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Wu Y, Zhang W, Yao X, Song W, Zhao Y, Yuan Y, Zhang W. Investigation of ocular involvement in patients with Fabry disease. Ann Med 2023; 55:2226909. [PMID: 37354009 PMCID: PMC10291927 DOI: 10.1080/07853890.2023.2226909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023] Open
Abstract
PURPOSE To investigate ocular abnormalities in Fabry disease (FD). METHODS Forty-five patients with FD diagnosed by genetic analysis were enrolled in a single medical centre. The following ocular examinations were performed: slit-lamp examination, ophthalmic fundus imaging, in vivo confocal microscopy (IVCM) and optical coherence tomography (OCT). The prevalences of typical abnormalities in the cornea, conjunctiva and retina were recorded; their differences between hemizygote and heterozygote were compared. RESULTS In this study, the prevalence of corneal verticillata was 97.8% (44/45). Corneal examination with IVCM demonstrated hyper-reflective intracellular inclusions located within basal epithelial cells. Conjunctival vessel malformations were observed in 64.4% (29/45) of patients, and retinal vessel tortuosity was observed in 62.2% (28/45) of patients. OCT revealed many strong hyper-reflective foci (HRF) in the inner retinal layer (in 66.7% [30/45] of patients); these foci may represent retinal vascular plexi. The prevalences of conjunctival vessel malformation, retinal vessel tortuosity and HRF were higher in hemizygote than in heterozygote. CONCLUSIONS Corneal verticillata, HRF on OCT, conjunctival vessel malformation and retinal vessel tortuosity exhibit high prevalence in patients with FD. These ocular manifestations are characteristic and easily accessible; thus, they should be considered diagnostic criteria for FD.
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Affiliation(s)
- Yuan Wu
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Wenbo Zhang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Xuyang Yao
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Wenjing Song
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Yawen Zhao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
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Gambini G, Scartozzi L, Giannuzzi F, Carlà MM, Boselli F, Caporossi T, De Vico U, Baldascino A, Rizzo S. Ophthalmic Manifestations in Fabry Disease: Updated Review. J Pers Med 2023; 13:904. [PMID: 37373893 DOI: 10.3390/jpm13060904] [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: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder, causing Gb-3 (globotriaosylceramide) buildup in cellular lysosomes throughout the body, in particular in blood vessel walls, neuronal cells, and smooth muscle. The gradual accumulation of this glycosphingolipid in numerous eye tissues causes conjunctival vascular abnormalities, corneal epithelial opacities (cornea verticillata), lens opacities, and retinal vascular abnormalities. Although a severe vision impairment is rare, these abnormalities are diagnostic indicators and prognostics for severity. Cornea verticillata is the most common ophthalmic feature in both hemizygous men and heterozygous females. Vessel tortuosity has been linked to a faster disease progression and may be useful in predicting systemic involvement. New technologies such as optical coherence tomography angiography (OCTA) are useful for monitoring retinal microvasculature alterations in FD patients. Along with OCTA, corneal topographic analysis, confocal microscopy, and electro-functional examinations, contributed to the recognition of ocular abnormalities and have been correlated with systemic involvement. We offer an update regarding FD ocular manifestations, focusing on findings derived from the most recent imaging modalities, to optimize the management of this pathology.
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Affiliation(s)
- Gloria Gambini
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Luca Scartozzi
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Francesco Boselli
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy
| | - Umberto De Vico
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
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Fanlo P, Garralda A, Gómez-Cerezo JF, Echeverria M, López M, Heras H, Riera-Mestre A. Results of the screening program for Fabry disease in patients with cornea verticillata at the University Hospital of Navarre. Rev Clin Esp 2023; 223:25-31. [PMID: 36528303 DOI: 10.1016/j.rceng.2022.10.005] [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: 07/25/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Cornea verticillata (CV) or vortex keratopathy is characterized by the presence of spiral-shaped deposits in the corneal epithelium. The most frequent causes are antimalarial drugs and amiodarone and, among systemic causes, Fabry disease (FD). MATERIAL AND METHODS A multidisciplinary, prospective, descriptive study was conducted in a tertiary reference center in Spain's Autonomous Community of Navarre after the implementation of a FD screening program for patients attended to in the Ophthalmology Department. The study analyzed those diagnosed with CV, who were subsequently referred to the rare disease clinic of the University Hospital of Navarre's Internal Medicine Department for an FD study. RESULTS Two women and four men with a mean age of 76.8 years were diagnosed with CV out of a total of 17,280 patients evaluated in outpatient consultations by three ophthalmology specialists during the period from April 2018 to April 2020. One patient died before performing the screening study and no patients were diagnosed with FD. CONCLUSIONS Despite the fact that the University Hospital of Navarre's FD screening program for patients with CV did not confirm any cases of FD, ophthalmology specialists should consider the possible diagnosis of FD in patients with CV in their routine consultations.
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Affiliation(s)
- P Fanlo
- Unidad de Enfermedades Autoinmunes Sistémicas, Consulta de Enfermedades Minoritarias, Servicio de Medicina Interna, Hospital Universitario de Navarra, Pamplona, Spain.
| | - A Garralda
- Servicio de Oftalmología, Hospital Universitario de Navarra, Pamplona, Spain
| | - J F Gómez-Cerezo
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Docencia titular de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - M Echeverria
- Servicio de Oftalmología, Hospital Universitario de Navarra, Pamplona, Spain
| | - M López
- Unidad de Enfermedades Sistémicas Autoinmunes y Minoritarias, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - H Heras
- Servicio de Oftalmología, Hospital Universitario de Navarra, Pamplona, Spain
| | - A Riera-Mestre
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, Spain
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4
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Nilsson M, Kolagari HT, Epstein D, Samolov B, Olsson M, Naess K, Oscarson M, Teaer Fahnehjelm K. Visual outcome, ocular findings, and visual quality of life in patients with Fabry disease. Ophthalmic Genet 2022; 43:841-849. [PMID: 36325813 DOI: 10.1080/13816810.2022.2132515] [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: 11/05/2022]
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal disease, in which diagnosis is often established several years after onset of symptoms. Ocular manifestations can occur in childhood and be a clue to earlier diagnosis. The aim was to report ocular outcome and visual quality of life (QoL) in patients with FD. MATERIAL AND METHODS FD-patients recruited from Karolinska University Hospital underwent ophthalmological examinations including best corrected visual acuity (BCVA), refraction, biomicroscopy, optical coherence tomography, keratometry, review of medical records and QoL Inventories. A total severity score (TSS), as estimated via Fabry Stabilization Index, was calculated. RESULTS Twenty-six FD-patients (16 men) mean age 36.4 years (range 5.0-63.5 years) were included. BCVA was median 1.0 (range 0.5-1.6). Conjunctival blood vessel tortuosity occurred in 15/26 patients, chemosis in 2/26 patients, cornea verticillata in 23/26 patients, lens opacities in 19/26 patients, and tortuous or dilated retinal vessels in 20/25 patients. Group-wise comparisons of adult patients showed no differences regarding age, TSS, or ocular parameters. Overall, TSS was correlated to age (r = 0.53, p = 0.02). A linear regression model showed that age and sex explained 38% of the variance in TSS. Keratometry did not reveal corneal ectasia in any of the 12 patients examined. VFQ 25 in 15 patients showed a high median composite score, 93.6 (range: 78.1-100). CONCLUSIONS BCVA in FD-patients was good despite corneal and lens pathology. Ocular variables did not show an association with TSS in adult patients. Corneal or lens opacities should also lead to a suspicion of FD in children.
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Affiliation(s)
- Mattias Nilsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - David Epstein
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Vitreoretinal Diseases, St. Erik Eye Hospital, Stockholm, Sweden
| | - Branka Samolov
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Anterior Segment Diseases, St. Erik Eye Hospital, Stockholm, Sweden
| | - Monica Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Ophthalmology, Strabismus and Electrophysiology. St. Erik Eye Hospital, Stockholm, Sweden
| | - Karin Naess
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Pediatric Neurology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Oscarson
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Teaer Fahnehjelm
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Ophthalmology, Strabismus and Electrophysiology. St. Erik Eye Hospital, Stockholm, Sweden
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Fanlo P, Garralda A, Gómez-Cerezo J, Echeverria M, López M, Heras H, Riera-Mestre A. Resultados del programa de cribado de enfermedad de Fabry en pacientes con córnea verticillata en el Hospital Universitario de Navarra. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Qian Y, Zhou D, Zhu D, Shi T, Zou J, Ma X. Evaluation of Corneal and Retinal Toxicity in Rheumatoid Arthritis Patients Treated with Hydroxychloroquine. Ophthalmic Res 2022; 65:659-667. [PMID: 35705064 DOI: 10.1159/000525170] [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: 03/31/2022] [Accepted: 05/06/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The study aimed to assess the ocular toxicity of hydroxychloroquine (HCQ) by confocal microscopy, multifocal electroretinography (mfERG), and scanning laser polarimetry with variable corneal compensation (GDxVCC) in patients with rheumatoid arthritis (RA). METHODS A cross-sectional, comparative case series study was retrospectively conducted on 61 patients under HCQ treatment for RA without fundoscopic anomalies (group 1), 65 RA patients with no HCQ treatment (group 2), and 27 normal subjects (group 3). A comprehensive ophthalmological examination, including confocal microscopy, mfERG, and GDxVCC, was performed in the three groups. RESULTS In group 1, the duration of treatment ranged from 19 to 96 months (54.9 ± 15.2 months). The mean cumulative dose of HCQ was 446.1 ± 164.0 g (range 114-864 g). Confocal microscopy revealed hyper-reflective abnormal particles in 45 patients (73.8%) and beaded, tortuous fibers in 34 patients (55.7%) in group 1. No corneal change was observed in the other two groups. The mfERG responses in the 6 concentric rings (R1-R6) among the three groups differed except at R3 (all p < 0.05), and data from R1-R6 were not significantly different between groups 2 and 3. The retinal nerve fiber layer thicknesses were statistically thinner in group 1 than in groups 2 and 3 (all p < 0.05). CONCLUSIONS Early signs of corneal and neural retina structure changes were detected in patients with RA treated with HCQ. Whether these findings should be a mark of drug recession still needs further study and more evidence.
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Affiliation(s)
- Yiyong Qian
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China, .,Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China,
| | - Dan Zhou
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China
| | - Dan Zhu
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China
| | - Tingli Shi
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xiaoyun Ma
- Department of Ophthalmology, Shanghai University of Medicine & Health Science, Affiliated Zhou Pu Hospital, Shanghai, China
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Yamakawa H, Kato TS, Noh JY, Yuasa S, Kawamura A, Fukuda K, Aizawa Y. Thyroid Hormone Plays an Important Role in Cardiac Function: From Bench to Bedside. Front Physiol 2021; 12:606931. [PMID: 34733168 PMCID: PMC8558494 DOI: 10.3389/fphys.2021.606931] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/28/2021] [Indexed: 01/07/2023] Open
Abstract
Thyroid hormones (THs) are synthesized in the thyroid gland, and they circulate in the blood to regulate cells, tissues, and organs in the body. In particular, they exert several effects on the cardiovascular system. It is well known that THs raise the heart rate and cardiac contractility, improve the systolic and diastolic function of the heart, and decrease systemic vascular resistance. In the past 30 years, some researchers have studied the molecular pathways that mediate the role of TH in the cardiovascular system, to better understand its mechanisms of action. Two types of mechanisms, which are genomic and non-genomic pathways, underlie the effects of THs on cardiomyocytes. In this review, we summarize the current knowledge of the action of THs in the cardiac function, the clinical manifestation and parameters of their hemodynamics, and treatment principles for patients with hyperthyroid- or hypothyroid-associated heart disease. We also describe the cardiovascular drugs that induce thyroid dysfunction and explain the mechanism underlying the thyroid toxicity of amiodarone, which is considered the most effective antiarrhythmic agent. Finally, we discuss the recent reports on the involvement of thyroid hormones in the regulation of myocardial regeneration and metabolism in the adult heart.
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Affiliation(s)
- Hiroyuki Yamakawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomoko S. Kato
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | | | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
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Ismailova DS, Mitichkina TS, Tao EA, Moiseev AS. [Corneal confocal microscopy in Fabry patients with cornea verticillata]. Vestn Oftalmol 2021; 137:51-57. [PMID: 34410057 DOI: 10.17116/oftalma202113704151] [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: 11/17/2022]
Abstract
PURPOSE To study the changes in corneal microstructure and nerve fibers in patients with cornea verticillata in Fabry disease. MATERIAL AND METHODS The study included patients with a confirmed diagnosis of Fabry disease. All patients underwent standard ophthalmological examination. Corneal confocal microscopy was performed when slit-lamp examination revealed cornea verticillata. RESULTS Cornea verticillata was found in 64.5% of patients. Corneal microscopy revealed hyperreflective deposits in the basal cell layer of corneal epithelium in all patients with cornea verticillata. Characteristic features were desquamation of epithelial cells with islands of epithelial cells deficiency, as well as hyperreflective intracellular deposits in the basal layer. Changes in keratocytes in the form of perinuclear white microdots were found in the stroma of 25.8% of patients. Endothelial layer was not changed and had normal cell density, reflectivity and morphology in all patients with cornea verticillata. CONCLUSION Corneal confocal microscopy is a valuable diagnostic tool in patients with Fabry disease and may be important in evaluation of disease progression and monitoring of treatment efficacy.
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Affiliation(s)
| | | | - E A Tao
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A S Moiseev
- Lomonosov Moscow State University, Moscow, Russia
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9
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Non-infectious and non-hereditary diseases of the corneal epithelium. Exp Eye Res 2021; 202:108316. [DOI: 10.1016/j.exer.2020.108316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023]
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10
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Sivley MD, Benjamin WJ. Fabry keratopathy: manifestations and changes over time. Br J Ophthalmol 2019; 104:1148-1155. [PMID: 31666224 DOI: 10.1136/bjophthalmol-2019-314906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/04/2022]
Abstract
AIMS The goal was to find if changes in Fabry keratopathy were clinically observable over time. Also observed were variations of Fabry keratopathy, supplemental features, unique presentations and differences between keratopathies of right and left corneas and the same family and genotype. METHODS Biomicroscopic images of Fabry keratopathy in 10 persons with classic Fabry disease, 5 men and 5 women, were captured over an 18-month period. The keratopathies were categorised and scrutinised for changes over time, and differences between corneas of the same individual, family and genotype. RESULTS Fabry keratopathy ranged from mild change to marked change over 18 months. There was a great variety of whorl patterns. A few keratopathies were amorphous without vortices and many vortices were supplemented with amorphous features. All keratopathies were accompanied by diffuse epithelial haze. There was a range from negligible difference to marked difference between right and left eyes of the same individuals with similarities appearing as imprecise mirror images of each other. In some corneas, prominent vertical streams from the superior limbus integrated into the primary keratopathy. Comparisons between persons with the same family and genotype were obscured by gender and differences between right and left eyes. CONCLUSIONS Practitioners should be better able to detect Fabry disease having a fuller understanding of the variety of presentations of the dynamic, pathognomonic Fabry keratopathy. Routes of continuous centripetal renewal of corneal epithelium are spatially unique to each eye, in some cases subsidised by direct contribution of basal cells streamed from the superior limbus.
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11
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Wasielica-Poslednik J, Gericke A, Desuki A, Schlötzer-Schrehardt U, Pfeiffer N, Lisch W. Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy. Am J Ophthalmol Case Rep 2018; 11:87-91. [PMID: 30014052 PMCID: PMC6019764 DOI: 10.1016/j.ajoc.2018.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose To report on a case of recurrence of paraproteinemic keratopathy (PPK) associated with monoclonal gammopathy after bilateral penetrating keratoplasty. Observations Penetrating keratoplasty was performed on both eyes of a 45-year-old man due to bilateral progressive corneal stromal clouding. Recurrence of the corneal stromal opacities accompanied by a decrease in visual acuity was observed on slit-lamp examination already two years after penetrating keratoplasty. Confocal laser scanning microscopy (CLSM) of the corneal grafts performed three years after penetrating keratoplasty showed bilateral morphological changes identical to that found in the patient's corneas prior to penetrating keratoplasty. A hematological work-up revealed monoclonal gammopathy of type IgG kappa. The histochemical examination of the explanted corneas confirmed the diagnosis of PPK. Conclusions and importance Paraproteinemic keratopathy is an underdiagnosed ophthalmological condition, which may be associated with potentially life-threatening hematologic disorders. A hematological workup should be performed in patients with corneal opacities of uncertain etiology. Penetrating keratoplasty should be performed with caution in patients with monoclonal gammopathy due to the possibility of a very fast recurrence of PPK in the corneal graft. This is the first presentation of the recurrence of flake-like PPK after penetrating keratoplasty assessed with CLSM.
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12
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Bitirgen G, Turkmen K, Malik RA, Ozkagnici A, Zengin N. Corneal confocal microscopy detects corneal nerve damage and increased dendritic cells in Fabry disease. Sci Rep 2018; 8:12244. [PMID: 30116053 PMCID: PMC6095897 DOI: 10.1038/s41598-018-30688-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/03/2018] [Indexed: 11/30/2022] Open
Abstract
Fabry disease is characterised by neuropathic pain and accelerated vascular disease. This study evaluates the utility of corneal confocal microscopy (CCM) to non-invasively quantify corneal nerve and endothelial cell morphology and dendritic cell (DC) density in relation to disease severity in subjects with Fabry disease. Seventeen consecutive participants with Fabry disease and 17 healthy control subjects were included in this cross-sectional study. Fabry disease severity was measured using the Mainz Severity Score Index (MSSI). Central corneal sensitivity was assessed with a contact corneal esthesiometer. There was a significant reduction in the corneal sensitivity (5.75 [5.25–6.00] vs. 6.00 [6.00-6.00] cm, P = 0.014), nerve fiber density (NFD) (26.4 ± 10.1 vs. 33.7 ± 7.9 fibers/mm2, P = 0.025) and nerve fiber length (NFL) (15.9 ± 3.4 vs. 19.5 ± 4.4 mm/mm2, P = 0.012) and an increase in DC density (38.3 [17.5–97.3] vs. 13.5 [0–29.4] cells/mm2, P = 0.004) in subjects with Fabry disease compared to the healthy control subjects. The total MSSI score correlated with NFD (ρ = −0.686; P = 0.006), NFL (ρ = −0.692; P = 0.006), endothelial cell density (ρ = −0.511; P = 0.036), endothelial cell area (ρ = 0.514; P = 0.036) and α-galactosidase A enzyme activity (ρ = −0.723; P = 0.008). This study demonstrates reduced corneal sensitivity, corneal nerve fiber damage and increased DCs in subjects with Fabry disease.
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Affiliation(s)
- Gulfidan Bitirgen
- Department of Ophthalmology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.
| | - Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar.,Central Manchester University Teaching Hospitals Foundation Trust and Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Ahmet Ozkagnici
- Department of Ophthalmology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Nazmi Zengin
- Department of Ophthalmology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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Abstract
In recent years, there has been a rise in the number patients with CHD surviving into adulthood. Many have complications related to their CHD or its treatments, outside the heart, including ocular abnormalities. The objective of this review is to highlight the ocular abnormalities that occur in adults with CHD, either from their condition or related to the common drugs prescribed to manage it. In particular, we reviewed the effects of cyanosis, coarctation of the aorta, endocarditis, and the side effects of Sildenafil and Amiodarone. A change in the retinal vasculature is a common observation with cyanosis or coarctation of the aorta. Occlusion of the retinal vessels may also be observed in cyanotic patients, as well as those with infectious endocarditis. Sildenafil has established ocular side effects; here they are explored in the context of therapy for pulmonary hypertension. Similarly, Amiodarone has established ocular risks, which are summarised. The high prevalence of ocular consequences in adult CHD patients reinforces the need for knowledge of the risks involved and for frequent ophthalmological screening where appropriate.
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Role of Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Fabry Disease: A Case Report. Diseases 2018; 6:diseases6030055. [PMID: 29954050 PMCID: PMC6164009 DOI: 10.3390/diseases6030055] [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: 06/06/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 12/02/2022] Open
Abstract
Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by the deficient activity of the lysosomal enzyme α-galactosidase that leads to a systemic accumulation of globotriaosylceramide. Handheld in vivo reflectance confocal microscopy (HH-RCM) is a useful modern technique in diagnosis and follow-ups of many skin diseases. This noninvasive device provides high-resolution and high-contrast real-time images to study both the skin and the ocular surface structures that can help clinicians to confirm the diagnosis of FD. HH-RCM could be helpful even for the follow-ups of these patients, enabling us to monitor the effect of enzyme replacement therapy on corneal cells and keratinocytes.
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In Vivo Confocal Microscopic Observations of Vortex Keratopathy in Patients with Amiodarone-Induced Keratopathy and Fabry Disease. J Ophthalmol 2018; 2018:5315137. [PMID: 29750121 PMCID: PMC5884153 DOI: 10.1155/2018/5315137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/11/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare the morphology of two types of vortex keratopathy: amiodarone-induced keratopathy and the Fabry disease-associated keratopathy. Patients and Methods Eight patients who were receiving oral amiodarone therapy and 3 patients with Fabry disease, a mother and her 2 daughters, were examined by slit-lamp biomicroscopy and in vivo confocal microscopy (IVCM) regularly. Results Amiodarone-induced keratopathy developed in 7 of the 8 patients, and it was detected as early as 7 days by IVCM and 14 days by slit-lamp biomicroscopy. The in vivo confocal microscopic images showed a clustering of corneal epithelial cells with a highly reflective cytoplasm in both types of keratopathy. In the amiodarone-induced keratopathy, the highly reflective epithelial cells were first found at the center of the cornea and then spread to the periphery with increasing time on amiodarone. In Fabry disease, the highly reflective epithelial cells were consistently observed extending from the limbus to the central cornea. Conclusion These findings suggest that the corneal epithelial cells most likely endocytose amiodarone from the tear film in the amiodarone-induced keratopathy. In Fabry disease, globotriaosylceramide deposits are taken up by the lysosomes of the limbal epithelial stem cells, and they differentiate and migrate to the center of the cornea to form the whorl pattern.
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Confocal Microscopy Observation of Cornea Verticillata After Vandetanib Therapy for Medullary Thyroid Carcinoma. Cornea 2018. [PMID: 29521690 DOI: 10.1097/ico.0000000000001560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report 2 cases of cornea verticillata (CV) after vandetanib treatment for medullary thyroid carcinoma (MTC). METHODS In this retrospective interventional, case-report study, 2 patients who under vandetanib treatment for MTC were referred to our ophthalmology department because of vision complaints. Both subjects underwent a complete ophthalmologic examination, including confocal microscopy (CM) using the Heidelberg Retina Tomograph and Rostock Cornea Module. RESULTS A 70-year-old man and a 43-year-old woman, both with a history of MTC under treatment with vandetanib for 5 months and 30 months, respectively, presented with blurred vision. In both patients, a mild CV pattern was observed although deposits were more evident in the male patient. CM images showed hyperreflective deposits in the corneal epithelium and subepithelial nerve plexus. Bright microdots were also seen throughout the stroma, along with a few hyperreflective keratocytes in the anterior stroma. CONCLUSIONS In both patients, vandetanib seemed to be the cause of CV. The CM images supported the idea of drug-lipid complex deposits in vandetanib-induced CV.
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Drug-induced corneal epithelial changes. Surv Ophthalmol 2017; 62:286-301. [DOI: 10.1016/j.survophthal.2016.11.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 11/20/2022]
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Degirmenci C, Yilmaz SG, Onay H, Palamar M, Ucar SK, Kayikcioglu M, Coker M. A novel mutation and in vivo confocal microscopic findings in Fabry disease. Saudi J Ophthalmol 2017; 31:45-47. [PMID: 28337063 PMCID: PMC5352937 DOI: 10.1016/j.sjopt.2016.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 11/05/2016] [Accepted: 12/27/2016] [Indexed: 11/28/2022] Open
Abstract
Fabry disease is a hereditary, X-linked lysosomal storage disease due to a deficiency of the alpha galactosidase A enzyme. Globotriaosylceramide accumulates in tissues and results in multiorgan dysfunction. The most common ocular finding in Fabry disease is cornea verticillata. Increase in conjunctival vascular tortuosity, and cataract may also be seen. Herein, we demonstrate the in vivo confocal microscopic findings of a genetically proven Fabry disease patient with a novel hemizygous R112L mutation in GLA gene.
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Affiliation(s)
- Cumali Degirmenci
- Ege University Faculty of Medicine, Department of Ophthalmology, Izmir, Turkey
| | - Suzan Guven Yilmaz
- Ege University Faculty of Medicine, Department of Ophthalmology, Izmir, Turkey
| | - Huseyin Onay
- Ege University Faculty of Medicine, Department of Medical Genetics, Izmir, Turkey
| | - Melis Palamar
- Ege University Faculty of Medicine, Department of Ophthalmology, Izmir, Turkey
| | - Sema Kalkan Ucar
- Ege University Faculty of Medicine, Department of Paediatrics, Division of Metabolism and Nutrition, Izmir, Turkey
| | - Meral Kayikcioglu
- Ege University Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Mahmut Coker
- Ege University Faculty of Medicine, Department of Paediatrics, Division of Metabolism and Nutrition, Izmir, Turkey
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In Vivo Confocal Microscopy of the Human Cornea in the Assessment of Peripheral Neuropathy and Systemic Diseases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:951081. [PMID: 26770980 PMCID: PMC4685107 DOI: 10.1155/2015/951081] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/22/2015] [Indexed: 12/13/2022]
Abstract
In vivo confocal microscopy (IVCM) of the living human cornea offers the ability to perform repeated imaging without tissue damage. Studies using corneal IVCM have led to significant contributions to scientific and clinical knowledge of the living cornea in health and pathological states. Recently the application of corneal IVCM beyond ophthalmology to wider clinical and research fields has been demonstrated. Abnormalities of the corneal subbasal nerve plexus have been associated with many forms of peripheral neuropathy and Langerhans cells correlate with systemic inflammatory states. There is a rapidly growing evidence base investigating the use of corneal IVCM in many systemic conditions and a well-established evidence base for IVCM imaging of the corneal subbasal plexus in diabetic peripheral neuropathy. This paper reviews the potential use of corneal IVCM in general clinical practice as a noninvasive method of assessing peripheral neuropathies, monitoring inflammatory states and clinical therapeutic response.
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Sakuraba H, Tsukimura T, Tanaka T, Togawa T, Takahashi N, Mikami D, Wakai S, Akai Y. Clinical and biochemical investigation of male patients exhibiting membranous cytoplasmic bodies in biopsied kidney tissues; a pitfall in diagnosis of Fabry disease. J Nephropathol 2015; 4:91-6. [PMID: 26312237 PMCID: PMC4544560 DOI: 10.12860/jnp.2015.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 01/28/2015] [Accepted: 02/22/2015] [Indexed: 11/20/2022] Open
Abstract
Background: The existence of membranous cytoplasmic bodies in biopsied kidney tissues is one of the important findings when considering Fabry disease as the first choice diagnosis. However, there are possible acquired lysosomal diseases associated with pharmacological toxicity, although less attention has been paid to them.
Case Presentation: We experienced 3 male patients presenting with proteinuria and specific pathological changes strongly suggesting Fabry disease. We sought detailed clinical and biochemical information to avoid a wrong diagnosis. The patients were examined clinically and pathologically, and plasma α-galactosidase A (GLA) activity and the globotriaosylsphingosine (lyso-Gb3) concentrations were measured. Electron microscopic examination revealed numerous membranous inclusion bodies in podocytes, and biochemical analysis revealed normal GLA activity and a normal lyso-Gb3 level in plasma, showing that they did not have Fabry disease. They suffered from hyperlipidemia, myeloma, or lupus nephritis. They had received pitavastatin calcium, clarithromycin, loxoprofen and/or prednisolone, and there was no medication history of cationic amphiphilic drugs.
Conclusions: In this case series, the etiology of the inclusions was not clarified. However, these cases indicate that careful attention should be paid on diagnosis of patients exhibiting inclusion bodies in kidney cells, and it is important to confirm their past and present illnesses, and medication history as well as to measure the GLA activity and lyso-Gb3 level.
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Affiliation(s)
- Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Takahiro Tsukimura
- Departmentof Functional Bioanalysis, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Toshie Tanaka
- Department of Clinical Genetics, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Tadayasu Togawa
- Departmentof Functional Bioanalysis, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Naoki Takahashi
- Division of Nephrology, Department of General Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Daisuke Mikami
- Division of Nephrology, Department of General Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Sachiko Wakai
- Division of Nephrology, Department of Internal Medicine, Ohkubo Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Shinjuku, Tokyo, Japan
| | - Yasuhiro Akai
- The 1st Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
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Lee JJ, Choi BS, Park YM, Lee JS. In VivoConfocal Microscopic Findings of Corneal Tissue in Amiodarone-Induced Vortex Keratopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.1.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae Jung Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Beom Seok Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Young Min Park
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Perrot JL, Cinotti E, Labeille B, Cambazard F. [In vivo confocal microscopy for the diagnosis of lysosomal storage diseases]. Ann Dermatol Venereol 2014; 141:784-5. [PMID: 25433933 DOI: 10.1016/j.annder.2014.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 06/16/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Affiliation(s)
- J-L Perrot
- Service de dermatologie, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - E Cinotti
- Service de dermatologie, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
| | - B Labeille
- Service de dermatologie, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - F Cambazard
- Service de dermatologie, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
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Abstract
Purpose To evaluate a visual symptoms survey on patients with a known diagnosis of Fabry disease, and to compare the scores to those from a group of healthy subjects. Materials and methods An ocular symptom survey instrument was used to evaluate the symptoms of general ocular problems like itching, tearing, dryness, burning sensation, sensation of foreign body, difficulty in scotopic and photopic vision, and asthenopic symptoms. The survey instrument was administered to 95 participants (75 patients with Fabry disease and 20 healthy controls; median age: 32.5 years [standard deviation: 19.1 years] and 42.6 years [standard deviation: 14.7 years], respectively). A Mann–Whitney test was performed to evaluate the difference between the Fabry group and the healthy controls for each symptom survey severity score. A P-value <0.05 was considered significant. Results Of the survey instrument items, it was found that compared to the control group, the mean severity score of the Fabry disease group was significant for “dryness” of the eyes (P=0.02), “blurry/dim vision” (P=0.02), “hard to see in dark places” (P=0.01), and “halos around light” (P=0.01). The Fabry group also had a mean severity score for “soreness/tiredness” that was significantly higher than that of the control group (P=0.009). Conclusion The patients with Fabry disease may be suffering from ocular and visual symptoms related to manifestations of the disease. Further quantitative testing is needed to investigate the ocular and visual symptoms.
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Confocal microscopy in biopsy proven argyrosis. Case Rep Ophthalmol Med 2013; 2013:875989. [PMID: 23970986 PMCID: PMC3732605 DOI: 10.1155/2013/875989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/03/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the confocal microscopy findings of a 46-year-old male with bilateral biopsy proven argyrosis. Materials and Methods. Besides routine ophthalmologic examination, anterior segment photography and confocal microscopy with cornea Rostoch module attached to HRT II (Heidelberg Engineering GmbH, Heidelberg, Germany) were performed. Findings. Squamous metaplastic changes on conjunctival epithelium and intense highly reflective extracellular punctiform deposits in conjunctival substantia propria were detected. Corneal epithelium was normal. Highly reflective punctiform deposits starting from anterior to mid-stroma and increasing through Descemet's membrane were evident. Corneal endothelium could not be evaluated due to intense stromal deposits. Conclusion. Confocal microscopy not only supports diagnosis in ocular argyrosis, but also demonstrates the intensity of the deposition in these patients.
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Gokulgandhi MR, Vadlapudi AD, Mitra AK. Ocular toxicity from systemically administered xenobiotics. Expert Opin Drug Metab Toxicol 2012; 8:1277-91. [PMID: 22803583 DOI: 10.1517/17425255.2012.708337] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The eye is considered as the most privileged organ because of the blood-ocular barrier that acts as a barrier to systemically administered xenobiotics. However, there has been a significant increase in the number of reports on systemic drug-induced ocular complications. If such complications are left untreated, then it may cause permanent damage to vision. Hence, knowledge of most recent updates on ever-increasing reports of such toxicities has become imperative to develop better therapy while minimizing toxicities. AREAS COVERED The article is mainly divided into anterior and posterior segment manifestations caused by systemically administered drugs. The anterior segment is further elaborated on corneal complications where as the posterior segment is focused on optic nerve, retinal and vitreous complications. Furthermore, this article includes recent updates on acute and chronic ocular predicaments, in addition to discussing various associated symptoms caused by drugs. EXPERT OPINION Direct correlation of ocular toxicities due to systemic drug therapy is evident from current literature. Therefore, it is necessary to have detailed documentation of these complications to improve understanding and predict toxicities. We made an attempt to ensure that the reader is aware of the characteristic ocular complications, the potential for irreversible drug toxicity and indications for cessation.
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Affiliation(s)
- Mitan R Gokulgandhi
- University of Missouri-Kansas City, School of Pharmacy, Division of Pharmaceutical Sciences, HSB 5258, 2464 Charlotte St, Kansas City, MO 64108, USA
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