Ultrasound Biomicroscopic Morphologic Assessment in Aphakic Microphthalmic Eyes Developing Elevated IOP After Congenital Cataract Surgery
Narrative Responses:
Purpose
To identify anterior segment morphologic differences in aphakic microphthalmic eyes developing raised Intraocular Pressure(IOP) following congenital cataract surgery versus aphakic microphthalmic eyes with normal IOP and aphakic non-microphthalmic eyes, using Ultrasound Biomicroscopy (UBM)
Methods
In this observational comparative case series,Cases identified as 35 microphthalmic eyes(21 children) who had undergone congenital cataract surgery without IOL implantation before 1 year of age, without pre-existing raised IOP.Microphthalmos defined as axial length >2 standard deviations shorter than normal for that age.Control eyes comprised of 25 non-microphthalmic eyes(17 children) undergoing cataract surgery without IOL implantation before 1 year of age, without pre-existing raised IOP.One-time UBM imaging and anterior segment morphology analysis performed at of after minimum 1-year follow-up
Results
11 eyes(31.4%) of cases developed raised IOP versus 3 eyes(12%) in controls.In microphthalmic eyes,sulcus iris-ciliary process distance(p=0.03),internal angle width(p=0.004),white to white(p=0.01) were significantly smaller than controls.Angle opening distance at 500 µm(p=0.08),trabecular iris angle(p=0.4),trabecular ciliary process distance(p=0.2) were statistically similar to control eyes.All eyes with raised IOP showed unique morphology depicting flat pars plicata(10/35 versus 4/25),extended insertion of ciliary body to posterior iris surface(10/35 versus 1/25) and elongated ciliary processes parallel to the posterior iris surface(5/35 versus 1/25) obliterating the sulcus.These abnormalities were significantly more pronounced in microphthalmic eyes
Conclusion
An association of morphologic differences in ciliary body and angle anatomy to raised IOP was noted in both groups.Characteristic anterior and ciliary body development anomalies such as elongated ciliary processes, abnormal insertion of ciliary body to posterior iris and flat pars plicata were noted in higher number of microphthalmic eyes