Morphological features of anterior segment:factors influencing intraocular pressure after cataract surgery in nanophthalmos

Purpose:To investigate the anterior segment in nanophthalmic eyes and their association with intraocular pressure after cataract surgery.Methods:Thirty-two nanophthalmic eyes(axial length[AL]<18.5 mm)in 18 patients and 35 normal eyes(21≤AL≤24.5 mm)in 35 controls who had undergone uneventful cataract surgery were included.Swept-source optical coherence tomography was used to compare the anterior segment structures between the two groups.The associations between the anterior segment characteristics of nanophthalmic eyes and postoperative intraocular pressure(IOP)were also investigated.Results:The IOP-lowering effect of cataract surgery was remarkably insufficient in nanophthalmic eyes.Peripheral anterior synechiae(PAS)were observed in 56%(18/32)of nanophthalmic eyes,and a characteristic boomerangshaped iris was observed in 28%(9/32).The anterior surface of the iris seemed“smoother”in nanophthalmic eyes than in normal eyes.Schlemm’s canal(SC)diameter,SC area,trabecular meshwork(TM)thickness,TM width,and TM area were generally smaller in the nanophthalmic eyes.Younger age,higher preoperative IOP,broader PAS,and smaller SC area were main contributors to higher postoperative IOP.AL and SC diameter may also be of great importance in IOP prediction in patients without glaucoma surgery and PAS.Conclusions:The morphological features of the anterior segment in nanophthalmic eyes are significantly different from those of normal eyes.Influencing factors such as age,AL,preoperative IOP,extent of PAS,SC and TM size could all be prognostic for IOP after cataract surgery in nanophthalmic eyes.

Morphological features of anterior segment:factors influencing intraocular pressure after cataract surgery in nanophthalmos

Purpose:To investigate the anterior segment in nanophthalmic eyes and their association with intraocular pressure after cataract surgery.Methods:Thirty-two nanophthalmic eyes(axial length[AL]<18.5 mm)in 18 patients and 35 normal eyes(21.0≤AL≤24.5 mm)in 35 controls who had undergone uneventful cataract surgery were included.Swept-source optical coherence tomography was used to compare the anterior segment structures between the two groups.The associations between the anterior segment characteristics of nanophthalmic eyes and postoperative intraocular pressure(IOP)were also investigated.Results:The IOP-lowering effect of cataract surgery was remarkably insufficient in nanophthalmic eyes.Peripheral anterior synechiae(PAS)were observed in 56%(18/32)of nanophthalmic eyes,and a characteristic boomerangshaped iris was observed in 28%(9/32).The anterior surface of the iris seemed"smoother"in nanophthalmic eyes than in normal eyes.Schlemm's canal(SC)diameter,SC area,trabecular meshwork(TM)thickness,TM width,and TM area were generally smaller in the nanophthalmic eyes.Younger age,higher preoperative IOP,broader PAS,and smaller SC area were main contributors to higher postoperative IOP.AL and SC diameter may also be of great importance in IOP prediction in patients without glaucoma surgery and PAS.Conclusions:The morphological features of the anterior segment in nanophthalmic eyes are significantly different from those of normal eyes.Influencing factors such as age,AL,preoperative IOP,extent of PAS,SC and TM size could all be prognostic for IOP after cataract surgery in nanophthalmic eyes.Trial registration:ClinicalTrails.gov,Trial registration number:NCT02182921,Registered 8 July 2014.

Insight into small eyes: a practical description from phenotypes presentations to the management

This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search.The definition can be related to a number of special phenotypes.In the more challenging cases of complex microphthalmos,relative anterior microphthalmos,and nanophthalmos,the surgeon can approach these cases more safely if they have a deep understanding of the anatomical variations and ideal formulae for intraocular lens computation and knows how to avoid intra-and post-operative complications.In this article,we review the criteria by which we recognize and describe pre-,intra-,and post-operative considerations,as well as discuss the ideal intraocular lenses for microphthalmos,given the intricate varieties of small eye phenotypes.

Clinical features of posterior microphthalmic and nanophthalmic eyes

AIM： To clinically differentiate nanophthalmos（NO） and posterior microphthalmos（PM） and to explore the mechanisms related to papillomacular folds（PMF）.METHODS： Medical records of 34 unrelated patients with microphthalmos（54 eyes） from April 2009 to October 2017 were retrospectively reviewed.RESULTS： Fourteen eyes of 7 unrelated patients with NO and PM were included in the study. The presenting age of the NO cohort was significantly higher compared with the PM cohort（NO： 27±16 y; PM： 3.7±0.6 y）. PMF was more likely to occur in cases with PM than in NO（25% in NO, 100% in PM）. The anatomic features of PMF from optical coherence tomography（OCT） included： ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and outer nuclear layer. In eyes without an apparent PMF（these were all NO eyes）, rudimentary fovea without a foveal pit was noted. Four eyes that were NO developed angle closure glaucoma. Three NO eyes developed exudative retinal detachment and were successfully treated with lamellar sclerectomy.CONCLUSION： Posterior segment changes are pervasive both in PM and NO. Complications like angle closure glaucoma and exudative retinal detachment are likely to occur in eyes with NO but not with PM. Detailed OCT analysis found that PMF was partially a neural retinal issue, suggesting that redundancy of retinal issues involved only inner retinal layers.

Scleral resection in chronic central serous chorioretinopathy complicated by exudative retinal detachment

Background:Effective therapeutic options are limited for the management of chronic central serous chorioretinopathy(CSCR)complicated by exudative retinal detachments(RD).The authors describe the resolution of one such case following partial thickness scleral resection with mitomycin C.Case presentation:This 39-year-old male presented with a unilateral inferior exudative RD in the right eye.There was no history of steroid use either locally or systemically.The fundus fluorescein angiogram showed window defects and leaks typical of chronic CSCR.The axial length was 21.06 mm in the right eye and 21 mm in the left eye.Thickening of the ocular coats was evident on ocular ultrasound.Considering an axial length in the borderline-low range inferotemporal and inferonasal partial thickness scleral resection with mitomycin C was performed.The exudative RD resolved at 4 months.Conclusion:Partial thickness scleral resection may be considered as an option for treating chronic CSCR patients with borderline-low axial length complicated by exudative RD.