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Observational Study
. 2024 Jan 23;24(1):34.
doi: 10.1186/s12886-024-03286-z.

Classifications of anterior segment structure of congenital corneal opacity in infants and toddlers by ultrasound biomicroscopy and slit-lamp microscopic photographs: an observational study

Jing Hong  1   2 , Zijun Xie  3   4 , Xin Wang  3   4 , Ting Yu  3   4 , Siyi Ma  3   4 , Hanzhi Ben  3   4 , Shao-Feng Gu  3   4
Affiliations
Observational Study

Classifications of anterior segment structure of congenital corneal opacity in infants and toddlers by ultrasound biomicroscopy and slit-lamp microscopic photographs: an observational study

Jing Hong et al. BMC Ophthalmol. .

Abstract

Background: The structural features have an impact on the surgical prognosis for congenital corneal opacity (CCO). The structural classification system of CCO, however, is lacking. Based on data from ultrasound biomicroscopy (UBM) findings in infants and toddlers with CCO, this research proposed a classification system for the anterior segment structure severity.

Methods: Medical records, preoperative UBM images and slit-lamp photographs of infants and toddlers diagnosed with CCO at University Third Hospital between December 2018 and June 2022 were reviewed. According to the anterior segment structural features observed in UBM images, eyes were classified as follows: U1, opaque cornea only; U2, central anterior synechia; U3, peripheral anterior synechia combined with angle closure; and U4, aniridia or lens anomaly. The opacity appearance and corneal vascularization density observed in slit-lamp photographs were assigned grades according to previous studies. The extent of vascularization was also recorded. The corresponding intraocular anomaly classifications and ocular surface lesion severity were analysed.

Results: Among 81 eyes (65 patients), 41 (50.6%) were right eyes, and 40 (49.4%) were left eyes. The median age at examination was 6.91 months (n = 81, 1.00, 34.00). Two (2.5%) of the 81 eyes were classified as U1, 20 (24.7%) as U2, 22 (27.2%) as U3a, 11 (13.6%) as U3b and 26 (32.1%) as U4. Bilateral CCO eyes had more severe UBM classifications (P = 0.019), more severe dysgenesis (P = 0.012) and a larger angle closure (P = 0.009). Eyes with more severe UBM classifications had higher opacity grades (P = 0.003) and vascularization grades (P = 0.014) and a larger vascularization extent (P = 0.001). Eyes with dysgenesis had higher haze grades (P = 0.012) and more severe vascularization (P = 0.003 for density; P = 0.008 for extent), while the angle closure range was related to haze grade (P = 0.013) and vascularization extent (P = 0.003).

Conclusions: This classification method based on UBM and slit-lamp photography findings in the eyes of CCO infants and toddlers can truly reflect the degree of abnormality of the ocular surface and anterior segment and is correlated with the severity of ocular surface anomalies. This method might provide meaningful guidance for surgical procedure design and prognostic determinations for keratoplasty in CCO eyes.

Keywords: Congenital abnormalities; Cornea diseases; Corneal opacity; Ultrasound Biomicroscopy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Ultrasound biomicroscopic images of different ultrasound biomicroscopic classifications. (a) Only an opaque cornea was shown in ultrasound biomicroscopic images. (b) Ultrasound biomicroscopic images showed opaque cornea and central anterior synechia. (c) Ultrasound biomicroscopic images showed an opaque cornea and peripheral iridocorneal synechia, combined with angle closure ranging less than or equal to 180 degrees. (d) Ultrasound biomicroscopic images showed an opaque cornea and peripheral iridocorneal synechia, combined with angle closure greater than 180 degrees. (e) The eyes classified as U4 are coupled with or without angle closure, and ultrasound biomicroscopic images revealed an opaque cornea with iris and lens anomaly
Fig. 2
Fig. 2
Images of different grades of ocular surface features. (a) Mild corneal haze (F1): The opacity was smaller than 1/4 of the cornea, and iris details could be seen through it. (b) Moderate corneal haze (F2): The opacity was larger than 1/4 of the cornea with the lens and iris details blocked. (c) Severe corneal haze (F3): The lens and iris were completely hidden behind the opacity. (d) Nonvascularized (V0): Opacified cornea with no sign of vascularization. (e) Mildly vascularized (V1): Straight loop-shaped fine vessels grew on the corneal limbus from 4 to 12 o’clock. (f) Moderately vascularized (V2): Two large arborizing vessels grew across the limbus at 2 and 5 o’clock. (g) Severely vascularized (V3): The opacity was completely covered by retiform vessels
See this image and copyright information in PMC

References

    1. Bermejo E, Martínez-Frías ML. Congenital eye malformations: clinical-epidemiological analysis of 1,124,654 consecutive births in Spain. Am J Med Genet. 1998;75(5):497–504. doi: 10.1002/(SICI)1096-8628(19980217)75:5<497::AID-AJMG8>3.0.CO;2-K. - DOI - PubMed
    1. Kurilec JM, Zaidman GW. Incidence of Peters anomaly and congenital corneal opacities interfering with vision in the United States. Cornea. 2014;33(8):848–50. doi: 10.1097/ICO.0000000000000182. - DOI - PubMed
    1. Vanathi M, Panda A, Vengayil S, Chaudhuri Z, Dada T. Pediatric Keratoplasty. Surv Ophthalmol. 2009;54(2):245–71. doi: 10.1016/j.survophthal.2008.12.011. - DOI - PubMed
    1. Nischal KK. A new approach to the classification of neonatal corneal opacities. Curr Opin Ophthalmol. 2012;23(5):344–54. doi: 10.1097/ICU.0b013e328356893d. - DOI - PubMed
    1. Vanathi M, Raj N, Kusumesh R, Aron N, Gupta N, Tandon R. Update on pediatric corneal diseases and keratoplasty. Surv Ophthalmol. 2022;67(6):1647–84. doi: 10.1016/j.survophthal.2022.07.010. - DOI - PubMed

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