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Fresno Cañada C, Gispets Parcerisas J, Del Prado Sánchez C, Puigventós Rosanas E, Perez-Jaume S, Salvador H, Llorca Cardeñosa A, Prat Bartomeu J. DRI Triton SS-OCT applied to detect choroidal nodules in paediatric patients affected by NF1. Heliyon 2024; 10:e29263. [PMID: 38644819 PMCID: PMC11033099 DOI: 10.1016/j.heliyon.2024.e29263] [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: 09/04/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose To examine whether image processing of non-mydriatic DRI Triton SS-OCT (Topcon Corporation, Tokyo, Japan) using the red free filter could assess the presence of choroidal nodules and thus include their detection as a diagnostic criterion in neurofibromatosis type 1 (NF1). Material and methods We included 417 eyes from 210 patients, 377 - from 190 patients diagnosed with NF1 according to the criteria established by the National Institutes of Health Consensus Development Conference (NIH) and 40 from 20 healthy patients as a control group. The mean age was 9.4 years (range 2 years-18 years). All patients had their visual acuity measured by a test according to age, were examined for the presence of lisch nodules and an Optical Coherence Tomography (OCT) of the macular area was performed. All the OCT images were analysed to check if visible nodules could be identified. Results Ages 14 (95% CI=(9.7,18.3)) and 12 years (95% CI=(9.1,14)) are the cut-off points that best separate those with choroidal nodules with Triton OCT and lisch with slit lamp, respectively, from those without. lisch nodules were detected in 50% of cases of NF1 patients. The presence of choroidal nodules did not present a statistically significant correlation with the occurrence of optic pathway glioma (p = 0.96) nor with the patient's visual worsening (p = 0.072). A statistically significant correlation was observed between the presence of choroidal nodules and the presence of lisch nodules (p < 0.05). Conclusion The Topcon Triton OCT red free tool would not be a good tool to detect choroidal nodules in patients with NF1 because of its low sensitivity. If the presence of choroidal nodules were to be included in the diagnostic criteria for NF1, it would be convenient to use a device with red and infrared radiations.
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Affiliation(s)
- Carlos Fresno Cañada
- Universitat Politècnica de Catalunya. Facultat d'Òptica i Optometria de Terrassa, Carrer del Violinista Vellsola 37, 08222, Terrassa, Barcelona, Spain
- Hospital Vithas Valencia 9 de Octubre. Ophthalmology department.Carrer de la Vall de la Ballestera, 59, 46015, València, Valencia, Spain
| | - Joan Gispets Parcerisas
- Universitat Politècnica de Catalunya. Facultat d'Òptica i Optometria de Terrassa, Carrer del Violinista Vellsola 37, 08222, Terrassa, Barcelona, Spain
| | - Cristina Del Prado Sánchez
- Hospital Sant Joan de Déu of Barcelona. Ophthalmology department. Pg. de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Enric Puigventós Rosanas
- Hospital Sant Joan de Déu of Barcelona. Ophthalmology department. Pg. de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | | | - Héctor Salvador
- Hospital Sant Joan de Déu of Barcelona. Oncology department. Pg. de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Ana Llorca Cardeñosa
- Hospital General de Castelló, Ophthalmology department, Avinguda de Benicàssim 128, 12004, Castelló de la Plana, Castelló, Spain
| | - Joan Prat Bartomeu
- Hospital Sant Joan de Déu de Barcelona. Ophthalmology department. Pg. de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
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Stemmer-Rachamimov AO, Kozanno L, Plotkin SR, Jordan JT, Rd Rizzo JF. Histologic correlates of "Choroidal abnormalities" in Neurofibromatosis type 1 (NF1). Acta Neuropathol 2024; 147:71. [PMID: 38607446 DOI: 10.1007/s00401-024-02724-y] [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: 02/16/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disorder characterized by proliferation of cells from neural crest origin. The most common manifestations are cutaneous, neurologic, skeletal and ocular. The distinction of NF1 from other syndromes with multiple café-au-lait macules may be difficult in the pediatric age group, and ocular findings, especially Lisch nodules (i.e., melanocytic hamartomas on the irides), are a useful, early diagnostic tool. In recent years, novel ocular manifestations descriptively referred to as "choroidal abnormalities", choroidal "hyperpigmented spots" and "retinal vascular abnormalities" have been recognized in NF1. Choroidal abnormalities (CA) appear as bright patchy nodules that can be best detected with near-infrared ocular coherence tomography imaging (NIR-OCT). Because of their high specificity and sensitivity for NF1, CA have been added as an ocular diagnostic criterion of NF1 as an alternative to Lisch nodules. Although CA are important ocular diagnostic criteria for NF1, the histologic correlates are controversial. We present the postmortem ocular pathology findings of an NF1 patient for whom clinical notes and ocular imaging were available. Findings in this patient included choroidal hyperpigmented spots on funduscopy and retinal vascular abnormalities, both of which have been reported to be closely associated with CA. Histologic examination of the eyes showed multiple clusters of melanocytes of varying sizes in the choroid. Pathologic review of 12 additional postmortem eyes from 6 NF1 patients showed multiple, bilateral choroidal melanocytic aggregates in all eyes. These findings suggest that the CA seen on NIR-OCT and the hyperpigmented spots seen clinically in NF1 patients are manifestations of multifocal choroidal melanocytic clusters, consistent with choroidal melanocytic hamartomas. Lisch nodules, often multiple, were present in all eyes with morphology that differed from the choroidal hamartomas. As such, although CA and Lisch nodules are melanocytic hamartomas, there are clear phenotypical differences in their morphologies.
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Affiliation(s)
- Anat O Stemmer-Rachamimov
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 20114, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Liana Kozanno
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 20114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Scott R Plotkin
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Neurology and Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 20114, USA
| | - Justin T Jordan
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Neurology and Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 20114, USA
| | - Joseph F Rd Rizzo
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA, 02114, USA
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3
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Estrela T, Truong S, Garcia A, He J, Ying GS, Devakandan K, Reginald YA, Fisher MJ, Liu GT, Ullrich NJ, Avery RA, Heidary G. The Relationship Between Choroidal Abnormalities and Visual Outcomes in Pediatric Patients With NF1-Associated Optic Pathway Gliomas. J Neuroophthalmol 2024; 44:5-9. [PMID: 38252486 PMCID: PMC10922160 DOI: 10.1097/wno.0000000000002075] [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] [Indexed: 01/24/2024]
Abstract
BACKGROUND Choroidal abnormalities (CAs) visualized on near-infrared reflectance (NIR) imaging are a new diagnostic criterion for neurofibromatosis type 1 (NF1), but the association between the presence of CAs and visual function remains unknown. This study evaluated the relationship between visual acuity (VA) with the presence, number, or total area of CAs visualized by NIR in children with NF1-associated optic pathway gliomas (NF1-OPGs). METHODS Patients (<18 years) enrolled in a prospective longitudinal study of children with NF1-associated OPGs from 3 institutions were eligible if they had optical coherence tomography (OCT) of the macula (Heidelberg Spectralis) with ≥1 year of follow-up. The central 30° NIR images were reviewed by 2 neuro-ophthalmologists who manually calculated the number and total area of CAs. VA (logMAR) was measured using a standardized protocol. Cross-sectional associations of presence, number, and total area of CAs with VA, retinal nerve fiber layer thickness (RNFL), and ganglion cell-inner plexiform layer thickness were evaluated at the first and most recent visits using regression models. Intereye correlation was accounted for using generalized estimating equations. RESULTS Eighty-two eyes of 41 children (56% female) were included. The mean ± SD age at the first OCT was 10.1 ± 3.3 years, with a mean follow-up of 20.4 ± 7.2 months. At study entry, CAs were present in 46% of eyes with a mean number of 2.1 ± 1.7 and a mean total area of 2.0 ± 1.7 mm 2 per eye. At the most recent follow-up, CAs were present in 48% of eyes with a mean number of 2.2 ± 1.8 lesions and a mean total area of 2.3 ± 2.1 mm 2 per eye. Neither VA nor OCT parameters at first and follow-up visits were associated with the presence, number, or total area of CAs (all P > 0.05). CONCLUSIONS CAs are prevalent but not ubiquitous, in children with NF1-OPGs. Although CAs are a diagnostic criterion for NF1, their presence and size do not appear to be associated with visual function.
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Affiliation(s)
- Tais Estrela
- Neuro-Ophthalmology Department, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Saprina Truong
- Departments of Ophthalmology and Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arielle Garcia
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jocelyn He
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Michael J. Fisher
- Division of Neuro-Oncology Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grant T. Liu
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicole J. Ullrich
- Departments of Ophthalmology and Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert A. Avery
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gena Heidary
- Neuro-Ophthalmology Department, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
- Departments of Ophthalmology and Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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4
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Zehar S, Lazouni A. [Choroidal Yasunari nodules in neurofibromatosis type 1: Case report]. J Fr Ophtalmol 2024; 47:104008. [PMID: 37919149 DOI: 10.1016/j.jfo.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/17/2023] [Accepted: 09/07/2023] [Indexed: 11/04/2023]
Affiliation(s)
- S Zehar
- Établissement hospitalier privé d'ophtalmologie Lazouni, Imama Mansourah Tlemcen, Algérie.
| | - A Lazouni
- Établissement hospitalier privé d'ophtalmologie Lazouni, Imama Mansourah Tlemcen, Algérie
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Mallone F, Alisi L, Lucchino L, Di Martino V, Nebbioso M, Armentano M, Lambiase A, Moramarco A. Insights into Novel Choroidal and Retinal Clinical Signs in Neurofibromatosis Type 1. Int J Mol Sci 2023; 24:13481. [PMID: 37686284 PMCID: PMC10488231 DOI: 10.3390/ijms241713481] [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: 08/07/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is a rare inherited neurocutaneous disorder with a major impact on the skin, nervous system and eyes. The ocular diagnostic hallmarks of this disease include iris Lisch nodules, ocular and eyelid neurofibromas, eyelid café-au-lait spots and optic pathway gliomas (OPGs). In the last years, new manifestations have been identified in the ocular district in NF1 including choroidal abnormalities (CAs), hyperpigmented spots (HSs) and retinal vascular abnormalities (RVAs). Recent advances in multi-modality imaging in ophthalmology have allowed for the improved characterization of these clinical signs. Accordingly, CAs, easily detectable as bright patchy nodules on near-infrared imaging, have recently been added to the revised diagnostic criteria for NF1 due to their high specificity and sensitivity. Furthermore, subclinical alterations of the visual pathways, regardless of the presence of OPGs, have been recently described in NF1, with a primary role of neurofibromin in the myelination process. In this paper, we reviewed the latest progress in the understanding of choroidal and retinal abnormalities in NF1 patients. The clinical significance of the recently revised diagnostic criteria for NF1 is discussed along with new updates in molecular diagnosis. New insights into NF1-related neuro-ophthalmic manifestations are also provided based on electrophysiological and optical coherence tomography (OCT) studies.
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Affiliation(s)
| | | | | | | | | | | | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (F.M.); (L.A.); (L.L.); (V.D.M.); (M.N.); (M.A.); (A.M.)
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de Rivas MO, Gabás JM, Cabeza MÁT, Floría OE, Latorre RH, Moscarda EN, Clavería JA, Rivasés GP, Puyuelo JA. Choroidal Hyperreflective Nodules Detected by Infrared Reflectance Images Are a Diagnostic Criterion for Neurofibromatosis Type 1 Patients Excluding Those with High Myopia. Diagnostics (Basel) 2023; 13:diagnostics13071348. [PMID: 37046566 PMCID: PMC10093036 DOI: 10.3390/diagnostics13071348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is one of the central nervous system’s most common autosomal dominant conditions. The diagnosis is based on the clinical diagnostic criteria and/or a molecularly confirmed mutation in the NF1 gene. This study investigated the possibility of substantiating choroidal nodules as a diagnostic criterion for the disease, including patients affected with and without high myopia. A cross-sectional study was carried out in 60 eyes of 30 adult patients diagnosed with NF1. A total of 30 healthy individuals of equivalent age and sex served as control. The Spectralis HRA+OCT MultiColor (Heidelberg Engineering GmbH, Heidelberg, Germany) evaluated the presence of choroidal abnormalities with near-infrared reflectance imaging. Secondly, the presence of iridian Lisch nodules was evaluated by slit lamp examination. Near-infrared reflectance imaging showed the presence of choroidal hyperreflective nodules in 83% of the patients diagnosed with NF1, while these choroidal abnormalities were not observed in any control subject. The patients diagnosed with NF1 associated with high myopia were the only ones who did not present the characteristic choroidal disorders. Therefore, when excluding patients diagnosed with high myopia, choroidal nodules were more frequent than Lisch nodules in a statistically significant proportion. Hyperreflective nodules detected by near-infrared reflectance imaging are as regular as Lisch nodules or even significantly more frequent when excluding high myope patients. Our observation of the mutual exclusion of choroidal hyperreflective nodules and high myopia in the NF1 patients seems a novel and interesting remark.
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Affiliation(s)
- Marta Orejudo de Rivas
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain
| | - Javier Mateo Gabás
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain
| | - Miguel Ángel Torralba Cabeza
- Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain
- Department of Internal Medicine, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Olivia Esteban Floría
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain
| | - Raquel Herrero Latorre
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain
| | - Eva Núñez Moscarda
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain
| | | | | | - Javier Ascaso Puyuelo
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain
- School of Medicine, Department of Surgery, University of Zaragoza, 50009 Zaragoza, Spain
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7
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The role of near-infrared reflectance imaging in retinal disease: A systematic review. Surv Ophthalmol 2022; 68:313-331. [PMID: 36535488 DOI: 10.1016/j.survophthal.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Near-infrared reflectance (NIR) retinal imaging aids in a better visualization of structures at the level of outer retina, retinal pigment epithelium, and choroid. It has multiple advantages, including easy acquisition in association with structural spectral domain optical coherence tomography, more comfort for patients, and enhanced contrast and spatial resolution. It helps in the diagnosis of chorioretinal diseases that present with minimal funduscopic findings and can be used to follow up many chorioretinal conditions. We describe the chorioretinal NIR imaging appearance and the clinical role of NIR imaging in ocular inflammatory disease, vascular and acquired disease, degenerative disease, tumors, associated systemic condition, toxic and traumatic disease, optic nerve head conditions, and physiological findings.
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8
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Mallone F, Lucchino L, Giustini S, Lambiase A, Moramarco A. An update on choroidal abnormalities and retinal microvascular changes in neurofibromatosis type 1. Orphanet J Rare Dis 2022; 17:223. [PMID: 35698197 PMCID: PMC9195315 DOI: 10.1186/s13023-022-02369-8] [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: 10/26/2021] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Abstract
Neurofibromatosis Type 1 (NF1) is a rare neurocutaneous disorder transmitted in an autosomal dominant fashion, mainly affecting the nervous system, the eye and skin. Ocular diagnostic hallmarks of NF1 include iris Lisch nodules, optic gliomas, orbital and eyelid neurofibromas, eyelid café-au-lait spots. In recent years, a new ocular sign represented by choroidal abnormalities (CAs) has been characterized in NF1. The CAs, identified with near-infrared reflectance, have been reported with a frequency of up to 100% in NF1, and have recently been added to the actual diagnostic criteria for NF1. The present Letter to the journal is intended to provide an update on features and clinical significance of CAs in NF1. Moreover, the relation with other ocular manifestations recently described in NF1 including hyperpigmented spots and retinal microvascular abnormalities is discussed.
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Affiliation(s)
- Fabiana Mallone
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Luca Lucchino
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Sandra Giustini
- Department of Dermatology and Venereology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Antonietta Moramarco
- Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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9
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Touzé R, Abitbol MM, Bremond-Gignac D, Robert MP. Function of the Retinal Pigment Epithelium in Patients With Neurofibromatosis Type 1. Invest Ophthalmol Vis Sci 2022; 63:6. [PMID: 35394491 PMCID: PMC8994170 DOI: 10.1167/iovs.63.4.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Retinal and choroidal abnormalities in neurofibromatosis type 1 (NF1) remain poorly studied. It has been reported, however, that the function of the retinal pigment epithelium (RPE) in NF1 was abnormal, with a supra-normal Arden ratio of the electro-oculogram (EOG). This study aims to evaluate the function of the RPE, using EOG, first in patients with NF1 compared to controls and second in patients with NF1 with choroidal abnormalities compared to patients with NF1 without choroidal abnormalities. Methods This prospective case-control study included 20 patients with NF1 (10 patients with choroidal abnormalities and 10 patients without) and 10 healthy patients, matched for age. A complete ophthalmologic assessment with multimodal imaging, an EOG, and a full-field electroretinogram were performed for each included patient. The main outcome measured was the EOG light peak (LP)/dark trough (DT) ratio. Results The LP/DT ratio was 3.02 ± 0.52 in patients with NF1 and 2.63 ± 0.31 in controls (P = 0.02). DT values were significantly lower in patients with NF1 than in controls (240 vs. 325 µV, P = 0.02), while light peak values were not significantly different (P = 0.26). No difference was found for peak latencies. No significant correlation between the surface and number of choroidal abnormalities and EOG parameters was demonstrated. Conclusions This study confirms the dysfunction of the RPE in patients with NF1, involving a lower DT and a corresponding higher LP/DT ratio. We hypothesize that this pattern may be due to a dysregulation of the melanocytogenesis, inducing a disruption in Ca2+ ion flux and an abnormal polarization of the RPE.
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Affiliation(s)
- Romain Touzé
- Ophthalmology Department and Reference Center for Rare Ophthalmological Diseases (OPHTARA), AP-HP, University Hospital Necker-Enfants Malades, Paris, France.,Centre Borelli, ENS Paris-Saclay, Paris University, CNRS, INSERM, SSA, Paris, France
| | - Marc M Abitbol
- Ophthalmology Department and Reference Center for Rare Ophthalmological Diseases (OPHTARA), AP-HP, University Hospital Necker-Enfants Malades, Paris, France.,INSERM, UMRS 1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Paris University, Paris, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department and Reference Center for Rare Ophthalmological Diseases (OPHTARA), AP-HP, University Hospital Necker-Enfants Malades, Paris, France.,INSERM, UMRS 1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Paris University, Paris, France
| | - Matthieu P Robert
- Ophthalmology Department and Reference Center for Rare Ophthalmological Diseases (OPHTARA), AP-HP, University Hospital Necker-Enfants Malades, Paris, France.,Centre Borelli, ENS Paris-Saclay, Paris University, CNRS, INSERM, SSA, Paris, France
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10
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Chong C, Webber AL, Dai S. Ocular manifestations of systemic diseases in children. Clin Exp Optom 2022; 106:238-248. [PMID: 35296228 DOI: 10.1080/08164622.2022.2048999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Knowledge of ocular diseases and understanding of the complex interplay between eye and systemic health have increased over the years. This knowledge is particularly important when caring for our youngest and most vulnerable paediatric patients when ophthalmic manifestations may provide an insight to underlying systemic diseases and can act as the first indicator of an undiagnosed systemic condition. Further, the visual system can be vulnerable to manifestations of known systemic disease, with vigilant ophthalmic examination generally aiding early identification of ocular complications for collaborative multidisciplinary care to prevent avoidable vision loss. The potential ocular signs and complications of the following developmental, genetic or acquired childhood systemic disorders are presented: premature birth, trisomy 21, albinism, Marfan's syndrome, Stickler's syndrome, septo-optic dysplasia, aniridia, neurofibromatosis 1, Sturge-Weber syndrome, papilloedema, juvenile idiopathic arthritis and vitamin A deficiency. Rather than providing an exhaustive list of diseases, this review offers an overview of the more commonly encountered congenital or acquired childhood systemic conditions that have associated childhood ophthalmic disorders and presents referral and ongoing surveillance recommendations.
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Affiliation(s)
- Cheefoong Chong
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ann L Webber
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shuan Dai
- Department of Ophthalmology, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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11
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Choroidal Abnormalities in Pediatric NF1: A Cohort Natural History Study. Cancers (Basel) 2022; 14:cancers14061423. [PMID: 35326581 PMCID: PMC8946817 DOI: 10.3390/cancers14061423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to assess the long-term natural history of choroidal abnormalities (CAs) in a large pediatric neurofibromatosis type 1 (NF1) population, quantifying their progression in number and dimensions. Pediatric patients (<16 years old) affected by NF1 with a minimum follow-up of 3 years with at least one CA in one eye were consecutively recruited. Near-infrared (NIR) imaging was performed to identify CAs, which were quantified in number and size. The CAs area and perimeter were normalized for the optic disc dimensions to avoid possible bias related to the growing process of the eye. Ninety-nine eyes of 53 patients were evaluated. The CAs number, area and perimeter significantly increased during follow-up (p < 0.0001 for each parameter). The patient age at baseline was inversely correlated with the CAs number over time (coefficient = −0.1313, p = 0.0068), while no correlation was found between the patient age and CAs progression in size. In conclusion, we provide evidence that, in NF1 pediatric patients, CAs change over time, increasing both in number and dimensions, independently from the physiological growth of the eye. While the increase of the CAs number occurs particularly at an earlier age, the increase in the CAs dimensions is a slow process that remains constant during childhood.
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12
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Godinho G, Esteves-Leandro J, Alves G, Madeira C, Faria O, Brandão E, Magalhães A, Falcão-Reis F, Penas S. Correlation Between Ophthalmologic and Neuroradiologic Findings in Type 1 Neurofibromatosis. J Neuroophthalmol 2022; 42:101-107. [PMID: 33770007 DOI: 10.1097/wno.0000000000001241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurofibromatosis Type 1 (NF-1) is a genetic disease affecting the eye, and ocular findings such as Lisch nodules (LN) or optic pathway gliomas (OPGs) are a part of its diagnostic criteria. Recent imaging technologies such as infrared (IR) imaging and optical coherence tomography (OCT) have highlighted the visualization of choroidal focal abnormalities in these patients, even in the absence of other ocular lesions. This study aimed to establish a morphological multimodal evaluation of choroidal findings in patients with NF-1, correlating them with central nervous system (CNS) findings. METHODS This retrospective study included 44 eyes from 22 patients with NF-1. Central 30° IR imaging was obtained, and the number and total area of detectable lesions were calculated. Both macular and optic disc scanning with OCT were performed, with and without the enhanced depth imaging technique, to assess the presence of choroidal focal hyperreflective lesions. Central macular thickness, ganglion cell layer, and outer nuclear layer thickness were assessed, as well as subfoveal choroidal thickness. The peripapillary retinal nerve fiber layer (RNFL) thickness was also assessed. Patients' magnetic resonance images (MRI) were reviewed and categorized by a neuroradiology specialist, determining the presence of OPGs and CNS hamartomas. Correlations between the ophthalmological and neuroradiological findings were established. RESULTS Patients' mean age was 16.4 ± 7.3 years and 59.1% were women. On the MRI, 86.4% of the patients had CNS hamartomas, and 34.1% of the eyes had OPGs. LN were described in 29.5% of the eyes, whereas a total of 63.4% of the eyes presented the characteristic hyperreflective lesions in IR imaging, all of them matching the underlying choroidal lesions. A mean of 2.9 ± 3.3 lesions per eye and a median total lesion area of 1.52 mm2 were found. The presence of OPGs was correlated with a greater number (P = 0.004) and a larger area (P = 0.006) of IR lesions. For a cut-off of 3.5 lesions per eye, the sensitivity and specificity for the presence of OPGs were 75% and 80%, respectively. For a total lesion area of 2.77 mm2, the sensitivity and specificity for the presence of OPGs were 69.2% and 93.1%, respectively. Eyes with OPGs presented a significant reduction in the temporal RNFL (P = 0.018) thickness, as well as a reduction in subfoveal choroid thickness (P = 0.04). No relations were found between CNS hamartomas and ophthalmological findings. CONCLUSIONS This study suggests that focal choroidal abnormalities are correlated with the presence of CNS lesions as OPGs in patients with NF-1, and it might be a surrogate for the need for CNS imaging in these patients.
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Affiliation(s)
- Gonçalo Godinho
- Ophthalmology Department (GG, JE-L, CM, OF, EB, AM, FF-R, SP), and Neuroradiology Department (GA), Centro Hospitalar Universitário São João, Porto, Portugal; and Surgery and Physiology Department (FF-R, SP), Faculty of Medicine, University of Porto, Portugal
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13
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Flores Pimentel M, Heath A, Wan MJ, Hussein R, Leahy KE, MacDonald H, Tavares E, VandenHoven C, MacNeill K, Kannu P, Parkin PC, Heon E, Reginald A, Vincent A. Prevalence of Choroidal Abnormalities and Lisch Nodules in Children Meeting Clinical and Molecular Diagnosis of Neurofibromatosis Type 1. Transl Vis Sci Technol 2022; 11:10. [PMID: 35119474 PMCID: PMC8819284 DOI: 10.1167/tvst.11.2.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine the prevalence of choroidal abnormalities (CAs) and Lisch nodules (LNs) in children who met the clinical diagnostic criteria (CDC) alone and those with a molecularly confirmed diagnosis (MCD) of neurofibromatosis type 1 (NF1), and to ascertain any differences between the groups. Methods This was a cross-sectional observational study. All children who met the CDC and/or had MCD of NF1 and underwent eye examination were included. At least two CAs or LNs between the two eyes were set as a threshold to define the presence of either abnormality. Frequencies alongside 95% confidence intervals (CIs) were calculated. The relationship between patient age and the presence of LNs and/or CAs was estimated using logistic regression. Results The study cohort included 94 patients; CAs (64%) were more prevalent than LNs (41%) (0.22; 95% CI, 0.08–0.36; P = 0.0023). The probability of the presence of LNs was lower than that of CAs across all ages (odds ratio = 0.37; 95% CI, 0.20–0.69; P = 0.00173). CAs were exclusively found in 37% of patients and LNs in 16%; 80% had either CAs or LNs, or both. In the CDC group (n = 41), the difference in prevalence (CAs = 68%, LNs = 51%) did not attain statistical significance (0.17; 95% CI, −0.06 to 0.40; P = 0.18). In the MCD group (n = 53), the difference in prevalence (CAs = 60%, LNs = 34%) was significant (0.26; 95% CI, 0.006–0.47; P = 0.023). Conclusions CAs were more frequent than LNs in pediatric NF1 patients regardless of age and MCD status. Combining ophthalmological exams with near-infrared imaging will increase the diagnostic reach in pediatric NF1. Translational Relevance CAs detected on near-infrared imaging are objective biomarkers in NF1. They are more prevalent and detected earlier in the pediatric population compared with LNs. Hence, the presence of CAs should be routinely ascertained in children suspected with NF1.
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Affiliation(s)
- Mariana Flores Pimentel
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
| | - Anna Heath
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Michael J Wan
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
| | - Rowaida Hussein
- Genetics & Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kate E Leahy
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
| | - Heather MacDonald
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Department of Genetic Counselling, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Erika Tavares
- Genetics & Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia VandenHoven
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katelyn MacNeill
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Kannu
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia C Parkin
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elise Heon
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada.,Genetics & Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arun Reginald
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
| | - Ajoy Vincent
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada.,Genetics & Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
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14
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Abdolrahimzadeh S, Ciancimino C, Grassi F, Sordi E, Fragiotta S, Scuderi G. Near-Infrared Reflectance Imaging in Retinal Diseases Affecting Young Patients. J Ophthalmol 2021; 2021:5581851. [PMID: 34373789 PMCID: PMC8349282 DOI: 10.1155/2021/5581851] [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: 01/05/2021] [Revised: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Near-infrared reflectance (NIR) is a noninvasive, contactless, and rapid in vivo imaging technique for visualizing subretinal alterations in the photoreceptor layer, retinal pigment epithelium, and choroid. The present report describes the application of this imaging method in retinal and choroidal pathologies affecting young patients where scarce cooperation, poor fixation, and intense glare sensation can result in a challenging clinical examination. A literature search of the MEDLINE database was performed using the terms "near-infrared reflectance" and "spectral-domain optical coherence tomography." Articles were selected if they described the diagnostic use of NIR in children or young adults. Of 700 publications, 42 manuscripts published between 2005 and 2020 were inherent to children or young adults and were considered in this narrative literature review. The first disease category is the phakomatoses where NIR is essential in visualizing choroidal alterations recognized as cardinal biomarkers in neurofibromatosis type 1, microvascular retinal alterations, and retinal astrocytic hamartomas. Another diagnostic application is the accurate visualization of crystals of various nature, including the glistening crystals that characterize Bietti crystalline dystrophy. Acute macular neuropathy and paracentral acute middle maculopathy represent a further disease category with young adulthood onset where NIR is not only diagnostic but also essential to monitor disease progression. A further interesting clinical application is to facilitate the detection of laser-induced maculopathy where funduscopic examination can be normal or subnormal. In conclusion, NIR imaging has a noninterchangeable role in diagnosing certain retinal diseases, especially in children and young adults where there is scarce collaboration and a lack of evident clinical findings. Moreover, this technique can reveal unique retinal and choroidal biomarkers highly specific to rare conditions.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Chiara Ciancimino
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Flaminia Grassi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Edoardo Sordi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
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15
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Chilibeck CM, Shah S, Russell HC, Vincent AL. The presence and progression of choroidal neurofibromas in a predominantly pediatric population with neurofibromatosis type-1. Ophthalmic Genet 2021; 42:223-229. [PMID: 33594930 DOI: 10.1080/13816810.2021.1881977] [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] [Indexed: 10/22/2022]
Abstract
Background: Obtaining a definitive neurofibromatosis type-1 (NF1) diagnosis may take years. The natural history of choroidal neurofibromas in NF1 is unknown. This study evaluates a predominantly pediatric patient cohort for ocular features in NF1, including presence and progression of choroidal abnormalities, to determine their natural history, relationship to other NF1 features, and additive value in NF1 diagnosis.Methods: Retrospective analysis of 106 patients referred for Ophthalmic monitoring or diagnosis of NF1 between January 2012 and December 2018. Clinical records and Near-Infrared Reflectance (NIR) Optical Coherence Tomography imaging were analyzed for prevalence and progression of choroidal neurofibromas on NIR, and relation to other NF1 diagnostic criteria.Results: 54.7% of patients referred had a confirmed NF1 diagnosis, and 45.4% were NF1 suspects. First ophthalmic review resulted in an additional 6.6% patients meeting the diagnostic criteria, and 14.2% later developed sufficient features (total n = 80). Choroidal neurofibromas were present in 75.7% of patients that had NIR imaging and met diagnostic criteria, and detected in the absence of, or prior to Lisch nodules in 13.5%. Progression in the size and number of choroidal neurofibromas occurred in 26 eyes (32.5%) of 14 patients (35.0%), all under 16 years old. Patients without choroidal neurofibromas at first examination never developed them over the study period.Conclusion: Choroidal neurofibromas, detected by NIR imaging, are common in NF1, present early with frequent progression, and represent an additional tool to aid NF1 diagnosis in young children.
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Affiliation(s)
- Corina M Chilibeck
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.,Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Shaheen Shah
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.,Ophthalmology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Heather C Russell
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.,Ophthalmology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Andrea L Vincent
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.,Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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16
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Kaynezhad P, Tachtsidis I, Aboelnour A, Sivaprasad S, Jeffery G. Watching synchronous mitochondrial respiration in the retina and its instability in a mouse model of macular degeneration. Sci Rep 2021; 11:3274. [PMID: 33558624 PMCID: PMC7870852 DOI: 10.1038/s41598-021-82811-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022] Open
Abstract
Mitochondrial function declines with age and in some diseases, but we have been unable to analyze this in vivo. Here, we optically examine retinal mitochondrial function as well as choroidal oxygenation and hemodynamics in aging C57 and complement factor H (CFH-/-) mice, proposed models of macular degeneration which suffer early retinal mitochondrial decline. In young C57s mitochondrial populations respire in coupled oscillatory behavior in cycles of ~ 8 min, which is phase linked to choroidal oscillatory hemodynamics. In aging C57s, the oscillations are less regular being ~ 14 min and more dissociated from choroidal hemodynamics. The mitochondrial oscillatory cycles are extended in CFH-/- mice being ~ 16 min and are further dissociated from choroidal hemodynamics. Mitochondrial decline occurs before age-related changes to choroidal vasculature, hence, is the likely origin of oscillatory disruption in hemodynamics. This technology offers a non-invasive technique to detect early retinal disease and its relationship to blood oxygenation in vivo and in real time.
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Affiliation(s)
- Pardis Kaynezhad
- Institute of Ophthalmology, University College London, London, EC1V 9EL, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, WC1E 6BT, UK
| | - Asmaa Aboelnour
- Histology and Cytology Department, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
| | - Sobha Sivaprasad
- Institute of Ophthalmology, University College London, London, EC1V 9EL, UK
| | - Glen Jeffery
- Institute of Ophthalmology, University College London, London, EC1V 9EL, UK.
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17
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Liu S, Ran L, Qi D, Meng X, Yu T. Neovascular glaucoma in a pediatric patient with neurofibromatosis type 1: a case report. BMC Ophthalmol 2020; 20:168. [PMID: 32345252 PMCID: PMC7189718 DOI: 10.1186/s12886-020-01438-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background To report a case of a young patient with neurofibromatosis type 1 (NF1). Methods: Here we review the treatment administered to a 7-year-old NF1 patient with neovascular glaucoma as the primary diagnosis. Case presentation A 7-year-old boy developed visual loss in the right eye associated with periocular pain and ipsilateral headache that had persisted for 1 week. The patient’s condition did not improve after treatment with topical or systemic glaucoma medications. Fundus examination of the right eye showed superotemporal retinal vasoproliferative tumors (RVPT). Near-infrared reflectance scans of the left eye’s fundus revealed bright patchy regions, scattered across the posterior pole; systemic examination showed café-au-lait spots all over the patient’s body. The patient had a clear family history. Genetic testing confirmed NF1. The right eye was treated with intravitreal ranibizumab injection, retinal lesion cryotherapy, and transscleral ciliary body photocoagulation. After treatment, RVPT scarring was observed. The patient’s intraocular pressure remained within normal limits. Conclusions We report a rare case of neurofibromatosis in a pediatric patient with neovascular glaucoma accompanied by RVPT. We suggest that evaluations of young patients with neovascular glaucoma should include careful attention to the overall condition of the patient and his/her parents, as well as family history. If necessary, NF1 molecular testing should be performed to avoid a missed diagnosis or misdiagnosis.
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Affiliation(s)
- Sha Liu
- Department of ophthalmology, the first hospital affiliated to Army Medical University (Southwest Hospital), Chongqing, 400038, China
| | - Li Ran
- Department of ophthalmology, the first hospital affiliated to Army Medical University (Southwest Hospital), Chongqing, 400038, China
| | - Dongmei Qi
- Department of ophthalmology, the first hospital affiliated to Army Medical University (Southwest Hospital), Chongqing, 400038, China
| | - Xiaohong Meng
- Department of ophthalmology, the first hospital affiliated to Army Medical University (Southwest Hospital), Chongqing, 400038, China
| | - Tao Yu
- Department of ophthalmology, the first hospital affiliated to Army Medical University (Southwest Hospital), Chongqing, 400038, China.
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18
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Moramarco A, Giustini S, Nofroni I, Mallone F, Miraglia E, Iacovino C, Calvieri S, Lambiase A. Near-infrared imaging: an in vivo, non-invasive diagnostic tool in neurofibromatosis type 1. Graefes Arch Clin Exp Ophthalmol 2017; 256:307-311. [PMID: 29290016 DOI: 10.1007/s00417-017-3870-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Only a few reports in the literature have investigated the presence of ocular abnormalities in neurofibromatosis type 1 (NF-1) patients. The aim of this study was to evaluate the prevalence of ocular abnormalities in a large population of NF1 patients, focusing on the choroidal changes. METHODS This study was conducted on 160 consecutive patients with NF1 and 106 sex- and age-matched healthy subjects (control). Each patient underwent a complete ophthalmological examination inclusive of best-corrected visual acuity, intraocular pressure measurement, slit-lamp biomicroscopy, indirect fundus biomicroscopy, and near-infrared reflectance (NIR) retinography by using the spectral domain OCT. Moreover, all patients underwent complete dermatological exam and 1.5-Tesla MRI scan of the brain to assess the presence of optic nerve gliomas. RESULTS Choroidal abnormalities were detected in 97% of patients, with a positive predictive value of 100% and a negative predictive value of 96.4%. Interestingly, a small number of patients (4/160; 2.5%) showed Lisch nodules without choroidal abnormalities, whereas a larger number of patents (22/160; 13.75%) presented choroidal lesions in absence of Lisch nodules. None of the patients showed the absence of both choroidal lesions and Lisch nodules. The number of choroidal lesions increased with age (r = 0.364, p = 0.0001) and with the severity of pathology (r = 0.23, p = 0.003). Any statistically significant correlation between choroidal lesions, visual acuity, and intraocular pressure was observed. CONCLUSIONS NIR imaging represents an in vivo, non-invasive, sensitive and reproducible exam to detect choroidal nodules in NF-1 patients, suggesting that choroidal changes may represent an additional diagnostic criteria for NF1.
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Affiliation(s)
- Antonietta Moramarco
- Department of Sense Organs, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Sandra Giustini
- Department of Dermatology, 'Sapienza' University of Rome, Rome, Italy
| | - Italo Nofroni
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - Fabiana Mallone
- Department of Sense Organs, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Emanuele Miraglia
- Department of Dermatology, 'Sapienza' University of Rome, Rome, Italy
| | - Chiara Iacovino
- Department of Dermatology, 'Sapienza' University of Rome, Rome, Italy
| | - Stefano Calvieri
- Department of Dermatology, 'Sapienza' University of Rome, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Kinori M, Hodgson N, Zeid JL. Ophthalmic manifestations in neurofibromatosis type 1. Surv Ophthalmol 2017; 63:518-533. [PMID: 29080631 DOI: 10.1016/j.survophthal.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a relatively common multisystemic inherited disease and has been extensively studied by multiple disciplines. Although genetic testing and confirmation are available, NF1 remains a clinical diagnosis. Many manifestations of NF1 involve the eye and orbit, and the ophthalmologist, therefore, plays a significant role in the diagnosis and treatment of NF1 patients. Improvements in diagnostic and imaging instruments have provided new insight to study the ophthalmic manifestations of the disease. We provide a comprehensive and up-to-date overview of the ocular and orbital manifestations of NF1.
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Affiliation(s)
- Michael Kinori
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nickisa Hodgson
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, USA
| | - Janice Lasky Zeid
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
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20
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Cassiman C, Casteels I, Jacob J, Plasschaert E, Brems H, Dubron K, Keer K, Legius E. Choroidal abnormalities in café-au-lait syndromes: a new differential diagnostic tool? Clin Genet 2016; 91:529-535. [DOI: 10.1111/cge.12873] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/29/2022]
Affiliation(s)
- C. Cassiman
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - I. Casteels
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - J. Jacob
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - E. Plasschaert
- Department of Human Genetics; University Hospitals Leuven; Leuven Belgium
| | - H. Brems
- Department of Human Genetics; University Hospitals Leuven; Leuven Belgium
| | - K. Dubron
- Faculty of Medicine; Catholic University of Leuven; Leuven Belgium
| | - K.V. Keer
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - E. Legius
- Department of Human Genetics; University Hospitals Leuven; Leuven Belgium
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21
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Vagge A, Nelson LB, Capris P, Traverso CE. Choroidal Freckling in Pediatric Patients Affected by Neurofibromatosis Type 1. J Pediatr Ophthalmol Strabismus 2016; 53:271-4. [PMID: 27637020 DOI: 10.3928/01913913-20160719-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/10/2016] [Indexed: 11/20/2022]
Abstract
Greater understanding of choroidal freckling in patients affected by neurofibromatosis type 1 (NF1) has changed the previous belief that choroidal lesions are unusual in eyes with this disease. In fact, the high frequency of freckling suggests that the choroid is a structure commonly affected in patients with NF1. A review of patients aged 16 years or younger was performed. Recent studies using near-infrared reflectance imaging have shown that choroidal freckling frequently occurred in pediatric patients. As a result of these findings, some authors have suggested that choroidal freckling should be considered as a new diagnostic criterion for NF1. [J Pediatr Ophthalmol Strabismus. 2016;53(5):271-274.].
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Abdolrahimzadeh B, Piraino DC, Albanese G, Cruciani F, Rahimi S. Neurofibromatosis: an update of ophthalmic characteristics and applications of optical coherence tomography. Clin Ophthalmol 2016; 10:851-60. [PMID: 27257370 PMCID: PMC4874640 DOI: 10.2147/opth.s102830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Neurofibromatosis (NF) is a multisystem disorder and tumor predisposition syndrome caused by genetic mutation on chromosome 17-17q11.2 in NF type 1 (NF1), and on chromosome 22-22q12.2 in NF type 2. The disorder is characterized by considerable heterogeneity of clinical expression. NF1 is the form with the most characteristic ocular manifestations. Lisch nodules of the iris are among the well-known diagnostic criteria for the disease. Glaucoma and associated globe enlargement have been described in a significant proportion of patients with NF1 and orbital–facial involvement. Optic nerve glioma may cause strabismus and proptosis, and palpebral neurofibroma may reach considerable size and occasionally show malignant transformation. Near infrared reflectance has greatly contributed to enhancing our knowledge on choroidal alterations in NF1. Indeed, some authors have proposed to include these among the diagnostic criteria. Optical coherence tomography has given new insight on retinal alterations and is a noninvasive tool in the management of optic nerve gliomas in children. Ocular manifestations in NF type 2 can range from early-onset cataracts in up to 80% of cases to optic nerve hamartomas and combined pigment epithelial and retinal hamartomas.
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Affiliation(s)
| | - Domenica Carmen Piraino
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Giorgio Albanese
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Filippo Cruciani
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Siavash Rahimi
- Pathology Centre, Queen Alexandra Hospital, Portsmouth, UK
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23
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Vagge A, Camicione P, Capris C, Sburlati C, Panarello S, Calevo MG, Traverso CE, Capris P. Choroidal abnormalities in neurofibromatosis type 1 detected by near-infrared reflectance imaging in paediatric population. Acta Ophthalmol 2015; 93:e667-71. [PMID: 25990002 DOI: 10.1111/aos.12750] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 03/30/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate choroidal abnormalities in paediatric patients with neurofibromatosis type 1 (NF1) detected by near-infrared reflectance (NIR) retinography in order to evaluate diagnostic accuracy. METHODS Seventy-eight paediatric patients with NF1, diagnosed according to the National Institutes of Health (NIH) criteria, and 96 healthy control subjects matched for age were examined. Enrolled patients were under 16 years old. The presence of choroidal abnormalities was investigated by confocal scanning laser ophthalmoscopy. Main outcome measure was to evaluate diagnostic accuracy in paediatric patients compared with the NIH criteria. RESULTS Seventy-eight patients with NF1 (41 female, 37 male; mean age 8.1 ± 3.5 years) were compared with 96 healthy control subjects (42 female, 54 male; mean age 8 ± 3 years). Choroidal abnormalities were observed in 54 (69.2%) of the patients with NF1. As regards the fundus topographical distribution, choroidal abnormalities were more frequent at the posterior pole with a statistically significant correlation between patient age and the number of involved choroidal areas (Spearman r = 0.23; p < 0.04). No choroidal abnormalities were present in the control group. Detection accuracy of choroidal nodules was 70%. CONCLUSION Choroidal abnormalities appearing as bright patchy regions detected by NIR imaging occurred very frequently in paediatric patients affected by NF1. The present study appears to show that NIR used to detect choroidal involvement allows for elevated diagnostic accuracy.
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Affiliation(s)
- Aldo Vagge
- Eye Clinic; DiNOGMI; University of Genoa; Genoa Italy
| | - Paola Camicione
- Department of Ophthalmology; Giannina Gaslini Institute; Genoa Italy
| | | | - Carlo Sburlati
- Department of Ophthalmology; Giannina Gaslini Institute; Genoa Italy
| | - Simona Panarello
- Department of Ophthalmology; Giannina Gaslini Institute; Genoa Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit; Giannina Gaslini Institute; Genoa Italy
| | | | - Paolo Capris
- Department of Ophthalmology; Giannina Gaslini Institute; Genoa Italy
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Mbagwu M, Rahmani B, Srivastava A, Burrowes D, Bryar PJ. Unsuspected Ganglioneuroma of the Choroid Diagnosed after Enucleation. Ocul Oncol Pathol 2015; 2:48-50. [PMID: 27171204 DOI: 10.1159/000438863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/14/2015] [Indexed: 11/19/2022] Open
Abstract
We report a case of an unsuspected ganglioneuroma of the choroid in a patient with neurofibromatosis type 1. A 5-year-old girl presented from an outside institution with right proptosis and glaucoma since birth. Magnetic resonance imaging was obtained and showed a cavernous sinus mass extending into the right orbit and multiple orbital lesions. Additionally, increased signal in the posterior globe of the right eye was noted, but its etiology was unclear at the time. She was lost to follow-up for 3 years and later returned with a blind painful eye. Enucleation was performed, and histopathology was significant for diffuse choroidal ganglioneuroma and advanced glaucoma. We report the atypical history, examination findings, and histopathology to support the diagnosis.
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Affiliation(s)
- Michael Mbagwu
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Ill., USA
| | - Bahram Rahmani
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Ill., USA
| | - Arth Srivastava
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Ill., USA
| | - Delilah Burrowes
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill., USA
| | - Paul J Bryar
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Ill., USA
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Goktas S, Sakarya Y, Ozcimen M, Alpfidan I, Uzun M, Sakarya R, Yarbag A. Frequency of choroidal abnormalities in pediatric patients with neurofibromatosis type 1. J Pediatr Ophthalmol Strabismus 2014; 51:204-8. [PMID: 24844395 DOI: 10.3928/01913913-20140513-02] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/13/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the frequency of choroidal abnormalities in pediatric patients with neurofibromatosis type 1 detected by infrared reflectance imaging. METHODS The fundus of 38 eyes of 19 patients with neurofibromatosis type 1 was examined using infrared reflectance imaging with optical coherence tomography. Forty eyes of 20 age-matched controls were examined similarly. Each patient was evaluated for the presence and the number of choroidal abnormalities. The correlation between the total number of choroidal abnormalities and the patient's age was studied. RESULTS A total of 19 patients (11 females, 8 males) were included. The mean age of the neurofibromatosis group was 8.63 ± 3.15 years (range: 4 to 16 years) and that of the control group was 9.05 ± 3.27 years (range: 4 to 15 years). Choroidal nodules appearing as bright patchy nodules were detected in 15 (78.9%) of 19 patients with neurofibromatosis type 1 and 1 (5%) of 20 control subjects. In terms of the frequency of choroidal abnormalities, the difference was significant between the patients with neurofibromatosis type 1 and the controls (P < .001). There was a positive correlation between the number of choroidal abnormalities in both eyes and the patient's age (r = 0.701, P = .001). CONCLUSIONS Choroidal abnormalities are frequent in neurofibromatosis type 1. Choroidal abnormalities detected by infrared reflectance imaging with optical coherence tomography can be used to diagnose neurofibromatosis type 1.
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Makino S, Tampo H. Choroidal abnormalities in a 9-year-old girl with neurofibromatosis type 1. Pediatr Int 2014; 56:293. [PMID: 24730638 DOI: 10.1111/ped.12303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Shinji Makino
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Japan
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Makino S, Tampo H, Arai Y, Obata H. Correlations between choroidal abnormalities, Lisch nodules, and age in patients with neurofibromatosis type 1. Clin Ophthalmol 2013; 8:165-8. [PMID: 24403820 PMCID: PMC3883548 DOI: 10.2147/opth.s56327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To evaluate correlations between choroidal abnormalities, Lisch nodules, and age in patients with neurofibromatosis type 1 (NF1), we examined ten cases with NF1 using near-infrared reflectance imaging. Patients ranged in age from 4 to 39 years. The angle used for near-infrared reflectance imaging was 55°. We counted the total number of choroidal abnormalities in an area within a 55° angle centered on the fovea and the total number of Lisch nodules on the iris by slit-lamp examination. No positive correlation was found between the number of Lisch nodules and patient age (Spearman’s rank correlation coefficient ρ=0.117, P=0.7414). Choroidal abnormalities tended to increase with age (ρ=0.6150), but this difference was not statistically significant (P=0.0650). A positive correlation was found between the number of choroidal abnormalities and Lisch nodules (ρ=0.783, P=0.0267). In conclusion, choroidal abnormalities tend to increase with patient age and are correlated with the number of Lisch nodules.
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Affiliation(s)
- Shinji Makino
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hironobu Tampo
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yusuke Arai
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroto Obata
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Makino S, Tampo H. Rare and unusual choroidal abnormalities in a patient with systemic lupus erythematosus. Case Rep Ophthalmol 2013; 4:81-6. [PMID: 24019791 PMCID: PMC3764970 DOI: 10.1159/000354288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To report a case of rare and unusual choroidal abnormalities in a 42-year-old woman with systemic lupus erythematosus (SLE). METHODS Images were obtained using fundus photography, fluorescein angiography, near-infrared reflectance (NIR) imaging, and optical coherence tomography (OCT). RESULTS The patient had a history of SLE and central retinal artery occlusion in her right eye. Fundus examination showed no specific retinochoroidal abnormalities, with the exception of optic disc atrophy in her right eye and a peripapillary small hemorrhage in her left eye. However, NIR revealed multiple bright patchy lesions in the choroid of the posterior pole and the mid-periphery of the fundus in both eyes. OCT demonstrated irregular hyperreflectivity at the lesion sites. CONCLUSIONS The observed choroidal abnormalities are highly specific findings and therefore indicative of neurofibromatosis type 1 (NF1). Since the coexistence of SLE and NF1 is extremely rare, this case provided the chance to examine the relationship between SLE and NF1.
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Affiliation(s)
- Shinji Makino
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
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Retinal microvascular abnormalities in neurofibromatosis type 1 associated with congenital retinal macrovessels. Case Rep Ophthalmol Med 2013; 2013:604191. [PMID: 23781366 PMCID: PMC3676991 DOI: 10.1155/2013/604191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Here, we report a case of retinal microvascular abnormalities in a patient with neurofibromatosis type 1 (NF1) associated with congenital retinal macrovessels. An abnormal retinal macrovessel, crossing the macula horizontally, was detected in the right eye. Additionally, retinal microvascular abnormalities were detected. Eight years after the initial visit, the retinal microvascular abnormalities were noted to have changed substantially. We speculate that retinal microvascular abnormalities in NF1 may change dynamically over the years.
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Optical coherence tomography imaging of choroidal abnormalities in neurofibromatosis type 1. Case Rep Ophthalmol Med 2013; 2013:292981. [PMID: 23710396 PMCID: PMC3654718 DOI: 10.1155/2013/292981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/03/2013] [Indexed: 11/17/2022] Open
Abstract
We report a case of neurofibromatosis type 1 (NF1) examined by infrared fundus autofluorescence (IR-FAF) and optical coherence tomography (OCT) to characterize the associated choroidal abnormalities. The conventional ophthalmoscopic findings were unremarkable. However, IR-FAF revealed multiple bright patchy lesions in the choroid of the posterior pole, in both eyes. OCT demonstrated irregular hyperreflectivity at the sites of these lesions. Patients with NF1 may have typical choroidal lesions that are visible on IR-FAF, which can be confirmed through OCT.
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Ueda-Consolvo T, Miyakoshi A, Ozaki H, Houki S, Hayashi A. Near-infrared fundus autofluorescence-visualized melanin in the choroidal abnormalities of neurofibromatosis type 1. Clin Ophthalmol 2012; 6:1191-4. [PMID: 22888215 PMCID: PMC3413334 DOI: 10.2147/opth.s35321] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 11/26/2022] Open
Abstract
Purpose: To report a series of three cases of neurofibromatosis type 1 examined by
near-infrared fundus autofluorescence (NIR-AF) with a scanning laser
ophthalmoscope and spectral-domain optical coherence tomography (OCT) to
show the characteristics of choroidal abnormalities. Methods: Retrospective case series. Six eyes of three patients were examined by
conventional fundus examinations, near-infrared monochromatic light
reflectance (NIR-R) and NIR-AF, OCT, fluorescein angiography, and
indocyanine green angiography. Results: All eyes showed multiple bright patchy regions in the choroid of the
posterior pole with NIR-R. NIR-AF revealed high fluorescent regions of
similar sizes at fundus locations identical to those shown by NIR-R. In one
case, hypofluorescent regions were shown by indocyanine green angiography in
the bright fluorescent region shown by NIR-AF. The other two cases showed no
abnormality under conventional fundus examination or fluorescein
angiography. OCT images crossing the bright patchy region showed irregular
hyper-reflectivity in the choroid in two cases and hyporeflectivity in one
case. Conclusions: NIR-AF demonstrated that dense melanin was included in the choroidal nodules
of neurofibromatosis type 1. The choroidal nodules showed hyper- or
hyporeflectivity in the choroid on OCT, which did not affect the retinal
structure.
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Affiliation(s)
- Tomoko Ueda-Consolvo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Affiliation(s)
- Sara J Haug
- Department of Ophthalmology, University of California, San Francisco, 10 Koret Way, Room K301, San Francisco, CA 94143, USA
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Viola F, Villani E, Natacci F, Selicorni A, Melloni G, Vezzola D, Barteselli G, Mapelli C, Pirondini C, Ratiglia R. Choroidal abnormalities detected by near-infrared reflectance imaging as a new diagnostic criterion for neurofibromatosis 1. Ophthalmology 2011; 119:369-75. [PMID: 21963267 DOI: 10.1016/j.ophtha.2011.07.046] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 07/06/2011] [Accepted: 07/07/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate in a large sample of consecutive patients with neurofibromatosis type 1 (NF1) the possibility of including the presence of choroidal abnormalities detected by near-infrared reflectance (NIR) as a new diagnostic criterion for NF1. DESIGN Cross-sectional evaluation of a diagnostic test. PARTICIPANTS AND CONTROLS Ninety-five consecutive adult and pediatric patients (190 eyes) with NF1, diagnosed based on the National Institutes of Health (NIH) criteria. Controls included 100 healthy age- and gender-matched control subjects. METHODS Confocal scanning laser ophthalmoscopy was performed for each subject, investigating the presence and the number of choroidal abnormalities. MAIN OUTCOME MEASURES Sensitivity, specificity, and diagnostic accuracy for the different cutoff values of the criterion choroidal nodules detected by NIR compared with the NIH criteria. RESULTS Choroidal nodules detected by NIR imaging were present in 79 (82%) of 95 of the NF1 patients, including 15 (71%) of the 21 NF1 pediatric patients. Similar abnormalities were present in 7 (7%) of 100 healthy subjects, including 2 (8%) of the 25 healthy pediatric subjects. The highest accuracy was obtained at the cutoff value of 1.5 choroidal nodules detected by NIR imagery. Sensitivity and specificity of the examination at the optimal cutoff point were 83% and 96%, respectively. Diagnostic accuracy was 90% in the overall population and 83% in the pediatric population. Both of these values were in line with the most common NIH diagnostic criteria. CONCLUSIONS Choroidal abnormalities appearing as bright patchy nodules detected by NIR imaging frequently occurred in NF1 patients. The present study shows that NIR examination to detect choroidal involvement should be considered as a new diagnostic criterion for NF1.
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Affiliation(s)
- Francesco Viola
- Università degli Studi di Milano, UO Oculistica, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Near infrared fluorescence and OCT features of choroidal abnormalities in type 1 neurofibromatosis. Clin Exp Ophthalmol 2008; 36:390-2. [DOI: 10.1111/j.1442-9071.2008.001742.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Laser Literature Watch. Photomed Laser Surg 2006; 24:222-48. [PMID: 16706704 DOI: 10.1089/pho.2006.24.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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