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Turanzas NJ, Mathiasen R, Heegaard S, Schmiegelow K, Sehested A, Holtz JK, Siersma V, Nissen KR, von Holstein SL. Ophthalmic symptoms, clinical signs and diagnostic delay in infants diagnosed with brain tumours in Denmark between 2007 and 2017. Acta Ophthalmol 2024; 102:334-341. [PMID: 37574657 DOI: 10.1111/aos.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE To investigate ophthalmic onset manifestations and the impact of diagnostic delay on the prognosis in infants (<1 year) diagnosed with a brain tumour. METHODS A retrospective population-based nationwide study of infants diagnosed with a brain tumour between 2007 and 2017 in Denmark. Data was retrieved from the Danish Childhood Cancer Registry, the National Danish Health registries, and medical files. Primary outcome measures included symptoms, clinical findings, time to diagnosis and survival. RESULTS Thirty-seven infants were diagnosed with a brain tumour in Denmark between 2007 and 2017. In total, 19/37 infants (51%, 95% CI: 34-68) had ophthalmic manifestations at any time prior to or at diagnosis; and in 6/37 (16%, 95% CI: 6-32) ophthalmic manifestations were the initial symptom. The most common ophthalmic manifestations were strabismus (n = 7), sunset eyes (n = 6), nystagmus (n = 4), reduced pupillary light reflex (n = 4), and/or decreased vision (n = 4). The median number of symptoms per infant at the time of diagnosis was three (range 0-9). The median diagnostic delay was 26 days (range 0-283, IQR: 6;90). 5-year survival rate was 75% (95% CI: 61-90) and all children with diagnostic delay > 100 days (n = 9, 24%) were still alive at the end of follow-up (median 6.3 years, range 2.2-10.2). CONCLUSION We provide an overview of symptoms and clinical signs in a nation-wide series of infants with CNS tumours and demonstrate that ophthalmic manifestations are frequently observed in infants prior to diagnosis, but, often in combination with other clinical signs. The diagnostic delay was substantial for a large part of the infants, but this was not associated with increased mortality.
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Affiliation(s)
- Nathali J Turanzas
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
| | - René Mathiasen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Sehested
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeppe K Holtz
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla R Nissen
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sarah L von Holstein
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
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Joseph S, Naithani R, Alvarez S, Glaser T, Freedman S, El-Dairi M. Modernizing the evaluation of infantile nystagmus: the role of handheld optical coherence tomography. J AAPOS 2024:103924. [PMID: 38692560 DOI: 10.1016/j.jaapos.2024.103924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Infantile nystagmus syndrome can be associated with an afferent problem (anterior or posterior segment) or constitute an isolated idiopathic disorder. With a normal ophthalmic examination, current guidelines recommend electroretinography (ERG) rather than magnetic resonance (MRI) for preliminary workup. Given the limited use of optical coherence tomography (OCT) in preverbal children, the purpose of this study was to evaluate the role of handheld OCT (HH-OCT) in the initial diagnostic evaluation of infantile nystagmus. METHODS In this cross-sectional case series, the medical records of all children with infantile nystagmus and HH-OCT imaging at the Duke Eye Center from August 2016 to July 2021 were retrospectively reviewed. Children with anterior segment disorders or obvious retina/optic nerve structural pathology, bilateral ophthalmoplegia, or Down syndrome were excluded. Two masked pediatric ophthalmologists graded HH-OCT images for optic nerve head and macular abnormalities. A neuro-ophthalmologist reviewed clinical findings of each patient's presenting visit and recommended appropriate testing (MRI vs ERG), initially without, and again with HH-OCT image review. RESULTS A total of 39 cases were included, with mean presenting age of 1.3 years. Final diagnoses included retinal or foveal abnormalities (7), optic nerve pathology (13), idiopathic (10), or unknown (9). HH-OCT findings included optic nerve hypoplasia (1), optic nerve elevation (3), persistence of the inner layers at the fovea (9), thin ganglion cell layer (8), ellipsoid zone abnormality (3), and thin choroid (1). HH-OCT findings altered initial clinical-only management in 16 cases (41%), including avoiding MRI (5) and ERG (10) testing. CONCLUSIONS Our results suggest that HH-OCT has the potential to augment and streamline the evaluation of infantile nystagmus.
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Affiliation(s)
- Suzanna Joseph
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Rizul Naithani
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Samuel Alvarez
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Tanya Glaser
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sharon Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Mays El-Dairi
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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Fossataro C, Pafundi PC, Mattei R, Cima V, De Rossi F, Savino G. Infantile nystagmus syndrome: An observational, retrospective, multicenter study. Optom Vis Sci 2024; 101:211-223. [PMID: 38684064 DOI: 10.1097/opx.0000000000002131] [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: 05/02/2024] Open
Abstract
SIGNIFICANCE This multicenter study assessed clinical and psychological aspects of infantile nystagmus syndrome (INS) focusing on its management and nonsurgical treatment. PURPOSE This study aimed to assess clinical features, management, relationship life, and psychological impact in a group of patients with nystagmus onset in pediatric age. METHODS This observational study included patients diagnosed with INS referred to two Italian centers from January 1, 2017, to December 31, 2020. Ophthalmologic and orthoptic features and impact of visual function on quality of life, according to nystagmus-specific nystagmus quality of life questionnaire, were analyzed within the overall sample and in any of INS subgroups. RESULTS Forty-three patients were included; 65.1% of them had idiopathic INS (IINS), and 34.9% had INS associated with ocular diseases (INSOD). The median age was 15.4 years (interquartile range [IQR], 10.4 to 17.3 years), significantly different between groups (median, 15.8 years among those with IINS vs. 12.3 years among those with INSOD; p<0.001). In the INSOD subgroup, strabismus was significantly more prevalent (93.3 vs. 57.1%; p=0.017). Binocular distance best-corrected visual acuity in primary position was significantly higher in the IINS subsample (p<0.001). Such behavior was further confirmed at anomalous head position evaluation (p<0.001). At near best-corrected visual acuity assessment, differences between groups were more remarkable in primary position (p<0.001) than in anomalous head position. Contrast sensitivity showed significantly higher values in the IINS subgroup (p<0.001). The nystagmus quality of life questionnaire disclosed a significantly lower score in IINS as compared with INSOD (median total score, 90.5 [IQR, 84 to 97] vs. 94 [IQR, 83.0 to 96.5]; p<0.001). CONCLUSIONS The IINS group showed significantly better ophthalmologic and orthoptic outcomes than the INSOD group. The psychological and quality-of-life impact was instead significantly greater in the IINS group. To the best of our knowledge, this is the first multicenter study investigating the clinical features of IIN and comparing the two main subgroups, IINS and INSOD.
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Affiliation(s)
| | | | - Roberta Mattei
- Ophthalmological Oncology Unit, Department of Neuroscience, Sensory Organs and Chest, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Cima
- Ophthalmological Oncology Unit, Department of Neuroscience, Sensory Organs and Chest, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca De Rossi
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients, IAPB Italia Onlus, Rome, Italy
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Castillejos AG, Devlin J, Saini C, Sun JA, Wang M, Johnson G, Chodosh J, Shen LQ. Artifacts in OCT Retinal Nerve Fiber Layer Imaging in Patients with Boston Keratoprosthesis Type 1. Ophthalmol Glaucoma 2024; 7:206-215. [PMID: 37783274 DOI: 10.1016/j.ogla.2023.09.004] [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: 05/14/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To determine the clinical utility of OCT retinal nerve fiber layer (OCT RNFL) imaging for glaucoma evaluation in patients with Boston keratoprosthesis type 1 (KPro) by investigating imaging artifacts. DESIGN Case-control study. SUBJECTS Patients with KPro and without KPro (controls) matched for age, gender, and glaucoma diagnosis. METHODS The most recent Cirrus OCT RNFL scan from 1 eye was categorized as having good signal strength (SS; ≥ 6 out of 10) or poor SS (< 6). Those with good SS were analyzed by 2 independent reviewers for artifacts. Images with good SS and no artifacts affecting the scanning circle were considered useful for glaucoma evaluation. MAIN OUTCOME MEASURES The incidence of poor SS and artifacts in OCT RNFL images; patient characteristics associated with useful scans. RESULTS Sixty-five patients with KPro and 75 controls were included; 89.2% of KPro patients and 89.3% of control subjects had glaucoma (P = 0.98). Forty percent of KPro patients and 5.3% of controls had poor SS (P < 0.001). The proportion of images with either poor SS or artifacts was similar in KPro (76.9%) vs. controls (72.0%, P = 0.51). The most common artifacts in both groups were missing data (43.6%, 53.2%, respectively, P = 0.32) and motion artifact (25.6%, 19.7%, respectively, P = 0.47). Images were useful for glaucoma evaluation in 43.1% of KPro patients and in 69.3% of controls (P = 0.002). In the KPro group, patients with useful OCT scans, compared with those without, had better visual acuity (0.4 ± 0.3 vs. 0.9 ± 0.7 logarithm of the minimum angle of resolution, P = 0.004), and did not have congenital corneal pathologies (0.0% vs. 24.3%, P = 0.008). A multivariate analysis showed that KPro patients with older age had higher odds of useful OCT images (odds ratio, 1.05; P = 0.03). Among KPro patients with useful OCT scans, retinal nerve fiber layer thickness correlated with observed cup-to-disc ratio (Pearson correlation: r = -0.42, P = 0.03). CONCLUSIONS The rate of OCT RNFL images with either poor signal strength or artifacts in the KPro and control population was comparable. In patients with KPro, where intraocular pressure measurements are difficult and glaucoma is highly prevalent and often severe, OCT RNFL imaging can be useful for glaucoma evaluation. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Alexandra G Castillejos
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Julia Devlin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Chhavi Saini
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Jessica A Sun
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mengyu Wang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Grace Johnson
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - James Chodosh
- Department of Ophthalmology and Visual Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Lucy Q Shen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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Hertle RW, Evliyaoglu F, McRitchie B. Demographic and Clinical Characteristics of 600 Children With Nystagmus. J Pediatr Ophthalmol Strabismus 2023; 60:406-410. [PMID: 36546778 DOI: 10.3928/01913913-20221026-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To characterize a large, international cohort of children with nystagmus. METHODS Data were collected from a single-center, prospectively developed database on patients with nystagmus. Outcome variables for this study included: (1) demographic characteristics, (2) nystagmus type, (3) clinical characteristics, (4) associated ophthalmic conditions, (5) associated non-ophthalmic conditions, (6) special testing findings, and (7) treatments. RESULTS Six hundred patients from 38 states and 30 countries were included. Age ranged from birth to younger than 18 years (mean: 15.2 years), 58% were female, 55% were race other than White, 75% had infantile nystagmus syndrome, 17% had neurologically significant nystagmus, 7% had fusion maldevelopment nystagmus syndrome, 64% had strabismus, 56% had an anomalous head posture, 94% had a significant refractive error, 64% had an associated ophthalmic abnormality (excluding ametropia), and 45% had an associated systemic condition. Special testing showed abnormalities in 67% and 95% had treatment directed at their nystagmus. CONCLUSIONS The most common diagnosis in this cohort is neurologically non-significant infantile nystagmus syndrome. Eye movement recordings provide a path toward accurate diagnosis and classification. There was a high prevalence of underlying ocular and/or systemic conditions requiring ophthalmic special testing as part of a diagnostic routine. Clinical treatments are available to most patients. [J Pediatr Ophthalmol Strabismus. 2023;60(6):406-410.].
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Cavuoto KM, Binenbaum G, Chang MY, Heidary G, Morrison DG, Trivedi RH, Kim SJ, Pineles SL. Genetic testing for infantile nystagmus syndrome with or without associated findings. J AAPOS 2023; 27:259-264. [PMID: 37717615 PMCID: PMC10789387 DOI: 10.1016/j.jaapos.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To review the published literature assessing the clinical utility of genetic testing in individuals with infantile nystagmus syndrome (INS), defined as binocular conjugate nystagmus and onset prior to 6 months of age, with or without associated findings. METHODS A literature search was last conducted in October 2022. The results were limited to articles published in English. The search yielded 517 abstracts, of which 72 papers were reviewed in full text. Of these papers, 4 met the criteria for inclusion and were graded by a study methodologist. RESULTS The 4 studies that met inclusion criteria used next-generation sequencing with gene panels ranging from 31 to 336 genes. The overall molecular diagnostic rate ranged from 35% to 60% in the included studies, although the yield was higher when genetic testing was guided by clinical phenotyping (approximately 80%) and in the subsets of patients with a family history (up to 88%). As many as 30% of patients tested had a reclassification of the diagnosis based on the genetic testing results. CONCLUSIONS Genetic testing has the potential to provide a definitive diagnosis and identify treatable conditions in patients presenting with INS, especially when considered in conjunction with clinical phenotyping and family history.
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Affiliation(s)
- Kara M Cavuoto
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| | - Gil Binenbaum
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melinda Y Chang
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Rupal H Trivedi
- Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Chang MY, Binenbaum G, Heidary G, Cavuoto KM, Morrison DG, Trivedi RH, Kim SJ, Pineles SL. Surgical Treatments to Improve Visual Acuity in Infantile Nystagmus Syndrome: A Report by the American Academy of Ophthalmology. Ophthalmology 2023; 130:331-344. [PMID: 36435636 PMCID: PMC9979093 DOI: 10.1016/j.ophtha.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To review the literature on the efficacy of surgical procedures to improve visual acuity (VA) in patients with infantile nystagmus syndrome (INS). METHODS Literature searches were last conducted in January 2022 in the PubMed database for English-language studies with no date restrictions. The combined searches yielded 354 abstracts, of which 46 were reviewed in full text. Twenty-three of these were considered appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. RESULTS One included study was a randomized trial; the remaining 22 were case series. The 23 studies included children and adults with INS and a variable proportion with anomalous head position (AHP), strabismus, and sensory diagnoses. The surgical interventions evaluated included large recessions, tenotomy and reattachment (TAR), myectomy with or without pulley fixation, and anterior extirpation of the 4 horizontal rectus muscles, as well as various procedures to correct an AHP in which VA was reported as a secondary outcome. The data were mixed, with improvements in binocular best-corrected visual acuity (BCVA) ranging from no improvement to 0.3 logarithm of the minimum angle of resolution (logMAR), or 3 lines. (Most studies were in the range of 0.05-0.2 logMAR.) Statistically significant improvement in VA was noted in 12 of 16 studies (75%) that performed statistical analyses, with no clear advantage of any single procedure. Complications and reoperations were lowest in patients who underwent TAR and highest in those who underwent myectomy or anterior extirpation. CONCLUSIONS The best available evidence suggests that eye muscle surgery in patients with INS results in a modest improvement in VA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Melinda Y Chang
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Gil Binenbaum
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kara M Cavuoto
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Rupal H Trivedi
- Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Meo M, Del Punta JA, Sánchez I, de Luis García R, Gasaneo G, Martin R. A dynamical method to objectively assess infantile nystagmus based on eye tracking. A pilot study. JOURNAL OF OPTOMETRY 2023:S1888-4296(23)00002-X. [PMID: 36697270 DOI: 10.1016/j.optom.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this research is to propose a new method for the easy, inexpensive and objective quantification of nystagmus using eye-tracking records collected during a simple reading task that could be implantable in clinical practice to assess patients with nystagmus. METHODS This is a prospective, observational pilot study. Eye movements of 4 nystagmus patients and 9 healthy children during a reading task (a paragraph with 82 words) on a 15'' monitor were collected and compared. Data are time series indicating the gaze position on the screen. Two quantifiers were proposed: IndS (based on the speed of movements) and IndF (based on the variation of the gaze trajectory). RESULTS The indices proposed reflect differences in the behavior of eye movements between the two groups. Nystagmus patients present higher values of IndS - indicating smaller number of slow movements (16% of movements with speeds <0.33 1/s for nystagmus and 85% for the control group, with p = 0.01) - and higher values of IndF - indicating higher gaze fluctuation (p = 0.01). Differences were not related with reading speed as show the mean and standard deviation: the nystagmus group required 115±45 s to complete the task and the control group 151±85 s; p = 0.73. CONCLUSIONS The proposed indices provide a new method that allows an objective assessment of nystagmus, with potential use in clinical and research practice to improve the follow-up of patients by monitoring the nystagmus over time or treatment.
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Affiliation(s)
- Marcos Meo
- Instituto de Física del Sur, Departamento de Física, Universidad Nacional del Sur (UNS) - CONICET, 8000 Bahía Blanca, Argentina
| | - Jessica Adriana Del Punta
- Instituto de Física del Sur, Departamento de Física, Universidad Nacional del Sur (UNS) - CONICET, 8000 Bahía Blanca, Argentina; Departamento de Matemática, Universidad Nacional del Sur (UNS), 8000 Bahía Blanca, Argentina
| | - Irene Sánchez
- Optometry Research Group, IOBA Eye Institute. School of Optometry, University of Valladolid. 47011 Valladolid, Spain; Departamento de Física Teórica Atómica y Óptica. Universidad de Valladolid, 47011 Valladolid, Spain.
| | - Rodrigo de Luis García
- Laboratorio de Procesado de Imagen (LPI). Universidad de Valladolid, 47011 Valladolid, Spain
| | - Gustavo Gasaneo
- Instituto de Física del Sur, Departamento de Física, Universidad Nacional del Sur (UNS) - CONICET, 8000 Bahía Blanca, Argentina; Centro Integral de Neurociencias Aplicadas, 8000 Bahía Blanca, Argentina
| | - Raúl Martin
- Optometry Research Group, IOBA Eye Institute. School of Optometry, University of Valladolid. 47011 Valladolid, Spain; Departamento de Física Teórica Atómica y Óptica. Universidad de Valladolid, 47011 Valladolid, Spain
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Makoshi Z, Leonard JR. Clinical Manifestations of Chiari I Malformation. Neurosurg Clin N Am 2023; 34:25-34. [DOI: 10.1016/j.nec.2022.09.003] [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]
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Suppiej A, Ceccato C, Lonardi V, Reffo ME. Infantile nystagmus without overt eye abnormality: Early features and neuro-ophthalmological diagnosis. Dev Med Child Neurol 2022; 64:1532-1538. [PMID: 35644009 PMCID: PMC9796881 DOI: 10.1111/dmcn.15284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 01/31/2023]
Abstract
AIM To analyse the neuro-ophthalmological data of children referred for further work-up of infantile nystagmus where ophthalmological evaluation had not achieved a diagnosis. METHOD We retrospectively reviewed medical records of patients presenting with infantile nystagmus at our institution between 2007 and 2019. Inclusion criteria were onset before 6 months of age, availability of complete ophthalmic examination, visual electrophysiological tests, and neurological examination. Children with a previous definite ophthalmological diagnosis at onset and those with uncertain nystagmus onset age were not recruited. RESULTS Out of 142 infants (mean age at nystagmus onset 3.6 mo, SD 1.7, range 0-6 mo; 56 females, 86 males), 23% had neurological nystagmus, 7% mixed neurological and sensory nystagmus, 48% sensory defect, and 22% idiopathic infantile nystagmus. The neurological diagnoses were inborn errors of metabolism, white matter genetic disorders, and brain malformations. The prevalent diagnosis in the sensory defect subgroup was retinal dystrophy. INTERPRETATION Infantile nystagmus without diagnostic ocular findings may be due to neurological, retinal, and optic nerve disorders or be a benign idiopathic condition. In infants with and without neurological abnormalities, the search for a sensory defect should include visual electrophysiology performed early in the diagnostic pathway. WHAT THIS PAPER ADDS Infantile nystagmus without diagnostic ophthalmological signs has an underlying neurological cause in 30% of cases. Neurological diagnoses include congenital brain malformations, and metabolic and genetic disorders. Sensory defects are part of systemic neurological disorders in 23% of infants. Electrophysiology is useful when ophthalmological examination is uninformative.
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Affiliation(s)
- Agnese Suppiej
- Department of Medical Sciences, Paediatric SectionUniversity of FerraraFerraraItaly,Robert Hollman FoundationPadovaItaly
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Vemula SK, Kim SA, Muvavarirwa T, Bell JL, Whitman MC. Impaired Extraocular Muscle Innervation Is Present Before Eye Opening in a Mouse Model of Infantile Nystagmus Syndrome. Invest Ophthalmol Vis Sci 2022; 63:4. [PMID: 36083589 PMCID: PMC9469029 DOI: 10.1167/iovs.63.10.4] [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: 11/28/2022] Open
Abstract
Purpose To determine if extraocular muscles (EOMs) from mice with nystagmus show abnormalities in myofiber composition and innervation, as seen in EOMs from human nystagmus patients, and to determine when in development those changes occur. Methods Balb/c albino mice were crossed to pigmented mice to generate heterozygous mice, which were mated to create experimental litters containing albinos and wild-type controls. Orbits were harvested from adult animals (12 weeks old); on postnatal day (P)0, P10, P14, and P21; and from 6-week-old animals. EOM sections were collected from the intraorbital portion of the muscles. Sections were immunostained for slow and fast myosin and for neuromuscular junctions (NMJs). The proportion of each myofiber subtype and the density and size of NMJs were quantified. Initial innervation patterns were assessed using whole-mount immunostaining of embryonic day (E)13.5 embryos expressing IslMN:GFP. Results Adult albino EOMs display an increased proportion of slow myofibers, larger slow myofibers, and a decreased density of NMJs—similar to human nystagmus patients. The percentage of NMJs on slow myofibers is also lower in albino animals. The initial innervation pattern of the incoming ocular motor neurons is normal in E13.5 albino embryos. Differences in the proportion of slow and fast myofiber subtypes are present as early as P14, and a lower percentage of NMJs on slow myofibers is present by P21. There is a lower density of NMJs on albino EOMs as early as P10, prior to eye opening. Conclusions Changes in NMJ development observed before eye opening indicate that nystagmus is not solely secondary to poor vision.
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Affiliation(s)
- Sampath Kumar Vemula
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Seoyoung A Kim
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Tapiwa Muvavarirwa
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Jessica L Bell
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Mary C Whitman
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States.,F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, Massachusetts, United States
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Hassan A, Mir YR, Kuchay RAH. Ocular findings and genomics of X-linked recessive disorders: A review. Indian J Ophthalmol 2022; 70:2386-2396. [PMID: 35791118 PMCID: PMC9426149 DOI: 10.4103/ijo.ijo_252_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Advent of new sequencing technologies and modern diagnostic procedures has opened the door for a deeper understanding of disorders about which little was known previously. Discovery of novel genes, new genetic variants in previously known genes and better techniques of functional validation has immensely contributed to unraveling the molecular basis of genetic disorders. Availability of knockout animal models like the zebrafish and gene editing tools like CRISPR-Cas9 has elucidated the function of many new genes and helped us to better understand the functional consequences of various gene defects. This has also led to better diagnosis and therapeutic interventions. In this context, a good body of research work has been done on X-linked recessive disorders with ocular findings. This review will focus on ocular and genetic findings of these rare disorders. To our knowledge, this is the first comprehensive review encompassing ocular and genomic spectrum of X-linked recessive disorders.
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Affiliation(s)
- Asima Hassan
- Department of Health and Medical Education, Srinagar, Jammu and Kashmir, India
| | - Yaser R Mir
- Department of Biotechnology, Baba Ghulam Shah Badshah University, Rajouri, Jammu and Kashmir, India
| | - Raja A H Kuchay
- Department of Biotechnology, Baba Ghulam Shah Badshah University, Rajouri, Jammu and Kashmir, India
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13
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Shankar SP, Fallurin R, Watson T, Shankar PR, Young TL, Orel-Bixler D, Rauen KA. Ophthalmic manifestations in Costello syndrome caused by Ras pathway dysregulation during development. Ophthalmic Genet 2021; 43:48-57. [PMID: 34612139 DOI: 10.1080/13816810.2021.1978103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Costello syndrome (CS) is a multisystem developmental disorder caused by germline pathogenic variants in HRAS resulting in dysregulation of the Ras pathway. A systematic characterization of ophthalmic manifestations provides a unique opportunity to understand the role of Ras signal transduction in ocular development and guide optimal ophthalmic care in CS individuals. METHODS Visual function, ocular features and genotype/phenotype correlations were evaluated in CS individuals harboring HRAS pathogenic variants, by cross-sectional and retrospective studies, and were recruited through the Costello Syndrome Family Network (CSFN) between 2007 and 2020. RESULTS Fifty-six molecularly diagnosed CS individuals including 34 females and 22 males, ages ranging from 0.5 to 37 years were enrolled. The most common ophthalmic manifestations in the cross-sectional study were lack of stereopsis (96%), refractive errors (83%), strabismus (72%), nystagmus (69%), optic nerve hypoplasia or pallor (55%) and ptosis (13.7%) with higher prevalence than in the retrospective data (refractive errors (41%), strabismus (44%), nystagmus (26%), optic nerve hypoplasia or pallor (7%) and ptosis (11%)). Visual acuities were found to ranged from 20/25 to 20/800 and contrast sensitivity from 1.6% to 44%. HRAS pathogenic variants included p.G12S (84%), p.G13C (7%), p.G12A (5.4%), p.G12C (1.8%) and p.A146V (1.8%). CONCLUSION Majority of individuals with CS have refractive errors, strabismus, nystagmus, absent stereopsis, and optic nerve abnormalities suggesting that HRAS and the Ras pathway play a vital role in visual system development. Ptosis, refractive errors and strabismus are amenable to treatment and early ophthalmic evaluation is crucial to prevent long-term vision impairment and improve overall quality of life in CS.
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Affiliation(s)
- Suma P Shankar
- Department of Pediatrics, University of California Davis, Sacramento, California, USA.,Department of Ophthalmology, University of California Davis, Sacramento, California, USA
| | - Reshmitha Fallurin
- Department of Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tonya Watson
- The School of Optometry and Vision Science, University of California Berkeley, Berkeley, California, USA
| | - Prabhu R Shankar
- Department of Public Health, University of California Davis, Sacramento, California, USA
| | - Terri L Young
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Deborah Orel-Bixler
- The School of Optometry and Vision Science, University of California Berkeley, Berkeley, California, USA
| | - Katherine A Rauen
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
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14
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Obi O, Reagan A, Vachharajani A. Abnormal Eye Findings in a 3-month-old Infant. Neoreviews 2021; 22:e641-e643. [PMID: 34470768 DOI: 10.1542/neo.22-9-e641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Olugbemisola Obi
- Division of Neonatal Medicine, Department of Child Health, University of Missouri at Columbia, Columbia, MO
| | - Ashley Reagan
- Women and Children's Hospital, Neonatal Intensive Care Unit, Columbia, Columbia, MO
| | - Akshaya Vachharajani
- Division of Neonatal Medicine, Department of Child Health, University of Missouri at Columbia, Columbia, MO
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15
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Patel A, Abou-Al-Shaar H, Chiang MC, Algattas HN, McDowell MM, Stone JG, Mitchell EB, Emery SP, Greene S. Neuroophthalmological manifestations of congenital aqueductal stenosis. J Neurosurg Pediatr 2021; 28:320-325. [PMID: 34171841 DOI: 10.3171/2021.2.peds20824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Congenital aqueductal stenosis (CAS) is a common etiology of hydrocephalus that occurs in a subset of infants and may be linked to an increased incidence of ophthalmological abnormalities and delayed developmental milestones. Although hydrocephalus is common and widely studied, sparse literature exists on patients with isolated (no identifiable genetic link) CAS along with analysis of ophthalmological manifestations. In this study, the authors sought to describe the ophthalmological abnormalities and delayed developmental milestones of patients with isolated CAS. METHODS Data of patients with CAS were prospectively entered and monitored in a surgical database maintained by the Department of Neurological Surgery at Children's Hospital of Pittsburgh from January 2005 to October 2016. Patients with a family history of congenital hydrocephalus, positive testing for genetic forms of aqueductal stenosis, other congenital abnormalities suggesting an underlying genetic syndrome, and stenosis/obstruction due to secondary causes were excluded from this study. Prenatal and perinatal history, CSF diversion history, and a variety of outcomes, including ophthalmological deficits and developmental milestones, were collected and analyzed. RESULTS A total of 41 patients with isolated CAS were identified, with a mean follow-up duration of 6 years. Among that cohort, 26 patients (63.4%) developed neuroophthalmological complications, which were further stratified. Fourteen patients (34.1%) developed strabismus and 11 (26.8%) developed astigmatism, and 1 patient (2.4%) with papilledema was recorded. Among patients with ophthalmological abnormalities, 76.9% had delayed developmental milestones (p = 0.045). CONCLUSIONS Patients with CAS were found to have increased risk of ophthalmological abnormalities requiring correction, along with an increased risk of delayed developmental milestones. Importantly, there was a significant correlation between the development of ophthalmological abnormalities and delayed developmental milestones that was independent of CSF diversion history. Larger patient cohort studies are required to explore whether earlier development of hydrocephalus, as is the case in CAS, causes elevated rates of neurological and ophthalmological complications, and if earlier CSF diversion correlates with improved outcomes.
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Affiliation(s)
- Aneek Patel
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | | | | | | | | | | | | | - Stephen P Emery
- 4Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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16
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Falsaperla R, Saporito MAN, Pisani F, Mailo J, Pavone P, Ruggieri M, Suppiej A, Corsello G. Ocular Motor Paroxysmal Events in Neonates and Infants: A Review of the Literature. Pediatr Neurol 2021; 117:4-9. [PMID: 33581391 DOI: 10.1016/j.pediatrneurol.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ocular paroxysmal events can accompany a variety of neurological disorders. Particularly in infants, ocular paroxysmal events often represent a diagnostic challenge. Distinguishing between epileptic and nonepileptic events or between physiological and pathologic paroxysmal events can be challenging at this age because the clinical evaluation and physical examination are often limited. Continuous polygraphic video-electroencephalography (EEG) monitoring can be helpful in these situations. METHODS We review ocular paroxysmal events in newborns and infants. The aim is to improve clinical recognition of ocular paroxysmal events and provide a guide to further management. Using the PubMed database, we identified studies focused on all ocular motor paroxysmal events in neonates and infants. RESULTS Fifty-eight articles were selected on the topic. We summarized and divided these studies into those describing nonepileptic and epileptic ocular paroxysmal events. CONCLUSIONS The diagnosis of ocular paroxysmal events can be difficult, but their recognition is important because of the variety of underlying etiologies. The distinction between epileptic versus nonepileptic ocular paroxysmal events often often requires polygraphic video-EEG to identify the epileptic events. For nonepileptic events, further testing can characterize pathologic ocular movements. To determine the etiology and prognosis of ocular paroxysmal events, a multimodal approach is required, including a thorough full history and clinical examination, polygraphic video-EEG monitoring, neuroimaging, and a careful follow-up plan.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit, AOU Policlinico, PO San Marco, University of Catania, Catania, Italy; Unit of Pediatrics and Pediatric Emergency, AOU Policlinico, PO San Marco, University of Catania, Catania, Italy
| | | | - Francesco Pisani
- Unit of Child Neuropsychiatry, Department of Neuroscience, University of Parma, Parma, Italy
| | - Janette Mailo
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Piero Pavone
- Unit of Rare Diseases of the Nervous System, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, Department of Maternal and Child Health, University of Palermo, Palermo, Italy
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Celdrán-Vivancos D, Noval-Martín S, González-Manrique M, Negoita A, Porto-Castro S. Eye oscilations with neurological implications in pediatric age. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:366-376. [PMID: 34217474 DOI: 10.1016/j.oftale.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Eye oscillations, both nystagmic and non-nystagic, can occur from birth. Most correspond to infantile nystagmus that dubates in the first six months of life, which include idiopathic, sensory, latent, or overt latent motor nystagmus. Those associated with neurological diseases or syndromes correspond to approximately 33%, their identification and correct evaluation being important given the potential visual and vital complications. MATERIAL AND METHODS We made a systematic review of the literature on supranuclear gaze control mechanisms and the main ocular oscillations with possible neurological implications, both in childhood. With this, we intend to assess if there are already established clinical-anatomical associations, and to propose a protocol on the complementary studies to be carried out in these cases. RESULTS There are still anatomical pathways involved in supranuclear gaze control that are not fully clarified and understood. Besides, except in the case of nystagmus in seesaw and upbeat, we did not find anatomical explanations for their pathogenesis. The need for complete neuro-ophthalmological physical examinations and the request for additional tests in children who present ocular oscillations with neurological characteristics are clear. CONCLUSIONS Supranuclear gaze control follows a complex neurological network that still needs to be studied better. With a better dissection of the same we could try to understand why the ocular oscillations that we studied have these specific forms of presentation. As for the complementary requests, the request for neuroimaging tests is practically constant, making the others according to the specific case before which we find ourselves.
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Affiliation(s)
- D Celdrán-Vivancos
- Servicio de Oftalmología, Hospital Universitario de La Princesa, Madrid, Spain.
| | - S Noval-Martín
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain
| | | | - A Negoita
- Servicio de Radiodiagnóstico, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - S Porto-Castro
- Servicio de Oftalmología, Hospital Universitario de La Princesa, Madrid, Spain
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18
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Papageorgiou E, Gottlob I. The challenges faced by clinicians diagnosing and treating infantile nystagmus Part I: diagnosis. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1860754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Eleni Papageorgiou
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece
| | - Irene Gottlob
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
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Hvid K, Nissen KR, Bayat A, Roos L, Grønskov K, Kessel L. Prevalence and causes of infantile nystagmus in a large population-based Danish cohort. Acta Ophthalmol 2020; 98:506-513. [PMID: 32067411 DOI: 10.1111/aos.14354] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/31/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to provide a population-based estimate on the prevalence of infantile nystagmus and to describe the causes in the Capital Region of Denmark. METHODS Review of medical records of children with infantile nystagmus born in the period 1 January 2010 through 31 December 2017 and living in the Capital Region of Denmark. We used birth registry data from Statistics Denmark and the National Danish Birth Registry to calculate the prevalence of nystagmus in children born at term and prematurely. RESULTS A total of 103 patients (52 males/51 females) with infantile nystagmus were included. The overall prevalence of infantile nystagmus was 6.1 per 10 000 live births. It was higher in premature children (28.4/10 000 live births) than children born at term (4.4/10 000), p < 0.0001, and highest in children born extremely preterm, (97.3/10 000). The most common cause of infantile nystagmus was ocular disease (44%) followed by idiopathic nystagmus (32%), neurological disorders and genetic syndromes (20%) and prematurity without retinopathy of prematurity as the only cause (4%). CONCLUSIONS In this study, we provide the prevalence of infantile nystagmus based on national medical records in which all residents are accounted for. Our findings show a prevalence of 6.1 per 10 000 live births but six times higher among children born preterm than born at term. Ocular disease was the leading cause of infantile nystagmus with albinism and ocular malformations as the most frequent. In 1/3 of patients, no cause could be identified.
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Affiliation(s)
- Karen Hvid
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla Rothe Nissen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Bayat
- Danish Epilepsy Centre, Dianalund, Denmark.,Department of Pediatrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura Roos
- Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karen Grønskov
- Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Garone G, Suppiej A, Vanacore N, La Penna F, Parisi P, Calistri L, Palmieri A, Verrotti A, Poletto E, Rossetti A, Cordelli DM, Velardita M, d'Alonzo R, De Liso P, Gioè D, Marin M, Zagaroli L, Grosso S, Bonfatti R, Mencaroni E, Masi S, Bellelli E, Da Dalt L, Raucci U. Characteristics of Acute Nystagmus in the Pediatric Emergency Department. Pediatrics 2020; 146:peds.2020-0484. [PMID: 32732262 DOI: 10.1542/peds.2020-0484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.
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Affiliation(s)
- Giacomo Garone
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome Italy;
| | - Agnese Suppiej
- Neurophtalmology Programme, Padova Paediatric University Hospital, Padova, Italy.,Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institutes of Health, Rome, Italy
| | | | - Pasquale Parisi
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University and Sant'Andrea Hospital, Rome, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Antonella Palmieri
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Genova, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Elisa Poletto
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Annalisa Rossetti
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Duccio Maria Cordelli
- Child Neurology Unit, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy
| | - Mario Velardita
- Pediatric Operative Unit, Gravina Hospital, Caltagirone, Catania, Italy; and
| | - Renato d'Alonzo
- Pediatric Clinic, Santa Maria della Misericordia Hospital and Department of Surgical and Medical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | - Paola De Liso
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Gioè
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | - Marta Marin
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Genova, Italy
| | - Luca Zagaroli
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Rocco Bonfatti
- Child Neurology Unit, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy
| | - Elisabetta Mencaroni
- Pediatric Clinic, Santa Maria della Misericordia Hospital and Department of Surgical and Medical Sciences, Università Degli Studi di Perugia, Perugia, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer's Children Hospital, Florence, Italy
| | | | - Liviana Da Dalt
- Division of Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
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Gómez-Mariscal M, Hernández-Martínez P, Rodríguez-Del Valle JM, Ruiz-Guerrero M, Márquez-González C, Rodríguez-Sánchez JM. Consecutive strabismus after infantile nystagmus syndrome surgery and potential risk factors. Graefes Arch Clin Exp Ophthalmol 2020; 258:1549-1554. [PMID: 32307586 DOI: 10.1007/s00417-020-04686-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/25/2020] [Accepted: 04/04/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the incidence of consecutive strabismus after infantile nystagmus surgery and its potential risk factors. METHODS A retrospective study including 89 patients was conducted. Patients presented infantile nystagmus (idiopathic or ocular disease-associated nystagmus) without previous or coincidental strabismus. Sex, age at surgery, amblyopia, botulinum toxin (BT) injection before surgery, spherical equivalent, anisometropia, surgery procedure (Anderson's or retroequatorial recessions of four horizontal recti), and follow-up were analyzed. Kaplan-Meier and univariate Cox regression were performed. RESULTS The median age at surgery was 5 years. The median follow-up was 36 months. The incidence of consecutive strabismus was 11.2%. There were eight patients with exotropia and two patients with esotropia. Consecutive strabismus was associated with severe bilateral amblyopia (p = 0.036), previous treatment with BT injection (p = 0.025), and large recessions of the four horizontal muscles (p = 0.001). The hazard ratio for patients with severe bilateral amblyopia was 5.4 (95% CI 1.1-25.8), and for patients previously treated with BT was 6.1 (1.3-29.3). The survival rate was 95.4% at 6 months and 88.5% at 3 years. CONCLUSION Severe bilateral amblyopia, previous BT treatment, and type of surgery seem to be associated with consecutive strabismus after infantile nystagmus surgery. Most cases appear within the first months after surgery.
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Affiliation(s)
- Marta Gómez-Mariscal
- Ramón y Cajal University Hospital, Universidad de Alcalá, Carretera Colmenar Viejo, km 9.100, 28034, Madrid, Spain.
| | - P Hernández-Martínez
- Ramón y Cajal University Hospital, Universidad de Alcalá, Carretera Colmenar Viejo, km 9.100, 28034, Madrid, Spain
| | - J M Rodríguez-Del Valle
- Ramón y Cajal University Hospital, Universidad de Alcalá, Carretera Colmenar Viejo, km 9.100, 28034, Madrid, Spain.,Clínica Dr. Rodríguez, Madrid, Spain
| | - M Ruiz-Guerrero
- Ramón y Cajal University Hospital, Universidad de Alcalá, Carretera Colmenar Viejo, km 9.100, 28034, Madrid, Spain.,Clínica Dr. Rodríguez, Madrid, Spain
| | - C Márquez-González
- Ramón y Cajal University Hospital, Universidad de Alcalá, Carretera Colmenar Viejo, km 9.100, 28034, Madrid, Spain
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Structural variations in a non-coding region at 1q32.1 are responsible for the NYS7 locus in two large families. Hum Genet 2020; 139:1057-1064. [PMID: 32248360 PMCID: PMC7406531 DOI: 10.1007/s00439-020-02156-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/24/2020] [Indexed: 01/20/2023]
Abstract
Congenital motor nystagmus (CMN) is characterized by early-onset bilateral ocular oscillations without other ocular deficits. To date, mutations in only one gene have been identified to be responsible for CMN, i.e., FRMD7 for X-linked CMN. Four loci for autosomal dominant CMN, including NYS7 (OMIM 614826), have been mapped but the causative genes have yet to be identified. NYS7 was mapped to 1q32.1 based on independent genome-wide linkage scan on two large families with CMN. In this study, mutations in all known protein-coding genes, both intronic sequence with predicted effect and coding sequence, in the linkage interval were excluded by whole-genome sequencing. Then, long-read genome sequencing based on the Nanopore platform was performed with a sample from each of the two families. Two deletions with an overlapping region of 775,699 bp, located in a region without any known protein-coding genes, were identified in the two families in the linkage region. The two deletions as well as their breakpoints were confirmed by Sanger sequencing and co-segregated with CMN in the two families. The 775,699 bp deleted region contains uncharacterized non-protein-coding expressed sequences and pseudogenes but no protein-coding genes. However, Hi-C data predicted that the deletions span two topologically associated domains and probably lead to a change in the 3D genomic architecture. These results provide novel evidence of a strong association between structural variations in non-coding genomic regions and human hereditary diseases like CMN with a potential mechanism involving changes in 3D genome architecture, which provides clues regarding the molecular pathogenicity of CMN.
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Nezri DG, Zlotnik A, Zalevsky Z. Passive optical device for nystagmus correction and ophthalmic resolution enhancement. APPLIED OPTICS 2020; 59:484-491. [PMID: 32225325 DOI: 10.1364/ao.59.000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/30/2019] [Indexed: 06/10/2023]
Abstract
In this research, we present a novel device that solves the reduced visual acuity caused by involuntary movements of the retina in nystagmus. The proposed solution comprises a contact lens that moves together with the eyeball and an ophthalmic lens (spectacles). Our work has three parts: numerical simulation of the proposed solution, an experimental optical bench procedure, and a clinical experiment, with nonnystagmus subjects, in which we mimicked the uncontrolled eye movements in nystagmus. In the numerical and experimental bench sections of this study, we show that the proposed optics produces a clear and stable image on a screen. In the clinical study, subjects with the device felt only small movements of the image when they moved their eyes across the field of view. They described a magnification resulting in narrowing the field of view, and therefore had to move their heads to see the space of the room. This follows the theoretical expectation for the proposed concept. Thus, the proposed device may help nystagmus subjects fixate the image on the center of the retina and thus enable improved visual acuity. The device may be used in young children suffering from nystagmus to prevent amblyopia.
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Reading Performance and Compensatory Head Posture in Infantile Nystagmus after Null Zone Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234728. [PMID: 31783492 PMCID: PMC6926938 DOI: 10.3390/ijerph16234728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/17/2022]
Abstract
This study aimed to assess the visual function, reading performance, and compensatory head posture (CHP) in schoolchildren with infantile nystagmus. A total of 18 participants aged between 13 to 18 years old were divided into spectacle (n = 9) and null zone group (n = 9) based on their visual acuity. Visual acuity (LogMAR), contrast sensitivity (Pelli–Robson), reading time and rate (Tobii TX300), and CHP were measured pre and post null zone reading training. Participants in the null zone group received 10 sessions of training (5 weeks). Visual acuity and contrast sensitivity of participants in the spectacle and null zone groups were not significantly different pre and post training. Reading performance, i.e., reading time (z = −1.36; p = 0.173) and reading rate (z = −0.06; p = 0.953), of participants in the spectacle group was not significantly different after 5 weeks. Reading time (z = −2.55; p = 0.011) and reading rate (z = −2.07; p = 0.038 of participants in the null zone group showed significant improvement post training. After 5 weeks, CHP improved in six out of the nine participants (66.7%) of the null zone group and was unchanged in all participants in the spectacle group. Null zone reading training could benefit children with infantile nystagmus in improving reading performance and compensatory head posture.
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Abstract
Nystagmus has a profound impact on patients visual function and social life. Infantile nystagmus (IN) is much more common than neurological nystagmus, and establishing the correct diagnosis is key in guiding the appropriate treatment paradigm. This paper attempts to demonstrate a stepwise approach in investigation and clinical evaluation, that is (often) sufficient in differentiating IN from nystagmus of neurological origin, and to uncover underlying sensory etiologies of IN. Targeted and rational uses of paraclinical exams are emphasized when they deemed necessary to complement the clinical assessment. The author's preferred surgical and non-surgical strategies to optimize vision, and improve the head posture and strabismus that can accompany nystagmus, are discussed (although without the goal of writing a complete revision on the topic).
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Affiliation(s)
- Luis H Ospina
- a Department of Pediatric Ophthalmology and Neuro-Ophthalmology , Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal , Montréal , QC , Canada
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Xiu Y, Yao Y, Yang T, Pan M, Yang H, Fang W, Gu F, Zhao J, Zhu Y. Identification of a novel idiopathic congenital nystagmus‑causing missense mutation, p.G296C, in the FRMD7 gene. Mol Med Rep 2018; 18:2816-2822. [PMID: 30015830 PMCID: PMC6102629 DOI: 10.3892/mmr.2018.9260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/12/2018] [Indexed: 11/06/2022] Open
Abstract
Exploring the genetic basis for idiopathic congenital nystagmus is critical for improving our understanding of its molecular pathogenesis. In the present study, direct sequencing using gene specific primers was performed in order to identify the causative mutations in two brothers from a Chinese family who had been diagnosed with idiopathic congenital nystagmus. A comprehensive ophthalmological examination, including eye movement recordings, fundus examination, and retinal optical coherence tomography imaging was also conducted, to characterize the disease phenotype. The results revealed that the two brothers exhibited clear signs of nystagmus without any other ocular anomalies. Direct sequencing revealed a G to T transition (c.886G>T) in exon 9 of the four‑point‑one, ezrin, radixin, moesin domain‑containing 7 (FRMD7) gene, which resulted in a conservative substitution of glycine to cysteine at codon 296 (p.G296C), leading to idiopathic congenital nystagmus in the two affected brothers. c.886G>T is a novel idiopathic congenital nystagmus‑inducing mutation in the FRMD7 gene. This finding expands the spectrum of known gene mutations in idiopathic congenital nystagmus, and may be useful for faster gene diagnosis, prenatal testing, the development of potential gene therapies, and for improving the understanding of the molecular pathogenesis of idiopathic congenital nystagmus.
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Affiliation(s)
- Yanghui Xiu
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Yihua Yao
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Tanchu Yang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Meihua Pan
- Eye Institute and Xiamen Eye Center Affiliated Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Hui Yang
- Department of Ophthalmology, Xiamen Children's Hospital, Xiamen, Fujian 361000, P.R. China
| | - Weifang Fang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Feng Gu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, State Key Laboratory and Key Laboratory of Vision Science, Ministry of Health and Zhejiang Provincial Key Laboratory of Ophthalmology and Optometry, Wenzhou, Zhejiang 325027, P.R. China
| | - Junzhao Zhao
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yihua Zhu
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
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