-1β) was measured using multiplex bead assay. Corneal central-to-peripheral thickness ratio at 3.5 mm from the center (CPTR3.5) was determined as an objective metric for FECD severity before surgery by slit-scanning pachymetry. Pseudophakic FECD eyes showed significantly elevated expression compared with Controlcat and FECDph eyes for TGF-β1 (P < 0.001, respectively), for TGF-β2 (P < 0.05, respectively), and MCP-1 (P < 0.001, respectively). Levels of TGF-β1 (r = 0.6116, P < 0.05) and MCP-1 (r = 0.5934, P < 0.05) were positively correlated with CPTR3.5. No differences in EMT-associated protein levels were detected comparing FECDph eyes and Controlcat eyes. Simultaneous elevation of TGF-β1, TGF-β2, and MCP-1 concentrations in FECDpsph eyes confirms that cataract surgery leads to long-term alterations of the intraocular microenvironment. Positive correlation of increased aqueous TGF-β1 and MCP-1 levels with CPTR3.5 in pseudophakic FECD eyes suggests that changed cytokine levels may be involved in corneal decompensation after cataract surgery. Unchanged aqueous humor levels of EMT-related proteins analyzed in phakic FECD patients indicate that there is no primary role of these aqueous cytokines in FECD pathogenesis.