Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India.
Eye (Lond). 2022 May;36(5):985-993. doi: 10.1038/s41433-021-01564-4. Epub 2021 May 6.
To analyze the clinical profile of patients with posterior lenticonus and their surgical, visual, and refractive outcomes.
Retrospective interventional case series of 84 eyes of 63 patients with posterior lenticonus. The incidence of posterior lenticonus was 3.98% during a study period of 5 years. One-third of cases had bilateral posterior lenticonus. The mean age was 4.78 ± 4.28 years (unilateral cases were significantly older than bilateral, P = 0.0001). Males were 54%. Mean axial length and keratometry were 21.49 mm and 44.88 D, respectively. Eyes with the bilateral disease were significantly shorter (axial length, P = 0.0012) and smaller (horizontal corneal diameter, P < 0.0001) compared to those with unilateral disease. While 88% were pseudophakic; 12% were aphakic. The posterior capsular defect was noted intraoperatively in 44%. Sixty-eight percent of eyes had a pre-operative diagnosis of posterior lenticonus, 32% were diagnosed intraoperatively. The mean follow-up period was 1.3 years. Best-corrected visual acuity (BCVA) at 6 months was fair to poor in two-third of patients (median 20/100). The mean ± SD visual acuity (LogMAR) and spherical equivalence for unilateral and bilateral cases were 0.70 ± 0.27, 0.67 ± 0.26D (p = 0.57) and 2.04 ± 2.74, 5.15 ± 3.73D (p = 0.0001), respectively. Visual outcomes were better in children who are aged 2 years or more (P = 0.0056). Eight percent needed a second surgery.
We report a higher prevalence of bilateral posterior lenticonus in this cohort. The clinical profile of bilateral disease differs from unilateral disease. The diagnosis is not always clinical. In the bag, intra-ocular lens (IOL) implantation is possible in the majority. The visual outcomes remain fair to poor, possibly due to late presentation and the presence of dense refractory amblyopia.
The manuscript consists of the largest series of posterior lenticonus to date. It provides the prevalence of posterior lenticonus along with characteristics difference between unilateral and bilateral cases of posterior lenticonus. Newer insights in terms of diagnostics, pre-operative pick-up rate, how to improve, visual and refractive outcomes of unilateral and bilateral cases are described.
分析后发性晶状体混浊患者的临床特征及其手术、视力和屈光结果。
回顾性分析了 63 例 84 只眼的晶状体后囊混浊患者，研究期间后发性晶状体混浊的发病率为 3.98%。三分之一的病例为双侧后发性晶状体混浊。平均年龄为 4.78±4.28 岁（单侧患者明显大于双侧，P=0.0001）。男性占 54%。平均眼轴长度和角膜曲率分别为 21.49mm 和 44.88D。双眼疾病的眼轴明显较短（P=0.0012），水平角膜直径较小（P<0.0001）。88%为后发性白内障患者，12%为无晶状体眼。术中发现 44%存在后囊膜缺损。68%的眼术前诊断为后发性晶状体混浊，32%为术中诊断。平均随访时间为 1.3 年。6 个月时，三分之二的患者最佳矫正视力（BCVA）为中等至差（中位数为 20/100）。单侧和双侧病例的平均±标准差视力（LogMAR）和球镜等效值分别为 0.70±0.27、0.67±0.26D（p=0.57）和 2.04±2.74、5.15±3.73D（p=0.0001）。2 岁及以上儿童的视力结果更好（P=0.0056）。8%的患者需要第二次手术。
本研究报告了该队列中双侧后发性晶状体混浊的发病率较高。双侧疾病的临床特征与单侧疾病不同。诊断并不总是临床诊断。在囊袋内，大多数患者可植入人工晶状体（IOL）。视力结果仍为中等至差，可能是由于就诊较晚，存在难治性弱视。
本文报告了迄今为止最大的后发性晶状体混浊系列病例。它提供了后发性晶状体混浊的患病率，以及单侧和双侧后发性晶状体混浊病例之间的特征差异。本文描述了在诊断、术前检出率、如何改善、单侧和双侧病例的视力和屈光结果方面的新见解。
