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Coussa RG, Sohn EH, Han IC, Parikh S, Traboulsi EI. Mitochondrial DNA A3243G variant-associated retinopathy: a meta-analysis of the clinical course of visual acuity and correlation with systemic manifestations. Ophthalmic Genet 2021; 42:420-430. [PMID: 33827363 DOI: 10.1080/13816810.2021.1907598] [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: 01/27/2023]
Abstract
PURPOSE The mitochondrial DNA A3243G (m.3243A>G) variant causes a wide spectrum of phenotypes, with pigmentary retinopathy as the most common ocular finding. We undertook this meta-analysis to investigate the clinical course of visual acuity (VA) in patients with m.3243A>G variant and provide key clinical correlations with systemic manifestations. METHODS A PubMed literature search was performed and studies were selected after satisfying pre-set inclusion criteria. Demographic and clinical data, including retinal findings and systemic manifestations were recorded. Cross-sectional and linear regression analyses were used to investigate the relationship between VA and age, as well as between the age at diagnosis of retinopathy and the mean ages at diagnosis of sensorineural hearing loss or diabetes. The age and prevalence of systemic manifestations among patients with and without retinopathy were studied using t-tests and Mann-Whitney U-tests (performed on binarized data). Likelihood ratios were computed. RESULTS The mean VA (average of both eyes) of 90 patients (72.2% female; 65/90) were collected from 18 studies published between 1990 and 2018. The baseline mean age was 45.2 years (range 17 to 92). The mean logMAR VA was 0.10 (- 0.12 to 1.39). There was a statistically significant linear correlation between the logMAR VA and age (p = .008). The VA of patients less than or equal to 50 years of age was significantly better than that of patients older than 50 years (0.06 vs.0.18 logMAR, p = .002). 67 patients (74.4%) showed a characteristic pigmentary retinopathy with a mean age at diagnosis of 47.9 years (17 to 92) and VA of 0.14 logMAR (- 0.12 to 1.24). Age at diagnosis of retinopathy was linearly correlated with age at diagnosis of hearing loss or diabetes (p < .001). Patients with retinopathy were more likely to have hearing loss (83.6% vs. 56.5%, p = .03) or diabetes (56.7% vs. 17.4%, p = .001) than those without retinopathy. Those with both hearing loss and diabetes had an earlier onset of retinopathy than those without (46.4 vs. 60.4 years, p = .01). Patients without both hearing loss and diabetes were 5.3-fold less likely to develop a retinopathy. CONCLUSIONS Patients with m.3243A>G variant pigmentary retinopathy maintain highly functional VA until around the fifth decade of life, after which significant visual decline ensues. Patients without hearing loss and diabetes have a lower likelihood of exhibiting a retinopathy, which tends to appear about one decade after hearing loss and diabetes are diagnosed.
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Affiliation(s)
- Razek Georges Coussa
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Elliott H Sohn
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Ian C Han
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Sumit Parikh
- Cleveland Clinic, Mitochondrial Medicine Center, Cleveland, Ohio, USA
| | - Elias I Traboulsi
- Cleveland Clinic, Cole Eye Institute, Center for Genetic Eye Diseases, Cleveland, Ohio, USA
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Mitochondrial DNA A3243G variant-associated retinopathy: Current perspectives and clinical implications. Surv Ophthalmol 2021; 66:838-855. [PMID: 33610586 DOI: 10.1016/j.survophthal.2021.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Abstract
Cellular function and survival are critically dependent on the proper functionality of the mitochondrion. Neurodegenerative cellular processes including cellular adenosine triphosphate production, intermediary metabolism control, and apoptosis regulation are all mitochondrially mediated. The A to G transition at position 3243 in the mitochondrial MTTL1 gene that encodes for the leucine transfer RNA (m.3243A>G) causes a variety of diseases, including maternally inherited loss of hearing and diabetes syndrome (MIDD), mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS). Ophthalmological findings-including posterior sub-capsular cataract, ptosis, external ophthalmoplegia, and pigmentary retinopathy- have all been associated with the m.3243A>G variant. Pigmentary retinopathy is, however, the most common ocular finding, occurring in 38% to 86% of cases. To date, little is known about the pathogenesis, natural history, and heteroplasmic and phenotypic correlations of m.3243A>G-associated pigmentary retinopathy. We summarize the current understanding of mitochondrial genetics and pathogenesis of some associated diseases. We then review the pathophysiology, histology, clinical features, treatment, and important ocular and systemic phenotypic manifestations of m.3243A>G variant associated retinopathy. Mitochondrial diseases require a multidisciplinary team approach to ensure effective treatment, regular follow-up, and accurate genetic counseling.
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Piquin G, Astroz P, Ohayon A, Amoroso F, Miere A, Souied EH. [Optical coherence tomography, angiography and conventional multimodal imaging findings in a case of maternally inherited diabetes and deafness]. J Fr Ophtalmol 2020; 43:e405-e408. [PMID: 32950285 DOI: 10.1016/j.jfo.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 11/25/2022]
Affiliation(s)
- G Piquin
- Department of ophthalmology, university Paris-Est Créteil, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000, Créteil, France
| | - P Astroz
- Department of ophthalmology, university Paris-Est Créteil, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000, Créteil, France
| | - A Ohayon
- Department of ophthalmology, university Paris-Est Créteil, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000, Créteil, France
| | - F Amoroso
- Department of ophthalmology, university Paris-Est Créteil, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000, Créteil, France
| | - A Miere
- Department of ophthalmology, university Paris-Est Créteil, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000, Créteil, France
| | - E H Souied
- Department of ophthalmology, university Paris-Est Créteil, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000, Créteil, France.
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Ovens CA, Ahmad K, Fraser CL. Fundus Autofluorescence in Maternally Inherited Diabetes and Deafness: The Gold Standard for Monitoring Maculopathy? Neuroophthalmology 2020; 44:168-173. [DOI: 10.1080/01658107.2019.1653935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Christopher A. Ovens
- Discipline of Ophthalmology and Eye Health, the Sydney Medical School, the Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kate Ahmad
- Department of Neurology, Royal North Shore Hospital, St Leonards, Australia
| | - Clare L. Fraser
- Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, Macquarie University, Macquarie, Australia
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Panchal B, Saoji K. Commentary: Heteroplasmy in maternally inherited diabetes and deafness. Indian J Ophthalmol 2020; 68:253. [PMID: 31856544 PMCID: PMC6951128 DOI: 10.4103/ijo.ijo_1296_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hanif AM, Yan J, Jain N. Pattern Dystrophy: An Imprecise Diagnosis in the Age of Precision Medicine. Int Ophthalmol Clin 2019; 59:173-194. [PMID: 30585925 DOI: 10.1097/iio.0000000000000262] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Qian CX, Branham K, Khan N, Lundy SK, Heckenlively JR, Jayasundera T. Cystoid macular changes on optical coherence tomography in a patient with maternally inherited diabetes and deafness (MIDD)-associated macular dystrophy. Ophthalmic Genet 2017; 38:467-472. [PMID: 28140742 DOI: 10.1080/13816810.2016.1253106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The clinical presentation and optical coherence tomography findings in a patient with maternally inherited diabetes and deafness (MIDD) are presented to highlight the presence of macular cystoid spaces in some patients with this disease. Typically, patients with MIDD demonstrate progression of a pigmentary maculopathy into areas of geographic macular atrophy. At the time of initial visit, the 30-year-old patient had large macular cystoid changes in addition to retinal pigmentary changes in both eyes. The cystoid changes responded to treatment with systemic immunosuppression and a topical carbonic anhydrase inhibitor (CAI), recurred when treated with topical CAI monotherapy, and finally resolved after an intravitreal triamcinolone acetonide injection. Over time, the retinal atrophy continued to progress, but the macular cysts did not recur. The patient received systemic immunosuppression for renal transplantation due to renal failure resulting from focal glomerulosclerosis. There was no evidence of diabetic retinopathy at any time during the five-and-a-half-year follow-up, and the patient retained good visual acuity in both eyes.
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Affiliation(s)
- Cynthia X Qian
- a Kellogg Eye Center , University of Michigan , Ann Arbor , Michigan , USA.,b Department of Ophthalmology, Retina Service , University of Montreal , Montreal , Quebec , Canada
| | - Kari Branham
- a Kellogg Eye Center , University of Michigan , Ann Arbor , Michigan , USA
| | - Naheed Khan
- a Kellogg Eye Center , University of Michigan , Ann Arbor , Michigan , USA
| | - Steven K Lundy
- a Kellogg Eye Center , University of Michigan , Ann Arbor , Michigan , USA
| | | | - Thiran Jayasundera
- a Kellogg Eye Center , University of Michigan , Ann Arbor , Michigan , USA
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[Diabetes and reticular macular dystrophy]. J Fr Ophtalmol 2015; 39:118-20. [PMID: 26597553 DOI: 10.1016/j.jfo.2015.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 11/21/2022]
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Feigl B, Morris CP. Visual function and risk genotypes in maternally inherited diabetes and deafness. Can J Ophthalmol 2013; 48:e111-4. [DOI: 10.1016/j.jcjo.2013.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/26/2013] [Indexed: 10/26/2022]
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Gorman GS, Taylor RW. Mitochondrial DNA abnormalities in ophthalmological disease. Saudi J Ophthalmol 2011; 25:395-404. [PMID: 23960954 DOI: 10.1016/j.sjopt.2011.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 02/07/2011] [Accepted: 02/12/2011] [Indexed: 01/13/2023] Open
Abstract
Mitochondrial disorders are a group of clinically heterogeneous diseases, commonly defined by lack of cellular energy due to genetic defects of oxidative phosphorylation (OXPHOS). Ocular involvement is a prominent clinical feature of mitochondrial disease. This can manifest as optic nerve dysfunction specifically involving retinal ganglion cells as typified by Leber hereditary optic neuropathy (LHON), or progressive external ophthalmoplegia (PEO) and ptosis involving the extraocular muscles which is commonly associated with either primary mitochondrial DNA (mtDNA) mutations or acquired mtDNA defects secondary to a nuclear genetic disorder of mtDNA maintenance. In this short review, we will outline the unique characteristics of mitochondrial genetic disease and its investigation with reference to the clinical features and molecular genetic abnormalities underlying mitochondrial ophthalmological disease.
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Affiliation(s)
- Grainne S Gorman
- Mitochondrial Research Group, Institute for Ageing and Health, Newcastle University, United Kingdom
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Bibliography. Current world literature. Curr Opin Ophthalmol 2009; 20:417-22. [PMID: 19684489 DOI: 10.1097/icu.0b013e32833079c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Current literature in diabetes. Diabetes Metab Res Rev 2009; 25:i-xii. [PMID: 19405078 DOI: 10.1002/dmrr.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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