Morphological features of anterior segment: factors influencing intraocular pressure after cataract surgery in nanophthalmos

Qiang Lu, Wenwen He, Yi Lu, Xiangjia Zhu, Qiang Lu, Wenwen He, Yi Lu, Xiangjia Zhu

Abstract

Purpose: To investigate the anterior segment in nanophthalmic eyes and their association with intraocular pressure after cataract surgery.

Methods: Thirty-two nanophthalmic eyes (axial length [AL] < 18.5 mm) in 18 patients and 35 normal eyes (21 ≤ AL ≤ 24.5 mm) in 35 controls who had undergone uneventful cataract surgery were included. Swept-source optical coherence tomography was used to compare the anterior segment structures between the two groups. The associations between the anterior segment characteristics of nanophthalmic eyes and postoperative intraocular pressure (IOP) were also investigated.

Results: The IOP-lowering effect of cataract surgery was remarkably insufficient in nanophthalmic eyes. Peripheral anterior synechiae (PAS) were observed in 56% (18/32) of nanophthalmic eyes, and a characteristic boomerang-shaped iris was observed in 28% (9/32). The anterior surface of the iris seemed "smoother" in nanophthalmic eyes than in normal eyes. Schlemm's canal (SC) diameter, SC area, trabecular meshwork (TM) thickness, TM width, and TM area were generally smaller in the nanophthalmic eyes. Younger age, higher preoperative IOP, broader PAS, and smaller SC area were main contributors to higher postoperative IOP. AL and SC diameter may also be of great importance in IOP prediction in patients without glaucoma surgery and PAS.

Conclusions: The morphological features of the anterior segment in nanophthalmic eyes are significantly different from those of normal eyes. Influencing factors such as age, AL, preoperative IOP, extent of PAS, SC and TM size could all be prognostic for IOP after cataract surgery in nanophthalmic eyes.

Trial registration: ClinicalTrails.gov, Trial registration number: NCT02182921, Registered 8 July 2014.

Keywords: Anterior segment; Boomerang-shaped iris; Cataract surgery; Intraocular pressure; Iris crypt; Nanophthalmos; Peripheral anterior synechiae; Schlemm’s canal; Trabecular meshwork.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Measurement of Schlemm’s canal (SC) and the trabecular meshwork (TM). The boundary of SC is drawn freehand (red outline) in the enlarged view in the lower left corner. The SC diameter is measured from the posterior to the anterior SC (orange line) and the SC area is the black oval space surrounded by the red line. The TM thickness is measured at the anterior end point and halfway down SC (yellow line). The enlarged view in the upper left corner shows the TM area (yellow) and TM width (orange line). The TM width is the length between the scleral spur (SS) and Schwalbe’s line (SL)
Fig. 2
Fig. 2
Intraocular pressure change in nanophthalmic eyes and normal eyes after cataract surgery. *P < 0.05
Fig. 3
Fig. 3
Different iris morphologies in nanophthalmic eyes and normal eyes. a Representative boomerang-shaped iris from three different nanophthalmic patients. Orange lines indicate the irregular angle formed by the boomerang-shaped iris. b Representative images of irises from three different controls. c Representative images of irises from three different nanophthalmic patients
Fig. 4
Fig. 4
The Schlemm’s canal (SC) and trabecular meshwork (TM) are smaller in nanophthalmic eyes compared with normal eyes. a Representative images of SC (yellow outline) from three different control patients. b Representative images of SC from three different nanophthalmic patients. c Representative images of the TM (yellow area) from three different controls. d Representative images of the TM from three different nanophthalmic patients. All images were taken in the nasal quadrant

References

    1. Verma AS, Fitzpatrick DR. Anophthalmia and microphthalmia. Orphanet J Rare Dis. 2007;2:47.
    1. Duke-Elder S. System of ophthalmology. 1. London: Henry Kimpton Publishers; 1958.
    1. Lemos JA, Rodrigues P, Resende RA, Menezes C, Gonçalves RS, Coelho P. Cataract surgery in patients with nanophthalmos: results and complications. Eur J Ophthalmol. 2016;26(2):103–106.
    1. Singh OS, Simmons RJ, Brockhurst RJ, Trempe CL. Nanophthalmos: a perspective on identification and therapy. Ophthalmology. 1982;89(9):1006–1012.
    1. Seki M, Fukuchi T, Ueda J, Suda K, Nakatsue T, Tanaka Y, et al. Nanophthalmos: quantitative analysis of anterior chamber angle configuration before and after cataract surgery. Br J Ophthalmol. 2012;96(8):1108–1116.
    1. Carifi G. Cataract surgery in eyes with nanophthalmos and relative anterior microphthalmos. Am J Ophthalmol. 2012;154(6):1005–6.
    1. Atalay E, Nongpiur ME, Baskaran M, Perera SA, Wong TT, Quek D, et al. Intraocular pressure change after phacoemulsification in angle-closure eyes without medical therapy. J Cataract Refract Surg. 2017;43(6):767–773.
    1. Chua J, Thakku SG, Tun TA, Nongpiur ME, Chiang M, Tan L, et al. Iris crypts influence dynamic changes of iris volume. Ophthalmology. 2016;123(10):2077–2084.
    1. Wang BS, Narayanaswamy A, Amerasinghe N, Zheng C, He M, Chan YH, et al. Increased iris thickness and association with primary angle closure glaucoma. Br J Ophthalmol. 2011;95(1):46–50.
    1. Zoroquiain P, Mastromonaco C, Balaszi M, Lasiste J, Aldrees S, Saheb N, et al. Histopathological trabecular meshwork remodeling after cataract surgery detected with an advanced image analyzer. J Cataract Refract Surg. 2018;44(1):98–102.
    1. Zheng T, Chen Z, Xu J, Tang Y, Fan Q, Lu Y. Outcomes and prognostic factors of cataract surgery in adult extreme microphthalmos with axial length <18 mm or corneal diameter <8 mm. Am J Ophthalmol. 2017;184:84–96.
    1. Powe NR, Schein OD, Gieser SC, Tielsch JM, Luthra R, Javitt J, et al. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol. 1994;112(2):239–52.
    1. Xu BY, Mai DD, Penteado RC, Saunders L, Weinreb RN. Reproducibility and agreement of anterior segment parameter measurements obtained using the CASIA2 and Spectralis OCT2 optical coherence tomography devices. J Glaucoma. 2017;26(11):974–979.
    1. Mohamed A, Chaurasia S, Ramappa M, Jalali S. Corneal thickness in uveal coloboma with microcornea. Eye (Lond) 2018;32(3):586–589.
    1. Holladay JT. Visual acuity measurements. J Cataract Refract Surg. 2004;30(2):287–290.
    1. Choudhari NS, George R, Baskaran M, Vijaya L, Dudeja N. Measurement of Goldmann applanation tonometer calibration error. Ophthalmology. 2009;116(1):3–8.
    1. Chen Z, Song Y, Li M, Chen W, Liu S, Cai Z, et al. Schlemm's canal and trabecular meshwork morphology in high myopia. Ophthalmic Physiol Opt. 2018;38(3):266–272.
    1. Kagemann L, Wollstein G, Ishikawa H, Bilonick RA, Brennen PM, Folio LS, et al. Identification and assessment of Schlemm's canal by spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2010;51(8):4054–4059.
    1. Yan X, Li M, Chen Z, Zhu Y, Song Y, Zhang H. Schlemm's canal and trabecular meshwork in eyes with primary open angle glaucoma: a comparative study using high-frequency ultrasound biomicroscopy. PLoS One. 2016;11(1):e0145824.
    1. Guo C, Zhao Z, Zhang D, Liu J, Li J, Zhang J, et al. Anterior segment features in nanophthalmos with secondary chronic angle closure glaucoma: an ultrasound biomicroscopy study. Invest Ophthalmol Vis Sci. 2019;60(6):2248–2256.
    1. Day AC, MacLaren RE, Bunce C, Stevens JD, Foster PJ. Outcomes of phacoemulsification and intraocular lens implantation in microphthalmos and nanophthalmos. J Cataract Refract Surg. 2013;39(1):87–96.
    1. Shingleton BJ, Pasternack JJ, Hung JW, O'Donoghue MW. Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma. 2006;15(6):494–498.
    1. Yang HS, Lee J, Choi S. Ocular biometric parameters associated with intraocular pressure reduction after cataract surgery in normal eyes. Am J Ophthalmol. 2013;156(1):89–94.e1.
    1. Shingleton BJ, Chang MA, Bellows AR, Thomas JV. Surgical goniosynechialysis for angle-closure glaucoma. Ophthalmology. 1990;97(5):551–556.
    1. Tian T, Li M, Pan Y, Cai Y, Fang Y. The effect of phacoemulsification plus goniosynechialysis in acute and chronic angle closure patients with extensive goniosynechiae. BMC Ophthalmol. 2019;19(1):65.
    1. He N, Wu L, Qi M, He M, Lin S, Wang X, et al. Comparison of ciliary body anatomy between American Caucasians and ethnic Chinese using ultrasound biomicroscopy. Curr Eye Res. 2016;41(4):485–491.
    1. Kara N, Baz O, Altinkaynak H, Altan C, Demirok A. Assessment of the anterior chamber angle in patients with nanophthalmos: an anterior segment optical coherence tomography study. Curr Eye Res. 2013;38(5):563–568.
    1. Kwon J, Sung KR, Han S, Moon YJ, Shin JW. Subclassification of primary angle closure using anterior segment optical coherence tomography and ultrasound biomicroscopic parameters. Ophthalmology. 2017;124(7):1039–1047.
    1. Chen Z, Sun J, Li M, Liu S, Chen L, Jing S, et al. Effect of age on the morphologies of the human Schlemm's canal and trabecular meshwork measured with swept-source optical coherence tomography. Eye (Lond) 2018;32(10):1621–1628.
    1. Ji Y, Rong X, Lu Y. Metabolic characterization of human aqueous humor in the cataract progression after pars plana vitrectomy. BMC Ophthalmol. 2018;18(1):63.
    1. Cabrerizo J, Urcola JA, Vecino E. Changes in the lipidomic profile of aqueous humor in open-angle glaucoma. J Glaucoma. 2017;26(4):349–355.
    1. Williamson BK, Hawkey NM, Blake DA, Frenkel JW, McDaniel KP, Davis JK, et al. The effects of glaucoma drainage devices on oxygen tension, glycolytic metabolites, and metabolomics profile of aqueous humor in the rabbit. Transl Vis Sci Technol. 2018;7(1):14.
    1. Wang D, Huang W, Li Y, Zheng Y, Foster PJ, Congdon N, et al. Intraocular pressure, central corneal thickness, and glaucoma in Chinese adults: the Liwan Eye Study. Am J Ophthalmol. 2011;152(3):454–62.e1.
    1. Klein BE, Klein R, Linton KL. Intraocular pressure in an American community. The Beaver Dam Eye Study. Invest Ophthalmol Vis Sci. 1992;33(7):2224–8.
    1. Rodrigues FW, Silva CM, Modesto DC, de Oliveira AW, da Silva SR. Intraocular pressure variation by pneumatic tonometer before and after phacoemulsification. Eur J Ophthalmol. 2018;28(4):393–397.
    1. Masis SM, Lin SC. Cataract, phacoemulsification and intraocular pressure: Is the anterior segment anatomy the missing piece of the puzzle? Prog Retin Eye Res. 2018;64:77–83.
    1. Zhu X, Qi J, He W, Zhang S, Zhang K, Liu Q, et al. Early transient intraocular pressure spike after cataract surgery in highly myopic cataract eyes and associated risk factors. Br J Ophthalmol. 2020;104(8):1137–1141.
    1. Walsh MK, Goldberg MF. Abnormal foveal avascular zone in nanophthalmos. Am J Ophthalmol. 2007;143(6):1067–1068.
    1. Garnai SJ, Brinkmeier ML, Emery B, Aleman TS, Pyle LC, Veleva-Rotse B, et al. Variants in myelin regulatory factor (MYRF) cause autosomal dominant and syndromic nanophthalmos in humans and retinal degeneration in mice. PLoS Genet. 2019;15(5):e1008130.
    1. Singh H, Wang JC, Desjardins DC, Baig K, Gagné S, Ahmed IIK, et al. Refractive outcomes in nanophthalmic eyes after phacoemulsification and implantation of a high-refractive-power foldable intraocular lens. J Cataract Refract Surg. 2015;41(11):2394–2402.

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