Turner's syndrome in a male. Report of a case with myopia, retinal detachment, cataract, and glaucoma

Select pediatric vitreoretinal disease in the setting of Turner's syndrome

Purpose

To report 2 cases of pediatric vitreoretinal disease in the setting of Turner's syndrome.

Observations

A 4-year-old girl with Turner's syndrome was referred for evaluation of a tractional retinal detachment in the right eye. Fundoscopic examination disclosed temporal dragging of the macula in the right eye, and vascular nonperfusion in the right and left eyes. Genetic testing revealed a novel frameshift mutation in the LRP5 gene consistent with familial exudative vitreoretinopathy (FEVR). The patient was treated with laser. A 14-year-old girl with Turner's syndrome presented with nyctalopia. Dilated fundus exam disclosed peri-foveal pigmentary changes and peripheral bone spicules. Full-field electroretinography demonstrated decreased rod and cone responses, consistent with retinitis pigmentosa (RP).

Conclusions and importance

Vitreoretinal disease, including RP and FEVR, is rarely observed in patients with Turner's syndrome.

Increased central corneal thickness in patients with Turner syndrome

PURPOSE

To evaluate central corneal thickness (CCT) values in patients with Turner syndrome (TS) and compare these values with healthy subjects.

METHODS

A total of 31 subjects with TS and 67 age- and sex-matched healthy subjects made up the study and control group, respectively. The CCT values were measured by an ultrasound pachymeter in this cross-sectional prospective study. The ocular findings were recorded. We also evaluated to effect of karyotype analysis, recombinant growth hormone therapy (GHT), and mean duration of treatment on the CCT parameter in patients with TS.

RESULTS

The mean CCT values were 582.0 ± 40.8 µm (490-648) in the TS and 549.1 ± 34.6 µm (494-601) in the healthy group. The mean intraocular pressure (IOP) by Goldmann applanation tonometry was 16.3 ± 3.1 mm Hg (9-22) in the TS and 15.2 ± 2.5 mm Hg (10-21) in the healthy group. The mean CCT value was significantly higher in the TS group (p<0.05) but there was no statistically significant difference between the 2 groups for IOP (p>0.05). There was also no significant difference for CCT regarding the karyotype, GHT use, and mean duration of treatment in patients with TS (p>0.05).

CONCLUSIONS

Central corneal thickness values should be considered during measurement of IOP in individuals with TS as these values may be higher than in healthy subjects.

A rare association of familial exudative vitreoretinopathy and Turner's syndrome

A 6-year-old girl presented with left divergent strabismus that had been noticed by her parents. She was known to have Turner's syndrome. On examination, she had tractional retinal detachment in the left eye and a temporal avascular area with neovascularization at the junction with the vascular area. Clinical features were characteristic of familial exudative vitreoretinopathy. This case is a rare and, to the authors' knowledge, the first reported association of familial exudative vitreoretinopathy and Turner's syndrome.

Angle closure in younger patients

PURPOSE

Angle-closure glaucoma is rare in children and young adults; only scattered cases associated with specific clinical entities have been reported. We evaluated the findings in patients aged 40 or younger with angle closure in our database.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Our database was searched for patients aged 40 years or younger with angle closure. Data recorded included age at initial consultation, age at the time of diagnosis, gender, slit-lamp examination, gonioscopy, ultrasound biomicroscopy (from 1993 onward), clinical diagnosis, and therapy. Patients with prior incisional surgery were excluded, as were patients with anterior chamber proliferative mechanisms leading to angle closure.

RESULTS

Sixty-seven patients (49 females, 18 males) met entry criteria. Mean age at the time of consultation was 34.4 +/- 9.4 (standard deviation) years (range, 3-68 years). Diagnoses included plateau iris syndrome (35 patients); iridociliary cysts (8 patients); retinopathy of prematurity (7 patients); uveitis (5 patients); isolated nanophthalmos (3 patients); relative pupillary block (2 patients); Weill-Marchesani syndrome (3 patients); and 1 patient each with Marfan syndrome, miotic-induced angle closure, persistent hyperplastic primary vitreous, and idiopathic lens subluxation.

CONCLUSIONS

The etiology of angle closure in young individuals differs from the older population and is typically associated with structural/developmental ocular anomalies rather than relative pupillary block. After laser iridotomy, these eyes should be monitored for recurrent angle closure and the need for additional laser or incisional surgical intervention.

Two cases of unilateral retinal neovascularization in Turner syndrome

PURPOSE

To report two cases of unilateral retinal neovascularization in Turner syndrome.

METHOD

We examined two female infants, born at 34 weeks' and 33 weeks' gestation, who had received oxygen for 9 days and 3 days, respectively, after birth. Both infants had the 45,XO karyotype of Turner syndrome.

RESULTS

In each patient, the fundus of one eye showed an avascular area, neovascularization, and multiple branchings with anastomosis of retinal vessels in the temporal periphery. Fellow eyes showed no abnormalities in the fundi. Both infants were treated with argon laser photocoagulation to the avascular area and the neovascularization in the temporal periphery. The neovascularization regressed completely after retinal photocoagulation.

CONCLUSION

Abnormalities of retinal vessels may be one of the ocular findings associated with Turner syndrome.

Turner's syndrome associated with bilateral retinal detachments

PURPOSE

To report a case of Turner's syndrome associated with bilateral funnel-shaped retinal detachments.

METHODS

We examined a 2-month-old female infant with Turner's syndrome who was referred with a diagnosis of bilateral leukocoria.

RESULTS

Clinical examination showed bilateral funnel-shaped retinal detachments resembling stage V retinopathy of prematurity.

CONCLUSION

Bilateral retinal detachments should be added to the list of ocular findings in Turner's syndrome. Patients with Turner's syndrome need early ophthalmologic examinations not only to treat common strabismus abnormalities but also to diagnose and treat posterior segment abnormalities.

Vaginal rhabdomyosarcoma in a patient with Noonan syndrome

This is the first report of a Noonan syndrome patient who has had a vaginal rhabdomyosarcoma. Recent reports of Noonan syndrome patients with leukaemia have prompted speculation that there may be a slightly increased malignancy risk associated with this syndrome.

Noonan syndrome

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