First Author: E.Coskun TURKEY
Co Author(s): B. Gurler S. Okumus E. B. U. Aksoy
Purpose:
The aims of this study to investigate the surgical results of eyes with isolated lens coloboma and lens coloboma with accompanying cataracts in a fashion.
Setting:
Gaziantep University Faculty of Medicine Department of Ophthalmology
Methods:
Patients with lens coloboma and accompanying cataracts or who had a cylindrical refraction error of more than 6 diopter (D) because of lens coloboma were enrolled in this study. Eye examinations included Snellen uncorrected visual acuity (UCVA), refraction, keratometric values, best corrected visual acuity (BSCVA), slit-lamp biomicroscopy, applanation tonometry, and dilated fundus examination. UCVA and BSCVA were measured in decimal Snellen scale and were converted to the logarithm of the minimal angle of resolution (logMAR) scale for analysis. Exclusion criteria included microphthalmia, choroid, optic disc or macula coloboma. Eight eyes underwent phacoemulsification+ capsular tension ring (CTR) and intraocular lens (IOL) implantation. One eye underwent phacoemulsification and scleral fixation IOL implantation. One eye had lens coloboma and zonulolysis, rhegmatogenous retinal detachment. In this case in the same session phacoemulsification, Cionni CTR and IOL implantations, 20 gauge pars plana vitrectomy and laser photocoagulation around the retinal tear was performed. The eye was closed with silicon oil and silicon oil was removed in the fourth postoperative month. Patients were examined on the postoperative 1st day, 1st week, first, third and sixth months. Patients, who completed at least 3 months of follow ups, were admitted to the study group.
Results:
Ten eyes of 8 patients included in the study and the average age of the patients was 16.2 ± 7.3 (6 – 25) years. Three patients had unilateral and five patients had bilateral lens coloboma. Two patients had surgeries just on one eye because of low refraction value and not showing up for the follow ups. The patientsÂ’ average follow up durations were 3.3 ± 1.0 month. The average axial length of the eyes was 23.39 ± 1.60 (21.37 - 25.90) millimeter. The mean refractive cylinder and spherical equivalent at last follow up examination were decreased from 6.2 ± 3.2 D to 1.0 ± 1.65 D and from -7.2±4.4 to -0.65± 1.66, respectively (p=0.04 to p= 0.03). The mean keratometric astigmatism at preoperative and postoperative last follow up examination were 1.58±0.78 D and 1.92±1.20 D respectively (p=0.32). LogMAR UCVA and BSCVA improved from 1,51 ± 0,20 and 1,11 ± 0,47 before surgery to 0,86 ± 0,49 and 0,63 ± 0,53 at last follow up examination respectively (p= 0.005 to p= 0.005). Patching therapy was started tree eyes of the two pediatric patients and there was at least one line of increase in snellen lines during follow up period.
Conclusions:
Lens coloboma may cause amblyopia and a decrease in visual acuity because of severe anisometropia and cataract. Phacoemulsification along with lens aspiration and IOL implantation corrects the severe refraction error in these patients and increase visual acuity. Standard CTR should be used for capsular stabilization and IOL centralization in lens coloboma patients whereas Cionni CTR may be necessary for capsular stabilization and IOL centralization in patients with lens coloboma and zonulolysis. Retinal tears may occur in eyes with lens coloboma at the region of lens coloboma. Peripheral retina and the ciliary body in the region of the coloboma should be examined in a detailed fashion. Amblyopia due to severe anisometropia and cataract should be treated by surgery and / or optic rehabilitation and patching therapy in cases diagnosed in pediatric age groups. FINANCIAL DISCLOSURE?: No
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