Skip to main content
Download PDF

The ocular anterior segment examination of perinatal newborns by wide-field digital imaging system: a cross-sectional study

BMC Ophthalmology volume 23, Article number: 411 (2023) Cite this article

Abstract

Purpose

The aim of this study was to evaluate and summarize the developmental rules of the ocular anterior segment of neonates by means of wild-field digital imaging system.

Methods

We used the wide-field digital imaging system to sequentially capture images of the neonates’ eyes within 42 days after delivery, including the ocular surface, anterior segment, and fundus. At the same time, basic information at the time of birth and examination was collected.

Results

Among 248 newborns, 51.21% were male. Abnormalities of the anterior segment such as visualization of anterior chamber angle vessels (79.03%) and iris vessels (51.21%), iris process (42.34%), persistent pupillary membranes (19.35%), albinism, congenital cataracts, corneal leucoma, and subconjunctival hemorrhage were observed in this study. There were significant differences in the appearance of iris vessels among different sex, gestational age and birth weight, postmenstrual age and weight at the time of examination and iris color groups. The iris vessels were more visualized in males relative to females (OR = 6.313, 95% CI 2.529–15.759). The greater the postmenstrual age at the time of examination, the lower the visualization of iris vessels (OR = 0.377, 95% CI 0.247–0.575). In addition, although visualization of anterior chamber angle vessels differed within the birth gestation age and weight at examination groups, there was no significant correlation by regression analysis.

Conclusions

The anterior segment of perinatal neonates can be visualized by the wide-field digital imaging system. The neonatal iris and anterior chamber angle are immature, and the visible vessels at the anterior chamber angle that vanish later than the surface of the iris are characteristic structures.

Peer Review reports

Introduction

According to the World Health Organization in 2010, about 1% of children worldwide are affected by vision impairment [1]. Among the causes of visual impairment, congenital cataracts, retinopathy of prematurity, congenital glaucoma, and tumors can preserve vision as much as possible through early detection and treatment. In addition, as medical technology continues to develop, the tremendous advances in perinatal medicine and neonatal emergency medicine have greatly increased the survival rate of many previously difficult-to-treat preterm infants, which further adds to the complexity of neonatal eye disease [2]. Therefore, early and correct diagnosis and timely treatment of neonatal eye diseases can reduce low vision and blindness and reduce the economic burden on society.

There were various methods for neonatal eye examination. The earliest methods used include red reflex testing (RRT) [3], indirect ophthalmoscopy, and ultrasound biometrics. With the development of science and technology, wide-field digital imaging systems [4], handheld optical correlation tomography scanners [5], scanning laser fundus photography systems [6] are also gradually being used in the clinical and scientific research of neonatal eye diseases.

In recent years, the wide-field digital imaging systems (RetCam 3 Natus Medical, Inc., USA) had been used to screen newborns for eye diseases [7, 8]. In particular, retinopathy of prematurity, retinal hemorrhage, familial exudative vitreoretinopathy, abnormal fundus pigmentation, choroidal defect, idiopathic retinal vein tortuosity, exudative changes [9] and other posterior segment diseases. Although the wide-field digital imaging system can focus on the structures of the anterior segment such as the iris and the angle of the chamber by adjusting the focal length, the research in this area is very scarce. This study intends to conduct a cross-sectional study of the ocular anterior segment of neonates by using a wide-field digital imaging system in order to explore the reliability of the examination of anterior segment diseases and to observe the development of anterior segment structures.

Materials and methods

This is a cross-sectional study that was retrospectively assessed at the Zhongnan Hospital of Wuhan University.

Ethics statement

Informed consent from the subject’s parents was obtained, and the study was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University, Wuhan, China (Approval No.2,022,115 K). The registration number of the clinical trial center is ChiCTR2200062801 (19/08/2022).

Data collection

Perinatal neonates within 42 days of delivery undergoing eye examination in the outpatient clinic of Zhongnan Hospital of Wuhan University from April 2022 to July 2022 were collected. All newborns had eye examinations with flashlights, handheld slit-lamps, and wide-angle digital imaging systems. Basic information including sex, gestational age, birth weight, postmenstrual age, and weight at examination as well as previous systemic conditions were also recorded.

Inclusion criteria included: birth weight between 1000 and 4000 g, birth gestational age between 30 and 41 weeks and Han ethnicity, Chinese nationality. Exclusion criteria included: [1] the mother had chromosomal abnormalities and diabetes; [2] the mother had a history of drinking, smoking, and drug use; [3] the newborn had chromosomal abnormalities, severe metabolic disorders and central nervous system infections.

Widefield digital image system examination

After using mydriatic eye drops (tropicamide 5 mg/mL) to dilate the pupil by about 5 mm, turn on the machine and install a 130° lens. Adjust the focal length and light source (13–38 units) of the lens, disinfect the lens with an alcohol cotton swab, and drop Alcaine (proparacaine hydrochloride 0.5%) into the conjunctival sac for topical anesthesia. Stabilize the subject’s head, open the eyelids with an eyelid opener, and apply carbomer eye gel on the corneal surface. The lens is placed lightly in the center of the cornea, and the angle of the lens is adjusted to collect images of the iris and anterior chamber angle. Considering that the anterior chamber angle shooting is related to the tilt angle of the lens, only the images of the nasal chamber angle with a large operating space are collected. Then the focal length was moved back, and the lens, vitreous and posterior pole, temporal side, nasal side, upper side, and lower side of the retina were taken in turn.

A physician with ten years of clinical experience was responsible for image screening. In addition, the images were considered acceptable only if structure of the iris and anterior chamber angle were clearly distinguishable in follow-up studies.

Data analysis

Statistical analyses were performed using SPSS 21.0 (IBM Corporation, Armonk, NY, USA). The average gestational age and weight were described as mean ± SD. Student’s t-test was used for continuous variables and χ² test for categorical variables. We also performed logistic regression analyses to determine associations between the characteristic clinical manifestations encountered and other demographic and clinical factors. Variables were selected for the logistic regression models according to a p-value < 0.10 in the univariate analysis. The OR and 95% CI were calculated. A p-value less than 0.05 was considered as statistically significant.

Results

During primary screening, 325 perinatal newborns underwent wide-field digital image system examination, of which 248 were included in the study and 77 (23.69%) were excluded (Fig. 1). Of 248 newborns (496 eyes) in the screening study, 48.79% were female. The average gestational age was 35.24 ± 3.04 weeks, and the average birth weight was 2363.11 ± 730.56 g. The postmentrual age and weight at the time of examination were 40.94 ± 3.38 weeks and 3571.86 ± 1164.70 g (Table 1).

Fig. 1
figure 1

Flow chart of participants included for analysis

Full size image
Table 1 Perinatal characteristics of the study population
Full size table

Table 2 demonstrates the anterior segment abnormalities detected by ocular examinations of perinatal newborns with the wide-field digital image system. The most common abnormality was visualization of anterior chamber angle vessels (79.03%). Other abnormalities included visualization of iris vessels (51.21%), iris process (42.34%), persistent pupillary membranes (PPM) (19.35%), persistent hyperplasia of primary vitreous (PHPV) (8.47%). We also found albinism, congenital cataracts, corneal leucoma, and subconjunctival hemorrhage with a frequency of 0.81%, 3.23%, 0.4%, and 2.42%.

Table 2 Anterior segment abnormalities detected by ocular examination examination of perinatal newborns with the RetCam3
Full size table

Iris structure

Three iris colors including brown, light brown and light gray were found in the inspected newborns, of which brown was the most common (70.56%). The iris of newborns with albinism and fairer skin would appear light gray (Fig. 2.A). In the pupillary region of the iris, PPM were frequently observed, the majority of these membranes were filamentous or reticular across the lens and lacked vascular structures, but a few of these membranes could contain vascular structures (Fig. 2.B). Radial blood vessels were seen on the iris surface (Fig. 2.C), and its visualization was statistically significantly different from factors such as gender, iris color, PPM, and PHPV (Table 3). Following logistic regression analysis, the findings revealed that factors such as birth weight at birth and examination, PHPV, and PPM had no impact on the visualization of iris vessels. However, there was a strong correlation between the visualization of iris vessels and gender, gestational age at birth and examination, and iris color (Table 4). The iris vessels were more visualized in males relative to females (OR = 6.313, 95% CI 2.529–15.759). The greater the gestational age at the time of examination, the lower the visualization of iris vessels (OR = 0.377, 95% CI 0.247–0.575). In addition, the lighter the color of the iris, the more obvious the blood vessels in the iris.

Fig. 2
figure 2

At 42.14w (A), the iris with albinism appears light gray. At 36.43w (B), the persistent pupillary membranes of the blood vessels(white arrow)were found in the pupil area of the iris. At 36w (C), radial blood vessels were seen on the iris surface. At 44w (D), iris process was seen at the root of the iris and occasionally isolated blood vessels protruding from the surface of the iris at 39.86 (E). At 41w (F), the Schwalbe’s line (black arrow) was near the end of the Descemet’s membrane, the trabecular meshwork was dark (black asterisk), and the scleral spur (white arrow) was discontinuous. The iris root blood vessels were clearly apparent, and the dark gray area between the vessels (white asterisks) could be the posterior aspect of the iris pigment membrane, where iris stromal dysplasia or ciliary body band develops. Remarks: All data were at the time of examination gestational age

Full size image
Table 3 Difference analysis for visualization of iris vessels and anterior chamber angle vessels according to neonatal sociodemographic and clinical characteristics
Full size table
Table 4 Regression analysis for visualization of iris vessels and anterior chamber angle vessels according to neonatal sociodemographic and clinical characteristics
Full size table

Anterior chamber angle structure

Visualization of angle structures was achieved in all neonates. The most notable feature was the visualization of vascular at the root of the iris. Although the neonatal pupils were all dilated, all angles were open, the trabecular meshwork was fully exposed, and the hyperreflective scleral spur was occasionally visible (Fig. 2.D, E, F). Anterior chamber angle vessels visualization was statistically significantly different from iris and PPM (Table 3), there was no significant correlation by regression analysis. (Table 4).

Discussion

This study captured the development of the ocular anterior segment in newborns, including the cornea, lens, iris, and anterior chamber angle through the wide-field digital imaging system. The most common anterior segment abnormalities included visualization of anterior chamber angle vessels and iris vessels, iris process, PPM, and PHPV. We regressively analyzed these abnormal structures and neonatal sex, age, weight, etc., summarized the clinical significance of different abnormal anterior segments in the growth process of neonates.

Iris blood supply is composed by the terminal branches of the anterior and long posterior ciliary arteries [10, 11]. The small ring of iris arteries is located 1.5 mm outside the pupillary margin at the pupillary collar, and it is mainly a remnant of embryonic vessels, most of which are occluded. Most iris arteries enter the pupillary margin as capillaries, before folding back to form veins [12]. The iris vasculature is not visible in normal adults with darker pigments. Spierer observed normal White newborns through slit-lamp biomicroscopy and found that iris vascularity correlated significantly with postmenstrual age at examination [13], which was consistent with our study. The visibility of iris vessels in term infants in our research was lower than that of Spierer, which may be due to differences in participants’ races. Differences in iris vessels by sex may be related to inherent physiological differences. Gender differences were reflected in adverse respiratory illness, cardiovascular system, insulin secretion, and infectious diseases from embryonic to infant stages [14]. Choroidal volume, thickness, and circulation [15,16,17] in adults also show gender differences. The mechanism of this discrepancy requires further study.

The iris vasculature dysfunction has been linked to primary open-angle glaucoma, uveitis and even cataracts [18].In addition, iris vessels of cocaine intoxicated [19] and hypoxic ischemic encephalopathy [20] neonates were more tortuous and dilated. More than half of term infants born to mothers with diabetes have markedly twisted and dilated iris blood vessels in 2 weeks [21]. Our study shows that tortuous iris vessels were more likely to be observed in preterm infants. Preterm birth was associated with iris vessels, suggesting that iris vascularity characterizes the development of preterm infants. In addition, almost all neonates with PPM and PHPV are accompanied by iris vascularity, and this type of embryonic vascular degenerative disease may interact with iris vascular regression in pathogenesis. Iris vasculature which is

radial and has no obvious branches also needs to be distinguished from neovascularization.

Iris discoloration can be a sign of pathology. Hereditary, biochemical, and infectious lesions can present with iris discoloration [22]. In an experiment of iris color screening of full-term newborns, 80% of Asian newborns had brown irises [22]. We found that, with the exception of a few children with albinism, whose irises were light gray, the neonates in this study were almost all brown, and the irises of preterm infants were even lighter. Although changes in melanin production can lead to changes in iris color during infancy over time [23], it seems unlikely that brown irises will change much [24]. PPM are thought to be derived from the tunica vasculosa lentis (TVL) and have normally disappeared by the 34th week of gestation [25]. This anterior segment abnormality may be associated with possible intrauterine infection [26]. Our incidence of PPM in perinatal neonates was lower than 95% in the Tanzer [27] study, indicating rapid degeneration of perinatal PPM. In addition, PPM, which significantly affects visual pathways, was not significantly correlated with gestational age at birth, and eye screening should be recommended for all newborns including term infants.

When the anterior chamber angle develops normally during fetal stage, the ciliary body attachment from Schwalbe’s line (20 weeks) to the scleral spur (36 weeks), and then to a location behind the scleral spur (postnatally) [28, 29]. According to the histological study of Douglas [30], the anterior chamber angle of preterm infants in this study was open, the scleral spur was visible partially (34 weeks), and it turned more widely exposed at 47 weeks. We thought that although the neonatal anterior angle was structurally immature, the high-gloss white scleral spur, which was easily observed in front of the ciliary body in wide-field digital imaging system anterior angle photography, was important as an anatomical marker to assess the opening of the neonatal anterior chamber angle. The amount of pigmentation of the trabecular meshwork is important in the diagnosis of different glaucoma [31]. On anterior chamber angle examination in children older than 5 years by wide-field digital imaging system, the trabecular mesh was clearly pigmented [32]. However, because of the tiny angle between the irid-cornea, the trabecular meshwork was all shown dark in the image, which cannot clearly distinguish more details by increasing the brightness, according to our observation. Similar to the mammalian pectinate ligament, the iris process exists in the form of iris stroma or collagen covered by variably pigmented mesothelium stretching from the iris root to peripheral Descemet’s membrane [33]. The iris process can be filamentous, rod-shaped, or reticular, and it is rare in healthy adults. Ellis suggested that infantile glaucoma resulted from a congenital remnant of the pectinate ligament [34]. Severing the pectinate ligament can increase aqueous humor outflow in congenitally glaucomatous eyes [35, 36]. Previous studies have suggested that the iris process may be associated with pigmented glaucoma and developmental glaucoma. However, the present study found that the iris process was very common in perinatal neonates, and these neonates also had normal intraocular pressure and optic disc. Therefore, no conclusion can be drawn that the iris process is necessarily related to developmental glaucoma.

Vessels were visible at the iris root in almost all anterior chamber angles, inserting radially into the vascular annulus deep to the iris. Since anterior chamber angle vessels visualization was so common, we might consider it typical of neonatal anterior chamber angle. The visualization of iris vessels on the surface of the iris were significantly connected to gestational age at the time of examination. However, the visualization of anterior chamber angle vessels had no relationship with gestational age at the time of examination. It is possible that the iris root matrix and blood vessels develop much later than the iris surface matrix and blood vessels (more than 47 weeks). The dark gray area between the vessels at the anterior chamber angles may be the posterior surface of the iris pigment membrane where iris stromal dysplasia manifests or the ciliary body band. The width of the ciliary body band indicator of the development of the anterior chamber angle. An invisible or very narrow ciliary body band represents an underdevelopment of the iridocorneal angle [37, 38]. The ciliary body band of all perinatal neonatals in our study were underdeveloped.

Our study was subjected to several limitations that need to be addressed. The precision of our single-institution al

study was limited because it had a moderate sample size. Our study population was racially restricted, so the results may not be generalizable to more diverse groups. Mothers and infants with severe disease were excluded from the included investigators, and the incidence of anterior segment abnormalities may have been biased. In addition, the correlation between fundus disease and anterior segment disease was not analyzed in the studies, so we also need a larger sample and more detailed analysis to help with clinical diagnosis and treatment. Lastly, this technique requires more training and is more operator dependent. We intended our results to be generalizable to the general practice.

In conclusion, the anterior segment structure of the perinatal newborn has its own characteristics and is clearly different from that of children. The fast and non-invasive wide-field digital imaging system allows us to observe and record these features. It fills the gap of direct anterior segment angle examination of newborns, and future studies of anterior segment angle development based on this technology will provide a strong basis for the pathogenesis of glaucoma.

Data availability

Corresponding author will provide data when editors, reviewers or readers need it.

References

  1. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96(5):614–8.

    Article  PubMed  Google Scholar 

  2. O’Connor AR, Wilson CM, Fielder AR. Ophthalmological problems associated with preterm birth. Eye (Lond). 2007;21(10):1254–60.

    Article  PubMed  Google Scholar 

  3. Ludwig CA, Callaway NF, Blumenkranz MS, Fredrick DR, Moshfeghi DM. Validity of the Red Reflex exam in the Newborn Eye Screening Test Cohort. Ophthalmic Surg Lasers Imaging Retina. 2018;49(2):103–10.

    Article  PubMed  Google Scholar 

  4. Sun M, Ma A, Li F, Cheng K, Zhang M, Yang H, et al. Sensitivity and specificity of Red Reflex Test in Newborn Eye Screening. J Pediatr. 2016;179:192–6. e4.

    Article  PubMed  Google Scholar 

  5. Siebelmann S, Bachmann B, Lappas A, Dietlein T, Steven P, Cursiefen C. [Intraoperative optical coherence tomography for examination of newborns and infants under general anesthesia]. Ophthalmologe. 2016;113(8):651–5.

    Article  CAS  PubMed  Google Scholar 

  6. Magnusdottir V, Vehmeijer WB, Eliasdottir TS, Hardarson SH, Schalij-Delfos NE, Stefansson E. Fundus imaging in newborn children with wide-field scanning laser ophthalmoscope. Acta Ophthalmol. 2017;95(8):842–4.

    Article  PubMed  Google Scholar 

  7. Li LH, Li N, Zhao JY, Fei P, Zhang GM, Mao JB, et al. Findings of perinatal ocular examination performed on 3573, healthy full-term newborns. Br J Ophthalmol. 2013;97(5):588–91.

    Article  PubMed  Google Scholar 

  8. Vinekar A, Govindaraj I, Jayadev C, Kumar AK, Sharma P, Mangalesh S, et al. Universal ocular screening of 1021 term infants using wide-field digital imaging in a single public hospital in India - a pilot study. Acta Ophthalmol. 2015;93(5):e372–6.

    Article  PubMed  Google Scholar 

  9. Tang H, Li N, Li Z, Zhang M, Wei M, Huang C, et al. Fundus examination of 199 851 newborns by digital imaging in China: a multicentre cross-sectional study. Br J Ophthalmol. 2018;102(12):1742–6.

    Article  PubMed  Google Scholar 

  10. Henkind P. Circulation in the Iris and ciliary processes, possible reciprocal relationship. Br J Ophthalmol. 1965;49:6–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Yang H, Yu PK, Cringle SJ, Sun X, Yu DY. Microvascular Network and its endothelial cells in the human Iris. Curr Eye Res. 2018;43(1):67–76.

    Article  PubMed  Google Scholar 

  12. Jia Y, Xue W, Wang Y, Zhao L, Zou H. Quantitative changes in iris vasculature and blood flow in patients with different refractive errors. Graefes Arch Clin Exp Ophthalmol. 2022.

  13. Spierer A, Isenberg SJ, Inkelis SH. Characteristics of the iris in 100 neonates. J Pediatr Ophthalmol Strabismus. 1989;26(1):28–30.

    Article  CAS  PubMed  Google Scholar 

  14. Janice L, Werbinski MKR, Maria Demma I. Cabral the need to integrate sex and gender differences into Pediatric Pedagogy. Adv Pediatr. 2019;8(66):15–35.

    Google Scholar 

  15. Marco Centofanti SB, Manni G, Guinetti-Neuschüler C, Massimo G, Bucci, Alon Harris. Do sex and hormonal status influence choroidal circulation? Br J Ophthalmolodgy. 2000;84:786–7.

    Article  Google Scholar 

  16. Giulio Barteselli JC, Sharif El-Emam H, Wang J, Chuang I, Kozak L, Cheng D-U, Bartsch, William R. Freeman. Choroidal volume variations with age, axial length, and sex in healthy subjects: a three-dimensional analysis. Ophthalmology. 2012;119(12):2572–8.

    Article  PubMed  Google Scholar 

  17. Wei Wang MH, Xingwu Z. Sex-dependent Choroidal thickness differences in healthy adults: a study based on original and Synthesized Data. Curr Eye Res. 2018:1460–2202.

  18. Ang M, Devarajan K, Tan AC, Ke M, Tan B, Teo K, et al. Anterior segment optical coherence tomography angiography for iris vasculature in pigmented eyes. Br J Ophthalmol. 2021;105(7):929–34.

    Article  PubMed  Google Scholar 

  19. Isenberg SJ, Spierer A, Inkelis SH. Ocular signs of cocaine intoxication in neonates. Am J Ophthalmol. 1987;103(2):211–4.

    Article  CAS  PubMed  Google Scholar 

  20. Gorovoy IR, Vaccari JC. Dilated iris vasculature in the setting of the neonatal hypoxic encephelopathy. Semin Ophthalmol. 2015;30(4):313–5.

    Article  PubMed  Google Scholar 

  21. Ricci B, Scullica MG, Ricci F, Santo A. Iris vascular changes in newborns of diabetic mothers. Ophthalmologica. 1998;212(3):175–7.

    Article  CAS  PubMed  Google Scholar 

  22. Mackey DA, Wilkinson CH, Kearns LS, Hewitt AW. Classification of iris colour: review and refinement of a classification schema. Clin Exp Ophthalmol. 2011;39(5):462–71.

    Article  PubMed  Google Scholar 

  23. Bito LZ, Matheny A, Cruickshanks KJ, Nondahl DM, Carino OB. Eye color changes past early childhood. The Louisville Twin Study. Arch Ophthalmol. 1997;115(5):659–63.

    Article  CAS  PubMed  Google Scholar 

  24. Jabbehdari S, Sinow C, Ludwig CA, Callaway NF, Moshfeghi DM. Colour change in the newborn iris: 2-year follow-up of the Newborn Eye Screening Test study. Acta Ophthalmol. 2020;98(4):e521–e2.

    Article  PubMed  Google Scholar 

  25. Hittner HM, Speer ME, Rudolph AJ. Examination of the anterior vascular capsule of the lens: III. Abnormalities in infants with congenital infection. J Pediatr Ophthalmol Strabismus. 1981;18(2):55–60.

    Article  CAS  PubMed  Google Scholar 

  26. Burton BJ, Adams GG. Persistent pupillary membranes. Br J Ophthalmol. 1998;82(6):711–2.

    Article  CAS  PubMed  Google Scholar 

  27. Tanzer DJ, McClatchey SK. Spontaneous hyphema secondary to a prominent pupillary membrane in a neonate. J Pediatr Ophthalmol Strabismus. 1997;34(5):318–20.

    Article  CAS  PubMed  Google Scholar 

  28. Barishak YR. The development of the angle of the anterior chamber in vertebrate eyes. Doc Ophthalmol. 1978;45(2):329–60.

    Article  CAS  PubMed  Google Scholar 

  29. Hosaka F, Rodríguez-Vázquez J, Abe H, Murakami G, Fujimiya M, Ohguro H. Qualitative changes in fetal trabecular meshwork fibers at the human iridocorneal angle. Anat cell Biology. 2013;46(1):49–56.

    Article  Google Scholar 

  30. Anderson DR. The development of the trabecular meshwork and its abnormality in primary infantile glaucoma. Trans Am Ophthalmol Soc. 1981;79:458–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Buffault J, Labbé A, Hamard P, Brignole-Baudouin F, Baudouin C. [The trabecular meshwork: structure, function and clinical implications. A review of the littérature (french translation of the article)]. J Fr Ophtalmol. 2020;43(8):779–93.

    Article  CAS  PubMed  Google Scholar 

  32. Azad RV, Chandra P, Chandra A, Gupta A, Gupta V, Sihota R. Comparative evaluation of RetCam vs. gonioscopy images in congenital glaucoma. Indian J Ophthalmol. 2014;62(2):163–6.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Morrison JC, Van Buskirk EM. The canine eye: pectinate ligaments and aqueous outflow resistance. Invest Ophthalmol Vis Sci. 1982;23(6):726–32.

    CAS  PubMed  Google Scholar 

  34. Ellis OH. The etiology, symptomatology, and treatment of juvenile glaucoma. Am J Ophthalmol. 1948;31(12):1589–96.

    Article  CAS  PubMed  Google Scholar 

  35. Broughton WL, Fine BS, Zimmerman LE. Congenital glaucoma associated with a chromosomal defect. A histologic study. Arch Ophthalmol. 1981;99(3):481–6.

    Article  CAS  PubMed  Google Scholar 

  36. Pilat A, Proudlock F, Shah S, Sheth V, Purohit R, Abbot J, et al. Assessment of the anterior segment of patients with primary congenital glaucoma using handheld optical coherence tomography. Eye. 2019;33(8):1232–9.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tawara A, Inomata H, Tsukamoto S. Ciliary body band width as an indicator of goniodysgenesis. Am J Ophthalmol. 1996;122(6):790–800.

    Article  CAS  PubMed  Google Scholar 

  38. Tawara A, Inomata H. Developmental immaturity of the trabecular meshwork in juvenile glaucoma. Am J Ophthalmol. 1984;98(1):82–97.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all the members of Department of Ophthalmology, The Zhongnan Hospital of Wuhan University, Wuhan, China, for their helpful advice and support.

Funding

No funding sources.

Author information

Authors and Affiliations

  1. Dept of ophthalmology, Zhongnan Hospital of Wuhan University, 430060, Wuhan, Hubei Province, P. R. China

    Yu-jing Wang, Min Ke & Ming Yan

Authors
  1. Yu-jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Min Ke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ming Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors wrote the main manuscript text and reviewed the manuscript.

Corresponding author

Correspondence to Ming Yan.

Ethics declarations

Ethics approval and consent to participate

This study protocol was reviewed and approved the Ethics Committee of Zhongnan hospital of Wuhan university, Wuhan, China (Approval No.2022115 K). The registration number of the clinical trial center is ChiCTR2200062801. In the manuscript, we had stated that written informed consent was obtained from the participants’ parent to participate in the study and that the study protocol was approved by the institute’s committee on human research. All experiments were performed in accordance with relevant guidelines and regulations.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Yj., Ke, M. & Yan, M. The ocular anterior segment examination of perinatal newborns by wide-field digital imaging system: a cross-sectional study. BMC Ophthalmol 23, 411 (2023). https://doi.org/10.1186/s12886-023-03139-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12886-023-03139-1

Keywords

BMC Ophthalmology

ISSN: 1471-2415

Contact us