Suwal Rinkal, Khadka Simanta, Joshi Purushottam
Department of Optometry, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Service (CHEERS), Bhaktapur, Nepal.
Department of Vitreo-Retina, Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal.
Clin Ophthalmol. 2020 Aug 25;14:2463-2472. doi: 10.2147/OPTH.S269364. eCollection 2020.
To evaluate the ocular characteristics of Marfan's syndrome (MFS) fulfilling the revised Ghent-2 nosology in Eastern Nepal.
A hospital-based observational and cross-sectional study was conducted. Ocular manifestations and biometrics were incorporated. Patients were subdivided into adults (16 years or older) and children (5-15 years). Ocular biometric parameters consisted of values of refractive error, keratometry readings, anterior chamber depth (ACD), central corneal thickness (CCT), lens thickness (LT) and axial length (AL).
A total of 34 eyes of 17 patients with MFS were included, where 32 eyes were phakic. Mean age of the study participants was 14.5 ± 9.1 years. The mean best corrected visual acuity (BCVA) of phakic eyes was 0.99 ± 0.82 LogMAR. Myopia greater than -3 diopters (D) was present in 28/34 (82.35%) eyes. The average spherical equivalent was -12.34 ± 8.85 D. Ectopia lentis (EL) was present in 24/32 (75%) eyes where superonasal was the most common subluxation in 10/24 (41.7%) eyes. AL was longer in adults 26.54 ± 4.42 mm compared to 25.21 ± 1.93 mm in children. Likewise, LT in adults was 4.9 ± 0.70 mm and 4.40 ± 0.59 mm in pediatric participants. Flat corneas were noted in both the groups with an average of 41.53 ± 2.21 D. The mean CCT and ACD were 524.62 ± 21.74 μm and 3.64 ± 0.80 mm, respectively. There was a negative association between the AL and the average corneal curvature (K, correlation coefficient -0.11, =0.54).
Myopia is the foremost ocular involvement with significant visual disability in MFS. Though, AL and corneal curvature are not included in the revised Ghent-2 nosology, we strongly recommend these parameters to be considered during ophthalmic evaluation in suspected and diagnosed cases of MFS in the absence of genetic testing.
评估符合修订版根特-2诊断标准的尼泊尔东部马凡综合征(MFS)的眼部特征。
开展一项基于医院的观察性横断面研究。纳入眼部表现和生物测量数据。患者分为成人(16岁及以上)和儿童(5 - 15岁)。眼部生物测量参数包括屈光不正值、角膜曲率计读数、前房深度(ACD)、中央角膜厚度(CCT)、晶状体厚度(LT)和眼轴长度(AL)。
共纳入17例MFS患者的34只眼,其中32只为有晶状体眼。研究参与者的平均年龄为14.5±9.1岁。有晶状体眼的平均最佳矫正视力(BCVA)为0.99±0.82 LogMAR。34只眼中28只(82.35%)眼近视度数大于-3屈光度(D)。平均等效球镜度为-12.34±8.85 D。24/32(75%)只眼中存在晶状体异位(EL),其中10/24(41.7%)只眼最常见的半脱位位置为鼻上象限。成人的AL较长,为26.54±4.42 mm,而儿童为25.21±1.93 mm。同样,成人的LT为4.9±0.70 mm,儿童参与者为4.40±0.59 mm。两组均观察到扁平角膜,平均为41.53±2.21 D。平均CCT和ACD分别为524.62±21.74μm和3.64±0.80 mm。AL与平均角膜曲率(K)之间存在负相关(相关系数-0.11,P = 0.54)。
近视是MFS中最主要的眼部病变,伴有明显视力残疾。尽管修订版根特-2诊断标准未纳入AL和角膜曲率,但在缺乏基因检测的疑似和确诊MFS病例的眼科评估中,我们强烈建议考虑这些参数。