| Objective Fetal ocular dysplasia is a kind of facial dysplasia.Its incidence is relatively low,but it is extremely harmful.It is the most important cause of amblyopia and visual loss in children.The most common fetal eye development is congenital cataract and ocular morphological abnormalities,including anophthalmia and microphthalmia,etc.Prenatal ultrasound accurate evaluation of congenital cataract and ocular morphological abnormalities is of great significance to guide clinical diagnosis and treatment.Therefore,the first part of this study aimed to investigate the echo characteristics and specific sonograms of congenital lesions classification performance,cause analysis,perinatal outcome and postpartum surgery timing selection.The second part of the study was to investigate the ultrasonographic features and prognosis of different types of ocular morphologic abnormalities.Methods A total of 36 fetuses with congenital cataract detected by prenatal ultrasound in the First Affiliated Hospital of Anhui Medical University and Anhui Maternal and Child Health Hospital from January 2017 to October 2022 were retrospectively analyzed.The average age of pregnant women was 30.44±6.35 years,and the average gestational age was 25.31±2.89.All prenatal ultrasonographic examinations were performed by experienced sonographers who had been engaged in prenatal screening for more than 3 years.GE Voluson E8(General Electric Company)probe frequency of1 ～ 6 MHz;Samsung WS80A(Samsung Madison Company),abdominal probe frequency 1 ～ 7Mhz;Philips EPIQ5(Royal Philips Electronics,The Netherlands),transabdominal probe 1 ～ 5 MHz and each instrument was also equipped with a four-dimensional volumetric probe.Instrument Settings: Fetal systematic screening conditions in the first,second and third trimesters.All fetuses were routinely screened according to the guidelines of International Society of Ultrasound in Obstetrics and Gynecology(ISUOG)and Chinese Medical Doctor Association Sonographer Branch.If the internal echo of fetal lens was abnormal,a combination of transverse,coronal and parasagital views was used to diagnose the fetus with suspected cataract.To exclude factors such as chromosomal abnormalities and intrauterine infection,clinical and outpatient cases were followed up after delivery and induced labor.From January 2017 to October 2022,14 pregnant women with microphthalmia who underwent prenatal ultrasound examination in the First Affiliated Hospital of Anhui Medical University,the Second Affiliated Hospital of Anhui Medical University,the North District of the First Affiliated Hospital of Anhui Medical University,and Anhui Maternal and Child Health Hospital were selected,and 308 normal pregnant women were selected as control group.The average gestational age was 28±2.6 weeks(range,18 ～ 40 weeks)and the average maternal age was 30.0±5.4 years(range,21 ～ 42years).All prenatal ultrasound examinations were performed by experienced sonographers who had prenatal screening qualification certificates and had been engaged in prenatal screening for more than 3 years.,using GE Voluson E8(General Electric Company),the transabdominal probe frequency was 1 ～ 6MHz.All fetuses underwent routine and systematic screening according to the guidelines of International Society of Ultrasound in Obstetrics and Gynecology(ISUOG)and Chinese Association of Sonographers.The diagnosis of fetal ocular morphological dysplasia was based on the normal value of eye distance at different gestational weeks in "Prenatal Ultrasound diagnosis of Fetal Malformation 2 edition".The ultrasonic manifestations of different morphological ocular dysplasia were analyzed.Results1.36 cases of congenital cataract diagnosed by prenatal ultrasound were divided into three types according to the internal echo of the lens.Type I showed that the internal echo of the lens was completely hyperechoic.Type II lens showed double ring sign;Type Ⅲ ultrasound mainly showed a hyperechoic area in the center of the lens,which was punctate or cluster-like.There were 16 cases of type 1 cataract,accounting for44.4%;8 cases of type II,accounting for 22.2%;12 cases were type Ⅲ,accounting for33.3%.Type I cataract accounted for the highest proportion.2.36 cases of congenital cataract were diagnosed by prenatal ultrasound,including 26 cases of bilateral cataract,10 cases of unilateral cataract(8 cases of left eye cataract,2cases of right eye cataract),accounting for 72% of bilateral cataract and 28% of unilateral cataract.Among the 36 cases of cataract,12 cases(33.3%)were isolated cataract,24 cases(66.7%)were combined with other abnormal ultrasound findings: 14 cases were combined with extraocular ultrasound abnormalities,4 cases were combined with intraocular abnormalities(microphthalmia),6 cases were combined with both intraocular and extraocular ultrasound abnormalities.3.Among the 36 cases of fetal congenital cataract,7 cases were caused by viral infection,12 cases were caused by chromosome and gene mutations,and 1 case was caused by a newly discovered X-linked recessive gene mutation.4.The operation time of type Ⅰ cataract is earlier than that of type Ⅲ cataract.5.The relationship between fetal eyeball volume and gestational age was linear curve equation.The eyeball volume increased with the increase of biparietal diameter,and the correlation was quadratic,and the correlation between eyeball volume and biparietal diameter was more closely than that between eyeball volume and gestational age..6.There were statistically significant differences in the eyeball volume between microphthalmia and normal gestational weeks in 14 cases.Conclusion1.Fetal congenital cataract is a congenital disease caused by a variety of factors such as genetics,metabolism,intrauterine infection and so on.Prenatal ultrasound images are mainly divided into three types according to the internal echo of the lens.2.Pregnancy cytomegalovirus and rubella virus infection may be the risk factors of congenital cataract in offspring.Attention should be paid to the prevention of intrauterine infection during pregnancy.3.The measurement of fetal eyeball volume by three-dimensional ultrasound has good application value because of the small inter-observer difference.4.Fetal eyeball volume increases linearly with gestational age and quadratic with biparietal diameter. |
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