Abstract

FR.14.09

Results of a multifocal aspheric anterior chamber intraocular lens with optimized addition after cataract surgery

Thomas Kohnen
Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main

Objective
The fetal development of the human eye has been thoroughly studied but the evaluation of prenatal findings in disease processes is sparse. In some syndromes ocular involvement of the adult eye is well known. However, the presence and extent of prenatal changes remain unclear, possibly also due to the difficulty in distinguishing iatrogenic trauma or autolysis. Here, we have chosen the most interesting cases from our collection of fetal eyes for presentation and discussion.
Methods
Since March 2008 a cohort of 252 eyes from 118 fetuses was collected from the Dept. of Pathology/Paidopathology. In all cases an informed consent had been signed by the parents. Our cohort consisted of fetuses with syndromes/malformations and fetuses that had died in utero (e.g. due to placental insufficiency). The eyes were fixed in formalin and glutaraldehyde, respectively. After macroscopic inspection they were opened horizontally, examined with the dissecting microscope and embedded in paraffin. Step sections were stained routinely with H&E and PAS, and, if appropriate, immunohistochemistry was performed.
Results
A high percentage of the eyes showed artefacts of a varying extent due to fetozid, removal of the eyes and/or delayed fixation. Nevertheless, there were often additional interesting disease-related findings, e.g. in a fetus with cyclopia. Another fetus (with an unclassified syndrome due to a variety of complex findings) presented with an aphakic eye on one side and a morphologically similar but phakic fellow eye. Vitreous opacities of unknown etiology were found in four fetuses; indication for fetozid were Turner's syndrome (n=1) and TAR syndrome (n=1); and two fetuses died intrauterine due to placental insufficiency (n=2). One fetus without any stigmata or malformation displayed globes of different size but without further morphological abnormalities. Another fetus revealed a peripapillary lack of RPE of unknown etiology after intrauterine death due to chorioamnionitis.
Conclusions
Taking into account distinct artefacts, the majority of our fetal eyes - irrespective of a regular or abnormal genotype - presented a regular phenotype. Occasionally, however, unexpected findings were uncovered in both fetuses with syndromes as well as in fetuses without syndromes or malformations. For further evaluation of the specificity of these findings and their classification examination of a substantial number of fetal eyes is required.

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