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Lalgudi VG, Nischal KK. Pediatric corneal collagen cross-linking for keratoconus: not an experimental procedure. J AAPOS 2019; 23:63-65. [PMID: 30599204 DOI: 10.1016/j.jaapos.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022]
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Lee J, Scanga HL, Dansingani KK, Taubenslag KJ, Zlotcavitch L, Chauhan BK, Sylvester CL, Morton DH, Nischal KK. Clinical and imaging characteristics of posterior column ataxia with retinitis pigmentosa with a specific FLVCR1 mutation. Ophthalmic Genet 2018; 39:735-740. [DOI: 10.1080/13816810.2018.1547913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chowdhary S, Nischal KK. Banded technique for pediatric traumatic cataract surgery. J Cataract Refract Surg 2018; 45:8-10. [PMID: 30391155 DOI: 10.1016/j.jcrs.2018.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/16/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
Abstract
We describe a technique for pediatric traumatic cataract management in cases in which part of the anterior capsule has been ruptured. The technique requires creating a 2-incision push-pull capsulorhexis in the intact anterior capsule. The capsulorhexis is made in a manner that converts the edge of the ruptured anterior capsule into a band of capsule that holds the intraocular lens (IOL) in the bag, reducing the incidence of early, intermediate, or late postoperative lens-iris capture. It also reduces the chances of IOL displacement.
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Nanda KD, Blaha B, Churchfield WT, Fulwylie CR, Medsinge A, Nischal KK. Induced Tropia Test and Visual Acuity Testing in Nonverbal Children. J Binocul Vis Ocul Motil 2018; 68:134-136. [PMID: 30332333 DOI: 10.1080/2576117x.2018.1525235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of our study was to compare the Cardiff Acuity Card© test (CAC test) (Kay Pictures Ltd) with the induced tropia test (ITT) in nonverbal children for the detection of monocular vision deficit. This is a retrospective case note review of 34 nonverbal children, aged 12-48 months, attending the pediatric ophthalmology clinic at Children's Hospital of Pittsburgh of UPMC between October 2014 and January 2015. 30/34 were included for analysis. Binocular visual acuity and monocular visual acuity were tested at 50cm in 30 and 17 patients, respectively. At 100cm, binocular visual acuity and monocular visual acuity were tested in 16 and 11 patients, respectively. All 30 children had successful induced tropia testing; 21 had no fixation preference and 9 had a fixation preference. Of those that had no difference on monocular visual acuity, five had a fixation preference at 50cm and three at 100cm. Out of 21 that had no fixation preference, 3 had a monocular visual acuity difference, but of only one line. Our study suggests that to obtain as much information as possible without losing the interest or cooperation of the child, it may be more beneficial to perform the CAC test with both eyes open, followed by ITT, before attempting monocular visual acuity testing with the CAC test. Obtaining visual information using ITT was much more attainable compared to monocular CAC testing. The sensitivity using CAC test to find a visual acuity discrepancy is 40% using ITT as the standard, and the specificity is 63%. If one loses the interest of the child after the ITT, at least some information will have been gleaned rather than none about monocular visual behavior. This provides a more complete, attainable approach to gathering visual information.
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Taubenslag KJ, Scanga HL, Huey J, Lee J, Medsinge A, Sylvester CL, Cheng KP, Nischal KK. Iris anomalies and the incidence of ACTA2 mutation. Br J Ophthalmol 2018; 103:499-503. [PMID: 29875232 DOI: 10.1136/bjophthalmol-2018-312306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/11/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Central cysts of the iris pigment epithelium, or iris flocculi, are frequently reported in the literature in association with thoracic aortic aneurysm and dissection due to smooth muscle alpha-actin 2 (ACTA2) mutations. Children with ACTA2 mutations may also present with congenital mydriasis. We report our experience regarding the frequency of ACTA2 mutation in children with the above iris anomalies. METHODS This is a retrospective, consecutive case series of all children presenting for iris flocculi or congenital mydriasis at a single tertiary centre from October 2012 to December 2016. RESULTS 13 children with iris flocculi and 3 with congenital mydriasis presented during the study period. 10 children with iris flocculi completed genetic testing, and none were positive for ACTA2 mutation. All children with congenital mydriasis presented with a multisystem smooth muscle dysfunction syndrome; two of these three children tested positive for missense R179 ACTA2 mutations. CONCLUSIONS In this series, ACTA2 mutation or copy number variation was not detected in children presenting for iris flocculi, whereas congenital mydriasis was associated with R179 mutation in both cases that tested positive for ACTA2 mutation. The case of congenital mydriasis without typical cardiac features of the R179 ACTA2 phenotype or intracranial vasculopathy was negative for ACTA2 mutation. While all children presenting with these iris anomalies should be offered a genetic evaluation, incidence data should inform genetic counselling, particularly in the absence of a family history of aneurysm or sudden death, or systemic signs of smooth muscle dysfunction.
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Chauhan BK, Medsinge A, Baumgartner MP, Scanga HL, Kamakari S, Gajdosova E, Camacho CJ, Nischal KK. Case series: Pyramidal cataracts, intact irides and nystagmus from three novel PAX6 mutations. Am J Ophthalmol Case Rep 2018; 10:172-179. [PMID: 29780932 PMCID: PMC5956696 DOI: 10.1016/j.ajoc.2018.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/07/2018] [Accepted: 02/26/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the association between novel PAX6 mutations to bilateral anterior pyramidal congenital cataracts (APyC), complete and intact irides, and nystagmus. Observations This is a retrospective observational case series in a multi-center setting with genetic testing. Three female patients were diagnosed with bilateral APyC, intact irides and nystagmus. Genetic testing identified the three patients had novel missense mutations in PAX6 – c.128C > T; p.Ser43Phe (S43F), c. 197T > A; p.Ile66Asn (I66N) and c.781C > G; p.Arg261Gly (R261G). Conclusions and importance This study demonstrates a novel phenotype of bilateral APyC, intact irides, and nystagmus in whom genetic testing for PAX6 identified novel missense mutations (S43F, I66N, R261G) in highly conserved DNA-binding domains. Implications of understanding why the iris is present in these cases is discussed.
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Medsinge A, Speedwell L, Nischal KK. Defining Success in Infant Penetrating Keratoplasty for Developmental Corneal Opacities. ACTA ACUST UNITED AC 2017; 64:81-8. [DOI: 10.3368/aoj.64.1.81] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Smith KAV, Jones SM, Nischal KK. Refractive and Ocular Motility Findings in Children with Epidermolysis Bullosa. ACTA ACUST UNITED AC 2017; 59:76-83. [DOI: 10.3368/aoj.59.1.76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Scanga HL, Nischal KK. Overarching Concepts and Mechanisms Affecting Phenotypes of Ocular Genetic Conditions. CURRENT GENETIC MEDICINE REPORTS 2017. [DOI: 10.1007/s40142-017-0128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Partha R, Chauhan BK, Ferreira Z, Robinson JD, Lathrop K, Nischal KK, Chikina M, Clark NL. Subterranean mammals show convergent regression in ocular genes and enhancers, along with adaptation to tunneling. eLife 2017; 6:e25884. [PMID: 29035697 PMCID: PMC5643096 DOI: 10.7554/elife.25884] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/22/2017] [Indexed: 12/22/2022] Open
Abstract
The underground environment imposes unique demands on life that have led subterranean species to evolve specialized traits, many of which evolved convergently. We studied convergence in evolutionary rate in subterranean mammals in order to associate phenotypic evolution with specific genetic regions. We identified a strong excess of vision- and skin-related genes that changed at accelerated rates in the subterranean environment due to relaxed constraint and adaptive evolution. We also demonstrate that ocular-specific transcriptional enhancers were convergently accelerated, whereas enhancers active outside the eye were not. Furthermore, several uncharacterized genes and regulatory sequences demonstrated convergence and thus constitute novel candidate sequences for congenital ocular disorders. The strong evidence of convergence in these species indicates that evolution in this environment is recurrent and predictable and can be used to gain insights into phenotype-genotype relationships.
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Nanda KD, Lacey E, Liasis A, Nischal KK. Early Onset Sixth-Nerve Palsy with Eccentric Fixation. THE AMERICAN ORTHOPTIC JOURNAL 2017; 67:72-79. [PMID: 28904218 DOI: 10.3368/aoj.67.1.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To report four cases of early onset sixth-nerve palsy all of whom had eccentric fixation. METHODS A retrospective case note review was undertaken of all cases presenting to the senior author's private and NHS practice with early onset sixth palsy between 2006 and 2012. As well as demographic information, details of ophthalmic, orthoptic, electrophysiological examinations, and radiological investigations that were extracted from the records. RESULTS Four children with unilateral or asymmetric early onset sixth-nerve palsy were identified, of which three were congenital. All four had MRI and only one had a normal MRI. Age at presentation ranged from 14-42 months, but all four had marked esotropia and poor visual acuities in the worst affected eye with eccentric fixation, which became more easily or only noticeable after surgical correction. Three patients with congenital sixth-nerve palsy underwent vertical muscle transposition with Botulinum Toxin A (BTXA) to the ipsilateral medial rectus, and two of these patients also had Foster sutures to the transposed vertical muscles. The fourth patient had unilateral medial rectus recession and lateral rectus resection. The mean preoperative measurement was 55Δ ET (range 50-60Δ), and the mean postoperative measurement was 11Δ ET (range 16XT-25ET) at near, and 2Δ XT (range 15XT-14ET) at distance. CONCLUSIONS We speculate that early onset paralytic strabismus due to congenital sixth-nerve palsy results in an inability to cross fixate which results in the development of eccentric fixation. Attempts to use reverse occlusion to negate the eccentric fixation failed. We therefore recommend early surgery for this condition to avoid this sequelae.
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Nischal KK, Lathrop KL. The Palisades of Vogt in Congenital Corneal Opacification (An American Ophthalmological Society Thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2016; 114:T8. [PMID: 28042184 PMCID: PMC5161000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The purposes of this study are first, to determine if the palisades of Vogt (POV) are present or absent in cases of congenital corneal opacification (CCO) by using spectral domain ocular coherence tomography (SD-OCT), and second, in those cases already undergoing penetrating keratoplasty (PKP), to see whether the absence or presence of POV corresponds to re-epithelialization following transplant. METHODS This was a retrospective case review of 20 eyes (10 normal, 10 with CCO) evaluated with SD-OCT. The operator was masked to the clinician's assessment of the ocular surface. In those cases where the decision to perform PKP had already been made, the correlation between POV presence or absence and posttransplant graft epithelialization was determined. RESULTS All cases were imaged without adverse event. Nine eyes showed some evidence of POV and corresponding vasculature. Eight of 10 affected eyes underwent PKP, and subsequently 7 eyes epithelialized and 2 showed some peripheral neovascularization. The one eye that showed no signs of POV was the one that failed to epithelialize. All control subjects had consistent and regular POV. CONCLUSIONS Congenital corneal opacification is rare, and this study shows that at least some POV are present in the majority of cases of CCO. However, the palisades may not be entirely normal compared to age-matched controls. When there was absence of POV in a case of CCO, there was immediate and complete failure of epithelialization.
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Abstract
Childhood glaucoma is a major therapeutic challenge for pediatric ophthalmologists and glaucoma specialists worldwide. Management depends on the etiology and age at presentation. A variety of drugs are available for the control of intraocular pressure in children; however, none of these drugs have been licensed by the regulatory agencies for use in children. Furthermore, evidence gained from randomized controlled trials in the pediatric population is sparse, and little is known regarding the use of newer anti-glaucoma preparations. This evidence-based review aims to discuss the available pharmacotherapeutic options for glaucoma in children. Topical adrenoceptor blockers, topical and systemic carbonic anhydrase inhibitors, prostaglandin (PG) analogs, adrenoceptor agonists, parasympathomimetics, and combined preparations are available for use in children, but usually as an off-label indication. Therefore, it is important to recognize that serious side effects have been reported, even with topical drops, and measures to reduce systemic absorption should be taken. Most drugs have been shown to have comparable ocular hypotensive effects, with the lowest occurrence of systemic side effects with PG analogs. Whereas a newly introduced prostaglandin analog, tafluprost, and some other preservative-free preparations have shown promising results in adult glaucoma patients, no pediatric reports are available as yet. Future studies may describe their role in treating pediatric glaucoma. This review also shares some suggested treatment pathways for primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), developmental glaucoma, aphakic/pseudophakic glaucoma, and uveitic glaucoma.
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Ansari M, Rainger J, Hanson IM, Williamson KA, Sharkey F, Harewood L, Sandilands A, Clayton-Smith J, Dollfus H, Bitoun P, Meire F, Fantes J, Franco B, Lorenz B, Taylor DS, Stewart F, Willoughby CE, McEntagart M, Khaw PT, Clericuzio C, Van Maldergem L, Williams D, Newbury-Ecob R, Traboulsi EI, Silva ED, Madlom MM, Goudie DR, Fleck BW, Wieczorek D, Kohlhase J, McTrusty AD, Gardiner C, Yale C, Moore AT, Russell-Eggitt I, Islam L, Lees M, Beales PL, Tuft SJ, Solano JB, Splitt M, Hertz JM, Prescott TE, Shears DJ, Nischal KK, Doco-Fenzy M, Prieur F, Temple IK, Lachlan KL, Damante G, Morrison DA, van Heyningen V, FitzPatrick DR. Genetic Analysis of 'PAX6-Negative' Individuals with Aniridia or Gillespie Syndrome. PLoS One 2016; 11:e0153757. [PMID: 27124303 PMCID: PMC4849793 DOI: 10.1371/journal.pone.0153757] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/04/2016] [Indexed: 12/26/2022] Open
Abstract
We report molecular genetic analysis of 42 affected individuals referred with a diagnosis of aniridia who previously screened as negative for intragenic PAX6 mutations. Of these 42, the diagnoses were 31 individuals with aniridia and 11 individuals referred with a diagnosis of Gillespie syndrome (iris hypoplasia, ataxia and mild to moderate developmental delay). Array-based comparative genomic hybridization identified six whole gene deletions: four encompassing PAX6 and two encompassing FOXC1. Six deletions with plausible cis-regulatory effects were identified: five that were 3' (telomeric) to PAX6 and one within a gene desert 5' (telomeric) to PITX2. Sequence analysis of the FOXC1 and PITX2 coding regions identified two plausibly pathogenic de novo FOXC1 missense mutations (p.Pro79Thr and p.Leu101Pro). No intragenic mutations were detected in PITX2. FISH mapping in an individual with Gillespie-like syndrome with an apparently balanced X;11 reciprocal translocation revealed disruption of a gene at each breakpoint: ARHGAP6 on the X chromosome and PHF21A on chromosome 11. In the other individuals with Gillespie syndrome no mutations were identified in either of these genes, or in HCCS which lies close to the Xp breakpoint. Disruption of PHF21A has previously been implicated in the causation of intellectual disability (but not aniridia). Plausibly causative mutations were identified in 15 out of 42 individuals (12/32 aniridia; 3/11 Gillespie syndrome). Fourteen of these mutations presented in the known aniridia genes; PAX6, FOXC1 and PITX2. The large number of individuals in the cohort with no mutation identified suggests greater locus heterogeneity may exist in both isolated and syndromic aniridia than was previously appreciated.
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Samant M, Chauhan BK, Lathrop KL, Nischal KK. Congenital aniridia: etiology, manifestations and management. EXPERT REVIEW OF OPHTHALMOLOGY 2016; 11:135-144. [PMID: 30100922 DOI: 10.1586/17469899.2016.1152182] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Congenital aniridia manifests as total or partial absence of the iris caused most commonly by mutations in PAX6, FOXC1, PITX2, and CYP1B1. Recently two new genes, FOXD3 and TRIM44, have also been implicated in isolated studies. We discuss the genotype-phenotype correlations for the main implicated genes. Classic aniridia is a panocular condition, which includes aniridia, cataract, corneal pannus, foveal, and optic nerve hypoplasia associated with mutations in the PAX6 gene. Classical aniridia is due to PAX6 mutations, while other genes contribute to aniridia-like phenotypes. We review the challenges involved in the management of aniridia, and discuss various surgical interventions. The clinical importance of defining the genotype in cases of congenital aniridia has become acutely apparent with the advent of possible therapies for classical aniridia, which are discussed.
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Jones SM, Smith KA, Jain M, Mellerio JE, Martinez A, Nischal KK. The Frequency of Signs of Meibomian Gland Dysfunction in Children with Epidermolysis Bullosa. Ophthalmology 2016; 123:991-9. [PMID: 26876697 DOI: 10.1016/j.ophtha.2015.12.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/09/2015] [Accepted: 12/29/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the frequency of meibomian gland dysfunction (MGD) in children with epidermolysis bullosa (EB). DESIGN Hospital-based cross-sectional study. PARTICIPANTS One hundred five children with different forms of EB. METHODS Prospective ophthalmic examination of children with EB presenting over seventeen months including meibomian gland assessment using a recognized classification. MAIN OUTCOME MEASURES Frequency of MGD. RESULTS One hundred five children were recruited, 8.6% with junctional EB, 34.3% with simplex EB, 34.3% with autosomal recessive dystrophic EB, and 22.9% autosomal dominant dystrophic EB. Mean age was 7.42 years (range, 0.08-17.75 years). Ninety-two children (87.62%) demonstrated 1 or more features of MGD. CONCLUSIONS Most children with EB exhibit signs of MGD. To the best of our knowledge, this is the first prospective ocular surface evaluation in children with EB to include lid margin evaluation using a recognized classification system. Our findings help explain some of the ocular surface anomalies seen in children with EB.
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Serafino M, Trivedi RH, Levin AV, Wilson ME, Nucci P, Lambert SR, Nischal KK, Plager DA, Bremond-Gignac D, Kekunnaya R, Nishina S, Tehrani NN, Ventura MC. Use of the Delphi process in paediatric cataract management. Br J Ophthalmol 2015; 100:611-5. [DOI: 10.1136/bjophthalmol-2015-307287] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/04/2015] [Indexed: 11/03/2022]
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Brémond-Gignac D, Nischal KK, Mortemousque B, Gajdosova E, Granet DB, Chiambaretta F. Atopic Keratoconjunctivitis in Children: Clinical Features and Diagnosis. Ophthalmology 2015; 123:435-437. [PMID: 26278858 DOI: 10.1016/j.ophtha.2015.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/06/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022] Open
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Medsinge A, Nischal KK. Technique for identifying Schlemm's canal in paediatric glaucoma surgery. Br J Ophthalmol 2015; 99:715-6. [PMID: 25784213 DOI: 10.1136/bjophthalmol-2014-305164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/01/2015] [Indexed: 11/03/2022]
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Islam L, Kelberman D, Williamson L, Lewis N, Glindzicz MB, Nischal KK, Sowden JC. Functional Analysis of FOXE3
Mutations Causing Dominant and Recessive Ocular Anterior Segment Disease. Hum Mutat 2015; 36:296-300. [DOI: 10.1002/humu.22741] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 12/05/2014] [Indexed: 11/10/2022]
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Abstract
Craniosynostosis is the premature fusion of one or more cranial sutures that may be isolated or syndromic. These children can have multiple developmental issues including speech, hearing, and vision, in addition to the aesthetic issue of an abnormally shaped skull and midfacial hypoplasia. As the aesthetic outcomes of craniofacial surgery have improved, attention has turned on the functional outcomes and visual loss is a well-known problem with these patients. In the past 15 years, a greater understanding of the causes of visual loss has developed. Factors such as amblyopia, corneal exposure, and optic neuropathy are all now looked for to prevent or reduce visual loss. Optic neuropathy is caused by craniocerebral disproportion (though to a lesser extent than originally thought), cerebral hypo perfusion, hydrocephalus, and obstructive sleep apnea. Amblyopia is due to increased incidence of strabismus, anisometropia, astigmatism, and ametropia in these cases. A comprehensive approach to managing these children's visual function allows the clinician to reduce potential visual loss in children with craniosynostoses especially the syndromic variety.
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Medsinge A, Nischal KK. Cataract surgery in children with congenital keratolenticular adhesion (Peters anomaly type 2). J AAPOS 2015; 19:24-8. [PMID: 25727582 DOI: 10.1016/j.jaapos.2014.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 09/23/2014] [Accepted: 10/05/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the visual and surgical outcomes after cataract surgery in children with keratolenticular adhesion (Peters anomaly type 2). METHODS The medical records of consecutive patients with keratolenticular adhesion (KLA) with partial (iris defects)/complete aniridia were retrospectively reviewed. Cataract surgery (in-the-bag irrigation and aspiration) with or without intraocular lens implantation and with or without broad iridectomy was performed. The main outcome measures were postoperative visual acuity, complications, and progression of corneal opacity. RESULTS The study included 4 eyes of 3 patients ranging in age from 3 months to 7 years. The mean age at cataract surgery was 37 months; the median, 24 months (range, 3-84 months). The mean follow-up was 3.3 years and median was 2 years (range, 2-6 years). Preoperative visual acuity ranged from fixing and following objects to 20/200. Only 1 patient had PAX6 mutation-confirmed aniridia. The other 2 patients had partial iris defects. All eyes improved in visual acuity ranging from counting fingers at 3 feet to 20/60. There was no progression of corneal opacity. There were no postoperative complications. CONCLUSIONS Children with KLA with complete or partial iris defects with localized corneal opacity and cataract can achieve satisfactory visual outcomes by undergoing meticulous lensectomy with or without iridectomy.
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Mataftsi A, Haidich AB, Kokkali S, Rabiah PK, Birch E, Stager DR, Cheong-Leen R, Singh V, Egbert JE, Astle WF, Lambert SR, Amitabh P, Khan AO, Grigg J, Arvanitidou M, Dimitrakos SA, Nischal KK. Postoperative glaucoma following infantile cataract surgery: an individual patient data meta-analysis. JAMA Ophthalmol 2015; 132:1059-67. [PMID: 24921712 DOI: 10.1001/jamaophthalmol.2014.1042] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Infantile cataract surgery bears a significant risk for postoperative glaucoma, and no consensus exists on factors that may reduce this risk. OBJECTIVE To assess the effect of primary intraocular lens implantation and timing of surgery on the incidence of postoperative glaucoma. DATA SOURCES We searched multiple databases to July 14, 2013, to identify studies with eligible patients, including PubMed, MEDLINE, EMBASE, ISI Web of Science, Scopus, Central, Google Scholar, Intute, and Tripdata. We also searched abstracts of ophthalmology society meetings. STUDY SELECTION We included studies reporting on postoperative glaucoma in infants undergoing cataract surgery with regular follow-up for at least 1 year. Infants with concurrent ocular anomalies were excluded. DATA EXTRACTION AND SYNTHESIS Authors of eligible studies were invited to contribute individual patient data on infants who met the inclusion criteria. We also performed an aggregate data meta-analysis of published studies that did not contribute to the individual patient data. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Time to glaucoma with the effect of primary implantation, additional postoperative intraocular procedures, and age at surgery. RESULTS Seven centers contributed individual patient data on 470 infants with a median age at surgery of 3.0 months and median follow-up of 6.0 years. Eighty patients (17.0%) developed glaucoma at a median follow-up of 4.3 years. Only 2 of these patients had a pseudophakic eye. The risk for postoperative glaucoma appeared to be lower after primary implantation (hazard ratio [HR], 0.10 [95% CI, 0.01-0.70]; P = .02; I(2) = 34%), higher after surgery at 4 weeks or younger (HR, 2.10 [95% CI, 1.14-3.84]; P = .02; I(2) = 0%), and higher after additional procedures (HR, 2.52 [95% CI, 1.11-5.72]; P = .03; I(2) = 32%). In multivariable analysis, additional procedures independently increased the risk for glaucoma (HR, 2.25 [95% CI, 1.20-4.21]; P = .01), and primary implantation independently reduced it (HR, 0.10 [95% CI, 0.01-0.76]; P = .03). Results were similar in the aggregate data meta-analysis that included data from 10 published articles. CONCLUSIONS AND RELEVANCE Although confounding factors such as size of the eye and surgeon experience are not accounted for in this meta-analysis, the risk for postoperative glaucoma after infantile cataract surgery appears to be influenced by the timing of surgery, primary implantation, and additional intraocular surgery.
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Abstract
Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract.
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Zuccoli G, Panigrahy A, Haldipur A, Willaman D, Squires J, Wolford J, Sylvester C, Mitchell E, Lope LA, Nischal KK, Berger RP. Erratum to: Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma. Neuroradiology 2014. [PMCID: PMC4714000 DOI: 10.1007/s00234-014-1457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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77
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Fu V, Scanga HL, Medsinge A, Nischal KK. Improved visual function with dietary intervention in a child with lipemia retinalis. J AAPOS 2014; 18:488-90. [PMID: 25439305 DOI: 10.1016/j.jaapos.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 05/06/2014] [Accepted: 05/10/2014] [Indexed: 11/17/2022]
Abstract
We present a 4.8-year-old female with grade 3 lipemia retinalis due to lipoprotein lipase deficiency, an abnormal electroretinogram, and bilateral decreased visual acuity. Strict dietary intervention resulted in reversal of lipemia retinalis, normalization of her electroretinogram, and improved visual acuity in both eyes.
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Abstract
Increasingly accurate phenotyping leads to better genetic evaluation. Genetic eye conditions may be due to a common cellar defect (eg, ciliopathies or RASopathies). Early-onset retinal dystrophies may be associated with renal disease. An understanding of genetic testing helps clinicians identify shortcomings in testing which may lead to a better understanding of the most appropriate test for a given ocular condition. Dedicated genetic counselors within ophthalmic and pediatric clinics are likely to improve the delivery of clinical care in these settings.
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Way AL, Nischal KK. High-frequency ultrasound-guided transscleral diode laser cyclophotocoagulation. Br J Ophthalmol 2014; 98:992-4. [DOI: 10.1136/bjophthalmol-2014-305163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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80
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Medsinge A, Nischal KK. Managing blepharokeratoconjunctivitis in children: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2013.848791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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81
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Kelberman D, Islam L, Lakowski J, Bacchelli C, Chanudet E, Lescai F, Patel A, Stupka E, Buck A, Wolf S, Beales PL, Jacques TS, Bitner-Glindzicz M, Liasis A, Lehmann OJ, Kohlhase J, Nischal KK, Sowden JC. Mutation of SALL2 causes recessive ocular coloboma in humans and mice. Hum Mol Genet 2014; 23:2511-26. [PMID: 24412933 PMCID: PMC3990155 DOI: 10.1093/hmg/ddt643] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Ocular coloboma is a congenital defect resulting from failure of normal closure of the optic fissure during embryonic eye development. This birth defect causes childhood blindness worldwide, yet the genetic etiology is poorly understood. Here, we identified a novel homozygous mutation in the SALL2 gene in members of a consanguineous family affected with non-syndromic ocular coloboma variably affecting the iris and retina. This mutation, c.85G>T, introduces a premature termination codon (p.Glu29*) predicted to truncate the SALL2 protein so that it lacks three clusters of zinc-finger motifs that are essential for DNA-binding activity. This discovery identifies SALL2 as the third member of the Drosophila homeotic Spalt-like family of developmental transcription factor genes implicated in human disease. SALL2 is expressed in the developing human retina at the time of, and subsequent to, optic fissure closure. Analysis of Sall2-deficient mouse embryos revealed delayed apposition of the optic fissure margins and the persistence of an anterior retinal coloboma phenotype after birth. Sall2-deficient embryos displayed correct posterior closure toward the optic nerve head, and upon contact of the fissure margins, dissolution of the basal lamina occurred and PAX2, known to be critical for this process, was expressed normally. Anterior closure was disrupted with the fissure margins failing to meet, or in some cases misaligning leading to a retinal lesion. These observations demonstrate, for the first time, a role for SALL2 in eye morphogenesis and that loss of function of the gene causes ocular coloboma in humans and mice.
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84
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Absoud M, Lim MJ, Chong WK, De Goede CG, Foster K, Gunny R, Hemingway C, Jardine PE, Kneen R, Likeman M, Nischal KK, Pike MG, Sibtain NA, Whitehouse WP, Cummins C, Wassmer E. Paediatric acquired demyelinating syndromes: incidence, clinical and magnetic resonance imaging features. Mult Scler 2012; 19:76-86. [PMID: 22516794 PMCID: PMC3409874 DOI: 10.1177/1352458512445944] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Changing trends in multiple sclerosis (MS) epidemiology may first be apparent in the childhood population affected with first onset acquired demyelinating syndromes (ADSs). We aimed to determine the incidence, clinical, investigative and magnetic resonance imaging (MRI) features of childhood central nervous system ADSs in the British Isles for the first time. Methods: We conducted a population active surveillance study. All paediatricians, and ophthalmologists (n = 4095) were sent monthly reporting cards (September 2009–September 2010). International Paediatric MS Study Group 2007 definitions and McDonald 2010 MS imaging criteria were used for acute disseminated encephalomyelitis (ADEM), clinically isolated syndrome (CIS) and neuromyelitis optica (NMO). Clinicians completed a standard questionnaire and provided an MRI copy for review. Results: Card return rates were 90%, with information available for 200/222 positive notifications (90%). After exclusion of cases, 125 remained (age range 1.3–15.9), with CIS in 66.4%, ADEM in 32.0% and NMO in 1.6%. The female-to-male ratio in children older than 10 years (n = 63) was 1.52:1 (p = 0.045). The incidence of first onset ADS in children aged 1–15 years old was 9.83 per million children per year (95% confidence interval [CI] 8.18–11.71). A trend towards higher incidence rates of ADS in children of South Asian and Black ethnicity was observed compared with White children. Importantly, a number of MRI characteristics distinguished ADEM from CIS cases. Of CIS cases with contrast imaging, 26% fulfilled McDonald 2010 MS diagnostic criteria. Conclusions: We report the highest surveillance incidence rates of childhood ADS. Paediatric MS diagnosis at first ADS presentation has implications for clinical practice and clinical trial design.
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Khaier A, Nischal KK, Espinosa M, Manoj B. Periocular Port Wine Stain: The Great Ormond Street Hospital Experience. Ophthalmology 2011; 118:2274-2278.e1. [DOI: 10.1016/j.ophtha.2011.04.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Revised: 04/13/2011] [Accepted: 04/26/2011] [Indexed: 11/28/2022] Open
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87
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Kelberman D, Islam L, Holder SE, Jacques TS, Calvas P, Hennekam RC, Nischal KK, Sowden JC. Digenic inheritance of mutations in FOXC1 and PITX2 : correlating transcription factor function and Axenfeld-Rieger disease severity. Hum Mutat 2011; 32:1144-52. [PMID: 21837767 DOI: 10.1002/humu.21550] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 05/31/2011] [Indexed: 11/08/2022]
Abstract
Disease-causing mutations affecting either one of the transcription factor genes, PITX2 or FOXC1, have been previously identified in patients with Axenfeld-Rieger syndrome (AR). We identified a family who segregate novel mutations in both PITX2 (p.Ser233Leu) and FOXC1 (c.609delC). The most severely affected individual, who presented with an atypical phenotype of corneal opacification, lens extrusion, persistent hyperplastic primary vitreous (PHPV), and subsequent bilateral retinal detachment, inherited mutations in both genes, whereas the single heterozygous mutations caused mild AR phenotypes. This is the first report of such digenic inheritance. By analyzing cognate targets of each gene, we showed that FOXC1 and PITX2 can independently regulate their own and each other's target gene promoters and do not show synergistic action in vitro. Mutation in either gene caused reduced transcriptional activation to different extents on the FOXO1 and PLOD1 promoters, whereas both mutations in combination showed the lowest level of activation. These data show how the compensatory activity of one factor, when the other is impaired, may lessen the phenotypic impact of developmental anomalies, yet reduced activity of both transcription factors increased disease severity. This suggests an under-reported mechanism for phenotypic variability whereby single mutations cause mild AR phenotypes, whereas digenic inheritance increases phenotypic severity.
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Kelberman D, Islam L, Jacques TS, Russell-Eggitt I, Bitner-Glindzicz M, Khaw PT, Nischal KK, Sowden JC. CYP1B1-Related Anterior Segment Developmental Anomalies. Ophthalmology 2011; 118:1865-73. [DOI: 10.1016/j.ophtha.2011.01.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 01/12/2011] [Accepted: 01/14/2011] [Indexed: 02/07/2023] Open
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89
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Absoud M, Cummins C, Desai N, Gika A, McSweeney N, Munot P, Hemingway C, Lim M, Nischal KK, Wassmer E. Childhood optic neuritis clinical features and outcome. Arch Dis Child 2011; 96:860-2. [PMID: 20554767 DOI: 10.1136/adc.2009.175422] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To describe clinical features and outcome of a series of children with first-episode optic neuritis investigated in three paediatric neurology centres. METHODS Databases were searched to identify children (<16 years) with optic neuritis and life table analysis was used. RESULTS 44 children (female/male ratio 1.8) median age 10.9 years were followed up for median 1 year. Optic neuritis was unilateral in 43%. Maximal visual deficit was severe (<6/60) in 77%, with full recovery in 70%. Cumulative probability of developing MS (11/44) or NMO (3/44) at 2 years was 0.45. Relapsing optic neuritis was a strong predictor for development of MS or NMO. A positive MRI (>1 brain T2 hyperintense lesion) was a strong predictor for development of MS. DISCUSSION Childhood optic neuritis is associated with severe visual deficit with good recovery. An initial abnormal MRI brain scan or relapsing optic neuritis should alert the clinician to MS or NMO diagnosis.
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Liasis A, Walters B, Thompson D, Smith K, Hayward R, Nischal KK. Visual field loss in children with craniosynostosis. Childs Nerv Syst 2011; 27:1289-96. [PMID: 21279364 DOI: 10.1007/s00381-010-1378-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 12/23/2010] [Indexed: 02/08/2023]
Abstract
AIMS To identify visual field deficits in a group of children with syndromic craniosynostosis. METHODS Kinetic visual field examination and visual evoked potentials (VEPs) were recorded in 16 children with syndromic craniosynostosis as part of their ophthalmic evaluation. VEPs were analyzed for inter-hemispheric asymmetries and component amplitude and latency, while visual fields were analyzed both qualitatively and quantitatively. RESULTS All children with craniosynostosis were found to have visual field deficits compared to controls. In the Crouzon group, deficits tended to involve the nasal field, while infero-nasal field deficits were the most consistent finding in children with Apert syndrome. Children with Pfeiffer's demonstrated the greatest deficits, with severe constrictions affecting the whole visual field. VEPs were asymmetrical in four cases while the P100 component was subnormal in ten of the 16 patients for either amplitude and/or latency. CONCLUSION Although we may speculate about the mechanisms that cause visual field deficits, we currently are unable to explain the reason for the differing types and extent of visual field loss in the different syndromic groups. We can conclude that the visual field deficits do indicate previous or ongoing visual dysfunction that cannot be monitored employing central vision tests alone.
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Bharathi N, Sachdeva V, Gupta A, Rao HL, Nischal KK, Kekunnaya R. Author reply. Ophthalmology 2011; 118:1219-20; author reply 1220.e1. [DOI: 10.1016/j.ophtha.2011.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 02/15/2011] [Indexed: 12/17/2022] Open
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Mataftsi A, Nischal KK. Comparison of botulinum toxin with surgery as primary treatment for infantile esotropia. J AAPOS 2010; 14:558-9; author reply 559-60. [PMID: 21094067 DOI: 10.1016/j.jaapos.2010.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 09/18/2010] [Indexed: 11/28/2022]
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93
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Mataftsi A, Sowden JC, Nischal KK. Atypical Peters plus syndrome with new associations. J AAPOS 2010; 14:560-1; author reply 561. [PMID: 21168087 DOI: 10.1016/j.jaapos.2010.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 09/04/2010] [Indexed: 11/16/2022]
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Aragon-Martin JA, Ahnood D, Charteris DG, Saggar A, Nischal KK, Comeglio P, Chandra A, Child AH, Arno G. Role of ADAMTSL4 mutations in FBN1 mutation-negative ectopia lentis patients. Hum Mutat 2010; 31:E1622-31. [PMID: 20564469 DOI: 10.1002/humu.21305] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ectopia lentis (EL) is genetically heterogeneous with both autosomal-dominant and -recessive forms. The dominant disorder can be caused by mutations in FBN1, at the milder end of the type-1 fibrillinopathies spectrum. Recently in a consanguineous Jordanian family, recessive EL was mapped to locus 1q21 containing the ADAMTSL4 gene and a nonsense mutation was found in exon 11 (c.1785T>G, p.Y595X). In this study, 36 consecutive probands with EL who did not fulfill the Ghent criteria for MFS were screened for mutations in FBN1 and ADAMTSL4. Causative FBN1 mutations were identified in 23/36 (64%) of probands while homozygous or compound heterozygous ADAMTSL4 mutations were identified in 6/12 (50%) of the remaining probands. Where available, familial screening of these families confirmed the mutation co-segregated with the EL phenotype. This study confirms that homozygous mutations in ADAMTSL4 are associated with autosomal-recessive EL in British families. Furthermore; the first compound heterozygous mutation is described resulting in a PTC and a missense mutation in the PLAC (protease and lacunin) domain. The identification of a causative mutation in ADAMTSL4 may allow the exclusion of Marfan syndrome in these families and guide the clinical management, of particular relevance in young children affected by EL.
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Nischal KK, Solebo L, Russell-Eggitt I. Paediatric IOL implantation and postoperative refractive state: what role do study methodology and surgical technique play? Br J Ophthalmol 2010; 94:529-31. [PMID: 20447961 DOI: 10.1136/bjo.2009.168112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wong IBY, Nischal KK. Managing a child with an external ocular disease. J AAPOS 2010; 14:68-77. [PMID: 20227627 DOI: 10.1016/j.jaapos.2009.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 11/24/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
Abstract
Children are affected by some common external diseases, including allergic conjunctivitis and blepharokeratoconjunctivitis. This workshop aims to familiarize readers with the clinical features of each along with common presentations and to discuss strategies for managing these conditions, with emphasis on newer drugs and therapies. The other group of external diseases that commonly present in children comprises persistent punctate erosions and persistent epithelial defects. Etiology is varied, and making the correct diagnosis requires a systematic approach with close inspection of the microenvironment of the eye. Common causes and treatment modalities will be discussed. Types of lubrication and how they may best be used also will be outlined.
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Solebo AL, Russell-Eggitt I, Nischal KK, Moore AT, Cumberland P, Rahi JS. Cataract surgery and primary intraocular lens implantation in children <=2 years old in the UK and Ireland: finding of national surveys. Br J Ophthalmol 2009; 93:1495-8. [DOI: 10.1136/bjo.2009.160069] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wong IBY, Sukthankar VD, Cortina-Borja M, Nischal KK. Incidence of early-onset glaucoma after infant cataract extraction with and without intraocular lens implantation. Br J Ophthalmol 2009; 93:1200-3. [PMID: 19429583 DOI: 10.1136/bjo.2008.155200] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine the incidence of glaucoma, with onset within 1 year after the date of cataract surgery (early onset) performed in the first year of life, with or without intraocular lens (IOL) implantation. METHODS A retrospective review of a single surgeon's cohort from 1999 to 2006. Glaucoma onset risk, comparison of aphakic/pseudophakic eyes and IOL type were analysed together with microcornea, persistent fetal vasculature (PFV) and age < or =4 weeks at surgery. RESULTS Ninety-eight eyes (62 patients; mean age 2.88 months) were included with 61 eyes (36 patients) aphakic (57 planned and four failed implantations), and 37 eyes (26 patients) pseudophakic. At a mean follow-up of 2.51 years,15.3% (12.2% within 1 year) of all eyes, 9.8% of eyes (6.6% within 1 year) in the planned aphakic group, all four eyes with failed implantation and 13.5% of the pseudophakic eyes (10.8% within 1 year) developed glaucoma. Glaucoma incidence stratified by absence or presence of IOL showed no statistically significant difference, but eyes in the rigid polymethylmethacrylate group had an increased glaucoma risk compared with the Acrysof group (p = 0.002). Microcornea, PFV and age < or =4 weeks at surgery were not significant predictors of early-onset glaucoma. CONCLUSIONS In this single surgeon study of infant cataract surgery only, age < or =4 weeks at surgery was not a predictor of early-onset glaucoma. The rate of aphakic and pseudophakic early-onset glaucoma was not found to be statistically different, but we found a statistically different rate of glaucoma between the two IOL types which needs further evaluation, given that this is a retrospective review. Excessive surgical trauma influences incidence of glaucoma.
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Nischal KK. Full or partial hypermetropic correction for accommodative esotropia: does it matter? Br J Ophthalmol 2008; 92:1303. [PMID: 18815418 DOI: 10.1136/bjo.2008.141200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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