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| CASE REPORT |
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| Year : 2023 | Volume
: 3
| Issue : 2 | Page : 343-345 |
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The utility of extended depth-of-focus intraocular lens in the management of higher-order aberrations and modulation transfer function in a case of Alport syndrome
Pratik Shenoy1, Sonal Shah1, Onkar H Pirdankar2, Smitesh Shah1, Amit S Nene1, Pushpanjali Ramteke1, Ajay Butta2
1 Department of Ophthalmology, Isha Netralaya, Kalyan, Maharashtra, India
2 Department of Optometry, Isha Netralaya, Kalyan, Maharashtra, India
| Date of Submission | 23-Nov-2022 |
| Date of Acceptance | 14-Feb-2023 |
| Date of Web Publication | 28-Apr-2023 |
Correspondence Address:
Onkar H Pirdankar
Isha Netralaya, Radhakrishna Sankul, Opp Holy Cross Hospital, Karnik Road, Kalyan - 421 301, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/IJO.IJO_3083_22
This report describes the changes in the higher-order aberrations (HOAs) and modulation transfer function (MTF) in anterior lenticonus in a case of Alport syndrome managed by using extended depth of focus (EDOF) IOL. The patient was a 23-year-old male complaining of diminution of vision in both eyes and had a best-corrected visual acuity (BCVA) of 6/24 and 6/18 in the right and left eye, respectively. Slit-lamp examination revealed anterior lenticonus in both eyes. Optical coherence tomography showed temporal retinal thinning, and aberrometry revealed increased HOA and a reduction of MTF. The patient underwent sequential, bilateral, clear corneal phacoemulsification with EDOF IOL implantation. Postsurgery, improvements in BCVA and MTF with a significant reduction in HOA were noted. To conclude, the EDOF lens is a viable option for implantation in cases of Alport syndrome with anterior lenticonus.
Keywords: Alport syndrome, anterior lenticonus, EDOF IOL, higher-order aberrations, modulation transfer function
How to cite this article:
Shenoy P, Shah S, Pirdankar OH, Shah S, Nene AS, Ramteke P, Butta A. The utility of extended depth-of-focus intraocular lens in the management of higher-order aberrations and modulation transfer function in a case of Alport syndrome. Indian J Ophthalmol Case Rep 2023;3:343-5 |
How to cite this URL:
Shenoy P, Shah S, Pirdankar OH, Shah S, Nene AS, Ramteke P, Butta A. The utility of extended depth-of-focus intraocular lens in the management of higher-order aberrations and modulation transfer function in a case of Alport syndrome. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 2];3:343-5. Available from: https://www.ijoreports.in/text.asp?2023/3/2/343/375019 |
Alport syndrome is a rare inherited entity with an estimated prevalence of 1 in 50,000[1] and is characterized by hematuria, renal failure, hearing loss, and ocular abnormalities.[2] The various ocular manifestations include corneal opacities, cataracts, anterior lenticonus, temporal retinal thinning, abnormal retinal vasculature, and thickening of the choriocapillaris.[2],[3],[4] Anterior lenticonus, being one the commonest manifestations, results not only in poor visual acuity, but also causes poor contrast and image quality metrics due to the presence of significant higher order aberrations (HOAs) and decreased modulation transfer function (MTF).[5] Surgeons have circumvented a majority of these refractive anomalies with toric and extended depth of focus (EDOF) IOL implantation.[6] However, the effect of EDOF lens implantation on HOA and MTF in these cases has not been evaluated yet. Herein, we describe changes in the HOA and MTF in an anterior lenticonus in Alport syndrome managed by using EDOF IOL.
| Case Report | |  |
A 23-year-old male visited our outpatient department with complaints of a diminution of distant vision in both eyes. His unaided vision was finger counting at 3 m in the right eye improving to 6/24 and 6/60 in the left eye, which was improving to 6/18 with the best correction. Slit-lamp examination revealed anterior lenticonus in both eyes [Figure 1]a. Although the fundus evaluation was within normal limits, optical coherence tomography revealed thinning of the temporal retina in both eyes [Figure 1]b while optical coherence tomography (OCT) angiography revealed reduction in vascular density of the superficial and deep capillary plexus with normal choriocapillaris. Considering his high myopic refractive error due to the lenticonus, he was planned for lens extraction with IOL implantation. The IOL power calculations were carried out using the Barrett Universal II formula since it is the most accurate across all ranges of axial lengths. Patient also underwent aberrometry using HOYA i-Trace aberrometer (Tracey technology, Houston, USA) for evaluating the aberrations at 4 mm fixed pupil size which revealed the presence of significant internal HOAs [Figure 2]a and reduction in MTF [Figure 3]a. Central corneal thickness in the right and left eye was 548 and 541 μm, respectively. | Figure 1: Slit-lamp photo showing anterior lenticonus in both eyes (a) and OCT showing thinning of the temporal retina in both eyes (b)
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 | Figure 2: Internal higher-order aberrations pre (a) and post (b) cataract surgery
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 | Figure 3: Internal modulation transfer function pre (a) and post (b) cataract surgery
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His renal function tests revealed higher levels of blood urea nitrogen and creatinine. He also had associated sensorineural hearing loss. These constellations of signs and investigations helped us confirm the diagnosis of Alport syndrome.
The patient underwent uneventful cataract surgery, with an interval of 1 week between the two eyes, by a single surgeon. A 2.8-mm clear corneal incision phacoemulsification was performed and an EDOF IOL (AcrySof™ IQ Vivity™, Alcon) was implanted in the capsular bag. The postoperative aberrometry revealed a significant reduction in HOA [Figure 2]b and an improvement in MTF [Figure 3]b. Six months postoperatively, his uncorrected vision was 6/9 partial, N10 and 6/12, and N12 in the right and left eye, respectively, which improved to 6/9, N8 with best correction.
| Discussion | | |
In this case report, we detail the implantation of an EDOF IOL in a case of Alport syndrome and report its outcomes on the HOA and MTF. The Vivity EDOF IOL uses X-WAVE™ technology, which stretches and shifts the wavefronts, avoids light splitting, and results in an extended focus rather than the formation of multiple foci. Thus, it provides an expanded range of vision and better spectacle independence as compared with diffractive multifocal IOLs.[7] Cataracts in Alport have been managed by multifocal lenses,[5] however, we opted against it in view of the macular changes and hence implanted an EDOF IOL to provide the best possible uncorrected spectacle correction.
In the present case, we used the Barrett formula, which is based on Gaussian principles and takes into account the change in principle planes that occur with the different intraocular lens power. Although Barrett total K formula takes into consideration posterior corneal astigmatism (PCA) and effective lens position (ELP), in our case the difference between total k and anterior k was minimal. Hence, we do not expect that the PCA or ELP used in IOL power calculation formulae would have affected HOA and MTF significantly. Internal spherical aberrations are the prominent HOA in Alport syndrome.[5] In the present case, we noted the improvement of internal spherical aberrations using nondiffractive EDOF IOL in both eyes. We used i-Trace wavefront aberrometry as it is an effective tool for the evaluation of HOA and MTF. MTF curve describes the ratio of image contrast to the object contrast as a function of spatial frequencies. We measured HOA and MTF for a fixed pupil size of 4 mm as both HOA and MTF change as a function of pupil size.[5] Although the utility of EDOF IOL in Alport syndrome has been published,[6] to our knowledge, there are no reports that describe the changes in HOA and MTF in these cases after EDOF IOL implantation. Here, we have noted a significant reduction in HOA and an improvement in MTF.
| Conclusion | | |
To conclude, the EDOF lens is a viable option for implantation in cases of Alport syndrome with anterior lenticonus.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Warady BA, Agarwal R, Bangalore S, Chapman A, Levin A, Stenvinkel P, et al. Alport syndrome classification and management. Kidney Med 2020;2:639-49.  |
| 2. | Xu JM, Zhang SS, Zhang Q, Zhou YM, Zhu CH, Ge J, et al. Ocular manifestations of Alport syndrome. Int J Ophthalmol 2010;13:149-51. |
| 3. | Trancoso FG, Gallon L, Bomfim MLA, Silva AFMD, Cade F, Zanetti FR. Optical coherence tomography angiography findings in patients with Alport syndrome. Arq Bras Oftalmol 2020;83:473-7. |
| 4. | Fawzi AA, Lee NG, Eliott D, Song J, Stewart JM. Retinal findings in patients with Alport Syndrome: Expanding the clinical spectrum. Br J Ophthalmol 2009;93:1606-11. |
| 5. | Nath M, Gireesh P. Femtosecond laser-assisted cataract surgery in Alport's syndrome-A case report. Indian J Ophthalmol 2019;67:1891-3. [ PUBMED] [Full text] |
| 6. | Figueiredo Matias IF, Prata Gomes PN, da Cunha Diniz SN, Pereira Rita Neves PR, Melo de Ornelas MA. Bilateral phacoemulsification and toric extended depth of focus intraocular lens implantation in Alport's syndromes. Pan Am J Ophthalmol 2020;2:8. [Full text] |
| 7. | Hovanesian JA, Jones M, Allen Q. The vivity extended range of vision IOL vs the PanOptix Trifocal, ReStor 2.5 Active Focus and ReStor 3.0 multifocal lenses: A comparison of patient satisfaction, visual disturbances, and spectacle independence. Clin Ophthalmol 2022;16:145-52. |
[Figure 1], [Figure 2], [Figure 3]
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