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Ipsilateral posterior subcapsular cataract in a young patient with hourglass-like narrowing of the inferior temporal retinal artery.
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PMID:  22110439     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
We present an interesting and rare case of subcapsular cataract coexisting with ipsilateral narrowing of the inferior temporal retinal artery in a young woman. The possible role of retinal vessel malformation in cataract pathophysiology is discussed.
Authors:
Nikolaos Kozeis; Zisis Gatzioufas; Konstantinos T Tsaousis; Berthold Seitz
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Publication Detail:
Type:  Journal Article     Date:  2011-05-03
Journal Detail:
Title:  Case reports in ophthalmology     Volume:  2     ISSN:  1663-2699     ISO Abbreviation:  Case Rep Ophthalmol     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-11-23     Completed Date:  2011-11-23     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101532006     Medline TA:  Case Rep Ophthalmol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  145-8     Citation Subset:  -    
Affiliation:
Department of Ophthalmology, Hippokration General Hospital, Thessaloniki, Greece.
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Journal ID (nlm-ta): Case Report Ophthalmol
Journal ID (publisher-id): COP
ISSN: 1663-2699
Publisher: S. Karger AG, Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch
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Copyright © 2011 by S. Karger AG, Basel
open-access:
collection publication date: Season: May-Aug Year: 2011
Electronic publication date: Day: 3 Month: 5 Year: 2011
pmc-release publication date: Day: 3 Month: 5 Year: 2011
Volume: 2 Issue: 2
First Page: 145 Last Page: 148
ID: 3219449
PubMed Id: 22110439
DOI: 10.1159/000328388
Publisher Id: cop0002-0145

Ipsilateral Posterior Subcapsular Cataract in a Young Patient with Hourglass-Like Narrowing of the Inferior Temporal Retinal Artery
Nikolaos Kozeisa
Zisis Gatzioufasb
Konstantinos T. Tsaousisa*
Berthold Seitzb
aDepartment of Ophthalmology, Hippokration General Hospital, Thessaloniki, Greece
bDepartment of Ophthalmology, University of Saarland, Homburg/Saar, Germany
Correspondence: *Konstantinos T. Tsaousis, Department of Ophthalmology, Hippokration General Hospital, Konstantinoupoleos 49, GR-54642 Thessaloniki (Greece), Tel. +30 694 418 1298, E-Mail konstantinos.tsaousis@gmail.com

Introduction

Metabolic disorders (diabetes), ischemic conditions (carotid occlusive disease), and use of drugs (corticosteroids) are potential causes of cataract development in affected individuals [1, 2]. Numerous previous studies proposed retinal vessel abnormalities as a potential predisposing factor for cataract formation [3, 4]. These abnormalities may be caused by retinal atrophy (due to degeneration, inflammation, trauma, treatment with diathermy, light, or cryopexy) or any vascular retinopathy [5].

We report a case of focal narrowing of the inferior temporal retinal artery (ITRA) in the right eye (OD) in a young patient who presented with decreased visual acuity due to ipsilateral subcapsular cataract, and discuss the possible role of retinal vessel irregularities in the pathophysiology of cataracts.


Case Report

A 42-year-old woman was referred to our department with visual decline in the OD that had been initially observed 6 months before. The patient had a clear medical record and received no medication except for hormone replacement therapy. Best-corrected visual acuity of her OD and left eye (OS) was 20/50 and 20/25, respectively. Slit-lamp examination revealed a posterior subcapsular cataract in the OD with no other pathological findings. There were no abnormal findings in the OS. Fundus examination of the OD revealed focal narrowing of the ITRA (fig. 1a, b). Fluorescein angiography confirmed this finding (fig. 1c, d), demonstrating filling defects in the retinal branches beyond the position of narrowing (fig. 1e, f). Retinal perfusion in the area of interest was measured by the Heidelberg Retina Flowmeter (HRF) [6]. Blood flow was evaluated in 10 different horizontal levels above and below the axial level defined by the retinal narrowing. Regional mean blood flow in this area (288.46 ± 33.70 arbitrary units, AU) was significantly less than in the same location in the contralateral eye (426.76 ± 39.1 AU) (z test, p < 0.005). The patient underwent uneventful phacoemulsification and subsequent implantation of a posterior chamber intraocular lens. One week after the operation, visual acuity had improved to 20/20 (OD).


Discussion

Previous reports proposed that extracranial cerebrovascular disease could lead to ischemic optic neuropathy and cataract development [7]. In the present case, carotid ultrasound examination showed no underlying carotid artery stenosis. Our patient had no history of alcohol use or smoking, which are considered risk factors for the development of age-related cataract [8]. The main abnormal finding was the focal narrowing of the ITRA, which resulted in a reduced retinal blood perfusion in the inferior quadrants, as revealed by HRF.

Tan et al. [9] recently investigated whether local nutritional and ischemic factors may be involved in cataract pathogenesis. Retinal vessel narrowing was described as a predictive risk factor for the development of posterior capsular cataract and cataract surgery. A reasonable explanation of this link was proposed 20 years ago by Hopkins [10], who demonstrated that narrowed retinal arterioles lead to a decreased blood flow and reduced supply of nutrients and antioxidants to the lens, thereby inducing cataract. Reduced oxygen delivery to the retina may cause disproportionate lipid peroxidation and accumulation of peroxidative products that could diffuse through the vitreous to the lens and trigger the mechanisms of cataractogenesis [11].

In view of these findings, it is assumed that the focal ITRA narrowing observed in our patient may have influenced the lenticular metabolism, inducing an ipsilateral cataract. A feasible hypothesis is that like generalized retinal arterial alterations, focal malformations may exert a cataractogenic effect because they reduce retinal blood flow in particular patients.


Notes

This case report was presented at the 107th Congress of the German Society of Ophthalmology, Leipzig, Germany, 24–27 September 2009.

References
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10. Hopkins SD. Ocular haemodynamics in cataractous eyes: a pilot studyActa Ophthalmol SupplYear: 198919143482546367
11. Babizhayev MA. New concept in nutrition for the maintenance of the aging eye redox regulation and therapeutic treatment of cataract disease; synergism of natural antioxidant imidazole-containing amino acid-based compounds, chaperone, and glutathione boosting agents: a systemic perspective on aging and longevity emerged from studies in humansAm J TherYear: 20101737338920463577

Article Categories:
  • Published: May 2011

Keywords: Key Words Posterior capsular cataract, Cataractogenesis, Artery narrowing, Lenticular metabolism.

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