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Dalma-Weiszhausz J, Chacón-Camacho O, Chevez-Barrios P, Zenteno JC, Franco-Cárdenas V, García-Montaño LA, Pérez-Bravo J, García-Montalvo IA, Jiménez-Sierra JM, Dalma A. AUTOSOMAL DOMINANT MÜLLER CELL SHEEN DYSTROPHY: Clinical, Histopathologic, and Genetic Assessment in an Extended Family With Long Follow-Up. Retina 2022; 42:981-991. [PMID: 35125479 DOI: 10.1097/iae.0000000000003413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Autosomal dominant Müller cell dystrophy is a rare condition we described in 1991. It is characterized by a striking sheen appearance on the retinal surface with progressive retinal changes leading to disorganization and atrophy with a decreased b-wave electroretinograms. MATERIALS AND METHODS We examined 45 members of a 4-generation family. Fifteen subjects from three generations were found with the disease, without gender predilection. Seven patients underwent ophthalmic examination including fundus examination, intravenous fluorescein angiogram, spectral-domain optical coherence tomography, and electroretinogram. Six patients have a 30-year follow-up. Histopathology examination was performed on eyes of the eldest patient. Whole exome sequencing was done in four affected subjects. RESULTS Findings include a decreased visual acuity, abnormal cellophane-like sheen of the vitreoretinal interface, a "plush" nerve fiber layer, and characteristic macular changes. Electroretinogram showed a selective b-wave diminution. Intravenous fluorescein angiogram presented perifoveal hyperfluorescence and capillary leakage. Spectral-domain optical coherence tomography revealed cavitations involving inner and later outer retinal layers with later disorganization. Histopathologic findings included Müller cell abnormalities with cystic disruption of inner retinal layers, pseudoexfoliation in anterior segment, and amyloidosis of extraocular vessels. Pedigree analysis suggests an autosomal dominant inheritance with late onset. DNA analysis demonstrated a previously undescribed heterozygous missense p.Glu109Val mutation in transthyretin. CONCLUSION To the best of our knowledge, this is the first family reported with this disorder. Our data support the hypothesis that autosomal dominant Müller cell dystrophy is a distinct retinal dystrophy affecting Müller cells. Mutations in transthyretin gene may manifest as a predominantly retinal disorder.
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Affiliation(s)
- José Dalma-Weiszhausz
- Dr. Alejandro Dalma y Asociados, SC Mexico City, Mexico
- Retina Department, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Oscar Chacón-Camacho
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | | | - Juan C Zenteno
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Biochemistry Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; and
| | - Valentina Franco-Cárdenas
- Dr. Alejandro Dalma y Asociados, SC Mexico City, Mexico
- Retina Department, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
- Biochemistry Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; and
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México Campus Oaxaca (TECNM/ITO), Oaxaca, Mexico
| | - Leopoldo A García-Montaño
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México Campus Oaxaca (TECNM/ITO), Oaxaca, Mexico
| | - Jehieli Pérez-Bravo
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Iván A García-Montalvo
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México Campus Oaxaca (TECNM/ITO), Oaxaca, Mexico
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Bringmann A, Karol M, Unterlauft JD, Barth T, Wiedemann R, Kohen L, Rehak M, Wiedemann P. Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization. Int J Ophthalmol 2021; 14:818-833. [PMID: 34150536 DOI: 10.18240/ijo.2021.06.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema (CME) without and with internal limiting membrane (ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stabilization. METHODS A retrospective case series of 38 eyes of 35 patients is described. Of these, 17 eyes of 16 patients displayed foveal regeneration after resolution of CME, and 6 eyes of 6 patients displayed CME with ILM detachment. Eleven eyes of 9 patients displayed other kinds of foveal and retinal disorders associated with ILM detachment. RESULTS The pattern of edematous cyst distribution, with or without a large cyst in the foveola and preferred location of cysts in the inner nuclear layer or Henle fiber layer (HFL), may vary between different eyes with CME or in one eye during different CME episodes. Large cysts in the foveola may be associated with a tractional elevation of the inner foveal layers and the formation of a foveoschisis in the HFL. Edematous cysts are usually not formed in the ganglion cell layer. Eyes with CME and ILM detachment display a schisis between the detached ILM and nerve fiber layer (NFL) which is traversed by Müller cell trunks. ILM detachment was also found in single eyes with myopic traction maculopathy, macular pucker, full-thickness macular holes, outer lamellar holes, and glaucomatous parapapillary retinoschisis, and in 3 eyes with Müller cell sheen dystrophy (MCSD). As observed in eyes with MCSD, cellophane maculopathy, and macular pucker, respectively, fundus light reflections can be caused by different highly reflective membranes or layers: the thickened and tightened ILM which may or may not be detached from the NFL, the NFL, or idiopathic epiretinal membranes. In eyes with short single or multiple CME episodes, the central fovea regenerated either completely, which included the disappearance of irregularities of the photoreceptor layer lines and the reformation of a fovea externa, or with remaining irregularities of the photoreceptor layer lines. CONCLUSION The examples of a complete regeneration of the foveal morphology after transient CME show that the fovea may withstand even large tractional deformations and has a conspicuous capacity of structural regeneration as long as no cell degeneration occurs. It is suggested that the regenerative capacity depends on the integrity of the threedimensional glial scaffold for foveal structure stabilization composed of Müller cell and astrocyte processes. The glial scaffold may also maintain the retinal structure after loss of most retinal neurons as in late-stage MCSD.
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Affiliation(s)
- Andreas Bringmann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | | | - Jan Darius Unterlauft
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Thomas Barth
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Renate Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Leon Kohen
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany.,Helios Klinikum Aue, Aue 08280, Germany
| | - Matus Rehak
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
| | - Peter Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany
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Abstract
To report a rare case of Muller cell sheen dystrophy and to describe its clinical and diagnostic aspects. A 42-year-old woman presented with unilateral defective vision. Fundus evaluation revealed bilateral glistening retinal reflexes throughout the posterior pole with a wrinkled appearance in the right. Spectral Domain-OCT in the right showed abnormal internal limiting membrane, intraretinal schisis with serous detachment at macula. Angiography revealed staining along vessels. Electroretinogram in the affected eye was negative. At 4 months of follow up, vision dropped and intraretinal schisis increased. Family screening was negative.
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Affiliation(s)
- Haemoglobin Parida
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Naresh B Kannan
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - S R Rathinam
- Department of Uvea, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Oli A, Balakrishnan D. Multimodal imaging and adaptive optics in internal limiting membrane dystrophy. BMJ Case Rep 2020; 13:13/8/e234960. [PMID: 32816879 DOI: 10.1136/bcr-2020-234960] [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: 11/03/2022] Open
Abstract
An 18-year-old boy presented with a mild blurring of vision in both his eyes for the last 2 years. His best-corrected visual acuity was 20/60 in both the eyes with normal colour vision. Fundus evaluation showed exaggerated shiny reflex from the internal limiting membrane (ILM) with the wrinkled inner retinal surface at posterior pole. No vessel attenuation or retinal pigment epithelium changes were evident. Optical coherence tomography showed thickened ILM, which was appreciated in fundus photo also. The electrodiagnostic tests were normal, and the photoreceptors appeared normal in adaptive optics in the central macula at 2°-4° eccentricity. Among the very few reported cases of Muller cells sheen dystrophy, our patient was the probably the youngest and was picked up by a thoughtful ophthalmologist in detailed clinical examination. Adaptive optics in the case of ILM dystrophy is also not reported earlier.
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Affiliation(s)
- Avadhesh Oli
- Smt Kanuri Santhamma Center for Vitreo-retinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Divya Balakrishnan
- Smt Kanuri Santhamma Center for Vitreo-retinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
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