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Ma Y, Lv K, Yang K, Wu H. Secondary ocular hypertension due to tentorial dural arteriovenous fistula: a case report. BMC Ophthalmol 2023; 23:373. [PMID: 37697299 PMCID: PMC10496288 DOI: 10.1186/s12886-023-03124-8] [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: 12/27/2022] [Accepted: 09/01/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Tentorial dural arteriovenous fistulas (TDAVFs) are abnormal shunts between meningeal arteries and the intradural venous system located in the tentorial dura mater, which typically manifest with haemorrhage or progressive neurological disorders. TDAVFs with pure ocular presentation have been rarely reported. CASE PRESENTATIONS The case of a 56-year-old man presented with unilateral eye redness, proptosis and elevated intraocular pressure was reported herein, which was caused by a TDAVF. The fistula was fed by the left posterior cerebral artery and posterior meningeal artery. The drainage was into the basal vein and internal cerebral veins, which led the arterial blood flow forward to the left superior ophthalmic vein directly. The redundant blood flow caused the rise of episcleral venous pressure, leading to the clinical presentations. Gamma knife radiosurgery was performed then considering the delicate vascular structure and its deep location. The corkscrew hyperaemia was gradually alleviated after the surgery, but the intraocular pressure remained elevated at follow-ups. CONCLUSION Dural arteriovenous fistulas which are not directly connected to cavernous sinus could cause ocular presentations like proptosis, eye redness and ocular hypertension.
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Affiliation(s)
- Yao Ma
- Department of Ophthalmology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, 100044, Beijing, China
| | - Kun Lv
- Department of Ophthalmology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, 100044, Beijing, China
| | - Kangyi Yang
- Department of Ophthalmology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, 100044, Beijing, China
| | - Huijuan Wu
- Department of Ophthalmology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, 100044, Beijing, China.
- Eye diseases and optometry Institute, Beijing, China.
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.
- College of Optometry, Peking University Health Science Center, Beijing, China.
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Huang L, Sun H, Liu Y, Xu L, Hu M, Yang Y, Wang N, Wu Y, Guo W. GNAQ R183Q somatic mutation contributes to aberrant arteriovenous specification in Sturge-Weber syndrome through Notch signaling. FASEB J 2023; 37:e23148. [PMID: 37606556 DOI: 10.1096/fj.202300608r] [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: 03/30/2023] [Revised: 07/08/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
Episcleral vasculature malformation is a significant feature of Sturge-Weber syndrome (SWS) secondary glaucoma, the density and diameter of which are correlated with increased intraocular pressure. We previously reported that the GNAQ R183Q somatic mutation was located in the SWS episclera. However, the mechanism by which GNAQ R183Q leads to episcleral vascular malformation remains poorly understood. In this study, we investigated the correlation between GNAQ R183Q and episcleral vascular malformation via surgical specimens, human umbilical vein endothelial cells (HUVECs), and the HUVEC cell line EA.hy926. Our findings demonstrated a positive correlation between episcleral vessel diameter and the frequency of the GNAQ R183Q variant. Furthermore, the upregulation of genes from the Notch signaling pathway and abnormal coexpression of the arterial marker EphrinB2 and venous marker EphB4 were demonstrated in the scleral vasculature of SWS. Analysis of HUVECs overexpressing GNAQ R183Q in vitro confirmed the upregulation of Notch signaling and arterial markers. In addition, knocking down of Notch1 diminished the upregulation of arterial markers induced by GNAQ R183Q. Our findings strongly suggest that GNAQ R183Q leads to malformed episcleral vasculatures through Notch-induced aberrant arteriovenous specification. These insights into the molecular basis of episcleral vascular malformation will provide new pathways for the development of effective treatments for SWS secondary glaucoma.
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Affiliation(s)
- Lulu Huang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Hao Sun
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yixin Liu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Li Xu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Menghan Hu
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
| | - Yijie Yang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ning Wang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yue Wu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Wenyi Guo
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Wang X, Wang M, Liu H, Mercieca K, Prinz J, Feng Y, Prokosch V. The Association between Vascular Abnormalities and Glaucoma-What Comes First? Int J Mol Sci 2023; 24:13211. [PMID: 37686017 PMCID: PMC10487550 DOI: 10.3390/ijms241713211] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide. While intraocular pressure (IOP) presents a major risk factor, the underlying pathophysiology still remains largely unclear. The correlation between vascular abnormalities and glaucoma has been deliberated for decades. Evidence for a role played by vascular factors in the pathogenesis of glaucomatous neurodegeneration has already been postulated. In addition, the fact that glaucoma causes both structural and functional changes to retinal blood vessels has been described. This review aims to investigate the published evidence concerning the relationship between vascular abnormalities and glaucoma, and to provide an overview of the "chicken or egg" dilemma in glaucoma. In this study, several biomarkers of glaucoma progression from a vascular perspective, including endothelin-1 (ET-1), nitric oxide, vascular endothelial growth factor (VEGF), and matrix metalloproteinases (MMPs), were identified and subsequently assessed for their potential as pharmacological intervention targets.
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Affiliation(s)
- Xiaosha Wang
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
| | - Maoren Wang
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hanhan Liu
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
| | - Karl Mercieca
- Glaucoma Section, University Hospital Eye Clinic, 53127 Bonn, Germany;
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester M13 9WH, UK
| | - Julia Prinz
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
- Department of Ophthalmology, RWTH Aachen University, 52074 Aachen, Germany
| | - Yuan Feng
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
| | - Verena Prokosch
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
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Huang L, Xu L, Liu Y, Yang Y, Wang N, Gu M, Sun C, Wu Y, Guo W. Combined Trabeculotomy-Non-Penetrating Deep Sclerectomy for Glaucoma in Sturge-Weber Syndrome. Ophthalmic Res 2023; 66:958-967. [PMID: 37331334 PMCID: PMC10353303 DOI: 10.1159/000531143] [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: 10/28/2022] [Accepted: 05/05/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION The aim of the study was to evaluate the efficacy and safety of combined trabeculotomy-non-penetrating deep sclerectomy (CTNS) in the treatment of Sturge-Weber syndrome (SWS) secondary glaucoma. METHODS This retrospective study reviewed cases that underwent CTNS as initial surgery for SWS secondary glaucoma at our Ophthalmology Department center from April 2019 to August 2020. Surgical success was defined as an intraocular pressure (IOP) ≤ 21 mm Hg with (qualified success) or without (complete success) the use of anti-glaucoma medications. IOP >21 mm Hg or <5 mm Hg despite 3 or more applications of anti-glaucoma medications on 2 consecutive follow-up visits or at the last follow-up, performance of additional glaucoma (IOP-lowering) surgery, or with vision-threatening complications were classified as failure. RESULTS A total of 22 eyes of 21 patients were included. Twenty-one eyes were of early-onset type and 1 eye was of adulthood onset. For Kaplan-Meier survival analysis, the overall success rates at 1st and 2nd years were 95.2% and 84.9%, while the complete success rates at 1st and 2nd years were 42.9% and 36.7%. At the last follow-up (22.3 ± 4.0 months, range: 11.2∼31.2), overall success was achieved in 19 (85.7%) eyes and complete success in 12 (52.4%) eyes. Postoperative complications included transient hyphema (11/22, 50.0%) and transient Ⅰ degree shallow anterior chamber (1/22, 4.5%), and retinal detachment (1/22, 4.5%). No other severe com plications were detected during the follow-up. CONCLUSION CTNS significantly reduces IOP in SWS secondary glaucoma patients who have serious episcleral vascular malformation. CTNS in SWS secondary glaucoma patients is safe and effective for short and medium periods. A randomized controlled study comparing the long-term prognosis of SWS early-onset and late-onset glaucoma underwent CTNS is worth conducting.
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Affiliation(s)
- Lulu Huang
- Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Li Xu
- Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yixin Liu
- Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yijie Yang
- Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ning Wang
- Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Mengyang Gu
- Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Chengyang Sun
- Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yue Wu
- Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Wenyi Guo
- Department of Ophthalmology, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Alhayaza R, Khan SA, Semidey VA, Owaidhah O. The Effectiveness of Propranolol in Managing Hemorrhagic Choroidal and Exudative Retinal Detachment following Ahmed Glaucoma Valve Implantation in Sturge-Weber Syndrome: Case Report and Literature Review. Case Rep Ophthalmol 2021; 12:859-869. [PMID: 34899259 PMCID: PMC8613549 DOI: 10.1159/000518805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022] Open
Abstract
Sturge-Weber syndrome (SWS) is a congenital neurological disorder that is characterized by hamartomas involving the skin, brain, and eyes and marked by the presence of the facial port-wine stain, which consequently leads to various ocular complications. Among all ocular comorbidities, glaucoma is the most frequently witnessed in SWS patients with a prevalence of 30%–70%. If glaucoma is refractory to conventional medical management, surgical intervention can be considered. Common complications of glaucoma procedures in SWS are choroidal detachment and suprachoroidal hemorrhage. Moreover, we report a 6-year-old girl, known case of unilateral congenital glaucoma secondary to SWS. Despite being on maximal antiglaucoma drops and undergoing multiple surgical interventions, the patient had uncontrolled intraocular pressure of her right eye. A decision to proceed with Ahmed glaucoma valve implantation (AGVI) to the right eye was made. In the immediate postoperative period, the patient developed hemorrhagic choroidal detachment and exudative retinal detachment. A trial of oral propranolol (1.5–2 mg/kg/day) was then initiated for 4 months. After 30 days from oral propranolol course initiation, we started noticing a significant improvement of the hemorrhagic choroidal and exudative retinal detachment. Spontaneously, a marked reduction in subretinal fluid and suprachoroidal hemorrhage was also seen. Thus, the improvement was correlated with the propranolol therapy. Here, we report a significant improvement of the postoperative complications of AGVI in a patient with SWS, following 4 months of oral propranolol course (1.5–2 mg/kg/day). Further studies are needed to determine the dosage, duration, and optimal mechanism by which propranolol works in this situation.
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Affiliation(s)
- Raid Alhayaza
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Saud A Khan
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ohoud Owaidhah
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Hassanpour K, Nourinia R, Gerami E, Mahmoudi G, Esfandiari H. Ocular Manifestations of the Sturge-Weber Syndrome. J Ophthalmic Vis Res 2021; 16:415-431. [PMID: 34394871 PMCID: PMC8358762 DOI: 10.18502/jovr.v16i3.9438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Sturge-Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a non-inherited congenital disorder characterized by neurologic, skin, and ocular abnormalities. A somatic activating mutation (R183Q) in the GNAQ gene during early embryogenesis has been recently recognized as the etiology of vascular abnormalities in SWS. Approximately, half of the patients with SWS manifest ocular involvement including glaucoma as the most common ocular abnormality followed by choroidal hemangioma (CH). The underlying pathophysiology of glaucoma in SWS has not been completely understood yet. Early onset glaucoma comprising 60% of SWS glaucoma have lower success rates after medical and surgical treatments compared with primary congenital glaucoma. Primary angle surgery is associated with modest success in the early onset SWS glaucoma while the success rate significantly decreases in late onset glaucoma. Filtration surgery is associated with a higher risk of intraoperative and postoperative choroidal effusion and suprachoroidal hemorrhage. CH is reported in 40-50% of SWS patients. The goal of treatment in patients with CH is to induce involution of the hemangioma, with reduction of subretinal and intraretinal fluid and minimal damage to the neurosensory retina. The decision for treating diffuse CHs highly depends on the patient's visual acuity, the need for glaucoma surgery, the presence of subretinal fluid (SRF), its chronicity, and the potential for visual recovery.
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Affiliation(s)
- Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Gerami
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghavam Mahmoudi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Toris CB, Gagrani M, Ghate D. Current methods and new approaches to assess aqueous humor dynamics. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1902308] [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: 01/24/2023]
Affiliation(s)
- Carol B. Toris
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
- Dept. Of Ophthalmology and Visual Science, Case Western Reserve University, Cleveland, OH USA
| | - Meghal Gagrani
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
| | - Deepta Ghate
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
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Yeung HH, Kane SA, Turlapati N, Nzuna JS, Walton DS. Failure of Goniosurgery for Glaucoma Associated With Sturge-Weber Syndrome. J Pediatr Ophthalmol Strabismus 2020; 57:384-387. [PMID: 33211896 DOI: 10.3928/01913913-20200825-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the surgical results of goniosurgery for children with glaucoma associated with Sturge-Weber syndrome. METHODS Retrospective review of medical records of patients who had initial goniosurgery for glaucoma associated with Sturge-Weber syndrome. RESULTS A total of 46 eyes of 42 patients who had glaucoma associated with Sturge-Weber syndrome and were treated with initial goniosurgery were identified to determine the efficacy of therapeutic goniotomy and trabeculotomy (goniosurgery). The average age at the time of goniosurgery was 1.5 years (range: 1 month to 23 years). Office intraocular pressure (IOP) measurements before goniosurgery were recorded in 76% of patients (32 of 42 patients) with an average measurement of 35 mm Hg (range: 25 to 50 mm Hg). The average interval to failure was 4 months (range: 1 to 48 months). Forty-six eyes underwent goniosurgery with a rate of failure of 98% (45 of 46 eyes) and a qualified success rate of 2% (1 of 46 eyes). Fifty-one goniotomy and 11 trabeculotomy procedures were performed. On gonioscopy, the filtration angles were all abnormal with variable width and visibility of the ciliary body band and less visible scleral spur. The trabecular meshwork was seen preoperatively in 100% of eyes (41 of 41 eyes) examined, all of which underwent goniosurgery. Five eyes underwent goniosurgery without documented gonioscopy. The ciliary body band was seen in 39% of eyes (16 of 41 eyes) and the scleral spur was visible in 10% of eyes (4 of 41 eyes). CONCLUSIONS Goniosurgery is not an effective initial glaucoma surgery for glaucoma associated with Sturge-Weber syndrome. It can be used to temporize the IOP, but ultimately other forms of glaucoma surgery must be considered when indicated. [J Pediatr Ophthalmol Strabismus. 2020;57(6):384-387.].
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Miraldi Utz V, Brightman DS, Sandoval MA, Hufnagel RB, Saal HM. Systemic and ocular manifestations of a patient with mosaic ARID1A-associated Coffin-Siris syndrome and review of select mosaic conditions with ophthalmic manifestations. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:644-655. [PMID: 32888375 DOI: 10.1002/ajmg.c.31839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/16/2022]
Abstract
Mosaic genetic mutations may be somatic, germline, or "gonosomal" and have the potential to cause genetic syndromes, disorders, or malformations. Mutations can occur at any point in embryonic development and the timing determines the extent of distribution of the mutation throughout the body and different tissue types. The eye and visual pathway offer a unique opportunity to study somatic and gonosomal mosaic mutations as the eye consists of tissues derived from all three germ layers allowing disease pathology to be assessed with noninvasive imaging. In this review, we describe systemic and ocular manifestations in a child with mosaic Coffin-Siris syndrome. The patient presented with a significant medical history of accommodative esotropia and hyperopia, macrocephaly, polydactyly, global developmental delay, hypotonia, ureteropelvic junction (UPJ) obstruction, and brain MRI abnormalities. The ophthalmic findings in this patient were nonspecific, however, they are consistent with ocular manifestations reported in other patients with Coffin-Siris syndrome. We also review ophthalmic findings of select mosaic chromosomal and single-gene disorders. Ophthalmic assessment alongside clinical genetic testing may play an important role in diagnosis of genetic syndromes as well as understanding disease pathology, particularly when mosaicism plays a role.
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Affiliation(s)
- Virginia Miraldi Utz
- Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Diana S Brightman
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Monica A Sandoval
- Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert B Hufnagel
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Howard M Saal
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Surgical Treatment for SWS Glaucoma: Experience From a Tertiary Referral Pediatric Hospital. J Glaucoma 2020; 29:1132-1137. [PMID: 32852376 DOI: 10.1097/ijg.0000000000001645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRECIS Glaucoma associated with Sturge-Weber syndrome (SWS) often requires surgical intervention. Our study shows that trabeculectomy is efficacious in treating this condition. PURPOSE The purpose of this study was to describe the surgical outcomes of glaucoma associated with SWS in children presenting to the tertiary Paediatric Ophthalmology Department at The Children's Hospital at Westmead. MATERIALS AND METHODS A retrospective study of patients with SWS referred to the Department of Ophthalmology at The Children's Hospital at Westmead between 2003 and 2016 with at least 2 years of follow-up were identified, and information was collected from the clinical notes of all subjects. RESULTS A total of 27 patients with SWS were evaluated for glaucoma in which 8 were excluded due to inadequate follow-up. In total, 19 patients with SWS were included in this study in which glaucoma was diagnosed in 15 patients and 19 eyes, of which 13 eyes required glaucoma surgery. A total of 21 surgical procedures were performed with a median follow-up of 85 months. A primary trabeculotomy was performed in 5 eyes of which 4 required re-do trabeculotomy, and 3 of these eyes underwent a Baerveldt tube (BVT) shunt as a third procedure. One eye with a primary trabeculotomy underwent a BVT as a secondary procedure. A BVT was inserted in a total of 6 eyes in which it was a primary procedure in 2 eyes. Of the 6 eyes undergoing a BVT insertion, 5 achieved success (2 complete and 3 qualified), and 1 failed. One case underwent intraluminal stent removal. Six eyes underwent a primary trabeculectomy and needed no further surgical intervention. In the trabeculectomy group, 4 eyes achieved complete success and 2 eyes achieved qualified success. CONCLUSIONS Glaucoma affects a significant proportion of patients with SWS and is associated with the presence of an ipsilateral port-wine stain in most cases. In our study, trabeculectomy was the most efficacious procedure for controlling intraocular pressure and reducing the burden of ongoing treatment in SWS-associated glaucoma.
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Zhao Z, Xu L, Ding X, Wu Y, Zhu X, Fu Y, Guo W. Optical Coherence Tomography Angiography of Perilimbal Vasculature in Port-Wine Stain and Sturge-Weber Syndrome Patients. Invest Ophthalmol Vis Sci 2020; 61:43. [PMID: 32343786 PMCID: PMC7401860 DOI: 10.1167/iovs.61.4.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose To evaluate episcleral vasculature in corneal limbus with optical coherence tomography angiography (OCTA) in normal controls, port-wine stain (PWS) patients, and Sturge-Weber syndrome (SWS) patients. Methods Unilateral eyes from 18 normal controls (25.41 ± 4.00 years), 16 PWS patients (21.35 ± 11.05 years), and 8 SWS patients with ipsilateral late-onset glaucoma (22.13 ± 7.82 years). Each subject underwent slit-lamp examination, applanation tonometry, and OCTA. All OCTA scans were performed using an OCTA system operating at a wavelength of 1050-nm in four quadrants (superior, inferior, nasal, and temporal). The scans were delineated into conjunctival and episcleral layers using IMAGEnet6 for analysis. Results Slit-lamp and OCTA images demonstrated dense dilated episcleral vessels in PWS and SWS patients, particularly in the SWS group. The mean limbal involvements of episcleral vascular anomalies under slit lamp were respectively 0.00 ± 0.00, 5.44 ± 2.92, and 8.88 ± 2.70 clock hours in the control, PWS, and SWS groups (F = 58.46, P < 0.01). Quantitative analysis of OCTA scans showed that the episcleral vessel density in controls, PWS, and SWS groups were 25.03% ± 1.47%, 28.28% ± 1.96%, and 33.59% ± 3.00%, respectively (F = 18.17, P < 0.01). We also observed higher episcleral vessel diameter index in the SWS and PWS groups in comparison with the controls, particularly in the SWS group (P < 0.01). The vessel measurements, including density and diameter, were significantly correlated with the increased IOP and cup-to-disc (C/D) in SWS patients (P < 0.01). Conclusions To our knowledge, this is the first demonstration of OCTA in PWS and SWS patients and represents direct pathoanatomic evidence for episcleral alterations in SWS patients. The episcleral vessel measurements correlated with the increased IOP and C/D in SWS patients, indicating the episcleral vascular hypertrophy may be a risk factor for glaucoma in adult SWS patients.
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Junttila TL, Alberto N, Winkels M, Greenwood MD. Successful Reduction of Intraocular Pressure in a Patient with Glaucoma Secondary to Sturge-Weber Syndrome Using a Suprachoroidal Shunt. J Curr Glaucoma Pract 2020; 14:43-46. [PMID: 32581468 PMCID: PMC7302605 DOI: 10.5005/jp-journals-10078-1266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim We present a case of successful reduction of intraocular pressure (IOP) in a patient with Sturge-Weber syndrome (SWS) and moderate open angle glaucoma using a suprachoroidal shunt. Background Patients with SWS glaucoma often have elevated episcleral venous pressure resulting in elevated IOP. This makes the conventional pathway for aqueous humor outflow a poor target for IOP reduction, yielding it difficult to treat. Medication and procedures that facilitate uveoscleral outflow have been more successful. Case description We present a case where a suprachoroidal shunt device (CyPass®) was used to reduce IOP in a patient with SWS. The IOP reduction has persisted for 12 months without complication or the requirement for topical prostaglandin analog use. Conclusion The uveoscleral pathway is a preferred target for IOP reduction in patients with elevated episcleral venous pressure. The CyPass device offers a promising ab interno minimally invasive glaucoma surgery (MIGS) approach to reduce IOP in cases where a pathologic pressure gradient exists in the trabecular meshwork. Clinical significance Glaucoma in patients with SWS has been historically difficult to treat. Previous surgical procedures that have been successful are more invasive and have required the creation of alternative drainage routes of aqueous humor. The CyPass device offers a promising less invasive option to reduce IOP in these patients. How to cite this article Junttila TL, Alberto N, Winkels M, et al. Successful Reduction of Intraocular Pressure in a Patient with Glaucoma Secondary to Sturge-Weber Syndrome Using a Suprachoroidal Shunt. J Curr Glaucoma Pract 2020;14(1):43-46.
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Affiliation(s)
- Tyler L Junttila
- Department of Transitional Year, University of North Dakota, Fargo, North Dakota, USA
| | - Neville Alberto
- Department of Medicine, University of North Dakota, Fargo, North Dakota, USA
| | - Matthew Winkels
- Department of Medicine, University of North Dakota, Fargo, North Dakota, USA
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Rihani HT, Dalvin LA, Hodge DO, Pulido JS. Incidence of Sturge-Weber syndrome and associated ocular involvement in Olmsted County, Minnesota, United States. Ophthalmic Genet 2020; 41:108-124. [PMID: 32233696 DOI: 10.1080/13816810.2020.1731834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Sturge-Weber syndrome (SWS) is a rare sporadic syndrome characterized by nevus flammeus (port-wine stain, PWS) in the trigeminal nerve distribution, diffuse choroidal hemangioma, and brain leptomeningeal hemangioma. We are unaware of previous reports of SWS incidence in the United States. This study investigated SWS incidence and associated ocular involvement in Olmsted County, Minnesota.Materials and methods: The Rochester Epidemiology Project database was used to identify SWS cases from January 1, 2000-December 31, 2017. Incidence of SWS was calculated using the Olmsted County census population. A literature review of studies investigating SWS-associated ocular involvement was also performed.Results: There were 13 patients with SWS in Olmsted County classified as type 1 (31%) or type 2 (69%). Age and sex-adjusted incidence of SWS was 0.19/100,000/year. Race was predominantly Caucasian (85%), with sex female (69%) or male (31%). All patients had PWS, mostly with unilateral distribution in the V1 and/or V2 region (85%). Two cases (15%) had associated Klippel-Trenaunay syndrome. The most common ocular features included: dilated episcleral vessels (46%), glaucoma (46%), retinal detachment (23%), DCH (7.7%), strabismus (31%), and refractive error (38%). PWS in the V1 distribution was associated with all cases of glaucoma, DCH, and neurological involvement. Severe visual impairment (>0.6 LogMAR, Snellen equivalent ≤20/100) was found in (23%) at final follow-up, and one patient (8%) required enucleation for uncontrolled glaucoma.Conclusions: SWS affects approximately 0.19/100,000/year in Olmsted County. Early diagnosis, intervention, lifelong follow-up, and multidisciplinary approach should be used to optimize systemic and ocular outcomes.
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Affiliation(s)
- Heba T Rihani
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Molecular Medicine, Mayo Clinic, Minnesota, USA
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Sarker BKD, Helen G, Malek MIA, Sadiq A, Hassan Z, Kabir J, Badmus S, Sazzad I, Rahman M, Mahatma M, Salam A. Choroidal detachment with exudative retinal detachment following Ahmed valve implantation in Sturge-Weber syndrome. GMS OPHTHALMOLOGY CASES 2019; 9:Doc33. [PMID: 31728260 PMCID: PMC6839027 DOI: 10.3205/oc000122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ahmed glaucoma valve implant appears to be a relatively useful drainage device in eyes with glaucoma secondary to Sturge-Weber syndrome (SWS). However, early postoperative choroidal and exudative retinal detachment may occur from a rapid expansion of the choroidal hemangioma with effusion of fluid into the suprachoroidal and subretinal spaces. We report the case of a ten-year-old boy who had SWS with choroidal haemangioma and secondary glaucoma. He had Ahmed glaucoma valve implantation on account of the secondary glaucoma which had been refractory to both conventional medical and surgical managements. He developed choroidal and exudative retinal detachment postoperatively. However, he responded to conservative treatment and further surgical management was not required. Ahmed glaucoma valve in the treatment of glaucoma secondary to SWS is useful, but the risk of choroidal effusion with exudative retinal detachment is still present. Surgeons should be alert to this likely complication and be prepared for prompt management.
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Affiliation(s)
| | - Ginger Helen
- Glaucoma, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | | | - Abdullahi Sadiq
- Glaucoma, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Zafrul Hassan
- Glaucoma, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Jahangir Kabir
- Glaucoma, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Sarat Badmus
- Paediatric and Strabismus, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Iftekhar Sazzad
- Paediatric and Strabismus, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Mostafizur Rahman
- Retina, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Mallika Mahatma
- Pathology and Microbiology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Abdus Salam
- Cornea, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
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15
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Thavikulwat AT, Edward DP, AlDarrab A, Vajaranant TS. Pathophysiology and management of glaucoma associated with phakomatoses. J Neurosci Res 2018; 97:57-69. [DOI: 10.1002/jnr.24241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/10/2018] [Accepted: 03/12/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Alisa T. Thavikulwat
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
| | - Deepak P. Edward
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
- King Khaled Eye Specialist Hospital; Riyadh Saudi Arabia
| | - Abdulrahman AlDarrab
- King Khaled Eye Specialist Hospital; Riyadh Saudi Arabia
- Department of Surgery, College of Medicine; Prince Sattam Bin Abdulaziz University; Alkharj Saudi Arabia
| | - Thasarat S. Vajaranant
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
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Lee SS, Burke J, Shen J, Almazan A, Orilla W, Hughes P, Zhang J, Li H, Struble C, Miller PE, Robinson MR. Bimatoprost sustained-release intracameral implant reduces episcleral venous pressure in dogs. Vet Ophthalmol 2018; 21:376-381. [PMID: 29457333 DOI: 10.1111/vop.12522] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the effect of a bimatoprost sustained-release intracameral implant (Bimatoprost SR) on episcleral venous pressure (EVP) in normal dogs. METHODS Normotensive beagle dogs were randomized to receive Bimatoprost SR 30 μg (n = 7) or sham injection (needle insertion only, n = 7) in one eye on day 1. EVP was measured with an episcleral venomanometer through day 65. Episcleral aqueous outflow vessels were identified using fluorescence imaging following intracameral injection of indocyanine green in one additional animal. A separate cohort of dogs that had been trained for conscious intraocular pressure (IOP) measurements received Bimatoprost SR 30 μg (n = 8) in one eye; IOP was evaluated through day 66. RESULTS Baseline mean EVP was 10.0 mmHg in the Bimatoprost SR group and 10.4 mmHg in the sham group. Eyes treated with Bimatoprost SR exhibited a transient increase in mean EVP that peaked at day 8, followed by a decrease to levels below baseline. From day 29 to day 65, the change in mean EVP from baseline ranged from -2.4 to -3.9 mmHg (P < 0.05 vs. sham). Baseline mean IOP in eyes treated with Bimatoprost SR was 14.9 mmHg, and a steady IOP reduction was maintained through day 66. Bimatoprost SR-treated eyes exhibited a selective, sustained dilation of aqueous outflow vessels that was not observed in sham-treated eyes. CONCLUSIONS In normal dogs, Bimatoprost SR was associated with a transient increase in EVP followed by a sustained decrease. Changes in EVP were accompanied by a sustained dilation of aqueous outflow vessels.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paul E Miller
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
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Javaid U, Ali MH, Jamal S, Butt NH. Pathophysiology, diagnosis, and management of glaucoma associated with Sturge-Weber syndrome. Int Ophthalmol 2017; 38:409-416. [PMID: 28064423 DOI: 10.1007/s10792-016-0412-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Sturge-Weber syndrome (SWS), also known as encephalotrigeminal angiomatosis, is a condition which includes leptomeningeal hemangioma, facial angiomatosis or nevus flammeus, and ocular changes. SWS can lead to severe complications of anterior segment involving conjunctiva and eyelids, whereas posterior segment of the eye may also be affected by diffuse choroidal hemorrhages. This article was written with the objectives to determine the pathophysiology, diagnosis, and treatment of glaucoma associated with this rare and challenging disorder. METHODS A detailed literature search was conducted on PubMed, EMBASE, Cochrane Library, and Google Scholar using the key words. Forty-five articles matched our inclusion criteria that were included in this systematic review. RESULTS Glaucoma is the one of the commonest ocular manifestations of SWS. It is caused by anterior chamber malformations, increased pressure in the episcleral veins, and changes in ocular hemodynamics. Glaucoma associated with SWS is usually congenital but can develop adults as well. The treatment of glaucoma associated with SWS is quite challenging because of early-onset, severe visual field impairment at the time of diagnosis, and unresponsiveness to standard medical treatment. Several surgical procedures have been devised but the long-term control of the intraocular pressure and visual function remain unsatisfactory. Modifications in the filtration surgery techniques and use of newer anti-fibrotic agents have produced good control of intraocular pressure. CONCLUSION Management of glaucoma associated with SWS is multi-dimensional and needs both medical and surgical interventions for better control. The treatment should be devised on case to case basis depending upon the intraocular pressure, stage of the disease, and type of glaucoma.
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Affiliation(s)
- Usman Javaid
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Muhammad Hassaan Ali
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan.
| | - Samreen Jamal
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Nadeem Hafeez Butt
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
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Lee BY, La TY, Choi JA. Choroidal Thickness in Thyroid-associated Ophthalmopathy between Normal Tension Glaucoma Using Optical Coherence Tomography. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.8.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bo Young Lee
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Tae Yoon La
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jin A Choi
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Atteintes ophtalmologiques de l’enfance dans le cadre du syndrome de Sturge-Weber-Krabbe. Arch Pediatr 2017; 24:36-40. [DOI: 10.1016/j.arcped.2016.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/16/2016] [Accepted: 10/24/2016] [Indexed: 11/23/2022]
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Mantelli F, Bruscolini A, La Cava M, Abdolrahimzadeh S, Lambiase A. Ocular manifestations of Sturge-Weber syndrome: pathogenesis, diagnosis, and management. Clin Ophthalmol 2016; 10:871-8. [PMID: 27257371 PMCID: PMC4874637 DOI: 10.2147/opth.s101963] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Sturge–Weber syndrome has been included in the group of phakomatoses that is characterized by hamartomas involving the brain, skin, and eyes. The characteristic facial port-wine stain, involving the first branch of the trigeminal nerve and the embryonic vasculature distribution in this area, leads to several ocular complications of the anterior segment and can involve the eyelids and conjunctiva. The posterior segment of the eyes is also affected with diffuse choroidal hemangiomas. However, the most frequent ocular comorbidity is glaucoma with a prevalence rate ranging from 30%–70%. Glaucoma is related to anterior chamber malformations, high episcleral venous pressure (EVP), and changes in ocular hemodynamics. Glaucoma can be diagnosed at birth, but the disease can also develop during childhood and in adults. The management of glaucoma in Sturge–Weber syndrome patients is particularly challenging because of early onset, frequently associated severe visual field impairment at the time of diagnosis, and unresponsiveness to standard treatment. Several surgical approaches have been proposed, but long-term prognosis for both intraocular pressure control and visual function remains unsatisfactory in these patients. Choroidal hemangiomas may also lead to visual impairment thorough exudative retinal detachment and macular edema. Treatment of exudative hemangioma complications is aimed at destructing the tumor or decreasing tumor leakage.
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Affiliation(s)
- Flavio Mantelli
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - Alice Bruscolini
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| | - Maurizio La Cava
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
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21
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Kaplan EH, Kossoff EH, Bachur CD, Gholston M, Hahn J, Widlus M, Comi AM. Anticonvulsant Efficacy in Sturge-Weber Syndrome. Pediatr Neurol 2016; 58:31-6. [PMID: 26997037 PMCID: PMC4943018 DOI: 10.1016/j.pediatrneurol.2015.10.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 10/31/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We analyzed individuals with epilepsy due to Sturge-Weber syndrome to determine which anticonvulsants provided optimal seizure control and which resulted in the fewest side effects. METHODS One-hundred-eight records from a single center were retrospectively analyzed for Sturge-Weber syndrome brain involvement, epilepsy, Sturge-Weber syndrome neuroscores, and currently used anticonvulsants. RESULTS Of the fourteen anticonvulsants that had been employed, the most often used agents were oxcarbazepine or carbamazepine, and levetiracetam. Individuals whose seizures at the most recent visit were fully controlled (seizure-free) for 6 months or longer were more likely to have ever tried, or currently used, oxcarbazepine or carbamazepine than those with uncontrolled seizures. Thirty-nine of 69 individuals (56.5%) were seizure-free with oxcarbazepine or carbamazepine history versus 11 of 35 individuals (31.4%) who had not taken these agents (P < 0.05); 38 of 62 patients (61.3%) were seizure-free while currently taking these anticonvulsants versus 12 of 42 (28.6%) not taking them (P < 0.01). Patients with seizure control for 6 months or longer were less likely to have ever tried, or to currently be taking, levetiracetam than those without control. Sixteen of 56 individuals (28.6%) were seizure-free with levetiracetam history versus 34 of 48 (70.8%) without it (P < 0.001); 14 of 43 individuals (32.6%) were seizure-free and currently taking levetiracetam versus 36 of 61 (59.0%) not taking it (P < 0.01). When topiramate was added as second-line medication, five of nine patients (55.6%) experienced decreased seizure severity, and worsening of glaucoma was not reported. CONCLUSIONS Carbamazepine and oxcarbazepine were associated with better seizure control than levetiracetam in this Sturge-Weber syndrome cohort and so may be preferred as the initial therapy. When used as adjunctive therapy, topiramate was effective in this limited analysis without a clear increased incidence of glaucoma.
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Affiliation(s)
- Emma H. Kaplan
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Eric H. Kossoff
- Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland,Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Milton Gholston
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Jihoon Hahn
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Matthew Widlus
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Anne M. Comi
- Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland,Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland,Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland,Communications should be addressed to: Dr. Comi; Department of Neurology; Kennedy Krieger Institute; 801 North Broadway; Baltimore, MD 21205.
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Abstract
Neurocutaneous syndromes are a heterogeneous group of congenital and hereditary disorders with manifestations in the skin and the nervous system, usually together with ocular features that represent diagnostic clues and potential sources of morbidity. Dermatologists and ophthalmologists often need to work together in identifying and managing patients with these conditions; herein, we focus on classic and under-recognized neurocutaneous syndromes. We begin with autosomal dominant genodermatoses characterized by hamartomas and tumors in the skin, eyes, and central nervous system: neurofibromatosis type 1, tuberous sclerosis complex, and PTEN hamartoma-tumor syndrome. This is followed by a discussion of two mosaic disorders, Sturge-Weber syndrome and neurocutaneous melanocytosis. In addition to providing an update on clinical presentations and evaluation of patients with these conditions, we review recent insights into their pathogenesis, drawing attention to relationships among the diseases on a molecular level and implications regarding treatment. We also highlight the major features of other neurocutaneous syndromes that have ocular findings plus pigmentary, vascular, hyperkeratotic, adnexal, connective tissue, photosensitive, and inflammatory manifestations in the skin.
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Affiliation(s)
- Karen A Chernoff
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA
| | - Julie V Schaffer
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA.
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Lee DH, Shin J, Seo JH, Byon IS, Jung JH, Lee JE. Mobile lens-induced angle closure glaucoma and rubeosis iridis in Sturge Weber syndrome. Int J Ophthalmol 2015; 8:1080-2. [PMID: 26558230 DOI: 10.3980/j.issn.2222-3959.2015.05.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 11/03/2014] [Indexed: 11/02/2022] Open
Affiliation(s)
- Dong Hyun Lee
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Jonghoon Shin
- Department of Ophthalmology, Pusan National University Hospital, Busan 49241, Korea
| | - Jae Hyun Seo
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea ; Research Institute for Convergence of Biomedical Science and Technology, Yangsan Pusan National University Hospital, Yangsan 50612, Korea ; Medical Institute, School of Medicine, Pusan National University, Busan 46241, Korea
| | - Ik Soo Byon
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea ; Research Institute for Convergence of Biomedical Science and Technology, Yangsan Pusan National University Hospital, Yangsan 50612, Korea ; Medical Institute, School of Medicine, Pusan National University, Busan 46241, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea ; Research Institute for Convergence of Biomedical Science and Technology, Yangsan Pusan National University Hospital, Yangsan 50612, Korea ; Medical Institute, School of Medicine, Pusan National University, Busan 46241, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University Hospital, Busan 49241, Korea ; Medical Institute, School of Medicine, Pusan National University, Busan 46241, Korea
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Dorairaj S, Ritch R. Encephalotrigeminal Angiomatosis (Sturge-Weber Syndrome, Klippel-Trenaunay-Weber Syndrome): A Review. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:226-34. [PMID: 26107478 DOI: 10.1097/apo.0b013e31826080a9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sturge-Weber syndrome (SWS) (encephalotrigeminal angiomatosis) is a phakomatosis associated with port-wine stains of the face, seizures, mental retardation, and usually ipsilateral meningeal vascular malformations. The classic form affects leptomeninges, eyes, and face. Although the precise etiology and pathogenesis are unclear, the postulated defect is primary venous dysplasia with failure of the primordial embryonic venous plexus to regress. A spontaneous somatic mutation in fibroblast fibronectin gene expression in the vascular malformation may occur during embryonic development. Ocular involvement is characterized by conjunctival, episcleral, retinal, and choroidal vascular abnormalities. The vascular lesions have been inconsistently described as angiomas, hemangiomas, and vascular malformations. Based on the endothelial cellular activity, they can be considered vascular malformations (or port-wine stains), which never regress spontaneously. Congenital, developmental, and adult-onset glaucoma are often seen when the malformations involve the distribution of the first branch of the trigeminal nerve.Both mechanical and vascular causes have been proposed to account for the development of glaucoma. The mechanical theory is based on obstruction of aqueous outflow secondary to developmental anterior chamber angle abnormalities, and the vascular theory is based primarily on elevated episcleral venous pressure. Management of glaucoma in patients with SWS is often challenging and is aimed at controlling intraocular pressure and preventing progressive visual loss and blindness. It also carries an increased risk for surgical complications. This review summarizes the literature regarding the genetics, clinical features, and management of ocular complications of SWS with special focus on glaucoma.
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Affiliation(s)
- Syril Dorairaj
- From the *Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY; †Hamilton Glaucoma Center, Shiley Eye Center and Department of Ophthalmology, University of California, San Diego, CA; and ‡Department of Ophthalmology, New York Medical College, Valhalla, NY
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