Wheeler D T, Mullaney P B, Awad A, Zwaan J
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Ophthalmology. 1999 Dec;106(12):2362-7. doi: 10.1016/S0161-6420(99)90540-7.
To document clinical features and subsequent management of pyramidal anterior polar cataracts in children.
Retrospective, noncomparative case series and clinicopathologic correlation.
Fifteen patients who presented to the pediatric ophthalmology clinic.
All patients underwent measurement of visual acuity, assessment of ocular motility, examination of the anterior and posterior segments, and cycloplegic refraction. Amblyopia treatment was instituted when appropriate. When visual impairment occurred from cataract progression or amblyopia or both, cataract removal with or without lens implantation was performed. After surgery, correction of refractive error and treatment of amblyopia were instituted. Several pyramidal opacities were retrieved during cataract extraction and examined by light and electron microscopy.
Visual acuity at initial presentation, size of lens opacity before surgery, amblyopia status, most recent visual acuity after cataract extraction, and histologic examination of lens opacity.
Nine children had bilateral and six had unilateral pyramidal cataracts (24 eyes). There was no discernible inheritance pattern. Patients were followed for 27 months on average. Twenty of 24 eyes developed cortical opacification that extended significantly beyond the base of the pyramidal lesion. Nineteen eyes required cataract surgery: 10 eyes underwent lensectomy with anterior vitrectomy and 9 had extracapsular cataract extraction, 8 of which had insertion of a posterior chamber intraocular lens. Amblyopia was present or developed in all six patients with unilateral cataract and in eight of nine patients with bilateral cataract. Visual acuity in many eyes remained poor despite amblyopia therapy. The pyramidal opacities consisted of hyperplastic lens epithelium, which exhibited a loss of polarity and was surrounded by a collagenous matrix.
Pyramidal anterior polar cataracts are present at birth and may represent a variant of anterior polar lens opacities. They may be unilateral or, if bilateral, they may be either symmetric or asymmetric. They consist of hyperplastic lens epithelium in a collagenous matrix. Patients with pyramidal cataracts are likely to develop amblyopia. This can result from either unilateral occurrence or asymmetry of bilateral opacities and is often worsened by surrounding cortical opacification. Many patients require cataract surgery. All infants and young children with anterior polar opacities showing this configuration should be followed for cataract progression and amblyopia.
记录儿童锥体前极性白内障的临床特征及后续治疗情况。
回顾性、非对照病例系列研究及临床病理相关性研究。
15例就诊于小儿眼科门诊的患者。
所有患者均接受视力测量、眼球运动评估、眼前段和后段检查以及散瞳验光。视情况进行弱视治疗。当白内障进展、弱视或两者共同导致视力损害时，进行白内障摘除术，可选择植入或不植入人工晶状体。术后进行屈光不正矫正和弱视治疗。在白内障摘除过程中获取了数个锥体混浊物，并进行光镜和电镜检查。
初诊时的视力、手术前晶状体混浊的大小、弱视状态、白内障摘除术后最近的视力以及晶状体混浊的组织学检查结果。
9例儿童为双侧锥体白内障，6例为单侧（共24只眼）。无明显的遗传模式。患者平均随访27个月。24只眼中有20只出现皮质混浊，其范围显著超出锥体病变的基底。19只眼需要进行白内障手术：10只眼行晶状体切除术联合前部玻璃体切除术，9只眼行白内障囊外摘除术，其中8只眼植入了后房型人工晶状体。所有6例单侧白内障患者以及9例双侧白内障患者中的8例存在或发生了弱视。尽管进行了弱视治疗，许多眼的视力仍较差。锥体混浊物由增生的晶状体上皮组成，其极性消失，并被胶原基质包绕。
锥体前极性白内障在出生时即存在，可能是前极性晶状体混浊的一种变异型。可为单侧，若为双侧，则可能对称或不对称。由胶原基质中的增生晶状体上皮组成。锥体白内障患者很可能发生弱视。这可能是由于单侧发病或双侧混浊不对称所致，且常因周围皮质混浊而加重。许多患者需要进行白内障手术。所有表现为此种形态的前极性混浊的婴幼儿均应密切随访白内障进展及弱视情况。
