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Tran EM, Wai KM, Kossler AL, Mruthyunjaya P, Rahimy E, Koo EB. Association of Ocular Manifestations of Marfan Syndrome With Cardiovascular Complications. Am J Ophthalmol 2024; 264:85-89. [PMID: 38403098 DOI: 10.1016/j.ajo.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To evaluate associations between ocular manifestations of Marfan syndrome and cardiovascular complications. DESIGN Retrospective cohort study. METHODS The TriNetX Analytics platform, a federated health research network of aggregated deidentified electronic health record data of more than 119 million patients, was used to identify patients diagnosed with Marfan syndrome. Univariate logistic regression models were used to evaluate the association of ocular manifestations of Marfan syndrome (such as retinal tears/detachment, lens dislocation, and myopia), with cardiovascular comorbidities. Additional sensitivity analyses were performed using propensity matching. Odds ratios and 95% CIs were calculated for incidence of cardiovascular comorbidities (including aortic dissection, valvular disease, and arrhythmias) following diagnosis of Marfan syndrome. RESULTS A total of 19,105 patients were identified who were diagnosed with Marfan disease without ocular manifestations, and an additional 3887 Marfan patients with ocular comorbidities. Patients who were diagnosed with ocular disease included 883 with ectopic lens, 417 with retinal tear or detachment, 683 with aphakia, 534 with pseudophakia, and 2465 with myopia. Patients with any ocular manifestations of Marfan were significantly more likely to be diagnosed with all cardiovascular comorbidities modeled including aortic aneurysm and dissection (OR 2.035; P < .0001), mitral valve prolapse (OR 2.725; P < .0001), tricuspid valve disorders (OR 2.142; P < .0001), cardiac arrhythmias (OR 1.836; P < .0001), and all cardiovascular outcomes combined (OR 2.194; P < .0001). CONCLUSIONS In a large and diverse cohort of patients with Marfan syndrome, ocular manifestations of the disorder appear strongly associated with cardiovascular comorbidities.
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Affiliation(s)
- Elaine M Tran
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California
| | - Karen M Wai
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California
| | - Andrea L Kossler
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California
| | - Prithvi Mruthyunjaya
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California
| | - Ehsan Rahimy
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California; Department of Ophthalmology, Palo Alto Medical Foundation (E.R.), Palo Alto, California, USA
| | - Euna B Koo
- Byers Eye Institute at Stanford (E.M.T., K.M.W., A.L.K., P.M., E.R., E.B.K.), Palo Alto, California.
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Alluyn L, Dequeker L, Dhaese S, Consejo A, De Zaeytijd J, Leroy BP, De Backer J, Kreps EO. Anterior scleral thickness in Marfan syndrome: A quantitative analysis. Acta Ophthalmol 2024. [PMID: 38773052 DOI: 10.1111/aos.16721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/11/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE To investigate the anterior scleral thickness (AST) in patients with Marfan syndrome (MFS). METHODS A prospective, cross-sectional study was conducted at the Department of Ophthalmology, Ghent University Hospital, Ghent, including patients with a genetically confirmed clinical diagnosis of MFS and age-, gender- and axial length-matched controls. Subjects with known corneal, conjunctival or scleral pathology and a history of ocular surgery, including pars plana vitrectomy, recent contact lens use or high-grade astigmatism were excluded. Subjects underwent non-cycloplegic autorefraction, Scheimpflug-based corneal tomography, axial length measurement and spectral-domain optical coherence tomography (OCT). AST was manually measured at 1 mm (AST1), 2 mm (AST2) and 3 mm (AST3) from the scleral spur, temporally and nasally. RESULTS A total of 56 subjects (28 subjects in the MFS group and 28 matched subjects in the control group) were included in this study. In patients with MFS, AST was significantly reduced compared to matched controls, both overall and at every analysed measuring point in the nasal and temporal areas (p < 0.001). Central corneal thickness (CCT) and mean keratometry (Kmean) values were significantly lower in patients with MFS (p < 0.05). A positive correlation was found between nasal AST and CCT in patients with MFS. No correlation was found between AST and Kmean or between AST and axial length. In patients with MFS with ectopia lentis, compared to those without, temporal AST3 was significantly lower (p < 0.05). AST was significantly lower in patients with MFS harbouring a variant predicted to cause haploinsufficiency compared to those with a variant expected to lead to a dominant negative effect for both nasal and temporal measurements. CONCLUSION Based on anterior segment OCT measurements, AST of patients with MFS is significantly lower compared to matched controls.
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Affiliation(s)
- Lien Alluyn
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Laure Dequeker
- Department of Ophthalmology, AZ Groeninge, Kortrijk, Belgium
| | | | - Alejandra Consejo
- Aragon Institute for Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Julie De Zaeytijd
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Bart P Leroy
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Division of Ophthalmology & Center for Cellular & Molecular Therapeutics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julie De Backer
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Elke O Kreps
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
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Jin G, Zou M, Li L, Liu Z, Young C, Qi H, Zheng D. Corneal biomechanics and their association with severity of lens dislocation in Marfan syndrome. Int Ophthalmol 2024; 44:148. [PMID: 38502381 DOI: 10.1007/s10792-024-03079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE To investigate corneal biomechanical properties and its associations with the severity of lens dislocation in patients with Marfan syndrome. METHODS A total of 30 patients with Marfan syndrome and 30 age-, sex- and axial length (AL)-matched controls were recruited. Corneal biomechanical parameters of both groups were measured by CorVis ST and were compared between groups. Potential associations between corneal biomechanical parameters and severity of lens dislocation were also investigated. RESULTS Lower applanation 1 velocity (A1V) (0.13 ± 0.004 vs. 0.15 ± 0.003, P = 0.016), shorter applanation 2 time (A2T)(22.64 ± 0.11 vs. 22.94 ± 0.11, P = 0.013), longer peak distance (PD) (5.03 ± 0.07 vs. 4.81 ± 0.05, P = 0.008), longer radius (R) of highest concavity (7.44 ± 0.16 vs. 6.93 ± 0.14, P = 0.012), greater Ambrosio relational thickness horizontal (ARTh) (603 ± 20 vs. 498 ± 12, P < 0.001), and integrated radius (IR) (8.32 ± 0.25 vs. 8.95 ± 0.21, P = 0.033) were detected among Marfan eyes compared with controls (all P < 0.05). Marfan individuals with more severe lens dislocation tended to have increased stiffness parameter as longer A1T, slower A1V, shorter A2T, slower application 2 velocity (A2V), smaller PD and smaller Distance Amplitude (DA) (P < 0.05). CONCLUSION Marfan patients were detected to have increased corneal stiffness compared with normal subjects. Corneal biomechanical parameters were significantly associated with the severity of lens dislocation in Marfan patients.
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Affiliation(s)
- Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Minjie Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Charlotte Young
- Albany Medical College, 49 New Scotland Ave, Albany, NY, USA
| | - Haotian Qi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
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Liu S, Lian Z, Young C, Ng K, Zhang X, Zheng D, Jin G. Postoperative longitudinal refractive changes in children younger than 8 years with ectopia lentis and Marfan syndrome. J Cataract Refract Surg 2024; 50:134-139. [PMID: 37753933 DOI: 10.1097/j.jcrs.0000000000001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To evaluate the postoperative longitudinal refractive changes in children younger than 8 years with ectopia lentis and Marfan syndrome (MFS). SETTING Zhongshan ophthalmic center, Guangzhou, China. DESIGN Retrospective cohort study. METHODS Medical data of patients diagnosed with ectopia lentis and MFS that underwent surgery younger than 8 years were collected. Refractive errors and ocular biometric parameters were collected preoperatively and at each follow-up visit. Patients were stratified into groups according to age at surgery, and only the eye operated on first was selected. Multivariate analysis was performed to determine the association between refractive shift and potential risk factors. RESULTS In total, 54 eyes of 54 patients were enrolled. The median age at surgery was 6.21 years (interquartile range [IQR], 5.25 to 6.85), and the median follow-up was 2.0 years (IQR, 1.2 to 2.8 years). At age 8 years, patients demonstrated a median myopic shift ranged from -1.75 diopters (D) (IQR, -2.75 to -1.00 D) for the 4-year-old group to -0.13 D (IQR, -0.50 to -0.06 D) for the 7-year-old group. Multivariate analysis showed that greater myopic shift was associated with younger age at surgery ( P = .004), male sex ( P = .026), and shorter preoperative axis length ( P = .005). CONCLUSIONS A tendency toward increasing postoperative myopic was demonstrated in children with ectopia lentis and MFS, with the greatest myopic shift in the younger age groups. If the goal is to reach emmetropia by age 8 years, the immediate postoperative hypermetropic targets should be 1.75 D for age 4 years, 1 D for age 5 years, 0.5 D for age 6 years, and 0 to 0.25 D for age 7 years.
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Affiliation(s)
- Siyuan Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (Liu, Lian, Ng, Zhang, Zheng, Jin); Albany Medical College, Albany, New York (Young)
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Ng K, Xu P, Jin G, Cheng W, Luo X, Ding X, Zheng D, Liu Y. Quantitative analysis of choriocapillaris flow deficits and choroidal thickness in children with Marfan syndrome. Br J Ophthalmol 2024; 108:274-279. [PMID: 36575623 DOI: 10.1136/bjo-2022-322535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the characteristics and associated factors of choroidal thickness (ChT) and choriocapillaris flow deficit percentage (CC FD%) in children with Marfan syndrome (MFS). METHODS This is a cross-sectional study. The ChT of the subfoveal area and other areas 0.5, 1.5, and 2.5 mm away from the fovea were assessed. The CC FD% of quadrant and circular regions with diameters of 0.5, 1.5 and 2.5 mm were assessed with 3×3 mm macular choriocapillaris images. Best-corrected visual acuity (BCVA) and cardiac function factor such as Z score were measured to analyse the associations with ChT and CC FD%. RESULTS 51 MFS children and 50 healthy controls were enrolled in this study. Compared with the healthy controls, the ChT in the MFS group was thinner in the subfoveal area, temporal 0.5, 1.5 and 2.5 mm (all p<0.001). The CC FD% was higher in circle 0.5, 1.5 and 2.5 mm (all p<0.001). Multivariate regression analysis showed that CC FD% in the circle 2.5 mm when the Z score ≥2 was associated with BCVA (β=9.08 (95% CI 3.96 to 14.20); p=0.005) and Z score (β=4.19 (95% CI 1.28 to 12.00); p=0.012). CONCLUSIONS Thinner ChT and a higher CC FD% were observed in children with MFS, and an increased CC FD% in circle 2.5 mm was significantly associated with worse BCVA and cardiac function. These findings may help identify future visual impairment and early cardiac events in MFS children.
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Affiliation(s)
- Kityee Ng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Pusheng Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Weijing Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Xiaoling Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
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Wu J, Li F, Zhang J, Hao XD. Genetic mutation and aqueous humor metabolites alterations in a family with Marfan syndrome. Heliyon 2024; 10:e23696. [PMID: 38187261 PMCID: PMC10770601 DOI: 10.1016/j.heliyon.2023.e23696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/26/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024] Open
Abstract
This study used four generations of a Chinese family to reveal the genetic etiology and ocular manifestation pathogenesis of Marfan syndrome (MFS) through whole genome sequencing (WGS) and metabolomics analysis. In the study, we explored the pathogenic gene variant and aqueous humor (AH) metabolites alterations of MFS. Using WGS, a novel heterozygous variant (NM_000138: c.G4192A, p.D1398 N) in the fibrilin-1 (FBN1) gene was identified. This variant was co-segregated with the phenotype and considered "deleterious" and highly conserved during evolution. The p.D1398 N variant is located in a cbEGF-like domain and predicted to lead to a new splice site, which might result in structural and functional changes to the FBN1 protein. FBN1 is highly expressed in the mouse cornea, conjunctiva and lens capsule, which highlights the important role of FBN1 in eyeball development. AH metabolomics analysis identified eight differentially expressed metabolites, including 3-hydroxyphenylacetic acid, 4-pyridoxic acid, aminoadipic acid, azelaic acid, chlordiazepoxide, niacinamide, ribose, 1,5-bisphosphate and se-methylselenocysteine, associated with relevant metabolic pathways likely involved in the pathogenesis of ocular symptoms in MFS. Our analysis extends the existing spectrum of disease-causing mutations and reveals metabolites information related to the ophthalmic features of MFS. This may provide a new sight and a basis for the diagnosis and mechanism of MFS.
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Affiliation(s)
- Jing Wu
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
| | - Fei Li
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
| | - Jingjing Zhang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan, 250021, China
| | - Xiao-dan Hao
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
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Savastano A, Carlà MM, Gambini G, Caporossi T, Giannuzzi F, Boselli F, Rizzo S. Spontaneous ciliary body detachment in a Marfan patient: A case of personalized management. Am J Ophthalmol Case Rep 2023; 30:101840. [PMID: 37077295 PMCID: PMC10106476 DOI: 10.1016/j.ajoc.2023.101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/20/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose We present a case of a patient with Marfan Syndrome who underwent a personalized approach to manage a spontaneous ciliary body detachment and degeneration of the ciliary processes, causing refractive ocular hypotony. Observations A 20-year-old MFS man, with a history of bilateral juvenile cataract surgery with failed IOL positioning due to subluxation and consequent explantation, was referred to our clinic after the discovery of persistent ocular hypotonia in his left eye for the past two months, non-responder to corticosteroids. Slit-lamp examination showed shallow anterior chamber and aphakia, with chorioretinal folds, optic disc swelling and mild peripheral retinal lifting. Intraocular pressure (IOP) was 4 mmHg. Ultrasound biomicroscopy (UBM) revealed the presence of a flat, annular ciliochoroidal detachment, posterior pole congestion and total ciliary body separation. One-month systemic therapy with corticosteroids revealed ineffective, and a newly performed UBM showed a significant reduction in the number and thickness of the ciliary processes. At this point, he underwent 23-gauge pars plana vitrectomy with silicone oil endotamponade, combined with a focal trans-scleral cryopexy of the ciliary body, 2 mm behind the limbus and one spot per quadrant, in order to favor ciliary body reattachment. Post-operative IOP was 28 mmHg and the choroidal detachment was resolved, with UBM highlighting ciliary body reattachment. Six months after, with good IOP control using topical therapy, silicone oil was removed. One year after, visual acuity had inccreased to 6/10 and a good IOP control was still maintained with eye drops. Conclusion and Importance A rare case of spontaneous ciliary body detachment in a long standing aphakic MFS patient was successfully managed with focal trans-scleral cryopexy of the ciliary body combined with pars plana vitrectomy and silicone oil endotamponade.
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Liu X, Liu K, Nie D, Zhang J, Zhang L, Liu X, Wang J. Case report: Biochemical and clinical phenotypes caused by cysteine substitutions in the epidermal growth factor-like domains of fibrillin-1. Front Genet 2022; 13:928683. [PMID: 36035136 PMCID: PMC9402891 DOI: 10.3389/fgene.2022.928683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022] Open
Abstract
Marfan syndrome, an autosomal dominant disorder of connective tissue, is primarily caused by mutations in the fibrillin-1 (FBN1) gene, which encodes the protein fibrillin-1. The protein is composed of epidermal growth factor-like (EGF-like) domains, transforming growth factor beta-binding protein-like (TB) domains, and hybrid (Hyb) domains and is an important component of elastin-related microfibrils in elastic fiber tissue. In this study, we report a cysteine to tyrosine substitution in two different domains of fibrillin-1, both of which cause Marfan syndrome with ocular abnormalities, in two families. Using protease degradation and liquid chromatography-tandem mass spectrometry analyses, we explored the different effects of substitution of cysteine by tyrosine in an EGF-like and a calcium-binding (cb) EGF-like domain on protein stability. The results showed that cysteine mutations in the EGF domain are more likely to result in altered proteolytic sensitivity and thermostability than those in the cbEGF domain. Furthermore, cysteine mutations can lead to new enzymatic sites exposure or hidden canonical cleavage sites. These results indicate the differential clinical phenotypes and molecular pathogenesis of Marfan syndrome caused by cysteine mutations in different fibrillin-1 domains. These results strongly suggest that failure to form disulfide bonds and abnormal proteolysis of fibrillin-1 caused by cysteine mutations may be an important factor underlying the pathogenesis of diseases caused by fibrillin-1 mutations, such as Marfan syndrome.
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Affiliation(s)
- Xin Liu
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, Shenzhen, China
| | - Kaiqing Liu
- Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Danyao Nie
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, Shenzhen, China
| | - Jing Zhang
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, Shenzhen, China
| | - Liyun Zhang
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, Shenzhen, China
| | - Xinhua Liu
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, Shenzhen, China
- *Correspondence: Xinhua Liu, ; Jiantao Wang,
| | - Jiantao Wang
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, Shenzhen, China
- *Correspondence: Xinhua Liu, ; Jiantao Wang,
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Femtosecond Laser Combined with Double-Flange Polypropylene Suture Capsular Tension Ring Suspension for the Treatment of Subluxation of Lens in Marfan Syndrome. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9348311. [PMID: 35991146 PMCID: PMC9385373 DOI: 10.1155/2022/9348311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the use of femtosecond laser combined with double-flange polypropylene suture capsular tension ring (CTR) suspension to treat subluxation of lens in Marfan syndrome. The objective is to provide safer and more effective surgical procedures for patients. Setting. Eye Hospital, Aier Eye Hospital of Wuhan University, Wuhan, China Methods In this retrospective study, we observed sixteen patients (16 eyes) with Marfan syndrome who had undergone this operation. Femtosecond laser incision was performed on the anterior capsule with the lens as the center. The suspending CTR was clipped to anterior capsule to support it, which was secured to the sclera with a double-flange polypropylene suture. Uncorrected visual acuity (UCVA), intraocular pressure (IOP), tilt, and decentration of the intraocular lens (IOL) and postoperative complications were evaluated. Results All 16 patients were successfully implanted with suspended CTR and IOL after femtosecond laser assisted surgery. Visual acuity improved significantly after surgery (p < 0.01). At 1 month, 3 months and 6 months postoperatively, the tilt of the IOL was 2.70 ± 0.934, 2.65 ± 0.897, and 2.66 ± 0.781, and the decentration of the IOL was 0.30 ± 0.770, 0.30 ± 0.682, and 0.29 ± 0.737; both had no statistically significant difference between the three groups. After the operation, 4 patients had hyphema and 2 patients experienced a temporary postoperative IOP increase. Only one flange was exposed one month after operation and recovered right after secondary adjustment. Conclusion Femtosecond laser combined with double-flange polypropylene suture CTR suspension was effective in fixing the lens capsule to the scleral wall in cases of subluxation of lens seen in Marfan syndrome during our short-term observation. The long-term efficacy of this operation needs further observation and follow-up.
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Sandvik GF, Rand‐Hendriksen S, Drolsum L, Kristianslund O. Pupillary response in adults with Marfan syndrome and its effect on straylight. Acta Ophthalmol 2021; 100:648-653. [PMID: 34890490 DOI: 10.1111/aos.15079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The main objective of this study was to examine the pupillary response in patients with Marfan syndrome (MFS) and secondarily to determine whether changes in the pupillary response are associated with the increased disability glare previously shown in the same patient population. METHODS This study included 60 eyes of 34 patients with MFS diagnosed in accordance with the Ghent-2 criteria and 81 eyes of 44 controls. Pupillary response was measured with a pupillograph and disability glare with a straylight meter. RESULTS The patients with MFS had a significantly smaller maximum pupil size than the control group, 4.87 (4.50-5.23) mm versus 5.58 (5.25-5.90) mm (p = 0.01). In addition, they exhibited slower contraction velocities (p = 0.03) and longer re-dilation times (p = 0.01) compared with the control group. The mean straylight value was higher in patients with MFS than controls, even when including pupillary parameters together with lens surgery, cataract, iris colour, axial length and corneal curvature as possible explanatory variables in the analysis. However, when including data from both groups, a significant negative correlation was seen between maximum pupillary diameter and straylight value (p = 0.01). The other pupillary parameters did not correlate with straylight. CONCLUSION Patients with MFS had a smaller maximum pupil diameter, slower pupillary contraction and longer re-dilation time than the controls. Despite the correlation between pupil size and straylight value, the pupillary response demonstrated in MFS eyes could not explain the increased straylight in these patients.
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Affiliation(s)
- Gunhild Falleth Sandvik
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Svend Rand‐Hendriksen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- TRS National Resource Centre for Rare Disorders Sunnaas Rehabilitation Hospital Nesodden Norway
| | - Liv Drolsum
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Olav Kristianslund
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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Karamichos D, Escandon P, Vasini B, Nicholas SE, Van L, Dang DH, Cunningham RL, Riaz KM. Anterior pituitary, sex hormones, and keratoconus: Beyond traditional targets. Prog Retin Eye Res 2021; 88:101016. [PMID: 34740824 PMCID: PMC9058044 DOI: 10.1016/j.preteyeres.2021.101016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022]
Abstract
"The Diseases of the Horny-coat of The Eye", known today as keratoconus, is a progressive, multifactorial, non-inflammatory ectatic corneal disorder that is characterized by steepening (bulging) and thinning of the cornea, irregular astigmatism, myopia, and scarring that can cause devastating vision loss. The significant socioeconomic impact of the disease is immeasurable, as patients with keratoconus can have difficulties securing certain jobs or even joining the military. Despite the introduction of corneal crosslinking and improvements in scleral contact lens designs, corneal transplants remain the main surgical intervention for treating keratoconus refractory to medical therapy and visual rehabilitation. To-date, the etiology and pathogenesis of keratoconus remains unclear. Research studies have increased exponentially over the years, highlighting the clinical significance and international interest in this disease. Hormonal imbalances have been linked to keratoconus, both clinically and experimentally, with both sexes affected. However, it is unclear how (molecular/cellular signaling) or when (age/disease stage(s)) those hormones affect the keratoconic cornea. Previous studies have categorized the human cornea as an extragonadal tissue, showing modulation of the gonadotropins, specifically luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Studies herein provide new data (both in vitro and in vivo) to further delineate the role of hormones/gonadotropins in the keratoconus pathobiology, and propose the existence of a new axis named the Hypothalamic-Pituitary-Adrenal-Corneal (HPAC) axis.
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Affiliation(s)
- Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Paulina Escandon
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Brenda Vasini
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Sarah E Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Lyly Van
- University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA; Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Deanna H Dang
- College of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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12
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Chen ZX, Chen TH, Zhang M, Chen JH, Lan LN, Deng M, Zheng JL, Jiang YX. Correlation between FBN1 mutations and ocular features with ectopia lentis in the setting of Marfan syndrome and related fibrillinopathies. Hum Mutat 2021; 42:1637-1647. [PMID: 34550612 DOI: 10.1002/humu.24283] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/07/2021] [Accepted: 09/17/2021] [Indexed: 02/01/2023]
Abstract
Mutations of fibrillin-1 (FBN1) have been associated with Marfan syndrome and pleiotropic connective tissue disorders, collectively termed as "type I fibrillinopathy". However, few genotype-phenotype correlations are known in the ocular system. Patients with congenital ectopia lentis (EL) received panel-based next-generation sequencing, complemented with multiplex ligation-dependent probe amplification. In a total of 125 probands, the ocular phenotypes were compared for different types of FBN1 mutations. Premature termination codons were associated with less severe EL and a thinner central corneal thickness (CCT) than the inframe mutations. The eyes of patients with mutations in the C-terminal region had a higher incidence of posterior staphyloma than those in the middle and N-terminal regions. Mutations in the TGF-β-regulating sequence had larger horizontal corneal diameters (white-to-white [WTW]), higher incidence of posterior staphyloma, but less severe EL than those with mutations in other regions. Mutations in the neonatal region were associated with thinner CCT. Longer axial length (AL) was associated with mutations in the C-terminal region or TGF-β regulating sequence after adjusting for age, EL severity, and corneal curvature radius. FBN1 genotype-phenotype correlations were established for some ocular features, including EL severity, AL, WTW, CCT, and so forth, providing novel perspectives and directions for further mechanistic studies.
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Affiliation(s)
- Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Tian-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Min Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Li-Na Lan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Michael Deng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Lei Zheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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13
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Abstract
Marfan syndrome (MFS) is an autosomal dominant, age-related but highly penetrant condition with substantial intrafamilial and interfamilial variability. MFS is caused by pathogenetic variants in FBN1, which encodes fibrillin-1, a major structural component of the extracellular matrix that provides support to connective tissues, particularly in arteries, the pericondrium and structures in the eye. Up to 25% of individuals with MFS have de novo variants. The most prominent manifestations of MFS are asymptomatic aortic root aneurysms, aortic dissections, dislocation of the ocular lens (ectopia lentis) and skeletal abnormalities that are characterized by overgrowth of the long bones. MFS is diagnosed based on the Ghent II nosology; genetic testing confirming the presence of a FBN1 pathogenetic variant is not always required for diagnosis but can help distinguish MFS from other heritable thoracic aortic disease syndromes that can present with skeletal features similar to those in MFS. Untreated aortic root aneurysms can progress to life-threatening acute aortic dissections. Management of MFS requires medical therapy to slow the rate of growth of aneurysms and decrease the risk of dissection. Routine surveillance with imaging techniques such as transthoracic echocardiography, CT or MRI is necessary to monitor aneurysm growth and determine when to perform prophylactic repair surgery to prevent an acute aortic dissection.
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14
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Lewis PN, Young RD, Souza RB, Quantock AJ, Meek KM. Contrast-Enhanced Tissue Processing of Fibrillin-Rich Elastic Fibres for 3D Visualization by Volume Scanning Electron Microscopy. Methods Protoc 2021; 4:mps4030056. [PMID: 34449675 PMCID: PMC8395850 DOI: 10.3390/mps4030056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022] Open
Abstract
Elastic fibres constitute an important component of the extracellular matrix and currently are the subject of intensive study in order to elucidate their assembly, function and involvement in cell-matrix interactions and disease. However, few studies to date have investigated the 3D architecture of the elastic fibre system in bulk tissue. We describe a protocol for preparation of tissue samples, including primary fixation and backscatter electron contrast-enhancement steps, through dehydration into stable resin-embedded blocks for volume electron microscopy. The use of low molecular weight tannic acid and alcoholic lead staining are critical stages in this procedure. Block preparation by ultramicrotomy and evaporative metal coating prior to microscopical examination are also described. We present images acquired from serial block face scanning electron microscopy of cornea and aorta showing target structures clearly differentiated from cells and other matrix components. The processing method imparts high contrast to fibrillin-containing elastic fibres, thus facilitating their segmentation and rendering into 3D reconstructions by image analysis software from large serial image datasets.
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Affiliation(s)
- Philip N. Lewis
- Structural Biophysics Research Group, School of Optometry & Vision Sciences, Cardiff University, Cardiff CF24 4HQ, UK; (R.D.Y.); (A.J.Q.); (K.M.M.)
- Correspondence:
| | - Robert D. Young
- Structural Biophysics Research Group, School of Optometry & Vision Sciences, Cardiff University, Cardiff CF24 4HQ, UK; (R.D.Y.); (A.J.Q.); (K.M.M.)
| | - R. B. Souza
- Department of Genetics and Evolutionary Biology, University of São Paulo, Rua de Matão 05508-090, Brazil;
| | - Andrew J. Quantock
- Structural Biophysics Research Group, School of Optometry & Vision Sciences, Cardiff University, Cardiff CF24 4HQ, UK; (R.D.Y.); (A.J.Q.); (K.M.M.)
| | - Keith M. Meek
- Structural Biophysics Research Group, School of Optometry & Vision Sciences, Cardiff University, Cardiff CF24 4HQ, UK; (R.D.Y.); (A.J.Q.); (K.M.M.)
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15
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Tack M, Kreps EO, De Zaeytijd J, Consejo A. Scheimpflug-Based Analysis of the Reflectivity of the Cornea in Marfan Syndrome. Transl Vis Sci Technol 2021; 10:34. [PMID: 34448821 PMCID: PMC8399399 DOI: 10.1167/tvst.10.9.34] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose We sought to investigate corneal reflectivity in Marfan syndrome (MFS) on the basis of Scheimpflug light intensity distribution. Methods In a retrospective case-control analysis, the left eyes of 40 MFS patients and 40 age- and refraction-matched healthy controls were investigated. Patients with MFS meeting the Ghent II diagnostic criteria and with genetic confirmation of disease were included. Exclusion criteria were the following: coexisting corneal, conjunctival, or scleral pathology; use of medication known to affect corneal transparency; history of ocular surgery; and insufficient data. Scheimpflug tomography images were exported to analyze corneal transparency in different corneal layers and regions. Each corneal image was automatically segmented, after which the corresponding pixel intensities in the defined regions of interest were statistically modeled using a Weibull probability density function from which parameters α (transparency) and β (homogeneity) were derived. Results The cornea in MFS showed significantly higher light reflectivity (overall cornea, α = 71 ± 17 arbitrary units (a.u.)) than in the control group (overall cornea, α = 59 ± 15 a.u.) (t test, P = 0.003). The α parameter was significantly higher in MFS eyes in all examined layers and regions (P < 0.05), whereas the β parameter showed no statistical difference between MFS and controls (P > 0.05). The difference in α did not correlate with ocular biometric properties (corneal thickness and curvature) or ectopia lentis (P > 0.05). Conclusions The cornea in MFS shows significantly higher reflectivity than healthy controls with similar levels of homogeneity. Translational Relevance The proposed methodology detects corneal reflectivity changes in MFS not available from regular slit-lamp examination.
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Affiliation(s)
- Michèle Tack
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Elke O Kreps
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medical Sciences, Ghent University, Ghent, Belgium.,Faculty of Medical Sciences, Antwerp University, Antwerp, Belgium
| | - Julie De Zaeytijd
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medical Sciences, Ghent University, Ghent, Belgium
| | - Alejandra Consejo
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain.,Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland
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16
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Meng X, Cao X, Jia Y, Pan J, Du Y, Li X. Sutured scleral fixation of posterior chamber intraocular lens in children under the age of 9 with congenital ectopia lentis. Ophthalmic Res 2021; 64:837-843. [PMID: 34247162 DOI: 10.1159/000516324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/28/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Xuyun Meng
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xi Cao
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yiyue Jia
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianhui Pan
- Department of Ophthalmology, Guiping City People's Hospital, Guiping, China
| | - Yi Du
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xia Li
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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17
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Vanhonsebrouck E, Consejo A, Coucke PJ, Leroy BP, Kreps EO. The corneoscleral shape in Marfan syndrome. Acta Ophthalmol 2021; 99:405-410. [PMID: 32996688 DOI: 10.1111/aos.14636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/07/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the corneoscleral shape in Marfan syndrome (MFS) patients. METHODS Thirty eyes of 15 participants with molecularly proven MFS were included in this prospective, cross-sectional study. Optical biometry, Scheimpflug imaging, and corneoscleral topography (Eye Surface Profiler) were performed in all patients. Topographic data were compared to data from controls (25 emmetropes and 17 myopes). The raw three-dimensional anterior height data from MFS eyes and control eyes were exported for further analysis. Custom-made software was used to demarcate the limbal radius and to calculate the sagittal height in different concentric annuli centred at the corneal apex, placed in a pupil plane, for the central cornea (0-4 mm radius), peripheral cornea (4-6 mm radius) and sclera (6-8 mm radius) and the corneoscleral asymmetry. RESULTS Marfan syndrome (MFS) eyes had significantly lower values of mean sagittal height compared to non-MFS eyes in all three annuli (central cornea, corneal periphery and sclera (independent t-test, p < 0.01 except for the inferior area of the scleral radius: p > 0.05). The sclera was significantly more asymmetric in MFS eyes compared to myopes (independent t-test, p < 0.01 for both eyes), but similar to emmetropes (independent t-test, p = 0.17 and p = 0.93 for right and left eyes, respectively). In MFS eyes, scleral asymmetry was not found to be correlated with axial length (Pearson correlation coefficient, r < 0.30, p > 0.05). CONCLUSION The peripheral cornea and sclera of Marfan syndrome patients have a significantly different shape compared to healthy controls.
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Affiliation(s)
| | - Alejandra Consejo
- Institute of Physical Chemistry Polish Academy of Sciences Warsaw Poland
| | - Paul J. Coucke
- Center for Medical Genetics Ghent University Hospital Ghent Belgium
| | - Bart P. Leroy
- Department of Ophthalmology Ghent University Hospital Ghent Belgium
- Center for Medical Genetics Ghent University Hospital Ghent Belgium
- Division of Ophthalmology & Center for Cellular & Molecular Therapeutics Children’s Hospital of Philadelphia Philadelphia USA
| | - Elke O. Kreps
- Department of Ophthalmology Ghent University Hospital Ghent Belgium
- Faculty of Medical Sciences Antwerp University Antwerp Belgium
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18
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Singh B, Sharma S, Dadia S, Bharti N, Bharti S. Bilateral Toric Phakic Intraocular Lens Implantation for Correction of High Myopic Astigmatism in a Patient with Marfan Syndrome with Lens Coloboma: A Case Report. Case Rep Ophthalmol 2021; 12:208-213. [PMID: 33976684 PMCID: PMC8077456 DOI: 10.1159/000513345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
Marfan syndrome (MFS) is known to cause significant refractive error. Treatment options are limited in this condition for correcting refractive error. Clear lens exchange is done in these cases, but complication rates are high. Loss of accommodation is another concern in these young adults. We report toric phakic intraocular lens (pIOL) implantation in improving the uncorrected visual acuity (UCVA) in a known case of MFS with lens coloboma. A 22-year-old female patient with MFS with inferior lens coloboma underwent bilateral toric pIOL implantation in the same sitting. Pre- and post-operative UCVA and best-corrected visual acuity were assessed. Central and peripheral vaulting of the pIOL in relation to the natural lens was also assessed. UCVA improved from 20/500 to 20/20 in the right and 20/550–20/20 in the left eye. Marked central vaulting with partial peripheral vaulting was achieved. There were no post-operative complications. Phakic IOL implantation surgery could be an effective approach to achieve excellent uncorrected refractive outcome in patients with MFS to treat high myopia.
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Affiliation(s)
- Bhupesh Singh
- Bharti Eye Foundation and Hospital, New Delhi, India
| | | | - Suchit Dadia
- Bharti Eye Foundation and Hospital, New Delhi, India
| | - Neha Bharti
- Bharti Eye Foundation and Hospital, New Delhi, India
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19
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DeDreu J, Walker JL, Menko AS. Dynamics of the lens basement membrane capsule and its interaction with connective tissue-like extracapsular matrix proteins. Matrix Biol 2021; 96:18-46. [PMID: 33383103 PMCID: PMC7902460 DOI: 10.1016/j.matbio.2020.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 12/11/2022]
Abstract
The lens, suspended in the middle of the eye by tendon-like ciliary zonule fibers and facing three different compartments of the eye, is enclosed in what has been described as the thickest basement membrane in the body. While the protein components of the capsule have been a subject of study for many years, the dynamics of capsule formation, and the region-specific relationship of its basement membrane components to one another as well as to other matrix molecules remains to be explored. Through high resolution confocal and super-resolution imaging of the lens capsule and 3D surface renderings of acquired z-stacks, our studies revealed that each of its basement membrane proteins, laminin, collagen IV, nidogen and perlecan, has unique structure, organization, and distribution specific both to the region of the lens that the capsule is located in and the position of the capsule within the eye. We provide evidence of basal membrane gradients across the depth of the capsule as well as the synthesis of distinct basement membrane lamella within the capsule. These distinctions are most prominent in the equatorial capsule zone where collagen IV and nidogen span the capsule depth, while laminin and perlecan are located in two separate lamellae located at the innermost and outermost capsule domains. We discovered that an extracapsular matrix compartment rich in the connective tissue-like matrix molecules fibronectin, tenascin-C, and fibrillin is integrated with the superficial surface of the lens capsule. Each matrix protein in this extracapsular zone also exhibits region-specific distribution with fibrils of fibrillin, the matrix protein that forms the backbone of the ciliary zonules, inserting within the laminin/perlecan lamella at the surface of the equatorial lens capsule.
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Affiliation(s)
- JodiRae DeDreu
- Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 564 Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107, United States.
| | - Janice L Walker
- Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 564 Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107, United States.
| | - A Sue Menko
- Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 564 Jefferson Alumni Hall, 1020 Locust Street, Philadelphia, PA 19107, United States.
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20
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Oikawa K, Teixeira LBC, Keikhosravi A, Eliceiri KW, McLellan GJ. Microstructure and resident cell-types of the feline optic nerve head resemble that of humans. Exp Eye Res 2020; 202:108315. [PMID: 33091431 DOI: 10.1016/j.exer.2020.108315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 01/15/2023]
Abstract
The lamina cribrosa (LC) region of the optic nerve head (ONH) is considered a primary site for glaucomatous damage. In humans, biology of this region reflects complex interactions between retinal ganglion cell (RGC) axons and other resident ONH cell-types including astrocytes, lamina cribrosa cells, microglia and oligodendrocytes, as well as ONH microvasculature and collagenous LC beams. However, species differences in the microanatomy of this region could profoundly impact efforts to model glaucoma pathobiology in a research setting. In this study, we characterized resident cell-types, ECM composition and ultrastructure in relation to microanatomy of the ONH in adult domestic cats (Felis catus). Longitudinal and transverse cryosections of ONH tissues were immunolabeled with astrocyte, microglia/macrophage, oligodendrocyte, LC cell and vascular endothelial cell markers. Collagen fiber structure of the LC was visualized by second harmonic generation (SHG) with multiphoton microscopy. Fibrous astrocytes form glial fibrillary acidic protein (GFAP)-positive glial columns in the pre-laminar region, and cover the collagenous plates of the LC region in lamellae oriented perpendicular to the axons. GFAP-negative and alpha-smooth muscle actin-positive LC cells were identified in the feline ONH. IBA-1 positive immune cells and von Willebrand factor-positive blood vessel endothelial cells are also identifiable throughout the feline ONH. As in humans, myelination commences with a population of oligodendrocytes in the retro-laminar region of the feline ONH. Transmission electron microscopy confirmed the presence of capillaries and LC cells that extend thin processes in the core of the collagenous LC beams. In conclusion, the feline ONH closely recapitulates the complexity of the ONH of humans and non-human primates, with diverse ONH cell-types and a robust collagenous LC, within the beams of which, LC cells and capillaries reside. Thus, studies in a feline inherited glaucoma model have the potential to play a key role in enhancing our understanding of ONH cellular and molecular processes in glaucomatous optic neuropathy.
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Affiliation(s)
- Kazuya Oikawa
- Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA; Surgical Sciences, University of Wisconsin-Madison, WI, USA; McPherson Eye Research Institute, Madison, WI, USA
| | - Leandro B C Teixeira
- McPherson Eye Research Institute, Madison, WI, USA; Pathobiological Sciences, University of Wisconsin-Madison, WI, USA
| | - Adib Keikhosravi
- Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin W Eliceiri
- McPherson Eye Research Institute, Madison, WI, USA; Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Gillian J McLellan
- Ophthalmology & Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA; Surgical Sciences, University of Wisconsin-Madison, WI, USA; McPherson Eye Research Institute, Madison, WI, USA.
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21
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Abstract
The Zonule of Zinn, or ciliary zonule, is the elaborate system of extracellular fibers that centers the lens in the eye. In humans, the fibers transmit forces that flatten the lens during the process of disaccommodation, thereby bringing distant objects into focus. Zonular fibers are composed almost entirely of 10-12 nm-wide microfibrils, of which polymerized fibrillin is the most abundant component. The thickest fibers have a fascicular organization, where hundreds or thousands of microfibrils are gathered into micrometer-wide bundles. Many such bundles are aggregated to form a fiber. Dozens of proteins comprise the zonule. Most are derived from cells of the non-pigmented ciliary epithelium in the pars plana region, although some are probably contributed by the lens and perhaps other tissues of the anterior segment. Zonular fibers are viscoelastic cables but their component microfibrils are rather stiff structures. Thus, the elastic properties of the fibers likely stem from lateral interactions between microfibrils. Rupture of zonular fibers and subsequent lens dislocation (ectopia lentis) can result from blunt force trauma or be a sequela of other eye diseases, notably exfoliation syndrome. Ectopia lentis is also a feature of syndromic conditions caused typically by mutations in microfibril-associated genes. The resulting ocular phenotypes raise the possibility that the zonule regulates lens size and shape, globe size, and even corneal topology, in addition to its well-recognized role in accommodation.
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Affiliation(s)
- Steven Bassnett
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8096, St. Louis, MO 63110, USA.
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22
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Satz-Jacobowitz B, Hubmacher D. The quest for substrates and binding partners: A critical barrier for understanding the role of ADAMTS proteases in musculoskeletal development and disease. Dev Dyn 2020; 250:8-26. [PMID: 32875613 DOI: 10.1002/dvdy.248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/16/2022] Open
Abstract
Secreted ADAMTS metalloproteases are involved in the sculpting, remodeling, and erosion of connective tissues throughout the body, including in the musculoskeletal system. ADAMTS proteases contribute to musculoskeletal development, pathological tissue destruction, and are mutated in congenital musculoskeletal disorders. Examples include versican cleavage by ADAMTS9 which is required for interdigital web regression during limb development, ADAMTS5-mediated aggrecan degradation in osteoarthritis resulting in joint erosion, and mutations in ADAMTS10 or ADAMTS17 that cause Weill-Marchesani syndrome, a short stature syndrome with bone, joint, muscle, cardiac, and eye involvement. Since the function of ADAMTS proteases and proteases in general is primarily defined by the molecular consequences of proteolysis of their respective substrates, it is paramount to identify all physiological substrates for each individual ADAMTS protease. Here, we review the current knowledge of ADAMTS proteases and their involvement in musculoskeletal development and disease, focusing on some of their known physiological substrates and the consequences of substrate cleavage. We further emphasize the critical need for the identification and validation of novel ADAMTS substrates and binding partners by describing the principles of mass spectrometry-based approaches and by emphasizing strategies that need to be considered for validating the physiological relevance for ADAMTS-mediated proteolysis of novel putative substrates.
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Affiliation(s)
- Brandon Satz-Jacobowitz
- Orthopedic Research Laboratories, Leni & Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dirk Hubmacher
- Orthopedic Research Laboratories, Leni & Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kumar A, Narde H, Agarwal D, Rani D, Sonkar R. A rare association of optic disc pit maculopathy and ectopia lentis. Indian J Ophthalmol 2020; 68:2229-2230. [PMID: 32971655 PMCID: PMC7727934 DOI: 10.4103/ijo.ijo_1707_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Areaux RG, Grajewski AL. Pigment dispersion syndrome and response to laser peripheral iridotomies in a child with Marfan syndrome. J AAPOS 2019; 23:300-302. [PMID: 31513900 DOI: 10.1016/j.jaapos.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 11/24/2022]
Abstract
Pigment dispersion syndrome (PDS) and pigmentary glaucoma have rarely been reported in Marfan syndrome and have never been reported in a child with Marfan syndrome. We report the clinical and ultrasound biomicroscopic findings of PDS in a 14-year-old girl with Marfan syndrome and its favorable response to bilateral laser peripheral iridotomy.
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Affiliation(s)
- Raymond G Areaux
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis.
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25
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Sandvik GF, Vanem TT, Rand-Hendriksen S, Cholidis S, Saethre M, Drolsum L. Ten-year reinvestigation of ocular manifestations in Marfan syndrome. Clin Exp Ophthalmol 2018; 47:212-218. [PMID: 30260057 DOI: 10.1111/ceo.13408] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/03/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Long-term follow-up of Marfan syndrome (MFS) patients. BACKGROUND Investigate changes in ocular features in MFS patients fulfilling the Ghent-2 criteria following a period of 10 years. DESIGN Repeated cross-sectional study with two observations. PARTICIPANTS Eighty-four MFS patients were investigated in 2003-2004 (baseline). Forty-four of these patients (52%) were examined after 10 years. METHODS A comprehensive ocular examination performed at baseline and follow-up. MAIN OUTCOME MEASURES Development or progression of ectopia lentis (EL). RESULTS At follow-up, mean age was 50.1 ± 11.9 years (range: 30-80 years), 74% were female and 70% of the patients were diagnosed with EL compared to 66% at baseline. Two patients (3 eyes) had developed EL over the decade, representing a 13% risk. Furthermore, one eye had progressed from a subtle tilt of the lens to dislocation. We found no significant change in the axial length (P = 0.96), the corneal curvature (P = 0.64) or the spherical equivalent (P = 0.23). Best corrected visual acuity was improved at follow-up (P = 0.02). There were 7% and 33% risks for development of retinal detachment and cataract between baseline and follow-up, respectively. CONCLUSIONS AND RELEVANCE Our study indicates that even though EL typically occurs at an early stage in most MFS patients, there is still a risk of developing EL in adulthood. The risk of developing vision-threatening complications such as retinal detachment and cataract was much higher than in the normal population, but even so, the visual potential of the MFS patients was relatively good.
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Affiliation(s)
- Gunhild F Sandvik
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thy T Vanem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svend Rand-Hendriksen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Symira Cholidis
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Marit Saethre
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Enlarged Optic Nerve Axons and Reduced Visual Function in Mice with Defective Microfibrils. eNeuro 2018; 5:eN-NWR-0260-18. [PMID: 30406200 PMCID: PMC6220594 DOI: 10.1523/eneuro.0260-18.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/13/2018] [Indexed: 01/13/2023] Open
Abstract
Glaucoma is a leading cause of irreversible vision loss due to retinal ganglion cell (RGC) degeneration that develops slowly with age. Elevated intraocular pressure (IOP) is a significant risk factor, although many patients develop glaucoma with IOP in the normal range. Mutations in microfibril-associated genes cause glaucoma in animal models, suggesting the hypothesis that microfibril defects contribute to glaucoma. To test this hypothesis, we investigated IOP and functional/structural correlates of RGC degeneration in mice of either sex with abnormal microfibrils due to heterozygous Tsk mutation of the fibrilin-1 gene (Fbn1Tsk/+). Although IOP was not affected, Fbn1Tsk/+ mice developed functional deficits at advanced age consistent with glaucoma, including reduced RGC responses in electroretinogram (ERG) experiments. While RGC density in the retina was not affected, the density of RGC axons in the optic nerve was significantly reduced in Fbn1Tsk/+ mice. However, reduced axon density correlated with expanded optic nerves, resulting in similar numbers of axons in Fbn1Tsk/+ and control nerves. Axons in the optic nerves of Fbn1Tsk/+ mice were significantly enlarged and axon diameter was strongly correlated with optic nerve area, as has been reported in early pathogenesis of the DBA/2J mouse model of glaucoma. Our results suggest that microfibril abnormalities can lead to phenotypes found in early-stage glaucomatous neurodegeneration. Thinning of the elastic fiber-rich pia mater was found in Fbn1Tsk/+ mice, suggesting mechanisms allowing for optic nerve expansion and a possible biomechanical contribution to determination of axon caliber.
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Gan NY, Lam WC. Retinal detachments in the pediatric population. Taiwan J Ophthalmol 2018; 8:222-236. [PMID: 30637194 PMCID: PMC6302562 DOI: 10.4103/tjo.tjo_104_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
In this review, we present a concise summary of the more commonly seen types of retinal detachments (RDs) that one can encounter in pediatric patients. A spectrum of diseases from rhegmatogenous RD in Stickler syndrome, Marfan syndrome, and choroidal coloboma to exudative RD in Coats disease, to tractional RD in persistent fetal vasculature, and combined RDs in familial exudative vitreoretinopathy are described with the management pearls for each.
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Affiliation(s)
- Nicola Yi'an Gan
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Wai-Ching Lam
- Department of Ophthalmology, The University of Hong Kong, Hong Kong
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
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Guo C, Wu N, Niu X, Wu Y, Chen D, Guo W. Comparison of T Helper Cell Patterns in Primary Open-Angle Glaucoma and Normal-Pressure Glaucoma. Med Sci Monit 2018; 24:1988-1996. [PMID: 29616680 PMCID: PMC5900463 DOI: 10.12659/msm.904923] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND HSP60-related immunological activities are found in normal-pressure glaucoma (NPG) patients, in whom an elevated intraocular pressure (IOP) found in primary open-angle glaucoma (POAG) is not observed. HSP60 was found in POAG and NPG patients, while anti-HSP60 level was mainly found to be higher in NPG patients. The purpose of this study was to compare the percentages of Th cells and levels of related cytokines, attempting to provide evidence to explain this discrepancy. MATERIAL AND METHODS Blood samples from POAG, NPG, and normal control (NC) groups were collected and peripheral blood monocytes were isolated and cultured with or without the stimulation of HSP60. Flow cytometry and enzyme-linked immunosorbent assay were used to assess the percentages of Th1, Th2, Th17, and Treg cells, as well as HSP60 antibody levels and related cytokine levels, before and after culture. RESULTS Significantly higher titers of anti-HSP60 were observed only in NPG patients. Comparable Th1 and Th2 cell frequencies, IL-4 level, and IFN-γ level were found in POAG and NPG patients, while higher Treg cell frequency was only found in POAG patients. After culturing with HSP60, increased Th2 frequencies and decreased Th1 frequencies were observed in the POAG, NPG, and NC groups, while increased Treg frequency was only identified in the POAG and NC groups. CONCLUSIONS Different Th cell patterns were observed among POAG, NPG, and NC groups. Lack of induction of Treg cells and imbalance of the pro-inflammatory and anti-inflammatory response patterns of Th cells exist in some NPG patients.
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Affiliation(s)
- Chunyu Guo
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (mainland)
| | - Ningbo Wu
- Shanghai Institute of Immunology, Shanghai JiaoTong University School of Medicine, Shanghai, China (mainland)
| | - Xiaoyin Niu
- Shanghai Institute of Immunology, Shanghai JiaoTong University School of Medicine, Shanghai, China (mainland)
| | - Yue Wu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (mainland)
| | - Dongfeng Chen
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
| | - Wenyi Guo
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (mainland)
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Scheibenberger D, Frings A, Steinberg J, Schüler H, Druchkiv V, Katz T, von Kodolitsch Y, Linke S. Ocular manifestation in Marfan syndrome: corneal biomechanical properties relate to increased systemic score points. Graefes Arch Clin Exp Ophthalmol 2018. [DOI: 10.1007/s00417-018-3946-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gehle P, Goergen B, Pilger D, Ruokonen P, Robinson PN, Salchow DJ. Biometric and structural ocular manifestations of Marfan syndrome. PLoS One 2017; 12:e0183370. [PMID: 28931008 PMCID: PMC5607136 DOI: 10.1371/journal.pone.0183370] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background To study biometric and structural ocular manifestations of Marfan syndrome (MFS). Methods Observational, retrospective, comparative cohort study in a tertiary referral center on 285 MFS patients and 267 controls. Structural and biometric ocular characteristic were compared. Results MFS eyes were longer (axial length 24.25 ± 1.74 mm versus 23.89 ± 1.31 mm, p < 0.001) and had a flatter cornea than control eyes (mean keratometry 41.78 ± 1.80 diopters (D) versus 43.05 ± 1.51 D, p < 0.001). Corneal astigmatism was greater and the central cornea was thinner in MFS eyes (530.14 ± 41.31 μm versus 547.02 ± 39.18 μm, p < 0.001). MFS eyes were more myopic than control eyes (spherical equivalent -2.16 ± 3.75 D versus -1.17 ± 2.58 D, p < 0.001). Visual acuity was reduced (0.13 ± 0.25 logMAR versus 0.05 ± 0.18 logMAR, p < 0.001) and intraocular pressure was lower in MFS eyes (14.6 ± 3.4 mmHg versus 15.1 ± 3.2 mmHg, p = 0.01). Iris transillumination defects (ITD) were significantly more common in MFS eyes (odds ratio for MFS in the presence of ITD, 3.7). Ectopia lentis (EL) was only present in MFS eyes (33.4%). History of retinal detachment was significantly more common in MFS eyes. Glaucoma was equally common in both groups. Conclusions ITD and EL are most characteristic findings in MFS. ITD and corneal curvature should be studied as diagnostic criteria for MFS. Visual acuity is reduced in MFS. MFS patients need regular eye exams to identify serious ocular complications.
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Affiliation(s)
- Petra Gehle
- Department of Cardiology, Charité –University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Barbara Goergen
- Department of Ophthalmology, Charité –University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Charité –University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany
| | | | - Peter N. Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, United States of America
| | - Daniel J. Salchow
- Department of Ophthalmology, Charité –University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany
- * E-mail:
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White TL, Lewis P, Hayes S, Fergusson J, Bell J, Farinha L, White NS, Pereira LV, Meek KM. The Structural Role of Elastic Fibers in the Cornea Investigated Using a Mouse Model for Marfan Syndrome. Invest Ophthalmol Vis Sci 2017; 58:2106-2116. [PMID: 28395026 PMCID: PMC5695733 DOI: 10.1167/iovs.16-21358] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose The presence of fibrillin-rich elastic fibers in the cornea has been overlooked in recent years. The aim of the current study was to elucidate their functional role using a mouse model for Marfan syndrome, defective in fibrillin-1, the major structural component of the microfibril bundles that constitute most of the elastic fibers. Methods Mouse corneas were obtained from animals with a heterozygous fibrillin-1 mutation (Fbn1+/-) and compared to wild type controls. Corneal thickness and radius of curvature were calculated using optical coherence tomography microscopy. Elastic microfibril bundles were quantified and visualized in three-dimensions using serial block face scanning electron microscopy. Transmission electron microscopy was used to analyze stromal ultrastructure and proteoglycan distribution. Center-to-center average interfibrillar spacing was determined using x-ray scattering. Results Fbn1+/- corneas were significantly thinner than wild types and displayed a higher radius of curvature. In the Fbn1+/- corneas, elastic microfibril bundles were significantly reduced in density and disorganized compared to wild-type controls, in addition to containing a higher average center-to-center collagen interfibrillar spacing in the center of the cornea. No other differences were detected in stromal ultrastructure or proteoglycan distribution between the two groups. Proteoglycan side chains appeared to colocalize with the microfibril bundles. Conclusions Elastic fibers have an important, multifunctional role in the cornea as highlighted by the differences observed between Fbn1+/- and wild type animals. We contend that the presence of normal quantities of structurally organized elastic fibers are required to maintain the correct geometry of the cornea, which is disrupted in Marfan syndrome.
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Affiliation(s)
- Tomas L White
- Structural Biophysics Research Group, School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, United Kingdom
| | - Philip Lewis
- Structural Biophysics Research Group, School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, United Kingdom
| | - Sally Hayes
- Structural Biophysics Research Group, School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, United Kingdom
| | - James Fergusson
- Vision Science Bioimaging Labs, School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - James Bell
- Structural Biophysics Research Group, School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, United Kingdom
| | - Luis Farinha
- Department of Genetics and Evolutionary Biology, University of São Paulo, Rua do Matão, São Paulo, Brazil
| | - Nick S White
- Vision Science Bioimaging Labs, School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Lygia V Pereira
- Department of Genetics and Evolutionary Biology, University of São Paulo, Rua do Matão, São Paulo, Brazil
| | - Keith M Meek
- Structural Biophysics Research Group, School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, United Kingdom
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Biometry Characteristics in Adults and Children With Marfan Syndrome: From the Marfan Eye Consortium of Chicago. Am J Ophthalmol 2017; 177:144-149. [PMID: 28257833 DOI: 10.1016/j.ajo.2017.02.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE To report on the biometric findings of adults and children with Marfan syndrome (MFS) recruited from 2 annual National Marfan Foundation conferences (2012 and 2015). DESIGN Cross-sectional study. METHODS Subjects diagnosed with MFS by Ghent 2 nosology were included for analysis. Subjects were divided into "adults" (≥16 years of age) and "children" (5-15 years of age). Biometric data included values for refractive error, axial length (AL), corneal curvature, anterior chamber depth, lens thickness, and central corneal thickness. RESULTS Of the 117 subjects evaluated, 74 (35 adults, 32 children, and 7 children <5 years of age) had a definite diagnosis of MFS and were included in the study. The AL was longer (25.25 ± 0.32 mm vs 24.24 ± 0.33 mm, P = .03) and the lens was thicker (3.94 ± 0.09 mm vs 3.62 ± 0.10 mm, P = .03) in adults. Both groups had flat corneas (average keratometry [Kmed] of 41.59 ± 0.35 diopters [D] in adults vs 40.89 ± 0.36 D in children, P = .17). A negative correlation was found between AL and Kmed (-0.33, P < .001). The corneas of patients with MFS with ectopia lentis (EL) were significantly flatter and with higher degree of corneal astigmatism compared to patients without EL (Kmed of 40.68 ± 0.31 D vs 41.75 ± 0.28 D, P < .01 and corneal astigmatism of 1.68 ± 0.16 D vs 1.13 ± 0.14 D, P = .01). CONCLUSIONS Children with established MFS have flat corneas at least to the same degree as adults. Corneas of patients with MFS with EL are flatter and have a higher degree of corneal astigmatism. We strongly suggest that corneal parameters should be measured if MFS is suspected, especially in children that may not yet have developed EL.
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Xu W, Kurup SP, Fawzi AA, Durbin MK, Maumenee IH, Mets MB. Comparative data on SD-OCT for the retinal nerve fiber layer and retinal macular thickness in a large cohort with Marfan syndrome. Ophthalmic Genet 2017; 38:34-38. [PMID: 28095089 DOI: 10.1080/13816810.2016.1275017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the distribution of macular and optic nerve topography in the eyes of individuals with Marfan syndrome aged 8-56 years using spectral domain optical coherence tomography (SD-OCT). METHODS Thirty-three patients with Marfan syndrome underwent a full eye examination including slit-lamp biomicroscopy, indirect ophthalmoscopy, and axial length measurement; and SD-OCT measurements of the retinal nerve fiber layer (RNFL) and macular thickness. RESULTS For patients between the ages of 8 and 12 years, the average RNFL thickness is 98 ± 9 μm, the vertical cup to disc (C:D) ratio is 0.50 ± 0.10, the central subfield thickness (CST) is 274 ± 38 μm, and the macular volume is 10.3 ± 0.6 mm3. For patients between the ages of 13 and 17 years, the average RNFL is 86 ± 16 μm, the vertical C:D ratio is 0.35 ± 0.20, the CST is 259 ± 15 μm, and the macular volume is 10.1 ± 0.5 mm3. For patients 18 years or older, the average RNFL is 89 ± 12 μm, the vertical C:D ratio is 0.46 ± 0.18, the CST is 262 ± 20 μm, and the macular volume is 10.2 ± 0.4 mm3. When the average RNFL data are compared to a normative, age-adjusted database, 6 of 33 (18%) were thinner than the 5% limit. CONCLUSION This study reports the distribution of SD-OCT data for patients with Marfan syndrome. Compared to a normative database, 18% of eyes with Marfan syndrome had RNFL thickness < 5% of the population.
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Affiliation(s)
- WanWan Xu
- a Department of Ophthalmology , Northwestern University , Chicago , Illinois , USA.,b Division of Ophthalmology , Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , Illinois , USA
| | - Sudhi P Kurup
- a Department of Ophthalmology , Northwestern University , Chicago , Illinois , USA.,b Division of Ophthalmology , Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , Illinois , USA
| | - Amani A Fawzi
- a Department of Ophthalmology , Northwestern University , Chicago , Illinois , USA
| | - Mary K Durbin
- c Carl Zeiss Meditec, Inc ., Dublin , California , USA
| | - Irene H Maumenee
- d Department of Ophthalmology and Visual Sciences , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Marilyn B Mets
- a Department of Ophthalmology , Northwestern University , Chicago , Illinois , USA.,b Division of Ophthalmology , Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , Illinois , USA
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Abstract
In many health-related fields, there is great interest in the identification of biomarkers that distinguish diseased from healthy individuals. In addition to identifying the diseased state, biomarkers have potential use in predicting disease risk, monitoring disease progression, evaluating treatment efficacy, and informing pathogenesis. This review details the genetic and biochemical markers associated with canine primary glaucoma. While there are numerous molecular markers (biochemical and genetic) associated with glaucoma in dogs, there is no ideal biomarker that allows early diagnosis and/or identification of disease progression. Genetic mutations associated with canine glaucoma include those affecting ADAMTS10, ADAMTS17, Myocilin, Nebulin, COL1A2, RAB22A, and SRBD1. With the exception of Myocilin, there is very limited crossover in genetic biomarkers identified between human and canine glaucomas. Mutations associated with canine glaucoma vary between and within canine breeds, and gene discoveries therefore have limited overall effects as a screening tool in the general canine population. Biochemical markers of glaucoma include indicators of inflammation, oxidative stress, serum autoantibodies, matrix metalloproteinases, tumor necrosis factor–α, and transforming growth factor–β. These markers include those that indicate an adaptive or protective response, as well as those that reflect the damage arising from oxidative stress.
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Affiliation(s)
- K. L. Graham
- Department of Ophthalmology and Eye Health, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - C. McCowan
- Department of Pathology, Faculty of Veterinary Science, University of Melbourne, Parkville, Australia
- Department of Economic Development, Jobs, Transport and Resources, Victoria, Australia
| | - A. White
- Department of Ophthalmology and Eye Health, Sydney Medical School, University of Sydney, New South Wales, Australia
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Sridhar J, Chang JS, Aziz HA, Erickson BP. Delayed sclerotomy wound dehiscence after lensectomy and vitrectomy in Marfan syndrome. Oman J Ophthalmol 2016; 8:198-9. [PMID: 26903732 PMCID: PMC4738671 DOI: 10.4103/0974-620x.169893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Marfan syndrome (MFS) is associated with abnormal fibrillin development that can cause morbidity and mortality. A case of acute onset hypotony due to sclerotomy wound dehiscence 13 years after 20-gauge pars plana vitrectomy and lensectomy is reported in a patient with MFS. Slit lamp examination revealed a leaking sclerotomy wound and intraoperatively the source was noted to be the prior sclerotomy site. On postoperative follow-up, the patient's vision returned to baseline, and intraocular pressure normalized. Twenty-gauge sclerotomy wound dehiscence may occur years after surgery, especially in patients with abnormal collagen as in MFS.
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Affiliation(s)
- Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan S Chang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hassan A Aziz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Benjamin P Erickson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Shah R, Weikert MP, Grannis C, Hamill MB, Kong L, Yen KG. Long-Term Outcomes of Iris-sutured Posterior Chamber Intraocular Lenses in Children. Am J Ophthalmol 2016; 161:44-9.e1. [PMID: 26429583 DOI: 10.1016/j.ajo.2015.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To report the long-term outcomes and complications of iris-sutured posterior chamber intraocular lenses (PCIOLs) in the pediatric population. DESIGN Retrospective interventional case study. METHODS This study involved 12 consecutive pediatric patients (17 eyes) who underwent placement of foldable iris-sutured PCIOLs between September 2004 and September 2007. Outcome measures included change in visual acuity and complications. RESULTS Of the 17 eyes were reviewed, 6 (35%) had hereditary or idiopathic ectopia lentis, 5 (29%) had Marfan syndrome, 2 (12%) were aphakic after pars plana vitrectomy and 4 (24%) were aphakic after surgical intervention for trauma. Average follow-up was 4.69 ± 3.21 years and mean age of surgery was 7.21 ± 3.78 years. Seven eyes suffered dislocation of the PCIOL an average of 12.11 ± 11.97 months after surgery, with 2 patients undergoing dislocation a second time. There was a higher rate of dislocation in patients with a history of ectopia lentis due to Marfan syndrome, idiopathic causes, or hereditary causes than in patients being treated for aphakia resulting from other causes (71% vs 29%). Mean visual acuity improved in 12 of 17 patients (71%), from 0.80 ± 0.6 logMAR preoperatively to 0.35 ± 0.5 logMAR at most recent visit, P = .009. One eye of a Marfan patient sustained a retinal detachment 8 months after dislocation of the PCIOL, and 1 patient experienced iris capture of the PCIOL after surgery. CONCLUSIONS Iris-sutured intraocular lenses have been used as an alternative to transsclerally sutured intraocular lenses to correct aphakia in pediatric patients. Dislocation of the intraocular lenses can occur frequently, however. The procedure should be considered with caution in pediatric patients.
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Affiliation(s)
- Ravi Shah
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | | | - Charity Grannis
- Department of Ophthalmology and Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Marshall B Hamill
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Lingkun Kong
- Department of Ophthalmology and Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Kimberly G Yen
- Department of Ophthalmology and Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
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Beene LC, Traboulsi EI, Seven I, Ford MR, Sinha Roy A, Butler RS, Dupps WJ. Corneal Deformation Response and Ocular Geometry: A Noninvasive Diagnostic Strategy in Marfan Syndrome. Am J Ophthalmol 2016; 161:56-64.e1. [PMID: 26432567 DOI: 10.1016/j.ajo.2015.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate corneal air-puff deformation responses and ocular geometry as predictors of Marfan syndrome. DESIGN Prospective observational clinical study. METHODS Sixteen investigator-derived, 4 standard Ocular Response Analyzer (ORA), and geometric variables from corneal tomography and optical biometry using Oculus Pentacam and IOL Master were assessed for discriminative value in Marfan syndrome, measuring right eyes of 24 control and 13 Marfan syndrome subjects. Area under the receiver operating characteristic (AUROC) curve was assessed in univariate and multivariate analyses. RESULTS Six investigator-derived ORA variables successfully discriminated Marfan syndrome. The best lone disease predictor was Concavity Min (Marfan syndrome 47.5 ± 20, control 69 ± 14, P = .003; AUROC = 0.80). Corneal hysteresis (CH) and corneal resistance factor (CRF) were decreased (Marfan syndrome CH 9.45 ± 1.62, control CH 11.24 ± 1.21, P = .01; Marfan syndrome CRF 9.77 ± 1.65, control CRF 11.03 ± 1.72, P = .01) and corneas were flatter in Marfan syndrome (Marfan syndrome Kmean 41.25 ± 2.09 diopter, control Kmean 42.70 ± 1.81 diopter, P = .046). No significant differences were observed in central corneal thickness, axial eye length, or intraocular pressure. A multivariate regression model incorporating corneal curvature and hysteresis loop area (HLA) provided the best predictive value for Marfan syndrome (AUROC = 0.85). CONCLUSIONS This study describes novel biodynamic features of corneal deformation responses in Marfan syndrome, including increased deformation, decreased bending resistance, and decreased energy dissipation capacity. A predictive model incorporating HLA and corneal curvature shows greatest potential for noninvasive clinical diagnosis of Marfan syndrome.
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Affiliation(s)
- Lauren C Beene
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Genetic Eye Diseases, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Elias I Traboulsi
- Center for Genetic Eye Diseases, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ibrahim Seven
- Ocular Biomechanics & Imaging Laboratory, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew R Ford
- Ocular Biomechanics & Imaging Laboratory, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Abhijit Sinha Roy
- Ocular Biomechanics & Imaging Laboratory, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert S Butler
- Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio
| | - William J Dupps
- Ocular Biomechanics & Imaging Laboratory, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio.
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Groman-Lupa S, Santos-Cantú D, Quiroz-Mercado H. What is the best surgical approach for ectopia lentis in Marfan syndrome? REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2015.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Collin GB, Hubmacher D, Charette JR, Hicks WL, Stone L, Yu M, Naggert JK, Krebs MP, Peachey NS, Apte SS, Nishina PM. Disruption of murine Adamtsl4 results in zonular fiber detachment from the lens and in retinal pigment epithelium dedifferentiation. Hum Mol Genet 2015; 24:6958-74. [PMID: 26405179 DOI: 10.1093/hmg/ddv399] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/21/2015] [Indexed: 12/16/2022] Open
Abstract
Human gene mutations have revealed that a significant number of ADAMTS (a disintegrin-like and metalloproteinase (reprolysin type) with thrombospondin type 1 motifs) proteins are necessary for normal ocular development and eye function. Mutations in human ADAMTSL4, encoding an ADAMTS-like protein which has been implicated in fibrillin microfibril biogenesis, cause ectopia lentis (EL) and EL et pupillae. Here, we report the first ADAMTSL4 mouse model, tvrm267, bearing a nonsense mutation in Adamtsl4. Homozygous Adamtsl4(tvrm267) mice recapitulate the EL phenotype observed in humans, and our analysis strongly suggests that ADAMTSL4 is required for stable anchorage of zonule fibers to the lens capsule. Unexpectedly, homozygous Adamtsl4(tvrm267) mice exhibit focal retinal pigment epithelium (RPE) defects primarily in the inferior eye. RPE dedifferentiation was indicated by reduced pigmentation, altered cellular morphology and a reduction in RPE-specific transcripts. Finally, as with a subset of patients with ADAMTSL4 mutations, increased axial length, relative to age-matched controls, was observed and was associated with the severity of the RPE phenotype. In summary, the Adamtsl4(tvrm267) model provides a valuable tool to further elucidate the molecular basis of zonule formation, the pathophysiology of EL and ADAMTSL4 function in the maintenance of the RPE.
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Affiliation(s)
| | - Dirk Hubmacher
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | | | | | - Lisa Stone
- The Jackson Laboratory, Bar Harbor, ME, USA
| | - Minzhong Yu
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA, Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA and
| | | | | | - Neal S Peachey
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA, Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA and Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Suneel S Apte
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
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Komáromy AM, Petersen-Jones SM. Genetics of Canine Primary Glaucomas. Vet Clin North Am Small Anim Pract 2015; 45:1159-82, v. [PMID: 26277300 DOI: 10.1016/j.cvsm.2015.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Primary glaucomas are a leading cause of incurable vision loss in dogs. Based on their specific breed predilection, a genetic cause is suspected to be responsible, and affected dogs should be excluded from breeding. Despite the high prevalence of primary glaucomas in dogs, their genetics have been studied in only a small number of breeds. The identification of canine glaucoma disease genes, and the development of genetic tests, will help to avoid the breeding of affected dogs in the future and will allow for earlier diagnosis and potentially more effective therapy.
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Affiliation(s)
- András M Komáromy
- Department of Small Animal Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine, Michigan State University, 736 Wilson Road, Room D-208, East Lansing, MI 48824, USA.
| | - Simon M Petersen-Jones
- Department of Small Animal Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine, Michigan State University, 736 Wilson Road, Room D-208, East Lansing, MI 48824, USA
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Hubmacher D, Apte SS. ADAMTS proteins as modulators of microfibril formation and function. Matrix Biol 2015; 47:34-43. [PMID: 25957949 DOI: 10.1016/j.matbio.2015.05.004] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 01/17/2023]
Abstract
The ADAMTS (a disintegrin-like and metalloproteinase domain with thrombospondin-type 1 motifs) protein superfamily includes 19 secreted metalloproteases and 7 secreted ADAMTS-like (ADAMTSL) glycoproteins. The possibility of functional linkage between ADAMTS proteins and fibrillin microfibrils was first revealed by a human genetic consilience, in which mutations in ADAMTS10, ADAMTS17, ADAMTSL2 and ADAMTSL4 were found to phenocopy rare genetic disorders caused by mutations affecting fibrillin-1 (FBN1), the major microfibril component in adults. The manifestations of these ADAMTS gene disorders in humans and animals suggested that they participated in the structural and regulatory roles of microfibrils. Whereas two such disorders, Weill-Marchesani syndrome 1 and Weill-Marchesani-like syndrome involve proteases (ADAMTS10 and ADAMTS17, respectively), geleophysic dysplasia and isolated ectopia lentis in humans involve ADAMTSL2 and ADAMTSL4, respectively, which are not proteases. In addition to broadly similar dysmorphology, individuals affected by Weill-Marchesani syndrome 1, Weill-Marchesani-like syndrome or geleophysic dysplasia each show characteristic anomalies suggesting molecule-, tissue-, or context-specific functions for the respective ADAMTS proteins. Ectopia lentis occurs in each of these conditions except geleophysic dysplasia, and is due to a defect in the ciliary zonule, which is predominantly composed of FBN1 microfibrils. Together, this strongly suggests that ADAMTS proteins are involved either in microfibril assembly, stability, and anchorage, or the formation of function-specific supramolecular networks having microfibrils as their foundation. Here, the genetics and molecular biology of this subset of ADAMTS proteins is discussed from the perspective of how they might contribute to fully functional or function-specific microfibrils.
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Affiliation(s)
- Dirk Hubmacher
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
| | - Suneel S Apte
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
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Garza-Leon M. Características anatómicas, biomecánicas y aberrométricas de la córnea de pacientes con síndrome de Marfan. REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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43
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Hubmacher D, Wang LW, Mecham RP, Reinhardt DP, Apte SS. Adamtsl2 deletion results in bronchial fibrillin microfibril accumulation and bronchial epithelial dysplasia--a novel mouse model providing insights into geleophysic dysplasia. Dis Model Mech 2015; 8:487-99. [PMID: 25762570 PMCID: PMC4415891 DOI: 10.1242/dmm.017046] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 03/05/2015] [Indexed: 12/24/2022] Open
Abstract
Mutations in the secreted glycoprotein ADAMTSL2 cause recessive geleophysic dysplasia (GD) in humans and Musladin–Lueke syndrome (MLS) in dogs. GD is a severe, often lethal, condition presenting with short stature, brachydactyly, stiff skin, joint contractures, tracheal-bronchial stenosis and cardiac valve anomalies, whereas MLS is non-lethal and characterized by short stature and severe skin fibrosis. Although most mutations in fibrillin-1 (FBN1) cause Marfan syndrome (MFS), a microfibril disorder leading to transforming growth factor-β (TGFβ) dysregulation, domain-specific FBN1 mutations result in dominant GD. ADAMTSL2 has been previously shown to bind FBN1 and latent TGFβ-binding protein-1 (LTBP1). Here, we investigated mice with targeted Adamtsl2 inactivation as a new model for GD (Adamtsl2−/− mice). An intragenic lacZ reporter in these mice showed that ADAMTSL2 was produced exclusively by bronchial smooth muscle cells during embryonic lung development. Adamtsl2−/− mice, which died at birth, had severe bronchial epithelial dysplasia with abnormal glycogen-rich inclusions in bronchial epithelium resembling the cellular anomalies described previously in GD. An increase in microfibrils in the bronchial wall was associated with increased FBN2 and microfibril-associated glycoprotein-1 (MAGP1) staining, whereas LTBP1 staining was increased in bronchial epithelium. ADAMTSL2 was shown to bind directly to FBN2 with an affinity comparable to FBN1. The observed extracellular matrix (ECM) alterations were associated with increased bronchial epithelial TGFβ signaling at 17.5 days of gestation; however, treatment with TGFβ-neutralizing antibody did not correct the epithelial dysplasia. These investigations reveal a new function of ADAMTSL2 in modulating microfibril formation, and a previously unsuspected association with FBN2. Our studies suggest that the bronchial epithelial dysplasia accompanying microfibril dysregulation in Adamtsl2−/− mice cannot be reversed by TGFβ neutralization, and thus might be mediated by other mechanisms. Summary: The extracellular protein ADAMTSL2 is a crucial regulator of microfibril composition in the extracellular matrix of bronchial smooth muscle cells and influences bronchial epithelial function.
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Affiliation(s)
- Dirk Hubmacher
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Lauren W Wang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Robert P Mecham
- Department of Cell Biology and Physiology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Dieter P Reinhardt
- Department of Anatomy and Cell Biology and Faculty of Dentistry, McGill University, 3640 University Street, Montreal, Quebec, Canada H3A 0C7
| | - Suneel S Apte
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Drolsum L, Rand‐Hendriksen S, Paus B, Geiran OR, Semb SO. Ocular findings in 87 adults with Ghent-1 verified Marfan syndrome. Acta Ophthalmol 2015; 93:46-53. [PMID: 24853997 DOI: 10.1111/aos.12448] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To study ocular characteristics in 87 patients with verified Marfan syndrome (MFS) based on the Ghent criteria from 1996 (Ghent-1). METHODS The position of the lens was noted by observing the eye in different gaze directions in maximal mydriasis during slit lamp examination. Ectopia lentis (EL) was classified as subluxated (dislocation slightly backwards) or luxated (vertical or horizontal displacement). Corneal curvature, axial length (AL), corneal diameter, central corneal thickness, anterior chamber depth, lens thickness, condition of the iris, intraocular pressure, spherical equivalent and visual acuity were also investigated. RESULTS EL was found in 108 eyes (62.1%). Of the 68 phakic eyes with EL, 43 (63.2%) had subluxation. Mean AL was 24.80 ± 2.57 mm, and the AL was above 23.5 mm in 65.3%. Mean keratometry (K) in phakic eyes was 41.79 ± 1.70 diopters (D), and the K value was <41.5D in 46.8%. Iris hypoplasia was found in 3.4%. Myopia above 3D occurred in 38.4% of the phakic eyes. Mean binocular logMAR was 0.10 ± 0.32. Only five patients (5.7%) had a logMAR more than 0.5. These 5 patients had EL, and 4 of them were amblyopic. CONCLUSION In this strictly defined MFS group fulfilling the Ghent-1 criteria, the prevalence of EL was 62.1%. In many cases, the dislocation of the lens was subtle. On average, the corneas were flattened and the globe length was increased. Only a few patients were visually impaired. Children with MFS should have a thorough follow up to avoid amblyopia.
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Affiliation(s)
- Liv Drolsum
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- University of Oslo Oslo Norway
| | - Svend Rand‐Hendriksen
- University of Oslo Oslo Norway
- Sunnaas Rehabilitation Hospital TRS National Resource Centre for Rare Disorders Nesodden Norway
| | - Benedicte Paus
- University of Oslo Oslo Norway
- Department of Medical Genetics Oslo University Hospital Oslo Norway
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Hanlon SD, Behzad AR, Sakai LY, Burns AR. Corneal stroma microfibrils. Exp Eye Res 2015; 132:198-207. [PMID: 25613072 DOI: 10.1016/j.exer.2015.01.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/15/2015] [Accepted: 01/17/2015] [Indexed: 12/12/2022]
Abstract
Elastic tissue was first described well over a hundred years ago and has since been identified in nearly every part of the body. In this review, we examine elastic tissue in the corneal stroma with some mention of other ocular structures which have been more thoroughly described in the past. True elastic fibers consist of an elastin core surrounded by fibrillin microfibrils. However, the presence of elastin fibers is not a requirement and some elastic tissue is comprised of non-elastin-containing bundles of microfibrils. Fibers containing a higher relative amount of elastin are associated with greater elasticity and those without elastin, with structural support. Recently it has been shown that the microfibrils, not only serve mechanical roles, but are also involved in cell signaling through force transduction and the release of TGF-β. A well characterized example of elastin-free microfibril bundles (EFMBs) is found in the ciliary zonules which suspend the crystalline lens in the eye. Through contraction of the ciliary muscle they exert enough force to reshape the lens and thereby change its focal point. It is believed that the molecules comprising these fibers do not turn-over and yet retain their tensile strength for the life of the animal. The mechanical properties of the cornea (strength, elasticity, resiliency) would suggest that EFMBs are present there as well. However, many authors have reported that, although present during embryonic and early postnatal development, EFMBs are generally not present in adults. Serial-block-face imaging with a scanning electron microscope enabled 3D reconstruction of elements in murine corneas. Among these elements were found fibers that formed an extensive network throughout the cornea. In single sections these fibers appeared as electron dense patches. Transmission electron microscopy provided additional detail of these patches and showed them to be composed of fibrils (∼10 nm diameter). Immunogold evidence clearly identified these fibrils as fibrillin EFMBs and EFMBs were also observed with TEM (without immunogold) in adult mammals of several species. Evidence of the presence of EFMBs in adult corneas will hopefully pique an interest in further studies that will ultimately improve our understanding of the cornea's biomechanical properties and its capacity to repair.
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Affiliation(s)
- Samuel D Hanlon
- College of Optometry, University of Houston, Houston, TX, 97204, USA.
| | - Ali R Behzad
- Imaging and Characterization Core Lab, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Lynn Y Sakai
- Shiners Hospital for Children and Department of Biochemistry and Molecular Biology, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Alan R Burns
- College of Optometry, University of Houston, Houston, TX, 97204, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
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Hubmacher D, Reinhardt DP, Plesec T, Schenke-Layland K, Apte SS. Human eye development is characterized by coordinated expression of fibrillin isoforms. Invest Ophthalmol Vis Sci 2014; 55:7934-44. [PMID: 25406291 DOI: 10.1167/iovs.14-15453] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Mutations in human fibrillin-1 and -2, which are major constituents of tissue microfibrils, can affect multiple ocular components, including the ciliary zonule, lens, drainage apparatus, cornea, and retina. However, the expression pattern of the three human fibrillins and an integral microfibrillar component, MAGP1, during human eye development is not known. METHODS We analyzed sections from human eyes at gestational weeks (GWs) 6, 8, and 11 and at 1 and 3 years of age with antibodies specific for each human fibrillin isoform or MAGP1, using immunofluorescence microscopy. RESULTS During embryonic development, each fibrillin isoform was detected in vascular structures bridging the ciliary body and the developing lens, hyaloid vasculature, and retina. In addition, they were present in the developing corneal basement membranes and lens capsule. MAGP1 codistributed with the fibrillin isoforms. In contrast, the juvenile zonule was composed of fibrillin-1 microfibrils containing MAGP1, but fibrillin-2 was absent and fibrillin-3 was only sparsely detected. CONCLUSIONS Fibrillin-1, -2, and, unique to humans, fibrillin-3 are found in various ocular structures during human embryonic eye development, whereas fibrillin-1 dominates the postnatal zonule. We speculate that vasculature spanning the ciliary body and lens, which elaborates fibrillin-2 and -3, may provide an initial scaffold for fibrillin assembly and zonule formation.
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Affiliation(s)
- Dirk Hubmacher
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio, United States
| | - Dieter P Reinhardt
- Faculty of Medicine and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Thomas Plesec
- Cleveland Clinic, Department of Anatomic Pathology, Cleveland, Ohio, United States
| | - Katja Schenke-Layland
- Department of Women's Health, University Women's Hospital, Eberhard-Karls-University, Tübingen, Germany
| | - Suneel S Apte
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio, United States
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Ahonen SJ, Kaukonen M, Nussdorfer FD, Harman CD, Komáromy AM, Lohi H. A novel missense mutation in ADAMTS10 in Norwegian Elkhound primary glaucoma. PLoS One 2014; 9:e111941. [PMID: 25372548 PMCID: PMC4221187 DOI: 10.1371/journal.pone.0111941] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/02/2014] [Indexed: 12/11/2022] Open
Abstract
Primary glaucoma is one of the most common causes of irreversible blindness both in humans and in dogs. Glaucoma is an optic neuropathy affecting the retinal ganglion cells and optic nerve, and elevated intraocular pressure is commonly associated with the disease. Glaucoma is broadly classified into primary open angle (POAG), primary closed angle (PCAG) and primary congenital glaucoma (PCG). Human glaucomas are genetically heterogeneous and multiple loci have been identified. Glaucoma affects several dog breeds but only three loci and one gene have been implicated so far. We have investigated the genetics of primary glaucoma in the Norwegian Elkhound (NE). We established a small pedigree around the affected NEs collected from Finland, US and UK and performed a genome-wide association study with 9 cases and 8 controls to map the glaucoma gene to 750 kb region on canine chromosome 20 (praw = 4.93×10−6, pgenome = 0.025). The associated region contains a previously identified glaucoma gene, ADAMTS10, which was subjected to mutation screening in the coding regions. A fully segregating missense mutation (p.A387T) in exon 9 was found in 14 cases and 572 unaffected NEs (pFisher = 3.5×10−27) with a high carrier frequency (25.3%). The mutation interrupts a highly conserved residue in the metalloprotease domain of ADAMTS10, likely affecting its functional capacity. Our study identifies the genetic cause of primary glaucoma in NEs and enables the development of a genetic test for breeding purposes. This study establishes also a new spontaneous canine model for glaucoma research to study the ADAMTS10 biology in optical neuropathy.
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Affiliation(s)
- Saija J. Ahonen
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland
- The Folkhälsan Institute of Genetics, Helsinki, Finland
| | - Maria Kaukonen
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland
- The Folkhälsan Institute of Genetics, Helsinki, Finland
| | - Forrest D. Nussdorfer
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Christine D. Harman
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - András M. Komáromy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, United States of America
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Hannes Lohi
- Department of Veterinary Biosciences and Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland
- The Folkhälsan Institute of Genetics, Helsinki, Finland
- * E-mail:
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Kuchtey J, Kunkel J, Burgess LG, Parks MB, Brantley MA, Kuchtey RW. Elevated transforming growth factor β1 in plasma of primary open-angle glaucoma patients. Invest Ophthalmol Vis Sci 2014; 55:5291-7. [PMID: 25061114 DOI: 10.1167/iovs.14-14578] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To test the hypothesis that primary open-angle glaucoma (POAG) patients have a systemic elevation of transforming growth factor β1 (TGFβ1). METHODS Plasma was prepared from blood samples drawn from patients of the Vanderbilt Eye Institute during clinic visits. Concentrations of total TGFβ1 and thrombospondin-1 (TSP1) in plasma were determined by ELISA. Statistical significance of differences between POAG and control samples was evaluated by Mann-Whitney test. Regression analysis was used to evaluate correlations between plasma TGFβ1 and patient age and between plasma TGFβ1 and TSP1. RESULTS Plasma samples were obtained from 148 POAG patients and 150 controls. Concentration of total TGFβ1 in the plasma of POAG patients (median = 3.25 ng/mL) was significantly higher (P < 0.0001) than in controls (median = 2.46 ng/mL). Plasma TGFβ1 was not correlated with age of patient (P = 0.17). Thrombospondin-1 concentration was also significantly higher (P < 0.0001) in POAG patients (median = 0.774 μg/mL) as compared to controls (median = 0.567 μg/mL). Plasma total TGFβ1 and TSP1 concentrations were linearly correlated (P < 0.0001). CONCLUSIONS Plasma samples from POAG patients display elevated total TGFβ1 compared to controls, consistent with elevated systemic TGFβ1 in POAG patients.
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Affiliation(s)
- John Kuchtey
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, United States
| | - Jessica Kunkel
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, United States
| | - L Goodwin Burgess
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, United States
| | - Megan B Parks
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, United States
| | - Milam A Brantley
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, United States
| | - Rachel W Kuchtey
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, United States
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49
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Fan F, Luo Y, Liu X, Lu Y, Zheng T. Risk factors for postoperative complications in lensectomy–vitrectomy with or without intraocular lens placement in ectopia lentis associated with Marfan syndrome. Br J Ophthalmol 2014; 98:1338-42. [DOI: 10.1136/bjophthalmol-2013-304144] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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50
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Miraldi Utz V, Coussa RG, Traboulsi EI. Surgical management of lens subluxation in Marfan syndrome. J AAPOS 2014; 18:140-6. [PMID: 24698610 DOI: 10.1016/j.jaapos.2013.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 12/06/2013] [Accepted: 12/22/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To review the literature on the surgical management, describe a simplified surgical technique, and to report the postoperative clinical course of ectopia lentis removal in patients with Marfan syndrome. METHODS The medical records of patients with a clinical diagnosis of Marfan syndrome and clinically significant lens subluxation were retrospectively reviewed. Patients underwent lens extraction by a single surgeon via a simplified anterior segment approach. The pre- and postoperative best-corrected visual acuity, biometric measurements, intraocular pressure, and incidence of surgery-related complications were reviewed. RESULTS A total of 42 eyes of 22 patients were included. Mean postoperative follow-up was 4.9 ± 2.9 years (range, 1-10 years). Average age at surgery was 10.2 ± 9.2 years (range, 2-37 years), with 18 patients (36 eyes) ≤ 18 years of age. The average preoperative best-corrected visual acuity was 20/80, and the average postoperative best-corrected visual acuity at last follow-up was 20/25, with an average improvement of 6 lines on the Snellen chart. All eyes had a best-corrected visual acuity > 20/30 at last follow-up with aphakic correction. One eye of 1 patient developed a retinal detachment following blunt trauma. No other intra- or postoperative complications were reported. CONCLUSIONS Anterior lensectomy and limited vitrectomy with aphakic correction is safe and provides a consistent visual outcome in patients with lens subluxation secondary to Marfan syndrome. This is especially important in pediatric patients, in whom long-term follow-up for iris- and scleral-fixated intraocular lenses is limited.
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Affiliation(s)
- Virginia Miraldi Utz
- Abrahamson Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Elias I Traboulsi
- The Cole Eye Institute, Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
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