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Thiagasorupan P, Barreau E, Gendron G, Frau E, Cauquil C, Adams D, Labetoulle M, Rousseau A. Specific postoperative complications of vitrectomy in hereditary transthyretin amyloidosis. Eur J Ophthalmol 2021; 32:11206721211006569. [PMID: 33781115 DOI: 10.1177/11206721211006569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Vitrectomy may improve visual acuity of hereditary transthyretin amyloidosis (ATTRv) patients presenting with vitreous opacities but is associated with severe complications. The objective of this study is to report visual outcomes, early and late complications of a series of ATTRv patients who underwent vitrectomy in the French ATTRv reference center. METHODS This retrospective, single-center study, included all ATTRv patients who underwent vitrectomy between 2002 and 2017. Data were collected on pre and postoperative best corrected visual acuity (BCVA) and early and late postoperative complications. RESULTS A total of 21 eyes from 15 patients were included. The mean postoperative follow-up was 40 ± 20 months (6-160 months). BCVA increased from 0.7 ± 0.4 LogMAR preoperatively to 0.3 ± 0.4 LogMAR (p = 0.003) at last postoperative visit. During follow-up, all initially glaucomatous eyes worsened, with three eyes (37%) requiring filtering surgery and two eyes (25%) had further vision loss. Among non-glaucomatous patients, four eyes (31%) developed glaucoma with two requiring trabeculectomy and one eye (8%) had further vision loss. Three eyes (three patients) presented with complications of amyloid angiopathy. Three eyes (three patients) experienced recurrence of vitreous deposits requiring surgical revision. CONCLUSION Due to the potential complications, vitrectomy in ATTRv requires specific perioperative management and life-long postoperative monitoring.
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Affiliation(s)
- Pathma Thiagasorupan
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
| | - Emmanuel Barreau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
| | - Gaël Gendron
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
- Department of Ophthalmology, Centre Hospitalier National Ophtalmologique des XV-XX, Paris, France
| | - Eric Frau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
- Centre Ophtalmologique Saint-Sulpice, Paris, France
| | - Cécile Cauquil
- Department of Neurology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), Le Kremlin-Bicêtre, France
| | - David Adams
- Department of Neurology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), Le Kremlin-Bicêtre, France
| | - Marc Labetoulle
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
| | - Antoine Rousseau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference Center for Hereditary Transthyretin Amyloidosis (NNERF), French Reference Network for Rare Ophthalmic diseases (OPHTARA), Le Kremlin-Bicêtre, France
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García Franco R, Arias Gómez A, García Roa M, Ramírez Neria P, Corredor Casas S. Vitreous amyloidosis as primary manifestation of disease: case report. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:244-247. [PMID: 32145978 DOI: 10.1016/j.oftal.2019.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
A 35-year-old woman with progressive decrease of vision in both eyes and with no other associated symptoms, manifested as the only antecedent, the death of her brother due to amyloidosis. The visual acuity was counting fingers at 30 centimetres in the right eye and 20/70 in the left eye. In ophthalmoscopy of the right eye, a white, homogeneous vitreous, that was difficult to assess in detail, was observed, and in the left eye a whitish vitreous with band-like opacities in the cortical region. Vitrectomy was performed in the right eye, and a study with specific stains showed positive for amyloid material. A case is reported of amyloidosis diagnosed with specific stains in a vitreous sample for which the initial and only manifestation was the presence of vitreous opacities. The processing of these samples should be considered in patients with family history, early vitreous opacities, negative results of systemic biopsy, or atypical course of the disease.
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Affiliation(s)
- R García Franco
- Departamento de Retina y Vítreo, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México
| | - A Arias Gómez
- Departamento de Retina y Vítreo, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México.
| | - M García Roa
- Departamento de Retina y Vítreo, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México
| | - P Ramírez Neria
- Departamento de Retina y Vítreo, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México
| | - S Corredor Casas
- Departamento de Patología, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México
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Coppock JD, Dusenbery AC, Elghawy O, Fellenstein LA, Frierson HF, Shildkrot Y. Cytodiagnosis and protein typing of amyloid from a vitreous washing: initial diagnostic workup of hereditary amyloidosis. J Am Soc Cytopathol 2020; 9:173-176. [PMID: 32113804 DOI: 10.1016/j.jasc.2020.01.003] [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: 12/06/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 11/24/2022]
Abstract
Hereditary amyloidosis is a challenging but critical diagnosis, with serious implications with regard to treatment and disease surveillance for both patients and their families. Systemic symptomology is often vague. As vitreous amyloid deposition is strongly linked to the systemic, hereditary disease, its cytodiagnosis in the vitreous may be the incipient finding of hereditary amyloidosis. We describe a 64-year-old man with a history of heart disease and peripheral neuropathy who presented with asymmetric visual disturbances and vitreous opacities, leading to diagnostic vitrectomy. Amyloid was identified on a ThinPrep slide of the vitreous sample via Congo red stain. Creation of a cell block from the residual ThinPrep sample allowed for amyloid protein typing, identifying ATTR (transthyretin)-type amyloid and strongly suggesting hereditary amyloidosis. Subsequent sequencing of the patient's TTR gene identified a pathogenic variant that is associated with autosomal dominant hereditary transthyretin-mediated amyloidosis.
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Affiliation(s)
- Joseph D Coppock
- Department of Pathology, University of Virginia, Charlottesville, Virginia.
| | - Anna C Dusenbery
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Omar Elghawy
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Lynn A Fellenstein
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Henry F Frierson
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Yevgeniy Shildkrot
- Department of Ophthalmology, University of Virginia, Charlottesville, Virginia
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Binmadi N, Intapa C, Chaisuparat R, Akeel S, Sindi A, Meiller T. Immunophenotyping Oral Amyloidosis for the Precise Identification of the Biochemical Forms: A Retrospective Study. Open Dent J 2018. [DOI: 10.2174/1874210601812011036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background:Amyloidosis refers to a group of systemic and localized disorders associated with the accumulation of misfolded protein aggregates called amyloids in different parts of the body. Owing to the existence of multiple forms of amyloids with similar tertiary structures, precise identification of their biochemical form is critical for correct therapy.Objective:This retrospective study aimed to determine whether typing of oral amyloid deposits can help diagnose a serious systemic condition in the early phase of the diseaseMethods:All histopathologically confirmed cases of amyloidosis managed over a 14-year period (January 1, 1997 to December 31, 2011) were retrieved for analysis. Two board-certified oral and maxillofacial pathologists reviewed the histopathological findings of amyloidosis on the basis of its classic Congo red staining characteristics. This was followed by immunohistochemical analysis of biopsy samples using a panel of antibodies specific for different forms of amyloidosis.Results:The most common location of amyloidosis was the tongue, and women were more commonly affected than men. The patient age ranged from 11 to 83 years (average 59.3 years). In patient 9, light-chain and pre-albumin (transthyretin) antibodies were related to arthritis and senile amyloidosis, respectively. The biopsy sample of patient 10, who was reported to have multiple myeloma, was positive for light chains and β2 microglobulin. All other samples exhibited localized (solitary) amyloidosis.Conclusion:Histological analysis coupled with immunostaining with a panel of specific antibodies might assist in identifying early systemic amyloidosis in patients with localized oral forms of the disease.
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Ishida K, Nishida T, Niimi Y, Suemori S, Mochizuki K, Kawakami H, Kimura A, Hirayama T. Elderly onset vitreous opacities as the initial manifestation in hereditary transthyretin (ATTR Val30Met) carries. Ophthalmic Genet 2017; 38:387-391. [PMID: 28085522 DOI: 10.1080/13816810.2016.1232413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Familial amyloid polyneuropathy (FAP) is a systemic disorder transmitted as an autosomal dominant trait and is characterized by deposits of protein fibrils in various organs leading to physiologic dysfunction. In cases with FAP in Japanese endemic foci, their signs and symptoms often develop before the age of 40 years. We report on two elderly patients (an 80-year-old woman and an 83-year-old man) with progressive vitreous opacities (VOs) as the initial manifestation of hereditary transthyretin (ATTR Val30Met) carries, who had no evidence of systemic involvement or family history of amyloidosis and lived in non-endemic areas. Therapeutic vitrectomy with extensive vitreous removal combined with cataract surgery was performed. Clinicians should consider the possibility of hereditary transthyretin carries in cases presenting with VOs of undetermined etiology to avoid misdiagnosis.
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Affiliation(s)
- Kyoko Ishida
- a Department of Ophthalmology , Gifu University Graduate School of Medicine , Gifu , Japan.,b Department of Ophthalmology , Toho University Ohashi Medical Center , Tokyo , Japan
| | - Takashi Nishida
- a Department of Ophthalmology , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Yusuke Niimi
- a Department of Ophthalmology , Gifu University Graduate School of Medicine , Gifu , Japan.,c Department of Ophthalmology , Ogaki Municipal Hospital , Gifu , Japan
| | - Shinsuke Suemori
- a Department of Ophthalmology , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Kiyofumi Mochizuki
- a Department of Ophthalmology , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Hideaki Kawakami
- d Department of Ophthalmology , Gifu Municipal Hospital , Gifu , Japan
| | - Akio Kimura
- e Department of Neurology and Geriatrics , Gifu University Graduate School of Medicine , Gifu , Japan
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