Correlation of the recurrent FBN1 mutation (c.364C>T) with a unique phenotype in a Chinese patient with Marfan syndrome

PURPOSE

To describe a Chinese patient with Marfan syndrome who had a unique phenotype and a recurrent mutation in the fibrillin-1 (FBN1) gene.

CASE AND METHODS

A 31-year-old man who had a spontaneous bilateral lens dislocation into the vitreous cavity in childhood was found to have retinal and choroidal detachments in both eyes. A congenital atrial septal defect was detected. Pars plana vitrectomy, lensectomy, and silicone oil tamponade were performed on his right eye. Genomic DNA was extracted from leukocytes of peripheral blood, and the 65 exons and flanking intronic sequences of the FBN1 gene were amplified by polymerase chain reaction for mutational screening.

RESULTS

A recurrent mutation, c.364C>T was detected in exon 4 that resulted in p.Arg122Cys. The visual acuity of the right eye improved to 6/60 one year after the surgeries.

CONCLUSION

DNA screening helps in the diagnosis of Marfan syndrome with unique phenotypes. The mutation c.364C>T can be considered to be a hotspot for Marfan patients with predominant ectopia lentis.

Clinical characteristics of posterior staphyloma in eyes with pathologic myopia

PURPOSE

To determine the morphologic features (grade and type) of posterior staphylomas and to analyze the relationship between the morphologic features and the incidence of myopic macular lesions.

DESIGN

Observational case series.

METHODS

Two hundred and nine eyes of 108 consecutive patients with high myopia were studied. The grade of staphylomas was determined from B-scan ultrasonographic images across the optic disk. The type of staphyloma was determined by binocular funduscopy and was classified according to the criteria of Curtin. The participants were divided into two groups: younger than 50 years and 50 years and older. The long-term morphologic progression of staphylomas was analyzed in nine patients who were followed up for more than 20 years.

RESULTS

Ninety percent of 209 eyes had a staphyloma. The prevalence of staphylomas and more advanced grades of staphylomas (> grade 2) were significantly higher in the older than in the younger patients. The higher grades of staphylomas were associated with more severe myopic retinal degeneration. Type II staphyloma was the most prominent overall; however, in older subjects, the incidence of type II was decreased significantly, and that of type IX was increased significantly. The eyes with type IX staphyloma tended to have more severe myopic retinal degeneration than eyes with type II staphylomas. The long-term follow-up study demonstrated a progression from type II to type IX with increasing age.

CONCLUSIONS

These results suggest that the morphologic features of staphylomas worsens as the patient ages. The progression from type II to type IX probably increases the mechanical tension on the macular area of highly myopic eyes, which then leads to myopic fundus lesions.

Technical note: method for estimating volume of subretinal fluid in cases of localized retinal detachment by OCT ophthalmoscopy

The volume of the subretinal fluid can be used to assess the condition of different types of retinal and macular disorders. The purpose of this report is to introduce a method to measure the volume of the subretinal fluid with the images of the optical coherence tomography (OCT) Ophthalmoscope in three cases of central serous chorioretinopathy and one case of retinal pigment epithelial detachment. We used the topography-mode program of the OCT Ophthalmoscope and measured the average height of the retinal detachment. By multiplying the size of the area of the retinal detachment and the average height of the retinal detachment, the volume of subretinal fluid could be determined. Examples are given to show the results of volume measurement of subretinal fluid in cases of localized retinal detachments.

[A new method for functional diagnosis and correction of vision. Color-pulse campimetry in patients with central chorioretinal dystrophy]

A new technique has been proposed for color-pulse campimetry and quantum-wave correction of vision on an ACO-05 spectral ophthalmological apparatus in central chorioretinal dystrophy. A correlation of scotomas in the central field of vision with visual acuity and retinal optical coherent tomographic findings was studied. After a 7-day course of photostimulation on the ACO-05 apparatus, visual acuity increased by 0.05 and 0.08 without and with correction, respectively. There were simultaneous increases in electrophysiological characteristics: the critical flicker frequency by 1.1 Hz, systemic electroretinography (ERG) to white light by on an average of 2 microV, central ERG to red light by an average of 1.4 microV, and foveal photosensitivity by an average of 0.8 dV, (p < 0.05). After alternative photostimulation, there was a 2-fold reduction in the area of central scotomas. Color-pulse campimetry is easy-to-use and accessible and may be recommended for introduction into ophthalmological care. The ACO-05 apparatus is convenient and reliable in operation; the parameters of stimulation are reproducible; and side effects have not been found.

Facial and physical features of Aicardi syndrome: infants to teenagers

Aicardi syndrome is a sporadic disorder that affects primarily females and is hypothesized to be caused by heterozygous mutations in an X-linked gene. Its main features include of a triad of infantile spasms, agenesis of the corpus callosum, and distinctive chorioretinal lacunae. Additional common findings include moderate to profound mental retardation, gray matter heterotopia, gyral anomalies, and vertebral and rib defects. To date, no consistent facial dysmorphisms have been described. We examined 40 girls with Aicardi syndrome and determined that consistent facial features appeared in over half the study participants and included a prominent premaxilla, upturned nasal tip, decreased angle of the nasal bridge, and sparse lateral eyebrows. Externally apparent microphthalmia was seen in 10/40 (25%). Various skin lesions (including multiple nevi, skin tags, hemangiomas, one giant melanotic nevus, and a history of a previously removed angiosarcoma) were present in 8/40 (20%). Hand abnormalities were seen in 3/40 (7.5%) and included camptodactyly, proximal placement of the thumb and hypoplasia of the fifth finger. This study clearly delineates the existence of a distinctive facial phenotype of Aicardi syndrome not previously described. We recommend that features of a prominent premaxilla with upturned nasal tip and vascular malformations/vascular tumors be added to the modified diagnostic criteria in order to improve the ability of geneticists to diagnose Aicardi syndrome.

Longitudinal cohort study of patients with birdshot chorioretinopathy. IV. Visual field results at baseline

PURPOSE

To describe visual field parameters at baseline examination of 80 participants in a longitudinal cohort study of birdshot chorioretinopathy and to identify relationships between these parameters and visual acuity, symptoms, clinical findings, and results of laboratory tests.

DESIGN

Single-center cross-sectional study.

METHODS

Standardized Fastpac, full-threshold Humphrey 30-2 (Carl Zeiss Meditec, Dublin, California, USA) visual field studies were performed for both eyes of all patients. A standardized protocol identified foveal threshold and mean deviation, specified categories of total deviation, and assigned visual field pattern descriptors. These parameters were compared with best-corrected visual acuity (BCVA), symptoms, color confusion score (CCS), cataract, vitreous inflammatory reactions, retinal vasculitis, birdshot lesion characteristics, and ocular coherence tomography (OCT) and fluorescein angiography parameters.

RESULTS

Each visual field parameter was closely related to the others, although mean deviation could be abnormal in the presence of a near normal foveal threshold. Mean deviation was related to BCVA, but the correlation was moderate (the Spearman correlation, -0.55; P < .001). It was also related to CCS and the symptoms of blurry vision, poor contrast sensitivity, and nyctalopia. The most common visual field patterns were multiple foci and arcuate defects. Among clinical and laboratory findings, visual field parameters were most closely related to absence of the third highly reflective band on OCT (P < .001).

CONCLUSIONS

Patients with birdshot chorioretinopathy may have a variety of visual field abnormalities, even with normal BCVA. Abnormalities seem to be associated with retinal damage. Automated visual field testing may provide objective measures for monitoring disease activity.

Assessment of central serous chorioretinopathy by optical coherence tomography and multifocal electroretinography

PURPOSE

To evaluate central serous chorioretinopathy (CSCR) by means of optical coherence tomography (OCT) and multifocal electroretinogram (mf-ERG) at presentation and after resolution of the acute phase.

DESIGN

Prospective comparative observational case series with a normal sample.

PATIENTS AND METHOD

Twenty-one eyes of 21 patients with unilateral CSCR were examined. Both eyes underwent complete ophthalmological examination, which included measurement of best-corrected visual acuity, fluorescein angiography, OCT and mf-ERG recording. Our results were compared with the corresponding findings of 33 normal volunteers of the same age.

RESULTS

At presentation, the averaged mean retinal thickness of the fovea, measured by OCT, was 303 mum in the affected eyes, 69.3% higher compared to the normal controls (p < 0.001). The averaged mean retinal response density of the mf-ERG of the affected eyes in area 1 was 11.29 nV/degree(2), 50.8% lower compared to the normal controls (p < 0.001). After regression of CSCR, the averaged mean retinal thickness of the fovea was 213 microm in the affected eyes, 19.3% greater compared to the normal controls (p < 0.001). The averaged mean retinal response density of the mf-ERG of the affected eyes in area 1 was 16.05 nV/degree(2), 30.1% lower compared to normal controls (p < 0.001). It is interesting that 6 of 21 fellow nonaffected eyes showed abnormal values, with an averaged mean retinal thickness of OCT (246 mum) and an averaged mean retinal response density of mf-ERG in area 1 (12 microV/degree(2)). In the remaining 15 eyes, the OCT and the mf-ERG values were within normal limits.

Choroidal and Optic Nerve Infarction in Hepatitis C-Associated Polyarteritis Nodosa

A 39-year-old man presented with headache, weight loss, bilateral subdural hematomas, pansinusitis, and visual loss. The neuro-ophthalmologic examination disclosed deep choroidal lesions and bilateral optic disc edema. Orchiectomy for testicular torsion showed acute vasculitis consistent with polyarteritis nodosa (PAN). Polymerase chain reaction (PCR) testing revealed hepatitis C. This is the first reported case of PAN due to hepatitis C with early findings of choroidal and optic nerve infarction.

The value of contrast sensitivity in diagnosing central serous chorioretinopathy

A 39-year-old hyperopic male was referred for laser refractive treatment. In the course of the pre-operative evaluation he complained of a recent deterioration of vision. The suspicion of unilateral central serous chorioretinopathy (CSCR) was confirmed by contrast sensitivity testing and by ocular fundus examination. Contrast sensitivity (CS) for six spatial frequencies (1, 2, 4, 8, 12 and 16 c/deg) was evaluated using Gabor patches of gratings projected on a high-resolution display by means of a stimulus generator card. Although VA remained unaltered, the pattern of contrast sensitivity function varied at different stages of CSCR: during the acute stage, performance at all spatial frequencies was depressed, while at two-month follow up, intermediate and high spatial frequencies were mainly affected. It is concluded that the level of visual deficit in CSCR cannot be evaluated by measuring visual acuity. History and contrast sensitivity can play a central role in setting the correct diagnosis and characterising its stage.

[Automated static perimetry in 5 eyes with multiple evanescent white dot syndrome]

PURPOSE

Multiple evanescent white dot syndrome (MEWDS) is a self-limiting disease in which reduced visual acuity and retinal changes recover without treatment. It also shows visual field defects including an enlarged blind spot of Mariotte. However the final outcome of the field change has rarely been documented. We therefore retrospectively studied the visual field change in eyes with MEWDS by reviewing the multiple results of automated static perimetry recorded in the clinical course of the disease.

SUBJECTS

We reviewed the clinical course of five eyes with MEWDS using the multiple recordings of the Humphrey central 30-2 program taken during their clinical course.

RESULTS

The initial findings of perimetry included an enlarged blind spot of Mariotte, depression of the central field, and paracentral scotoma. These field defects recovered within 2 weeks to 4 months.

CONCLUSION

Visual field defects as well as vision and retinal changes recover without treatment in eyes with MEWDS.

Hypotony maculopathy

Hypotony maculopathy, first described in 1954 by Dellaporta, usually occurs after antiglaucomatous surgery or after perforating eye injuries; it is characterized by hypotony associated with fundus abnormalities, including papilloedema, vascular tortuosity and chorioretinal folds. In hypotony maculopathy, the scleral wall collapses inward, resulting in redundancy of the choroid and retina, leading to chorioretinal wrinkling. As the antero-posterior diameter of the vitreous cavity decreases, the very thick perivofeal retina surrounding the very thin foveal retina is thrown into radial folds around the fovea. It has been reported that hypotony maculopathy occurs in up to 20% of cases of glaucoma filtering surgery and has become more common after the introduction of antimetabolites. Young age, myopia, primary filtering surgery, systemic illnesses and elevated preoperative intraocular pressure (IOP) have been found to be associated with hypotony maculopathy. Hypotony maculopathy is treated with procedures designed to elevate IOP, which may reverse the inward scleral bowing and improve visual acuity. The successful treatment of hypotony maculopathy depends on the correct identification of its cause. Once the cause is detected, treatment should be employed as soon as possible because delayed normalization of the IOP may result in permanent macular chorioretinal changes and poor vision. This review will explore the definition, mechanisms, clinical findings and treatment of hypotony maculopathy.

Central retinal sensitivity measured with the micro perimeter 1 after photodynamic therapy for polypoidal choroidal vasculopathy

PURPOSE

To evaluate central retinal sensitivity and its relation to the symptomatic change noted in central visual disturbance shortly after photodynamic therapy (PDT) in eyes with polypoidal choroidal vasculopathy (PCV).

DESIGN

Retrospective interventional case series.

METHODS

We reviewed retrospectively 20 eyes of 20 patients who underwent PDT for the treatment of subfoveal PCV. Microperimetry in the macular area was performed with Micro Perimeter 1 (MP1) [Nidek, Vigonza, Italy] before and at one, three, and six months after PDT. Forty measurement points were located within the central 10 degree of the macula.

RESULTS

After PDT, although most eyes showed a reduction in exudation, the mean posttreatment visual acuity did not change significantly. At one month after PDT, however, retinal sensitivities within the central 2 degree, 6 degree, and 10 degree fields, which were 3.6 +/- 3.1, 5.1 +/- 3.4, and 6.2 +/- 3.6 dB [decibels] at baseline, improved to 5.9 +/- 3.8 (P = .003), 7.1 +/- 3.6 (P = .003), and 8.1 +/- 3.5 dB (P = .004). At one month after treatment, 14 patients (70%) noted subjective improvement of the central visual disturbance and mean retinal sensitivity within the central 2 degree, 6 degree, and 10 degree fields had improved more than 2 dB in 11, 10, and eight eyes, respectively. At three and six months after PDT, however, postoperative improvement of the retinal sensitivities was diminished.

CONCLUSIONS

Retinal sensitivity in the macular area of eyes with subfoveal PCV improved shortly after PDT, and may account, at least in part, for the immediate subjective improvement in central vision after PDT.

The use of propranolol to treat central serous chorioretinopathy: an evaluation by serial OCT

PURPOSE

Although usually self-limiting, central serous chorioretinopathy (CSCR) may recur or adopt a chronic course, with permanent impairment of visual acuity. Previously suggested treatments for nonresolving or recurrent CSCR have included invasive techniques, such as laser photocoagulation and intravitreal triamcinolone. We evaluated the evidence for epinephrine in the pathophysiology of CSCR and the role beta-blockade may play in treating this condition.

METHODS

This study was comprised of a literature review and interventional case report. Two (2) patients with nonresolving or recurrent CSCR were commenced on a trial of oral propranolol 40 mg twice a day and followed up at monthly intervals. Visual acuity, metamorphopsia, and central retinal thickness quantified by ocular coherence tomography (OCT) were recorded at baseline and follow-up visits.

RESULTS

Two successive trials of propranolol in 1 patient and a trial in a 2nd patient with recurrent CSCR were associated with an improvement in visual acuity, symptoms, and retinal thickness. One (1) patient demonstrated recovery, remission, and subsequent rerecovery, which coincided with the commencement, cessation, and retreatment with propranolol.

CONCLUSIONS

Although there may have been a spontaneous improvement without treatment, beta-blockade has a plausible mechanism or action in CSCR.

Sympathetic-parasympathetic activity and reactivity in central serous chorioretinopathy: a case-control study

PURPOSE

This case-control study was conducted to evaluate autonomic function activity and reactivity in patients with central serous chorioretinopathy (CSCR), because stress and type A personality, known risk factors, are also related to autonomic nervous system activity.

METHODS

Patients with CSCR were selected from the outpatient department and medical retina services in one center. Control subjects were chosen from the healthy subjects of similar age group. The autonomic activity (both sympathetic and parasympathetic) in 45 patients with CSCR was evaluated and compared with that in 28 healthy control subjects, by using HRV (heart rate variability) analysis according to the guidelines laid down by the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). Autonomic reactivity (both sympathetic and parasympathetic) was also evaluated in 32 patients with CSCR and compared with that in 28 healthy control subjects, by using standard autonomic function tests: HRV, as a measure of the resting sympathetic and parasympathetic activity (tone), and changes in blood pressure response and heart rate changes during various stressor stimuli in the tests as a measure of sympathetic and parasympathetic reactivity.

RESULTS

Patients with CSCR showed significantly decreased parasympathetic activity (P = 0.002), significantly increased sympathetic activity (P = 0.005), and significantly increased sympathetic-parasympathetic balance (P = 0.004) as measured from different measures of beat-to-beat heart rate variability. The patients also showed significantly decreased parasympathetic reactivity (P = 0.03). Sympathetic reactivity showed a trend toward lessening.

CONCLUSIONS

Autonomic function, both activity and reactivity components of sympathetic and parasympathetic system, is impaired in patients with CSCR. Because autonomic supply modulates the choroidal blood flow, there may be a correlation between measures of autonomic function and the presence of CSCR.

Assessment of macular function by microperimetry in unilateral resolved central serous chorioretinopathy

PURPOSE

To determine macular sensitivity and fixation characteristics in patients with unilateral resolved central serous chorioretinopathy (CSC) using fundus-related microperimetry.

METHODS

We reviewed 15 eyes with resolved CSC and 15 normal healthy eyes that had undergone fundus-related microperimetry. The macular sensitivity was measured using the recently introduced fundus-related microperimeter, MP-1. The best-corrected visual acuity (VA) (BCVA), mean retinal sensitivity in the central 10 degrees (central microperimetry, cMP-1) and in the paracentral 10-20 degrees (paracentral microperimetry, pMP-1), and fixation stability and location were determined and compared with measurements in control eyes.

RESULTS

BCVA at the time of this study was 20/20 in all the affected eyes, and fundus examination and optical coherence tomography findings revealed no serous detachment. Eyes with CSC showed statistically significantly lower cMP-1 sensitivity and lower, but not significantly, pMP-1 sensitivity than control eyes (P<0.001, P=0.11, respectively). Eyes with CSC were not significantly different from control eyes in fixation location (P=1.00) or fixation stability (P=0.91). Fixation location was predominantly central in all eyes with CSC; fixation was stable in 12 (80%) and relatively unstable in 3 (20%).

CONCLUSION

Our study shows that eyes with resolved CSC can have lower retinal sensitivity in the central macula than control eyes, even after good VA has been obtained.

Alcohol- and light-induced electro-oculographic responses in age-related macular degeneration & central serous chorioretinopathy. alcohol- and light-induced EOG responses in ARMD & CSC

The non-photic electro-oculographic (EOG) response induced by alcohol has been proposed as an indicator of retinal pigment epithelial (RPE) integrity, and reported to be abnormal in age-related macular degeneration (ARMD). To evaluate this proposal, we have measured the alcohol-EOG as well as the ISCEV-standard EOG in patients with ARMD (n=11 patients, 4 eyes with drusen, 8 eyes with 'dry' and 7 eyes with 'wet' lesions) and central serous chorioretinopathy (CSC, n=11 patients, 7 eyes with active and 6 eyes with inactive lesions), compared with 29 normal controls. We recorded the alcohol-induced EOG response after a single oral administration of ethanol at 160 mg/kg, followed by an ISCEV-standard EOG. Blood alcohol levels were monitored with a breath analyzer. We found that neither the alcohol-EOG nor the light-induced EOG response showed any difference between either ARMD or CSC patients and normal controls. Nor was there difference among eyes of different ARMD or CSC subgroups. In addition, blood alcohol concentrations near the time of the alcohol-EOG peak showed no obvious relationship with peak/baseline ratios. These data suggest that neither the alcohol- nor the light-induced EOG is a sensitive indicator of these diseases.

Different transitions of multifocal electroretinogram recordings between patients with age-related macular degeneration and polypoidal choroidal vasculopathy after photodynamic therapy

AIM

To compare and evaluate the transitions in retinal function after photodynamic therapy (PDT) between age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) using multifocal electroretinograms (mfERGs).

METHODS

10 eyes with choroidal neovascularisation (CNV) secondary to AMD and 11 eyes with CNV secondary to PCV were included in the study. mfERGs were recorded before PDT, and 1 week and 3 months after PDT. mfERG recordings were acquired by a Veris system (V.3.1.3) using a 103 hexagon stimulus. The first-order kernel was used to calculate amplitudes and latencies. Mean amplitudes and latencies from two central rings rated 0-4 degrees of visual angle were analysed and compared with each disease.

RESULTS

In AMD, the mean first negative peak (N1) amplitudes tended to decrease, and the mean first positive peak (N1P1) amplitudes reduced to significant levels (p = 0.047) 1 week after PDT. 3 months after PDT, there were no significant differences in the mean N1 and N1P1 amplitudes compared with pre-PDT values. In PCV, there were no significant changes in the mean N1 and N1P1 amplitudes 1 week after treatment. However, 3 months after PDT, mean amplitudes showed significant increases in N1 (p = 0.008) and N1P1 (p = 0.006) amplitudes compared with pre-PDT values.

CONCLUSIONS

mfERG recording transitions are different between patients with AMD and those with PCV. In patients with AMD, these results may show transient impairments in retinal function 1 week after PDT, but in those with PCV, the efficacy of PDT is superior to the impairment after PDT.

Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy: a short term pilot study

AIM

To evaluate short term safety of an enhanced photodynamic therapy (PDT) protocol with half dose verteporfin for treating chronic central serous chorioretinopathy (CSC).

METHODS

20 eyes of 18 patients with symptomatic chronic CSC underwent PDT using 3 mg/m2 verteporfin. Verteporfin was infused over 8 minutes followed by indocyanine green angiography guided laser application 2 minutes later. Serial optical coherence tomography (OCT) and multifocal electroretinography (mfERG) recordings were performed before PDT, at 4 days, 2 weeks, and 1 month after PDT. The best corrected visual acuity (BCVA), OCT central retinal thickness, and mean mfERG response amplitudes and peak latencies were compared longitudinally. Subgroup analysis was further performed for eyes with or without pigment epithelial detachment (PED).

RESULTS

At 1 month after PDT, the median BCVA improved from 20/40 to 20/30 (p = 0.001). The mean central retinal thickness also reduced from 276 microm to 158 microm (p < 0.001) and 17 (85%) eyes had complete resolution of serous retinal detachment and/or PED. MfERG showed no significant changes in the mean N1 and P1 response amplitude and latency for all eyes. Subgroup analysis demonstrated that eyes without PED had a significant increase in the mean central mfERG P1 response amplitude with reduction in P1 peak latency at 1 month post-PDT. For eyes with PED, transient reduction in the mean central P1 response amplitude was observed at 4 days post-PDT.

CONCLUSIONS

The modified safety enhanced PDT protocol with half dose verteporfin appeared to be a beneficial treatment option for patients with chronic CSC, especially in eyes without serous PED. Further controlled study is warranted to demonstrate the long term safety and efficacy of this treatment option.