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Georgiou M, Shakarchi AF, Elhusseiny AM, Michaelides M, Sallam AB. Cataract Surgery Outcomes in Retinitis Pigmentosa A Comparative Clinical Database Study. Am J Ophthalmol 2024; 262:34-39. [PMID: 38311153 DOI: 10.1016/j.ajo.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To report visual acuity (VA) outcomes, intraoperative and postoperative complications of isolated cataract surgery in eyes with retinitis pigmentosa (RP), compared with non-RP-affected eyes. DESIGN Retrospective clinical cohort study. METHODS A total of 113,389 eyes underwent cataract surgery between July 2003 and March 2015 at 8 clinical sites in the United Kingdom. Eyes with RP as the only comorbid pathology and eyes without any ocular comorbidities (controls) undergoing cataract surgery were compared. VA at 4 to 12 weeks postoperatively and rates of intraoperative and postoperative complications are reported. RESULTS Seventy-two eyes had RP. The mean age in the RP group was 57 ± 15 compared to 75 ± 10 in controls (P < .001). Females represented 46% of RP cases and 60% of controls (P = .06). Preoperative VA (mean LogMAR = 1.03 vs 0.59, P < .001) and postoperative VA (0.71 vs 0.14, P < .001) were worse in RP group. The mean VA gain was 0.25 ± 0.60 LogMAR in RP vs 0.43 ± 0.48 LogMAR in controls (P < .001). There were no significant differences in the rate of intraoperative pupil expansion use, posterior capsular tears, or zonular dialysis. Postoperative cystoid macular edema developed in 6.9% of RP eyes and 1% of controls (P < .001). The need for IOL repositioning or exchange was not statistically different between the two groups. CONCLUSION Cataract surgery can improve vision in eyes with RP and cataract. Intraoperative complications were similar to control eyes; however, RP eyes experienced more frequent postoperative cystoid macular edema.
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Affiliation(s)
- Michalis Georgiou
- From the Jones Eye Institute (M.G., A.F.S., A.M.E., A.B.S.), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; UCL Institute of Ophthalmology (M.G., M.M.), University College London, London, UK; Moorfields Eye Hospital (M.G., M.M.), London, UK
| | - Ahmed F Shakarchi
- From the Jones Eye Institute (M.G., A.F.S., A.M.E., A.B.S.), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Abdelrahman M Elhusseiny
- From the Jones Eye Institute (M.G., A.F.S., A.M.E., A.B.S.), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michel Michaelides
- UCL Institute of Ophthalmology (M.G., M.M.), University College London, London, UK; Moorfields Eye Hospital (M.G., M.M.), London, UK
| | - Ahmed B Sallam
- From the Jones Eye Institute (M.G., A.F.S., A.M.E., A.B.S.), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; Ophthalmology Department (A.B.S.), Ain Shams University, Cairo, Egypt; Ophthalmology Department (A.B.S.), Gloucestershire Hospitals, Gloucestershire, UK.
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2
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Mees L, Li M, Antonio-Aguirre B, Liu TYA, Wu A, Kong X, Singh MS. Frequency and Distribution of Ophthalmic Surgical Procedures among Patients with Inherited Retinal Diseases. Ophthalmol Retina 2024:S2468-6530(24)00109-X. [PMID: 38485090 DOI: 10.1016/j.oret.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE In this study, we aimed to characterize the frequency and distribution of ocular surgeries in patients with inherited retinal diseases (IRDs) and evaluate associated patient and disease factors. DESIGN Retrospective cohort. PARTICIPANTS Subjects aged ≥ 18 years who were followed at the Johns Hopkins Genetic Eye Disease Center. METHODS We studied a retrospective cohort of patients with an IRD diagnosis to analyze the occurrence of laser and incisional surgeries. Subjects were categorized into 2 groups: central dysfunction (macular/cone/cone-rod dystrophy, "MCCRD group") and panretinal or peripheral dysfunction (retinitis pigmentosa-like, "RP group"). Genetic testing status was recorded. The association of patient and disease factors on the frequency, distribution, and timing of surgeries was analyzed. MAIN OUTCOME MEASURES Prevalence, prevalence odds ratio (POR), hazard ratio (HR) of ophthalmic procedures by phenotype. RESULTS A total of 1472 eyes of 736 subjects were evaluated. Among them, 31.3% (n = 230) had undergone ocular surgery, and 78.3% of those (n = 180/230) had a history of more than 1 surgery. A total of 602 surgical procedures were analyzed. Cataract extraction with intraocular lens implantation (CEIOL) was the most common (51.2%), followed by yttrium aluminum garnet capsulotomy, refractive surgery, retinal surgery, and others. Cataract extraction with intraocular lens implantation occurred more frequently in RP than in MCCRD subjects (POR, 2.59; P = 0.002). Retinitis pigmentosa subjects underwent CEIOL at a younger age than patients with MCCRD (HR, 2.11; P < 0.001). CONCLUSIONS Approximately one-third of patients with IRD had a history of laser or incisional surgery. Cataract extraction with intraocular lens implantation was the most common surgery; its frequency and timing may be associated with the IRD phenotype. This data may inform the design of prospective research. Such efforts may illuminate routine clinical decision-making and contribute to surgical strategy development for cell and gene therapy delivery. 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)
- Lukas Mees
- Retina Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Mingyi Li
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California; Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Bani Antonio-Aguirre
- Retina Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Tin Yan Alvin Liu
- Retina Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Adela Wu
- Retina Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Department of Neurosurgery, Stanford Health Care, Stanford, California
| | - Xiangrong Kong
- Retina Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mandeep S Singh
- Retina Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland.
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Català-Mora J, Santamaría Álvarez JF, Kyriakou D, Alforja S, Barraso Rodrigo M, Blasco Palacio PB, Casaroli-Marano R, Cobos Martín E, Coco Martín RM, Esmerado C, García Tirado A, García P, Gómez-Benlloch A, Rodríguez Fernández CA, Vilaplana Mira F. Protocol for the treatment of cystoid macular edema secondary to retinitis pigmentosa and other inherited retinal dystrophies. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:67-81. [PMID: 37940089 DOI: 10.1016/j.oftale.2023.11.001] [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: 06/29/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023]
Abstract
Inherited retinal dystrophies (IRD) are the leading cause of legal blindness in the working population. Cystic macular edema (CME) is one of the treatable causes of visual loss, affecting up to 50% of the patients. A bibliographic review has been carried out combining "inherited retinal dystrophy", "retinitis pigmentosa", "macular oedema" and a diagnostic-therapeutic protocol according to the levels of evidence and recommendations of the "US Agency for Healthcare Research and Quality". This protocol has been discussed in the monthly meetings of the XAREA DHR group with the participation of more than 25 ophthalmologists, creating a consensus document. The etiology of CME is multifactorial: dysfunction of the blood-retinal barrier, retinal pigment epithelium, and Müller cells, inflammation, and vitreous traction. OCT is the test of choice for the diagnosis and follow-up of CME associated with IRD. The drugs with the highest degree of scientific evidence are carbonic anhydrase inhibitors (IAC). Intravitreal corticosteroids, anti-VEGF, and vitrectomy with peeling of the internal limiting membrane do not have sufficient evidence. A treatment scheme is proposed for the CME in IRD in adults, another for pediatric patients and another for IRD and cataract surgery. Oral and topical IACs are effective in the treatment of CME secondary to IRD. Treatment with corticosteroids, anti-VEGF, and vitrectomy are second-line options. Randomized clinical trials are required to establish the therapeutic scale in these patients.
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Affiliation(s)
- J Català-Mora
- CSUR Distrofias Hereditarias de Retina, Hospital Sant Joan de Déu, Institut Oftalmològic del Pilar, Esplugues de Llobregat, Barcelona, Spain; Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J F Santamaría Álvarez
- Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Kyriakou
- Servicio de Oftalmología, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - S Alforja
- Departamento de Cirugía, Facultad de Medicina y Ciencias de la Salud, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M Barraso Rodrigo
- CSUR Distrofias Hereditarias de Retina, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - R Casaroli-Marano
- Departamento de Cirugía, Facultad de Medicina y Ciencias de la Salud, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - E Cobos Martín
- Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R M Coco Martín
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Facultad de Medicina de la Universidad de Valladolid, Valladolid, Spain; RICORS de Enfermedades Inflamatorias, Instituto de Salud Carlos III, Madrid, Spain
| | - C Esmerado
- Hospital Viladecans, Viladecans, Barcelona, Spain
| | - A García Tirado
- Servicio de Oftalmología, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - P García
- Servicio de Oftalmología, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - A Gómez-Benlloch
- Servicio de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, Spain; Servicio de Oftalmología, Hospital Universitario General de Cataluña, Sant Cugat del Vallès, Barcelona, Spain; Servicio de Oftalmología, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - C A Rodríguez Fernández
- Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F Vilaplana Mira
- Servicio de Oftalmología, Hospital Germans Trias i Pujols, Badalona, Barcelona, Spain
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4
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Nguyen XTA, Moekotte L, Plomp AS, Bergen AA, van Genderen MM, Boon CJF. Retinitis Pigmentosa: Current Clinical Management and Emerging Therapies. Int J Mol Sci 2023; 24:ijms24087481. [PMID: 37108642 PMCID: PMC10139437 DOI: 10.3390/ijms24087481] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/01/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Retinitis pigmentosa (RP) comprises a group of inherited retinal dystrophies characterized by the degeneration of rod photoreceptors, followed by the degeneration of cone photoreceptors. As a result of photoreceptor degeneration, affected individuals experience gradual loss of visual function, with primary symptoms of progressive nyctalopia, constricted visual fields and, ultimately, central vision loss. The onset, severity and clinical course of RP shows great variability and unpredictability, with most patients already experiencing some degree of visual disability in childhood. While RP is currently untreatable for the majority of patients, significant efforts have been made in the development of genetic therapies, which offer new hope for treatment for patients affected by inherited retinal dystrophies. In this exciting era of emerging gene therapies, it remains imperative to continue supporting patients with RP using all available options to manage their condition. Patients with RP experience a wide variety of physical, mental and social-emotional difficulties during their lifetime, of which some require timely intervention. This review aims to familiarize readers with clinical management options that are currently available for patients with RP.
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Affiliation(s)
- Xuan-Thanh-An Nguyen
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lude Moekotte
- Department of Ophthalmology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Astrid S Plomp
- Department of Clinical Genetics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Arthur A Bergen
- Department of Clinical Genetics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Maria M van Genderen
- Department of Ophthalmology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Bartiméus, Diagnostic Center for Complex Visual Disorders, 3703 AJ Zeist, The Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Ophthalmology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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5
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Khojasteh H, Riazi-Esfahani H, Mirghorbani M, Khalili Pour E, Mahmoudi A, Mahdizad Z, Akhavanrezayat A, Ghoraba H, Do DV, Nguyen QD. Cataract surgery in patients with retinitis pigmentosa: systematic review. J Cataract Refract Surg 2023; 49:312-320. [PMID: 36730350 PMCID: PMC9981325 DOI: 10.1097/j.jcrs.0000000000001101] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 02/03/2023]
Abstract
Retinitis pigmentosa (RP) is an inherited bilateral retinal degenerative disease with an incidence of 1 in 4000 people. RP affects more than 1 million individuals worldwide. Although night blindness and restricted visual field are the most typical symptoms of these individuals, generalized vision loss due to cataracts can be expected in the latter stages of the disease. It has been demonstrated that posterior subcapsular cataract is the most prevalent cataract in younger individuals with RP, as opposed to age-related cataracts. Although most ophthalmologists may have a negative view of cataract surgery in patients with RP, it appears that it can play an important role in the visual restoration of patients with RP. However, there are concerns about performing cataract surgery for patients with RP. Herein, a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses on databases of MEDLINE and Scopus.
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Affiliation(s)
- Hassan Khojasteh
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Hamid Riazi-Esfahani
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Masoud Mirghorbani
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Elias Khalili Pour
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Alireza Mahmoudi
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Zahra Mahdizad
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Amir Akhavanrezayat
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Hashem Ghoraba
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Diana V. Do
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Quan Dong Nguyen
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
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6
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Nguyen XTA, Thiadens AAHJ, Fiocco M, Tan W, McKibbin M, Klaver CCW, Meester-Smoor MA, Van Cauwenbergh C, Strubbe I, Vergaro A, Pott JWR, Hoyng CB, Leroy BP, Zemaitiene R, Khan KN, Boon CJF. Outcome of Cataract Surgery in Patients With Retinitis Pigmentosa. Am J Ophthalmol 2023; 246:1-9. [PMID: 36252678 DOI: 10.1016/j.ajo.2022.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To assess the visual outcome of cataract surgery in patients with retinitis pigmentosa (RP). DESIGN Retrospective, noncomparative clinical study. METHODS Preoperative, intraoperative, and postoperative data of patients with RP who were undergoing cataract surgery were collected from several expertise centers across Europe. RESULTS In total, 295 eyes of 226 patients were included in the study. The mean age at surgery of the first eye was 56.1 ± 17.9 years. Following surgery, best-corrected visual acuity (BCVA) improved significantly from 1.03 to 0.81 logMAR (ie, 20/214 to 20/129 Snellen) in the first treated eye (-0.22 logMAR; 95% CI = -0.31 to -0.13; P < .001) and from 0.80 to 0.56 logMAR (ie, 20/126 to 20/73 Snellen) in the second treated eye (-0.24 logMAR; 95% CI = -0.32 to -0.15; P < .001). Marked BCVA improvements (postoperative change in BCVA of ≥0.3 logMAR) were observed in 87 of 226 patients (39%). Greater odds for marked visual improvements were observed in patients with moderate visual impairment or worse. The most common complications were zonular dialysis (n = 15; 5%) and (exacerbation of) cystoid macular edema (n = 14; 5%), respectively. Postoperative posterior capsular opacifications were present in 111 of 295 eyes (38%). CONCLUSION Significant improvements in BCVA are observed in most patients with RP following cataract surgery. Baseline BCVA is a predictor of visual outcome. Preoperative evaluation should include the assessment of potential zonular insufficiency and the presence of CME, as they are relatively common and may increase the risk of complications.
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Affiliation(s)
- Xuan-Thanh-An Nguyen
- From the Department of Ophthalmology (X.N., C.J.F.B.), Leiden University Medical Center, Leiden, Netherlands
| | - Alberta A H J Thiadens
- Department of Ophthalmology (A.A.H.J.T., C.C.W.K., M.A.M.), Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marta Fiocco
- Mathematical Institute (M.F.), Leiden University, Leiden, the Netherlands; Department of Biomedical Data Sciences (M.F.), Leiden University Medical Center, Leiden, Netherlands
| | - Weijen Tan
- Department of Ophthalmology (W.T., M.M.), Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Martin McKibbin
- Department of Ophthalmology (W.T., M.M.), Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Caroline C W Klaver
- Department of Ophthalmology (A.A.H.J.T., C.C.W.K., M.A.M.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology (C.C.W.K., M.A.M.), Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Ophthalmology (C.C.W.K., C.B.H.), Radboud University Medical Center, Nijmegen, Netherlands; Institute of Molecular and Clinical Ophthalmology (C.C.W.K.), University of Basel, Basel, Switzerland
| | - Magda A Meester-Smoor
- Department of Ophthalmology (A.A.H.J.T., C.C.W.K., M.A.M.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology (C.C.W.K., M.A.M.), Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Caroline Van Cauwenbergh
- Department of Ophthalmology, Ghent (C.V., I.S., B.P.L.) University and Ghent University Hospital, Ghent, Belgium; Center for Medical Genetics (C.V., B.P.L.), Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Ine Strubbe
- Department of Ophthalmology, Ghent (C.V., I.S., B.P.L.) University and Ghent University Hospital, Ghent, Belgium
| | - Andrea Vergaro
- Department of Pediatrics and Inherited Metabolic Disorders (A.V.), Charles University and General University Hospital, Prague, Czech Republic
| | - Jan-Willem R Pott
- Department of Ophthalmology (J.R.P.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology (C.C.W.K., C.B.H.), Radboud University Medical Center, Nijmegen, Netherlands
| | - Bart P Leroy
- Department of Ophthalmology, Ghent (C.V., I.S., B.P.L.) University and Ghent University Hospital, Ghent, Belgium; Center for Medical Genetics (C.V., B.P.L.), Ghent University and Ghent University Hospital, Ghent, Belgium; Division of Ophthalmology (B.P.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Centre for Cellular & Molecular Therapeutics (B.P.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Reda Zemaitiene
- Department of Ophthalmology (R.Z.), Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kamron N Khan
- Novartis Institute of BioMedical Research (K.N.K.), Cambridge, Massachusetts, USA; Department of Ophthalmology (K.N.K.), Harvard Medical School, Boston, Massachusetts, USA
| | - Camiel J F Boon
- From the Department of Ophthalmology (X.N., C.J.F.B.), Leiden University Medical Center, Leiden, Netherlands; Department of Ophthalmology (C.J.F.B.), Amsterdam University Medical Centers, Amsterdam, Netherlands.
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7
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Zhu J, Stephenson KAJ, Dockery A, Turner J, O’Byrne JJ, Fitzsimon S, Farrar GJ, Flitcroft DI, Keegan DJ. Electrophysiology-Guided Genetic Characterisation Maximises Molecular Diagnosis in an Irish Paediatric Inherited Retinal Degeneration Population. Genes (Basel) 2022; 13:genes13040615. [PMID: 35456422 PMCID: PMC9033125 DOI: 10.3390/genes13040615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Inherited retinal degenerations (IRDs) account for over one third of the underlying causes of blindness in the paediatric population. Patients with IRDs often experience long delays prior to reaching a definitive diagnosis. Children attending a tertiary care paediatric ophthalmology department with phenotypic (i.e., clinical and/or electrophysiologic) evidence suggestive of IRD were contacted for genetic testing during the SARS-CoV-2-19 pandemic using a “telegenetics” approach. Genetic testing approach was panel-based next generation sequencing (351 genes) via a commercial laboratory (Blueprint Genetics, Helsinki, Finland). Of 70 patient samples from 57 pedigrees undergoing genetic testing, a causative genetic variant(s) was detected for 60 patients (85.7%) from 47 (82.5%) pedigrees. Of the 60 genetically resolved IRD patients, 5% (n = 3) are eligible for approved therapies (RPE65) and 38.3% (n = 23) are eligible for clinical trial-based gene therapies including CEP290 (n = 2), CNGA3 (n = 3), CNGB3 (n = 6), RPGR (n = 5) and RS1 (n = 7). The early introduction of genetic testing in the diagnostic/care pathway for children with IRDs is critical for genetic counselling of these families prior to upcoming gene therapy trials. Herein, we describe the pathway used, the clinical and genetic findings, and the therapeutic implications of the first systematic coordinated round of genetic testing of a paediatric IRD cohort in Ireland.
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Affiliation(s)
- Julia Zhu
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland; (K.A.J.S.); (J.T.); (J.J.O.); (D.J.K.)
- Correspondence: or
| | - Kirk A. J. Stephenson
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland; (K.A.J.S.); (J.T.); (J.J.O.); (D.J.K.)
- Ophthalmology Department, Children’s University Hospital, Temple Street, D01 XD99 Dublin, Ireland; (S.F.); (D.I.F.)
| | - Adrian Dockery
- Next Generation Sequencing Laboratory, Pathology Department, The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland;
| | - Jacqueline Turner
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland; (K.A.J.S.); (J.T.); (J.J.O.); (D.J.K.)
| | - James J. O’Byrne
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland; (K.A.J.S.); (J.T.); (J.J.O.); (D.J.K.)
| | - Susan Fitzsimon
- Ophthalmology Department, Children’s University Hospital, Temple Street, D01 XD99 Dublin, Ireland; (S.F.); (D.I.F.)
| | - G. Jane Farrar
- The School of Genetics & Microbiology, Trinity College Dublin, D02 PN40 Dublin, Ireland;
| | - D. Ian Flitcroft
- Ophthalmology Department, Children’s University Hospital, Temple Street, D01 XD99 Dublin, Ireland; (S.F.); (D.I.F.)
| | - David J. Keegan
- Mater Clinical Ophthalmic Genetics Unit, The Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland; (K.A.J.S.); (J.T.); (J.J.O.); (D.J.K.)
- Ophthalmology Department, Children’s University Hospital, Temple Street, D01 XD99 Dublin, Ireland; (S.F.); (D.I.F.)
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8
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Chen CX, Wang JD, Zhang JS, Xiong Y, Li J, Chen SY, Sun XL, Liu ZY, Mayinuer Y, Wan XH. Effect of lens capsular tension ring on preventing capsular contraction syndrome in the surgery of retinitis pigmentosa combined with cataract: Retrospective case series. Int J Clin Pract 2021; 75:e14272. [PMID: 33908134 DOI: 10.1111/ijcp.14272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/22/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To observe the effect of phacoemulsification and intraocular lens (IOL) implantation with or without lens capsular tension ring (CTR) on retinitis pigmentosa (RP) combined with cataract patients. DESIGN Retrospective cases series study. METHODS Sixty-three cases (84 eyes) of RP with cataract were collected, including 30 males and 33 females. Phacoemulsification with 3.0 mm clear corneal incision was performed in all the patients. IOL and CTR implantation were performed in 44 eyes, and IOL implantation alone was performed in 40 eyes. All cases were followed up at 1 day, 1 week and 1, 3, 6,12 months after the surgery to compare the best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count (ECC) and complications before and after the surgery. RESULTS All surgery were successfully completed by the same physician, and IOL and CTR were all implanted in capsule without complications. The BCVA at 6 months after surgery was 0.91 ± 0.88 LogMAR, showing an improvement compared with the BCVA(1.3 ± 0.7LogMAR) before surgery and there was a statistically significant difference (P = .003). Four cases of capsule contraction syndrome (CCS) occurred in no CTR implantation group and there was no CCS in CTR group. There was a statistically significant difference in the incidence of CCS between two groups (P = .047). CONCLUSIONS Phacoemulsification for RP combined with cataract is safe and reliable, and CTR implantation is conducive to reducing the complications caused by capsule contraction.
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Affiliation(s)
- Chang Xi Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Jin Da Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Jing Shang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Ying Xiong
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Jing Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Shu Ying Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Xiu Li Sun
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Zhen Yu Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Yusufu Mayinuer
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
| | - Xiu Hua Wan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital of Capital Medical University, Beijing, China
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9
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Chatterjee S, Agrawal D, Agrawal D, Parchand SM, Sahu A. Cataract surgery in retinitis pigmentosa. Indian J Ophthalmol 2021; 69:1753-1757. [PMID: 34146021 PMCID: PMC8374763 DOI: 10.4103/ijo.ijo_2916_20] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: The aim of this study was to evaluate visual outcomes of cataract surgery in patients with retinitis pigmentosa. Methods: This retrospective case series includes a review of the medical records of all patients with retinitis pigmentosa undergoing cataract surgery between 2005 and 2018. The primary outcome measure was corrected distant visual acuity and change in vision impairment after surgery. Results: Of the 103 (132) patients, 60 (58.3%) were men and 43 (41.7%) were women. The mean age of the study population was 51.3 ± 11.3 (22–74) years. The mean symptom duration was 35.4 ± 44.5 (1–300) months. The most common morphology of cataracts was a combination of nuclear sclerosis, posterior subcapsular, and cortical cataract (n = 65 eyes, 49.3%). Phacoemulsification (87 eyes, 65.9%) was the preferred surgical technique. The mean preoperative corrected distant visual acuity of 1.21 ± 0.87 log MAR units improved significantly (P < 0.001) to 0.60 ± 0.56 log MAR units after surgery. The number of blind patients reduced from 27 (26.2%) to 8 (7.8%) patients. Zonular dialysis and posterior capsule tear were seen in six (4.5%) eyes each. Good preoperative vision (odds ratio: 6.1 [95% confidence interval: 2.9–13.0], P < 0.0001) was associated with better outcome, wheras reduced central macular thickness (odds ratio: 3.5 [95% confidence interval: 1.3–9.2], P = 0.011) was associated with poor outcome. Conclusion: A considerable number of patients presented with advanced cataracts and severe vision impairment. Significant improvement in visual acuity and alleviation of vision impairment was seen after surgery, with few complications. Good preoperative visual acuity predicted a good outcome, whereas macular thinning predicted a poor outcome.
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Affiliation(s)
| | | | - Deepanshu Agrawal
- Vitreo-retina Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | | | - Anupam Sahu
- Pediatric Ophthalmology and Strabismus Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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10
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Lhussiez V, Dubus E, Cesar Q, Acar N, Nandrot EF, Simonutti M, Audo I, Lizé E, Nguyen S, Geissler A, Bouchot A, Ansar M, Picaud S, Thauvin-Robinet C, Olivier-Faivre L, Duplomb L, Da Costa R. Cohen Syndrome-Associated Cataract Is Explained by VPS13B Functions in Lens Homeostasis and Is Modified by Additional Genetic Factors. Invest Ophthalmol Vis Sci 2021; 61:18. [PMID: 32915983 PMCID: PMC7488618 DOI: 10.1167/iovs.61.11.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose Cohen syndrome (CS) is a rare genetic disorder caused by variants of the VPS13B gene. CS patients are affected with a severe form of retinal dystrophy, and in several cases cataracts also develop. The purpose of this study was to investigate the mechanisms and risk factors for cataract in CS, as well as to report on cataract surgeries in CS patients. Methods To understand how VPS13B is associated with visual impairments in CS, we generated the Vps13b∆Ex3/∆Ex3 mouse model. Mice from 1 to 3 months of age were followed by ophthalmoscopy and slit-lamp examinations. Phenotypes were investigated by histology, immunohistochemistry, and western blot. Literature analysis was performed to determine specific characteristic features of cataract in CS and to identify potential genotype–phenotype correlations. Results Cataracts rapidly developed in 2-month-old knockout mice and were present in almost all lenses at 3 months. Eye fundi appeared normal until cataract development. Lens immunostaining revealed that cataract formation was associated with the appearance of large vacuoles in the cortical area, epithelial–mesenchymal transition, and fibrosis. In later stages, cataracts became hypermature, leading to profound retinal remodeling due to inflammatory events. Literature analysis showed that CS-related cataracts display specific features compared to other forms of retinitis pigmentosa-related cataracts, and their onset is modified by additional genetic factors. Corroboratively, we were able to isolate a subline of the Vps13b∆Ex3/∆Ex3 model with delayed cataract onset. Conclusions VPS13B participates in lens homeostasis, and the CS-related cataract development dynamic is linked to additional genetic factors.
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Affiliation(s)
- Vincent Lhussiez
- INSERM UMR1231, Equipe GAD, Université de Bourgogne Franche Comté, Dijon, France
| | - Elisabeth Dubus
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France.,Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Quénol Cesar
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Niyazi Acar
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Emeline F Nandrot
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Manuel Simonutti
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Isabelle Audo
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Eléonore Lizé
- INSERM UMR1231, Equipe GAD, Université de Bourgogne Franche Comté, Dijon, France
| | - Sylvie Nguyen
- INSERM UMR1231, Equipe GAD, Université de Bourgogne Franche Comté, Dijon, France
| | - Audrey Geissler
- Plateforme d'Imagerie Cellulaire DImaCell (site CellImaP), INSERM LNC UMR1231, Dijon, France
| | - André Bouchot
- Plateforme d'Imagerie Cellulaire DImaCell (site CellImaP), INSERM LNC UMR1231, Dijon, France
| | - Muhammad Ansar
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.,Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - Serge Picaud
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Christel Thauvin-Robinet
- INSERM UMR1231, Equipe GAD, Université de Bourgogne Franche Comté, Dijon, France.,FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France.,Centre de Référence Déficiences Intellectuelles de Causes Rares, CHU Dijon Bourgogne, Dijon, France
| | - Laurence Olivier-Faivre
- INSERM UMR1231, Equipe GAD, Université de Bourgogne Franche Comté, Dijon, France.,FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France.,Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU Dijon Bourgogne, Dijon, France
| | - Laurence Duplomb
- INSERM UMR1231, Equipe GAD, Université de Bourgogne Franche Comté, Dijon, France.,FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Romain Da Costa
- INSERM UMR1231, Equipe GAD, Université de Bourgogne Franche Comté, Dijon, France.,FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
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11
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Daich Varela M, Cabral de Guimaraes TA, Georgiou M, Michaelides M. Leber congenital amaurosis/early-onset severe retinal dystrophy: current management and clinical trials. Br J Ophthalmol 2021; 106:445-451. [PMID: 33712480 PMCID: PMC8961750 DOI: 10.1136/bjophthalmol-2020-318483] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 12/26/2022]
Abstract
Leber congenital amaurosis (LCA) is a severe congenital/early-onset retinal dystrophy. Given its monogenic nature and the immunological and anatomical privileges of the eye, LCA has been particularly targeted by cutting-edge research. In this review, we describe the current management of LCA, and highlight the clinical trials that are on-going and planned. RPE65-related LCA pivotal trials, which culminated in the first Food and Drug Administration-approved and European Medicines Agency-approved ocular gene therapy, have paved the way for a new era of genetic treatments in ophthalmology. At present, multiple clinical trials are available worldwide applying different techniques, aiming to achieve better outcomes and include more genes and variants. Genetic therapy is not only implementing gene supplementation by the use of adeno-associated viral vectors, but also clustered regularly interspaced short palindromic repeats (CRISPR)-mediated gene editing and post-transcriptional regulation through antisense oligonucleotides. Pharmacological approaches intending to decrease photoreceptor degeneration by supplementing 11-cis-retinal and cell therapy’s aim to replace the retinal pigment epithelium, providing a trophic and metabolic retinal structure, are also under investigation. Furthermore, optoelectric devices and optogenetics are also an option for patients with residual visual pathway. After more than 10 years since the first patient with LCA received gene therapy, we also discuss future challenges, such as the overlap between different techniques and the long-term durability of efficacy. The next 5 years are likely to be key to whether genetic therapies will achieve their full promise, and whether stem cell/cellular therapies will break through into clinical trial evaluation.
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Affiliation(s)
- Malena Daich Varela
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | | | - Michalis Georgiou
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Michel Michaelides
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
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12
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A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery. J Ophthalmol 2020; 2020:6699103. [PMID: 33489339 PMCID: PMC7803180 DOI: 10.1155/2020/6699103] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 01/16/2023] Open
Abstract
Retinitis pigmentosa (RP) is a set of inherited retinal degenerative diseases that affect photoreceptor and retinal pigment epithelial cells (RPEs), possibly associated with some ocular complications, including cataract. The complicated cataract formation is most likely the result of RP-related inflammation response, and the most common morphology category is posterior subcapsular cataract (PSC). Despite the absence of curative pharmacologic treatment, phacoemulsification with intraocular lens implantation to deal with opacification in the lens is preferred due to the considerable visual outcomes. However, the incidence of intraocular and postoperative complications is higher in RP patients than those without, including intraoperative phototoxic retinal damage, posterior capsular opacification (PCO), capsular contraction syndrome (CCS), pseudophakic cystoid macular edema (PCME), increased postoperative intraocular pressure (IOP), and intraocular lens (IOL) dislocation. Hence, it needs much attention to surgery progress and close follow-up. In this review, we discuss the current understanding of RP patients with complicated cataracts from morphology to potential pathogenesis to cataract surgical procedure and provide a concise description and the recommended management of related surgery complications to broaden the knowledge and lower the latent risks to yield better clinical outcomes.
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13
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Benson MD, MacDonald IM, Sheehan M, Jain S. Improved electroretinographic responses following dietary intervention in a patient with Refsum disease. JIMD Rep 2020; 55:32-37. [PMID: 32904930 PMCID: PMC7463047 DOI: 10.1002/jmd2.12147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023] Open
Abstract
Refsum disease is a rare inherited metabolic disorder arising from a defect in peroxisomal metabolism. Patients lack the functional enzyme phytanoyl-CoA hydroxylase, resulting in perturbed alpha oxidation of fatty acids. Phytanic acid accumulates in nervous and adipose tissue and leads to several disease phenotypes including early-onset retinal degeneration, hearing loss, peripheral neuropathy, anosmia, and cerebellar ataxia, among others. Currently, restricting dietary phytanic acid is the only means of altering the chronic sequelae and the disease course. While dietary intervention has been demonstrated to improve peripheral neuropathy, ichthyosis, and ataxia, there have been no reports of improved retinal function in patients with Refsum disease. We describe the case of a 51-year-old patient with molecularly and biochemically confirmed Refsum disease who underwent electroretinography before and after beginning a phytanic acid-restricted diet. His post-intervention 30 Hz flicker electroretinogram demonstrated significantly improved waveform amplitudes and implicit times, suggesting improved retinal function. Thus, we propose that the possibility exists for some visual recovery in these patients and we highlight the utility of performing standardized electroretinography to assess treatment response in Refsum disease.
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Affiliation(s)
- Matthew D. Benson
- Department of Ophthalmology and Visual SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Ian M. MacDonald
- Department of Ophthalmology and Visual SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Melissa Sheehan
- Nutrition Services, Alberta Health ServicesStollery Children's HospitalEdmontonAlbertaCanada
| | - Shailly Jain
- Department of Medical GeneticsUniversity of AlbertaEdmontonAlbertaCanada
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14
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Koçak Altıntaş AG, İlhan Ç, Çıtırık M. Unusual Association of Inverse Retinitis Pigmentosa, Scleromalacia, and Neovascular Glaucoma. Turk J Ophthalmol 2020; 50:110-114. [PMID: 32367703 PMCID: PMC7204902 DOI: 10.4274/tjo.galenos.2020.07573] [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: 12/01/2022] Open
Abstract
A 31-year-old woman with inverse retinitis pigmentosa presented with severe ocular pain and ingrained visual loss. Biomicroscopy revealed a large scleromalacia area above the superior limbus, minimal Descemet’s membrane folds, aqueous flare, rubeosis iridis, and mature cataract. Intraocular pressure was 39 mmHg, and the clinical picture was consistent with neovascular glaucoma. After immediate medication to reduce ocular discomfort, an anterior chamber bevacizumab injection was performed. At 1 week post-injection, the rubeosis iridis had largely regressed and intraocular pressure was 21 mmHg. At post-injection 1 month, antiglaucomatous medication was discontinued because intraocular pressure was stable. Clear cornea, normal anterior chamber depth, and mature cataract were seen via biomicroscopy, and increased axial length with no significant change in posterior segment echogenicity were observed on ultrasonography. Three years after the single dose of bevacizumab, neovascularization was not seen in either the anterior chamber angle or on the iris surface, and intraocular pressure remained within normal range. The most important aspect of this case report is that it is the first to show an unusual association between neovascular glaucoma, scleromalacia, and inverse retinitis pigmentosa.
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Affiliation(s)
- Ayşe Gül Koçak Altıntaş
- University of Helath Science, Ulucanlar Göz Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Çağrı İlhan
- Hatay State Hospital, Clinic of Ophthalmology, Hatay, Turkey
| | - Mehmet Çıtırık
- University of Helath Science, Ulucanlar Göz Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
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15
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Al-Owaid AA, Alarfaj MA, Alarfaj FA, Awad A. Intraocular Lens Dislocation into the Anterior Chamber because of Repeated Eye-Poking in a Patient with Leber's Congenital Amaurosis. Case Rep Ophthalmol 2020; 11:48-53. [PMID: 32095132 PMCID: PMC7011747 DOI: 10.1159/000505596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022] Open
Abstract
The dislocation of a posterior chamber intraocular lens (PC IOL) because of constant eye rubbing is unusual and has never been reported in a child with Leber's congenital amaurosis (LCA). A 4-year-old full-term girl with an ocular history of LCA presented to the emergency room with a single-piece PC IOL dislocated into the anterior chamber (AC) of the left eye. There was no history of trauma or any other surgical intervention. A specific behavior known as Franceschetti's oculo-digital sign is a characteristic feature of LCA; this sign consists of repeated pressing, poking, and rubbing of the eyes with knuckles and fingers to stimulate the photoreceptors. This behavior caused the dislocation of the PC IOL into the AC. The dislocated IOL was explanted, and the patient was provided with aphakic glasses.
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Affiliation(s)
- Abdullah A Al-Owaid
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Motazz A Alarfaj
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faris A Alarfaj
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Awad
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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16
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Outer retinal layers as predictors of visual acuity in retinitis pigmentosa: a cross-sectional study. Graefes Arch Clin Exp Ophthalmol 2018; 257:265-271. [PMID: 30456418 DOI: 10.1007/s00417-018-4185-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the integrity of the outer retinal layers-outer nuclear layer (ONL), external limiting membrane (ELM), ellipsoid (EZ), and interdigitation band (IZ)-using spectral-domain optical coherence tomography and estimate their effect on visual acuity in retinitis pigmentosa (RP). METHODS A cross-sectional study was performed in the Ophthalmology Department of Hospital de Braga, Portugal. Patients with RP followed in the Hospital de Braga during January to August 2017 were included. Exclusion criteria were lack of data, macular edema due to RP, and concomitant retinal, optic nerve, or corneal disease that could interfere with visual acuity. Age, sex, time from diagnosis, phakic status, ONL thickness, and presence or absence of foveal ELM, EZ, and IZ were correlated to the best-corrected visual acuity (BCVA). RESULTS Forty-eight eyes were analyzed. There was a strong and positive correlation in BCVA between both eyes (p < .001*). ONL thickness was decreased in 95.8%. The EZ was the most absent layer (79.2%), followed by IZ (70.8%) and ELM (45.8%). A positive family history (p = .04*) and increased time from diagnosis (p = .037*) correlated with worse BCVA. A thicker ONL (p = .001*) and the presence of subfoveal ELM (p < .001*), EZ (p < .001*), and IZ (p = .02*) are correlated with better BCVA. There was a strong and positive correlation between the number of layers affected and a lower BCVA (p < .001). The presence of EZ was a significant predictor of BCVA (p = .02*). CONCLUSIONS The status of the outer retinal layers seems to influence BCVA. The status of the EZ was the most important predictor of BCVA but the ONL, ELM, and IZ may have a cumulative effect in the progression of visual loss.
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