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Bhatti MT, Gilbert AL, Hwang TN. A 72-Year-Old Kidney Transplant Recipient With Visual Changes. JAMA Ophthalmol 2023; 141:602-603. [PMID: 37140908 DOI: 10.1001/jamaophthalmol.2023.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A 72-year-old woman with a history of kidney transplant was referred for an eye examination because of visual changes in the left eye. Both optic discs were anomalous in appearance, with central excavation in the left eye greater than the right eye. What would you do next?
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Affiliation(s)
- M Tariq Bhatti
- Department of Ophthalmology, The Permanente Medical Group, Kaiser Permanente-Northern California, Roseville
| | - Aubrey L Gilbert
- Department of Ophthalmology, The Permanente Medical Group, Kaiser Permanente-Northern California, Vallejo
| | - Thomas N Hwang
- Department of Ophthalmology, The Permanente Medical Group, Kaiser Permanente-Northern California, Redwood City
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2
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Postolache L, Parsa A, Simoni P, Boitsios G, Ismaili K, Schurmans T, Monier A, Casimir G, Albert A, Parsa CF. Widespread kidney anomalies in children with Down syndrome. Pediatr Nephrol 2022; 37:2361-2368. [PMID: 35118542 DOI: 10.1007/s00467-022-05455-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rare autopsy studies have described smaller kidneys as well as urinary tract anomalies in Down syndrome. This observation has never been investigated in vivo and little is known about the possible consequences upon kidney function. Here we wish to confirm whether children with Down syndrome have smaller kidneys and to evaluate their kidney function in vivo. METHODS This retrospective cohort study enrolled 49 children with Down syndrome, as well as 49 age- and sex-matched controls at the Queen Fabiola Children's University Hospital in Brussels, Belgium. Doppler and kidney ultrasonography, spot urine albumin to creatinine ratio, estimated glomerular filtration rate (eGFR), and anthropometric data were recorded. RESULTS Kidney size in children with Down syndrome was smaller than age- and sex-matched controls in terms of length (p < 0.001) and volume (p < 0.001). Kidney function based on eGFR was also decreased in Down syndrome compared to historical normal. Twenty-one of the children with Down syndrome (42%) had eGFR < 90 mL/min/1.73 m2, with 5 of these (10%) having an eGFR < 75 mL/min/1.73 m2. In addition, 7 of the children with Down syndrome (14%) had anomalies of the kidney and/or urinary tract that had previously been undiagnosed. CONCLUSIONS Children with Down syndrome have significantly smaller kidneys than age-matched controls as well as evidence of decreased kidney function. These findings, in addition to well-noted increased kidney and urologic anomalies, highlight the need for universal anatomical and functional assessment of all individuals with Down syndrome. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Lavinia Postolache
- Department of Ophthalmology, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Afshin Parsa
- The Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Paolo Simoni
- Department of Radiology, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Grammatina Boitsios
- Department of Radiology, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Khalid Ismaili
- Department of Pediatrics, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Schurmans
- Department of Pediatrics, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Monier
- Department of Pediatrics, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Casimir
- Department of Pediatrics, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Adelin Albert
- Department of Biostatistics, Liège University Hospital, Liège, Belgium
| | - Cameron F Parsa
- Department of Ophthalmology, Erasmus Hospital, Université Libre de Bruxelles, 808 Route de Lennik, B-1070, Brussels, Belgium. .,Faculty of Medicine, Sorbonne University, Paris, France.
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3
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Ali M, Chang M, Leys M. De Novo PAX2 Mutation With Associated Papillorenal Syndrome: A Case Report and Literature Review of Penetrance and Expressivity. Cureus 2022; 14:e29026. [PMID: 36249605 PMCID: PMC9550200 DOI: 10.7759/cureus.29026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 11/05/2022] Open
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4
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Phenotypes and genotypes underlying paradoxical pupillary reaction in children. J AAPOS 2022; 26:205-207. [PMID: 35659618 DOI: 10.1016/j.jaapos.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022]
Abstract
Paradoxical pupillary reaction (initial pupillary constriction to darkness) has been most associated with the inherited retinal disorders congenital stationary night blindness and achromatopsia. However, underlying genotypes and associations with other pediatric retinal phenotypes are not well documented. A retrospective review for paradoxical pupillary reaction was performed at the Ocular Genetics Clinic of Cleveland Clinic Abu Dhabi (2016-2020). Four children from 4 different families were identified, all of whom had had genetic confirmation of the clinical diagnosis. Associated pathogenic variants were in TRPM1 (biallelic; two boys; congenital stationary night blindness), CABP4 (biallelic; one boy, congenital cone-rod synaptic disorder) and PAX2 (monoallelic; one girl, papillorenal syndrome). Genetically confirmed affected relatives of the 2 probands with TRPM1-related congenital stationary night blindness did not show the phenomenon. This study documents novel genotypes and phenotypes that can be associated with paradoxical pupillary reaction in children and confirms potential intrafamilial variable expressivity for the phenomenon.
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5
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Benador-Shen CL, Reichel E, Reed D, Milner LS, Pinnell N, Choi CS. Ocular phenotype in a patient with PAX2 gene mutation-associated papillorenal syndrome. Ophthalmic Genet 2021; 43:385-388. [PMID: 34889688 DOI: 10.1080/13816810.2021.2015786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Papillorenal syndrome is an autosomal dominant disorder associated with mutations in the gene PAX2 and often presents with characteristic and specific optic disc findings, frequently with renal dysplasia. In at least half of cases, an identifiable mutation in the PAX2 gene can be detected. We report the ocular findings in a second case of papillorenal syndrome with the c.350 G > C (p.Arg117Pro) mutation detected within the PAX2 gene. METHODS A case report of papillorenal syndrome due to PAX2 mutation. Complete ophthalmologic examination was performed as well as color fundus photography, fundus autofluorescence, and optical coherence tomography (OCT). Genetic testing was performed using a next-generation sequencing with CNV calling (NGS-CNV) panel test containing 55 genes associated with nephrotic syndrome or focal segmental glomerulosclerosis. RESULTS An 11-year-old boy who presented with hypertension and proteinuria was found to have stage IV chronic kidney disease. Presenting visual acuity was 20/25 in the right eye and 20/20 in the left eye. The fundus exam showed bilateral centrally excavated optic discs with absent central retinal vessels and a compensatory multiplicity of cilioretinal vessels, characteristic and specific for papillorenal syndrome. OCT showed outer retinal atrophy and macular schisis. Genetic testing identified the likely pathogenic c.350 G > C (p.Arg117Pro) mutation in PAX2. CONCLUSIONS We report the first description, to our knowledge, of the clinical presentation, ocular and systemic findings, and ophthalmic imaging in an individual with papillorenal syndrome associated with the PAX2 c.350 G > C (p.Arg117Pro) mutation. Our case adds to the current understanding of papillorenal syndrome and demonstrates that this condition is associated with a pathognomonic optic disc appearance and significant renal disease.
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Affiliation(s)
| | - Elias Reichel
- Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Dallas Reed
- Department of Pediatrics, Division of Genetics and Metabolism, Tufts Children's Hospital, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lawrence S Milner
- Department of Pediatric Nephrology, Tufts Children's Hospital, Boston, Massachusetts, USA
| | - Nancy Pinnell
- Department of Pediatrics, Division of Genetics and Metabolism, Tufts Children's Hospital, Boston, Massachusetts, USA
| | - Catherine S Choi
- Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, USA
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6
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Ng B, De Silva S, Bindra M. Papillorenal syndrome: a systemic diagnosis not to be missed on funduscopy. BMJ Case Rep 2021; 14:14/7/e241708. [PMID: 34285019 DOI: 10.1136/bcr-2021-241708] [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] [Indexed: 11/03/2022] Open
Abstract
A 45-year-old man presented to the ophthalmology department with visual symptoms in his left eye. Almost two decades ago, he required a renal transplant for focal segmental glomerular sclerosis and a detailed enquiry revealed a strong family history of renal and ocular disease. Fundus examination demonstrated significant optic disc dysplasia in his left eye and optical coherence tomography showed intraretinal fluid bilaterally. The diagnosis of papillorenal syndrome was suspected and genetic testing identified a heterozygous pathogenic variant in the PAX2 gene c.76dupG, p.Val26Glyfs*28, confirming the diagnosis. The patient was treated conservatively, and his vision eventually improved and stabilised. His renal disease and transplant were concurrently monitored by nephrologists. In this case, history-taking and ophthalmic examination raised suspicion of this rare systemic condition, which led to genetic testing and molecular confirmation of the diagnosis. We therefore highlight this case to raise awareness of papillorenal syndrome, which has significant systemic implications and also impacts familial screening and genetic counselling.
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Affiliation(s)
- Benjamin Ng
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK
| | - Samantha De Silva
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mandeep Bindra
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK
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7
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Liu R, Jian W, Zhao Y, Lu X, Wu Y, Duan J. Retinal oxygen saturation and vessel diameter in patients with chronic kidney disease. Acta Ophthalmol 2021; 99:e352-e359. [PMID: 32529722 DOI: 10.1111/aos.14398] [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] [Received: 03/31/2019] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate changes in retinal oximetry and the diameter of retinal vasculature in patients with chronic kidney disease (CKD) and relationships between retinal vasculature and the estimated glomerular filtration rate (eGFR), provide a scientific basis for the early detection and diagnosis of CKD. METHODS Eighty-three patients with CKD and 103 healthy individuals were included after providing informed consent. All participants were examined using a noninvasive technology (Oxymap Inc., Reykjavik, Iceland) for measuring the arterial (SaO2 ) and venous (SvO2 ) oxygen saturation and the arteriovenous difference in oxygen saturation (Sa-vO2 ). The corresponding retinal vessel diameters of these arterioles (D-A) and venules (D-V) were measured. The eGFR of patients with CKD was calculated from the serum creatinine concentration. RESULTS In general, patients with CKD had higher mean SaO2 values than healthy individuals (100.15 ± 4.68% versus 97.14 ± 4.22%; p < 0.001, mean ± SD). The mean SaO2 in the superior temporal, superior nasal and inferior nasal quadrants significantly increased. There was no significant difference measured in the SvO2 when patients with CKD (63.66 ± 5.29%) and healthy individuals (62.70 ± 5.27%) were compared. The mean Sa-vO2 of the CKD group (36.49 ± 4.98%) was increased compared with normal subjects (34.44 ± 4.76%) (p = 0.005). The retinal arteriole diameter was narrower in patients with CKD than in normal individuals (117.53 ± 14.88 μm versus 126.87 ± 14.98 μm; p < 0.001, mean ± SD), and the arteriovenous ratio was smaller than in normal individuals (0.71 ± 0.09 versus 0.77 ± 0.09; p < 0.001, mean ± SD). Pearson's two-tailed correlation showed a significant correlation between the SaO2 and eGFR (R = -0.363, p = 0.001), and narrower retinal arterial calibre was significantly associated with a lower eGFR (R = 0.415, p < 0.001). CONCLUSION Based on our results, there were alterations in retinal oxygen saturation and vascular diameter in patients with CKD. Further studies are needed to determine whether such changes play a role in the development of CKD.
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Affiliation(s)
- Ruibao Liu
- Eye College of Chengdu University of TCM Chengdu Sichuan China
| | - Wenyuan Jian
- Eye College of Chengdu University of TCM Chengdu Sichuan China
| | - Ying Zhao
- Eye College of Chengdu University of TCM Chengdu Sichuan China
| | - Xuejing Lu
- Eye College of Chengdu University of TCM Chengdu Sichuan China
- Ineye Hospital of Chengdu University of TCM Chengdu Sichuan China
| | - Yanxia Wu
- Eye College of Chengdu University of TCM Chengdu Sichuan China
| | - Junguo Duan
- Eye College of Chengdu University of TCM Chengdu Sichuan China
- Ineye Hospital of Chengdu University of TCM Chengdu Sichuan China
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8
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Wibbelsman TD, Xu D, Garg SJ. Papillorenal Syndrome With Macular Retinoschisis and Subretinal Fluid. JAMA Ophthalmol 2020; 138:e194774. [DOI: 10.1001/jamaophthalmol.2019.4774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Turner D. Wibbelsman
- MidAtlantic Retina, Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - David Xu
- MidAtlantic Retina, Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sunir J. Garg
- MidAtlantic Retina, Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
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9
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Zaitoun IS, Wintheiser CM, Jamali N, Wang S, Suscha A, Darjatmoko SR, Schleck K, Hanna BA, Lindner V, Sheibani N, Sorenson CM. Bcl-2 Expression in Pericytes and Astrocytes Impacts Vascular Development and Homeostasis. Sci Rep 2019; 9:9700. [PMID: 31273232 PMCID: PMC6609701 DOI: 10.1038/s41598-019-45915-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 06/18/2019] [Indexed: 11/08/2022] Open
Abstract
B-cell lymphoma 2 (Bcl-2) protein is the founding member of a group of proteins known to modulate apoptosis. Its discovery set the stage for identification of family members with either pro- or anti-apoptotic properties. Expression of Bcl-2 plays an important role during angiogenesis by influencing not only vascular cell survival, but also migration and adhesion. Although apoptosis and migration are postulated to have roles during vascular remodeling and regression, the contribution of Bcl-2 continues to emerge. We previously noted that the impaired retinal vascularization and an inability to undergo pathologic neovascularization observed in mice globally lacking Bcl-2 did not occur when mice lacked the expression of Bcl-2 only in endothelial cells. To further examine the effect of Bcl-2 expression during vascularization of the retina, we assessed its contribution in pericytes or astrocytes by generating mice with a conditional Bcl-2 allele (Bcl-2Flox/Flox) and Pdgfrb-cre (Bcl-2PC mice) or Gfap-cre (Bcl-2AC mice). Bcl-2PC and Bcl-2AC mice demonstrated increased retinal vascular cell apoptosis, reduced numbers of pericytes and endothelial cells and fewer arteries and veins in the retina. Bcl-2PC mice also demonstrated delayed advancement of the superficial retinal vascular layer and aberrant vascularization of the deep vascular plexus and central retina. Although pathologic neovascularization in oxygen-induced ischemic retinopathy (OIR) was not affected by lack of expression of Bcl-2 in either pericytes or astrocytes, laser-induced choroidal neovascularization (CNV) was significantly reduced in Bcl-2PC mice compared to littermate controls. Together these studies begin to reveal how cell autonomous modulation of apoptosis in vascular cells impacts development and homeostasis.
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Affiliation(s)
- Ismail S Zaitoun
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Catherine M Wintheiser
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nasim Jamali
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shoujian Wang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Andrew Suscha
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Soesiawati R Darjatmoko
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Katherine Schleck
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Barbara A Hanna
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Volkhard Lindner
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Nader Sheibani
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christine M Sorenson
- McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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10
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Denis D, Hugo J, Beylerian M, Ramtohul P, Aziz A, Matonti F, Lebranchu P. [Congenital abnormalities of the optic disc]. J Fr Ophtalmol 2019; 42:778-789. [PMID: 30935696 DOI: 10.1016/j.jfo.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/03/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
Congenital abnormalities of the optic disc are not uncommon in clinical practice and should be recognized. Size abnormalities of the optic disc include optic disc aplasia, hypoplasia, megalopapilla, and optic disc cupping in prematurity. Among congenital excavations of the optic disc head, morning glory disc anomaly and optic disc pit can be complicated by serous retinal detachment; the papillorenal disc is an association of bilateral optic disc cupping and renal hypoplasia which should be ruled out; optic disc coloboma is caused by an abnormal closure of the embryonic fissure and can be complicated by choroidal neovascularization and retinal detachment. Other abnormalities that will be discussed are congenital tilted disc syndrome, duplicity of the optic disc head, congenital pigmentation of the optic disc head and myelinated retinal nerve fibers. All of these abnormalities can be associated with syndromes and neurological diseases, as well as other potentially blinding ophthalmological defects which can be secondarily complicated by amblyopia, strabismus and nystagmus. Thus, they should be recognized in order to plan for appropriate follow-up.
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Affiliation(s)
- D Denis
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - J Hugo
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - M Beylerian
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - P Ramtohul
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - A Aziz
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - F Matonti
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - P Lebranchu
- Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000 Nantes, France
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11
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Galvez-Ruiz A, Lehner AJ, Galindo-Ferreiro A, Schatz P. Three New PAX2 Gene Mutations in Patients with Papillorenal Syndrome. Neuroophthalmology 2017; 41:271-278. [PMID: 29339962 DOI: 10.1080/01658107.2017.1307995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022] Open
Abstract
Papillorenal syndrome (PAPRS; Mendelian Inheritance in Man [MIM] 120330) is an autosomal dominant disease characterised by the presence of congenital renal and optic nerve abnormalities associated with mutations of the PAX2 gene. In this article, the authors present four patients with PAPRS who are carriers of three new PAX2 mutations, as well as another patient with a possible non-pathogenic variant of the PAX2 gene. All patients were given a full neurophthalmological examination, and all patients underwent a genetic test for PAX2. Patients 1 and 2 presented with the classic signs of PAPRS: renal disease associated with a congenitally abnormal optic disc, whereas patients 3 and 4 only presented with a congenital optic nerve abnormality and no renal involvement. In patients 1 and 2, the optic nerves were affected by the presence of a central excavation within the optic disc, absence of the central retinal artery, as well as multiple cilioretinal arteries radiating from the periphery of the optic disc. Bilateral optic nerve pits were seen in patient 3, and lastly, in patient 4 there was the presence of superficial gliotic tissue on the left optic disc. All patients presented with a missense mutation in the PAX2 gene, where in patient 4 possibly being only a non-pathogenic variant of the gene. In conclusion, the authors present two patients with classic clinical signs of PAPRS, having two new PAX2 mutations, which until now have not been described in the current literature; another patient with a new PAX2 mutation showing only ocular manifestations of the disease, and lastly, a patient who is a carrier of a variant of the PAX2 gene has a congenitally abnormal optic disc, which is probably not related to PAPRS.
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Affiliation(s)
| | - Anthony J Lehner
- Orthoptic Division, Vision Eye Institute, New South Wales, Australia
| | | | - Patrik Schatz
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Department of Clinical Sciences, Scane County University Hospital, University of Lund, Lund, Sweden
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12
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Yilmaz S, Ardagil A, Akalin I, Altinel MG, Dag Y, Kurum E, Koyun E, Ari Yaylali S, Bayramlar H. Cilioretinal artery: Vasculogenesis might be promoted by plasminogen activator inhibitor-1 5G allele. Ophthalmic Genet 2017; 38:428-433. [PMID: 28145780 DOI: 10.1080/13816810.2016.1253104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cilioretinal arteries (CAs) represent enlargements of microscopic and early established collaterals formed via vasculogenesis between choroidal and retinal circulations. We aimed to investigate whether genetic tendency to thrombosis due to well-known gene polymorphisms may induce CA vasculogenesis in embryonic life. METHODS We assessed plasminogen activator inhibitor-1 (PAI-1) 4G/5G, methylenetetrahydrofolatereductase (MTHFR), FACTOR V LEIDEN and PROTHROMBIN gene polymorphisms on 130 patients [82/48 females/males; Median age: 57 (18-84) with visible CAs and 100 (64/36: female/male; Median age: 55 (19-90)] without visible CAs. RESULTS Using multiple logistic regression models, we found PAI-1 4G/5G; MTHFR (C677T and A1298C) polymorphisms to have significant effects on the probability of visible CAs, that having at least one 5G allele would increase the odds of having visible cilioretinal artery by 98.4% [Odds ratio: 1984 (95% CI: 1.320-3.000, p = 0.001)], and having at least one MTHFR C677T or A1298C allele would decrease the odds of having visible CAs by approximately 38% (OR = 0.618, 95% CI: 0.394-0.961, p = 0.035) or 44% (OR = 0.558, 95% CI: 0.354-0.871, p = 0.011), respectively. CONCLUSIONS This is the first study to test the existence of significant association between presence of enlarged and visible CAs and genetic factors predisposing to thrombosis, according to the literature. Here we suggest that not only the lack of genetic predisposition to thrombosis by MTHFR gene polymorphisms, but also the PAI-1 5G allele might promote vasculogenesis of CAs.
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Affiliation(s)
- Sarenur Yilmaz
- a Department of Medical Genetics, Faculty of Medicine , Goztepe Research and Training Hospital, Istanbul Medeniyet University , Istanbul , Turkey
| | - Aylin Ardagil
- b Department of Ophthalmology, Faculty of Medicine , Goztepe Research and Training Hospital, Istanbul Medeniyet University , Istanbul , Turkey
| | - Ibrahim Akalin
- a Department of Medical Genetics, Faculty of Medicine , Goztepe Research and Training Hospital, Istanbul Medeniyet University , Istanbul , Turkey
| | - Meltem Guzin Altinel
- b Department of Ophthalmology, Faculty of Medicine , Goztepe Research and Training Hospital, Istanbul Medeniyet University , Istanbul , Turkey
| | - Yasar Dag
- b Department of Ophthalmology, Faculty of Medicine , Goztepe Research and Training Hospital, Istanbul Medeniyet University , Istanbul , Turkey
| | - Esra Kurum
- c Department of Biostatistics, Faculty of Medicine , Istanbul Medeniyet University , Istanbul , Turkey
| | - Efe Koyun
- b Department of Ophthalmology, Faculty of Medicine , Goztepe Research and Training Hospital, Istanbul Medeniyet University , Istanbul , Turkey
| | - Sevil Ari Yaylali
- b Department of Ophthalmology, Faculty of Medicine , Goztepe Research and Training Hospital, Istanbul Medeniyet University , Istanbul , Turkey
| | - Huseyin Bayramlar
- b Department of Ophthalmology, Faculty of Medicine , Goztepe Research and Training Hospital, Istanbul Medeniyet University , Istanbul , Turkey
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13
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Martín-Begué N, Saint-Gerons M. Congenital optic nerve anomalies. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:577-588. [PMID: 27378455 DOI: 10.1016/j.oftal.2016.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/28/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To update the current knowledge about congenital optic disc anomalies. METHODS A comprehensive literature search was performed in the major biomedical databases. RESULTS Patients with these anomalies usually have poor vision in infancy. Refractive errors are common, and serous retinal detachment may develop in some of these anomalies. It is critically important to clinically differentiate between these congenital optic disc anomalies, as central nervous system malformations are common in some, whereas others may be associated with systemic anomalies. CONCLUSIONS Congenital optic disc anomalies are a heterogeneous group of pathologies with characteristic fundus appearance and systemic associations. We should always try to make a correct diagnosis, in order to ask for specific tests, as well as to provide an adequate follow-up.
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Affiliation(s)
- N Martín-Begué
- Unidad de Oftalmología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - M Saint-Gerons
- Servicio de Oftalmología, Hospital Mútua de Terrassa , Terrassa, Barcelona, España
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Correspondence. Retina 2016; 36:e68. [DOI: 10.1097/iae.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reply. Retina 2016; 36:e68-9. [PMID: 27276646 DOI: 10.1097/iae.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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PERIPHERAL AVASCULAR RETINA WITH DISK ANOMALY AND HIGH MYOPIA: A Novel Association in a Hereditary Isolated Ocular Disorder. Retina 2015. [PMID: 26225485 DOI: 10.1097/iae.0000000000000713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a family pedigree with a previously undescribed association of autosomal dominantly inherited ocular abnormalities. METHODS Case series study performed on 15 family members. Examination included history taking, visual acuity, intraocular pressure, slit-lamp, gonioscopy, indirect ophthalmoscopy (10 members), fluorescein angiography (5 members), general examination and renal ultrasound (4 members), and hemoglobin electrophoresis for the proband and another member. RESULTS Family pedigree revealed autosomal-dominant inheritance. Visual acuity ranged from 6/36 to no light perception. Examination revealed rubeosis in 7 eyes and atrophia bulbi in 11 eyes. Indirect ophthalmoscopy for 11 eyes revealed evidence of an ocular triad of peripheral avascular retina, disk anomaly (cavitary optic disk anomaly or disk dysplasia), and tessellated fundus of high myopia. The authors also observed new vessels elsewhere with or without extensive subretinal exudations in 6 eyes. All patients with any residual vision (up to perception of light) had nystagmus. Four affected members underwent general examination, renal ultrasound, and serum creatinine level (to exclude papillorenal syndrome), and all were normal. Hemoglobin electrophoresis (to exclude sickle cell retinopathy) revealed within normal values. CONCLUSION To the authors' knowledge, the aforementioned ocular triad has not been previously described, in association, with an autosomal-dominant pattern of inheritance.
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Droms RJ, Liang MC, Duker JS. Retinoschisis and outer retinal hole formation in a patient with papillorenal syndrome. Ophthalmic Surg Lasers Imaging Retina 2015; 46:477-80. [PMID: 25932727 DOI: 10.3928/23258160-20150422-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 02/13/2015] [Indexed: 11/20/2022]
Abstract
This report describes a 19-year-old patient with the rare association of macular retinoschisis and outer retinal hole formation with papillorenal syndrome. Initially diagnosed with transplant-related central serous chorioretinopathy, she presented several years later with worsening vision and distortion in her right eye. On examination, she was found to have bilateral optic nerve dysplasia, bilateral macular and extramacular retinoschisis, and a serous retinal detachment with outer hole formation in the right eye. A history of prior renal transplantation due to poor kidney development led to the diagnosis of papillorenal syndrome.
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Bredrup C, Johansson S, Bindoff LA, Sztromwasser P, Kråkenes J, Mellgren AE, Brurås KR, Lind O, Boman H, Knappskog PM, Rødahl E. High myopia-excavated optic disc anomaly associated with a frameshift mutation in the MYC-binding protein 2 gene (MYCBP2). Am J Ophthalmol 2015; 159:973-9.e2. [PMID: 25634536 DOI: 10.1016/j.ajo.2015.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the ocular and neurologic manifestations, and to identify the causative mutation in a family with an excavated optic disc anomaly, high myopia, enlarged axial lengths, and abnormal visual evoked response (VER). DESIGN Prospective observational case series with whole exome sequencing. METHODS Institutional study of 8 family members from 3 generations. Clinical examination included visual field examination, optical coherence tomography, axial length measurement, audiometry, visual evoked response (VER), orbital and cerebral magnetic resonance imaging (MRI), and renal ultrasound. DNA was analyzed by whole exome sequencing and Sanger sequencing. Main outcome measures were clinical and radiological findings, and DNA sequence data. RESULTS Three affected family members, a father and his 2 daughters, were examined. The parents and siblings of the father were healthy. Affected individuals presented with excavated optic discs, high myopia (-1.00 to -16.00 diopters), and increased axial lengths. Reduced visual acuity (0.05-0.8) and decreased sensitivity on visual field examination were observed. VER revealed prolonged latency times. Affected eyes appeared ovoid on MRI and the father had thin optic nerves. Exome sequencing revealed that the father was heterozygous for a de novo 5 bp deletion in MYCBP2, c.5906_5910del; p.Glu1969Valfs*26. The same mutation was found in his 2 affected daughters, but not in his parents or siblings, or in public databases. CONCLUSION We describe a distinct excavated optic disc anomaly associated with high myopia and increased axial length. The condition appears to follow an autosomal dominant pattern and segregate with a deletion in MYCBP2. We suggest naming this entity high myopia-excavated optic disc anomaly.
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Amador-Patarroyo MJ, Pérez-Rueda MA, Tellez CH. Congenital anomalies of the optic nerve. Saudi J Ophthalmol 2014; 29:32-8. [PMID: 25859137 DOI: 10.1016/j.sjopt.2014.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 11/15/2022] Open
Abstract
Congenital optic nerve head anomalies are a group of structural malformations of the optic nerve head and surrounding tissues, which may cause congenital visual impairment and blindness. Each entity in this group of optic nerve anomalies has individually become more prevalent as our ability to differentiate between them has improved due to better characterization of cases. Access to better medical technology (e.g., neuroimaging and genetic analysis advances in recent years) has helped to expand our knowledge of these abnormalities. However, visual impairment may not be the only problem in these patients, some of these entities will be related to ophthalmologic, neurologic and systemic features that will help the physician to identify and predict possible outcomes in these patients, which sometimes may be life-threatening. Herein we present helpful hints, associations and management (when plausible) for them.
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Affiliation(s)
- Manuel J Amador-Patarroyo
- Department of Strabismus, Neuro-Ophthalmology and Ocular Electrophysiology, Escuela Superior de Oftalmología - Instituto Barraquer de América, Bogotá DC, Colombia
| | - Mario A Pérez-Rueda
- Department of Strabismus, Neuro-Ophthalmology and Ocular Electrophysiology, Escuela Superior de Oftalmología - Instituto Barraquer de América, Bogotá DC, Colombia
| | - Carlos H Tellez
- Department of Strabismus, Neuro-Ophthalmology and Ocular Electrophysiology, Escuela Superior de Oftalmología - Instituto Barraquer de América, Bogotá DC, Colombia
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Ganesh A. Cavitary anomalies of the optic disc: Different entities or part of a single spectrum of disease? Oman J Ophthalmol 2014; 7:53-4. [PMID: 25136226 PMCID: PMC4134545 DOI: 10.4103/0974-620x.137137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Anuradha Ganesh
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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Schimmenti LA. Genetic and developmental basis of renal coloboma (papillorenal) syndrome. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.09.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Megaw RD, Lampe A, Dhillon B, Yoshida S, Wright AF. Papillorenal syndrome in a family with unusual complications. Br J Ophthalmol 2013; 97:945-6. [PMID: 23686327 DOI: 10.1136/bjophthalmol-2013-303122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shapiro MJ, Chow CC, Blair MP, Kiernan DF, Kaufman LM. Peripheral nonperfusion and tractional retinal detachment associated with congenital optic nerve anomalies. Ophthalmology 2012. [PMID: 23178156 DOI: 10.1016/j.ophtha.2012.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To report an association of congenital optic nerve anomalies with peripheral retina nonperfusion and to describe the clinical manifestations and treatment. DESIGN Retrospective, observational case series. PARTICIPANTS Fifteen patients with congenital optic nerve anomalies referred for pediatric retina consultation were studied. Sixteen eyes of 9 patients with optic nerve hypoplasia and 8 eyes of 6 patients with other congenital optic nerve anomalies, including optic nerve coloboma, morning glory disc, and peripapillary staphyloma, were included. METHODS All patients underwent examinations under anesthesia. Wide-angle retina photographs and fluorescein angiograms were reviewed. The severity of nonperfusion was graded. The presence of fibrovascular proliferation (FP), vitreous hemorrhage (VH), and tractional retinal detachment (TRD) were documented. Anatomic outcome after treatment was recorded. MAIN OUTCOME MEASURES Severity of nonperfusion, occurrence of secondary complications, and the anatomic outcome of patients who underwent laser treatment. RESULTS In patients with optic nerve hypoplasia, 12 of 16 eyes (75%) had severe peripheral nonperfusion, 12 of 16 eyes (75%) had FP, 3 of 16 eyes (19%) had VH, and 10 of 16 eyes (63%) had TRD. Six of these eyes with severe nonperfusion received laser photocoagulation to the nonperfused retina; laser-treated retinas remained attached in all 6 eyes. In patients with the other optic nerve anomalies, 7 of 8 eyes (88%) had mild to moderate nonperfusion, 2 of 8 eyes (25%) had FP, 1 of 8 eyes (12%) had VH, and 2 of 8 eyes (25%) had TRD. Six of 9 patients (67%) with optic nerve hypoplasia and 1 of 6 patients (17%) with other anomalies had a coexisting congenital brain disease. CONCLUSIONS Congenital optic nerve anomalies may be associated with peripheral retina nonperfusion and the secondary complications of FP, VH, and TRD. In this select group of patients, the nonperfusion associated with optic nerve hypoplasia seemed to be more severe and associated more frequently with secondary complications. Peripheral retina examination in eyes with optic nerve anomalies may identify nonperfusion or FP. Laser treatment of the avascular retina may have helped prevent complications from proliferative retinopathy in eyes clinically observed to have progressed or considered at risk for progression to proliferative retinopathy.
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Affiliation(s)
- Michael J Shapiro
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois; Retina Consultants, Ltd., Des Plaines, Illinois.
| | - Clement C Chow
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Michael P Blair
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois; Retina Consultants, Ltd., Des Plaines, Illinois; Section of Ophthalmology and Section of Surgery, University of Chicago, Chicago, Illinois
| | | | - Lawrence M Kaufman
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
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Bower M, Salomon R, Allanson J, Antignac C, Benedicenti F, Benetti E, Binenbaum G, Jensen UB, Cochat P, DeCramer S, Dixon J, Drouin R, Falk MJ, Feret H, Gise R, Hunter A, Johnson K, Kumar R, Lavocat MP, Martin L, Morinière V, Mowat D, Murer L, Nguyen HT, Peretz-Amit G, Pierce E, Place E, Rodig N, Salerno A, Sastry S, Sato T, Sayer JA, Schaafsma GCP, Shoemaker L, Stockton DW, Tan WH, Tenconi R, Vanhille P, Vats A, Wang X, Warman B, Weleber RG, White SM, Wilson-Brackett C, Zand DJ, Eccles M, Schimmenti LA, Heidet L. Update of PAX2 mutations in renal coloboma syndrome and establishment of a locus-specific database. Hum Mutat 2012; 33:457-66. [PMID: 22213154 DOI: 10.1002/humu.22020] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/12/2011] [Indexed: 11/06/2022]
Abstract
Renal coloboma syndrome, also known as papillorenal syndrome is an autosomal-dominant disorder characterized by ocular and renal malformations. Mutations in the paired-box gene, PAX2, have been identified in approximately half of individuals with classic findings of renal hypoplasia/dysplasia and abnormalities of the optic nerve. Prior to 2011, there was no actively maintained locus-specific database (LSDB) cataloguing the extent of genetic variation in the PAX2 gene and phenotypic variation in individuals with renal coloboma syndrome. Review of published cases and the collective diagnostic experience of three laboratories in the United States, France, and New Zealand identified 55 unique mutations in 173 individuals from 86 families. The three clinical laboratories participating in this collaboration contributed 28 novel variations in 68 individuals in 33 families, which represent a 50% increase in the number of variations, patients, and families published in the medical literature. An LSDB was created using the Leiden Open Variation Database platform: www.lovd.nl/PAX2. The most common findings reported in this series were abnormal renal structure or function (92% of individuals), ophthalmological abnormalities (77% of individuals), and hearing loss (7% of individuals). Additional clinical findings and genetic counseling implications are discussed.
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Affiliation(s)
- Matthew Bower
- Division of Genetics and Metabolism, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota, USA.
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A novel interstitial deletion of 10q24.2q24.32 in a patient with renal coloboma syndrome. Eur J Med Genet 2012; 55:211-5. [PMID: 22361651 DOI: 10.1016/j.ejmg.2012.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 01/21/2012] [Indexed: 11/21/2022]
Abstract
Renal coloboma syndrome (RCS) is considered to be a rare autosomal dominant inherited disorder characterized by renal malformations and optic disc coloboma. Ocular anomalies range from asymptomatic abnormalities in retinal blood vessel patterning to large excavations of the optic nerve associated with reduced visual acuity. Commonly observed manifestations of the kidney are renal hypoplasia and vesicoureteric reflux leading to end-stage renal disease. Mutations in the PAX2 gene on chromosome 10 have been identified in patients with RCS. Up to date, nucleotide substitutions, insertions, small deletions, one de novo translocation, and one 240 kb deletion of the coding region of the PAX2 gene have been described to be responsible for RCS. We report here a new case of a patient with RCS due to a deletion of 3.8 Mb on chromosome 10q. Deletions on the long arm of chromosome 10 harboring the PAX2 gene seem to be a rare cause for RCS. Nevertheless, array-CGH testing should represent an important and valuable addition to PAX2 gene sequencing in diagnostic of RCS.
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Hughes AD. Genetic and Early Life Influences on the Human Retinal Microcirculation. Basic Clin Pharmacol Toxicol 2011; 110:19-25. [DOI: 10.1111/j.1742-7843.2011.00817.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Renal coloboma syndrome (RCS), also called papillorenal syndrome, is an autosomal dominant condition characterized by optic nerve dysplasia and renal hypodysplasia. The eye anomalies consist of a wide and sometimes excavated dysplastic optic disc with the emergence of the retinal vessels from the periphery of the disc, frequently called optic nerve coloboma or morning glory anomaly. Associated findings may include a small corneal diameter, retinal coloboma, scleral staphyloma, optic nerve cyst and pigmentary macular dysplasia. The kidney abnormalities consist of small and abnormally formed kidneys known as renal hypodysplasia. Histologically, kidneys exhibit fewer than the normal number of glomeruli and these glomeruli are enlarged, a finding called oligomeganephronia. Consequences of the ocular malformations include decreased visual acuity and retinal detachment. Consequences of the renal hypodysplasia include hypertension, proteinuria and renal insufficiency that frequently progresses to end-stage kidney disease. High frequency hearing loss has been reported. Autosomal dominant mutations in PAX2 can be identified in nearly half of all patients with clinical findings suggestive of RCS, however, the majority of published cases have mutations in PAX2, thus biasing the known information about the phenotype.
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Capo H, Repka MX, Edmond JC, Drack AV, Blumenfeld L, Siatkowski RM. Optic nerve abnormalities in children: a practical approach. J AAPOS 2011; 15:281-90. [PMID: 21683634 DOI: 10.1016/j.jaapos.2011.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 02/25/2011] [Accepted: 02/26/2011] [Indexed: 10/18/2022]
Abstract
Evaluation of children with optic nerve abnormalities is challenging. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, and genetic testing are helpful in the diagnosis and management of these patients. Importantly, many optic nerve problems are not isolated but occur in association with systemic and central nervous system anomalies. The ophthalmologist thus plays a critical role in recognizing patients who warrant systemic and neurologic assessment.
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Affiliation(s)
- Hilda Capo
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida 33136, USA.
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Savige J, Ratnaike S, Colville D. Retinal Abnormalities Characteristic of Inherited Renal Disease. J Am Soc Nephrol 2011; 22:1403-15. [DOI: 10.1681/asn.2010090965] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Abstract
Primary congenital glaucoma (isolated goniodysgenesis) has classic phenotypic features such as increased measured intraocular pressure, globe enlargement (buphthalmos) with associated myopia, Descemet membrane tears, corneal haze/scarring with associated astigmatism, iris atrophy, and optic nerve cupping. These signs also occur in developmental glaucoma (anterior segment dysgeneses) with infantile onset. However, similar findings can occur in other pediatric conditions which are sometimes are mistaken as early childhood glaucoma.
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Affiliation(s)
- Arif O Khan
- Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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Clinical utility gene card for: renal coloboma (Papillorenal) syndrome. Eur J Hum Genet 2011; 19:ejhg201116. [PMID: 21326282 DOI: 10.1038/ejhg.2011.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Cain JE, Di Giovanni V, Smeeton J, Rosenblum ND. Genetics of renal hypoplasia: insights into the mechanisms controlling nephron endowment. Pediatr Res 2010; 68:91-8. [PMID: 20421843 DOI: 10.1203/pdr.0b013e3181e35a88] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Renal hypoplasia, defined as abnormally small kidneys with normal morphology and reduced nephron number, is a common cause of pediatric renal failure and adult-onset disease. Genetic studies performed in humans and mutant mice have implicated a number of critical genes, in utero environmental factors and molecular mechanisms that regulate nephron endowment and kidney size. Here, we review current knowledge regarding the genetic contributions to renal hypoplasia with particular emphasis on the mechanisms that control nephron endowment in humans and mice.
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Affiliation(s)
- Jason E Cain
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1L7, Canada
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Martinovic-Bouriel J, Benachi A, Bonnière M, Brahimi N, Esculpavit C, Morichon N, Vekemans M, Antignac C, Salomon R, Encha-Razavi F, Attié-Bitach T, Gubler MC. PAX2 mutations in fetal renal hypodysplasia. Am J Med Genet A 2010; 152A:830-5. [PMID: 20358591 DOI: 10.1002/ajmg.a.33133] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Papillorenal syndrome also known as renal-coloboma syndrome (OMIM 120330) is an autosomal dominant condition comprising optic nerve anomaly and renal oligomeganephronic hypoplasia. This reduced number of nephron generations with compensatory glomerular hypertrophy leads towards chronic insufficiency with renal failure. We report on two fetuses with PAX2 mutations presenting at 24 and 18 weeks' gestation, respectively, born into two different sibships. In our first patient, termination of pregnancy was elected for anhydramnios and suspicion of renal agenesis in the healthy couple with an unremarkable previous clinical history. This fetus had bilateral asymmetric kidney anomalies including a small multicystic left kidney, and an extremely hypoplastic right kidney. Histology showed dysplastic lesions in the left kidney, contrasting with rather normal organization in the hypoplastic right kidney. Ocular examination disclosed bilateral optic nerve coloboma. The association of these anomalies, highly suggestive of the papillorenal syndrome, led us to perform the molecular study of the PAX2 gene. Direct sequencing of the PAX2 coding sequence identified a de novo single G deletion of nucleotide 935 in exon 3 of the PAX2 resulting in a frameshift mutation (c.392delG, p.Ser131Thrfs*28). In the second family, the presence of a maternally inherited PAX2 mutation led to a decision for termination of pregnancy. The 18-week gestation fetus presented the papillorenal syndrome including hypoplastic kidneys and optic nerve coloboma. In order to address the PAX2 involvement in isolated renal "disease," 18 fetuses fulfilling criteria were screened: 10/18 had uni- or bilateral agenesis, 6/18 had bilateral multicystic dysplasia with enlarged kidneys, and 2/18 presented bilateral severe hypodysplasia confirmed on fetopathological examination. To the best of our knowledge, our first patient represents an unreported fetal diagnosis of papillorenal syndrome, and another example of the impact of oriented fetopathological examination in genetic counseling of the parents.
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Affiliation(s)
- Jelena Martinovic-Bouriel
- AP-HP, Unit of Embryo-Fetal Pathology, Department of Histo-Embryology and Cytogenetics, Necker Hospital, Paris, France.
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Alur RP, Vijayasarathy C, Brown JD, Mehtani M, Onojafe IF, Sergeev YV, Boobalan E, Jones M, Tang K, Liu H, Xia CH, Gong X, Brooks BP. Papillorenal syndrome-causing missense mutations in PAX2/Pax2 result in hypomorphic alleles in mouse and human. PLoS Genet 2010; 6:e1000870. [PMID: 20221250 PMCID: PMC2832668 DOI: 10.1371/journal.pgen.1000870] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 02/02/2010] [Indexed: 11/21/2022] Open
Abstract
Papillorenal syndrome (PRS, also known as renal-coloboma syndrome) is an autosomal dominant disease characterized by potentially-blinding congenital optic nerve excavation and congenital kidney abnormalities. Many patients with PRS have mutations in the paired box transcription factor gene, PAX2. Although most mutations in PAX2 are predicted to result in complete loss of one allele's function, three missense mutations have been reported, raising the possibility that more subtle alterations in PAX2 function may be disease-causing. To date, the molecular behaviors of these mutations have not been explored. We describe a novel mouse model of PRS due to a missense mutation in a highly-conserved threonine residue in the paired domain of Pax2 (p.T74A) that recapitulates the ocular and kidney findings of patients. This mutation is in the Pax2 paired domain at the same location as two human missense mutations. We show that all three missense mutations disrupt potentially critical hydrogen bonds in atomic models and result in reduced Pax2 transactivation, but do not affect nuclear localization, steady state mRNA levels, or the ability of Pax2 to bind its DNA consensus sequence. Moreover, these mutations show reduced steady-state levels of Pax2 protein in vitro and (for p.T74A) in vivo, likely by reducing protein stability. These results suggest that hypomorphic alleles of PAX2/Pax2 can lead to significant disease in humans and mice. Congenital ocular malformations affecting the optic nerve are an important cause of childhood blindness. The papillorenal syndrome (PRS) is an autosomal dominant disorder that causes congenital optic nerve and kidney abnormalities, which may result in legal blindness and renal failure, respectively. Many cases of PRS are caused by mutations in the paired-box transcription factor PAX2. In this paper, we describe a novel mouse model of this human disease caused by a missense mutation in the Pax2 gene at the same position of one of the few disease-causing missense mutations in humans. We characterize the ocular and non-ocular phenotypes of this mouse and model the effect that murine and human Pax2/PAX2 mutations have on protein structure. We also experimentally test the effect these missense mutations have on protein localization, transactivation, and DNA binding, concluding that all three reduce steady-state levels of protein in vitro and (in p.T74A) in vivo by reducing protein stability. This work will help us better understand the pathophysiology of PRS and to dissect the molecular interactions important in normal PAX2 function.
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Affiliation(s)
- Ramakrishna P. Alur
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Camasamudram Vijayasarathy
- Section for Translational Research in Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Jacob D. Brown
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
- Department of Biochemistry, Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, D.C., United States of America
| | - Mohit Mehtani
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Ighovie F. Onojafe
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Yuri V. Sergeev
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Elangovan Boobalan
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - MaryPat Jones
- National Human Genome Research Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Ke Tang
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Haiquan Liu
- School of Optometry and Vision Science Program, University of California Berkeley, Berkeley, California, United States of America
| | - Chun-hong Xia
- School of Optometry and Vision Science Program, University of California Berkeley, Berkeley, California, United States of America
| | - Xiaohua Gong
- School of Optometry and Vision Science Program, University of California Berkeley, Berkeley, California, United States of America
| | - Brian P. Brooks
- Section for Translational Research in Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
- Department of Biochemistry, Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, D.C., United States of America
- * E-mail:
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Beby F, Roche O, Cochat P, Ranchin B, Kohler R, Bonifas C, Cordier MP, Attie-Bitach T, Burillon C, Denis P. New ocular phenotype associated with a mutation in the PAX2 gene. Eye (Lond) 2010; 24:1293-4. [PMID: 20075965 DOI: 10.1038/eye.2009.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Gucev ZS, Kirovski I, Jancevska A, Popjordanova N, Tasic V. Papillorenal Syndrome after Beta-Interferon Treatment in Pregnancy. Ren Fail 2009; 31:602-5. [DOI: 10.1080/08860220902968862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Holak HM, Kohlhase J, Holak SA, Holak NH. New Recognized Ophthalmic Morphologic Anomalies in CHARGE Syndrome Caused by the R2319C Mutation in theCHD7Gene. Ophthalmic Genet 2009; 29:79-84. [DOI: 10.1080/13816810801918391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Golnik KC. Cavitary anomalies of the optic disc: Neurologic significance. Curr Neurol Neurosci Rep 2008; 8:409-13. [DOI: 10.1007/s11910-008-0063-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Diagnosing papillorenal syndrome: see the optic papilla. Pediatr Nephrol 2008; 23:1893-4. [PMID: 18512081 DOI: 10.1007/s00467-008-0870-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 04/17/2008] [Accepted: 04/18/2008] [Indexed: 10/22/2022]
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Parsa CF. Of Pax2 laboratory mice and human papillorenal investigations: maintaining the distinctions between cause and effect. J AAPOS 2008; 12:113-4. [PMID: 18423339 DOI: 10.1016/j.jaapos.2008.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 03/03/2008] [Indexed: 10/22/2022]
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Affiliation(s)
- Dan Nguyen
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.
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Abstract
The morphology of optic disc dysplasia is the most consistent finding in the papillorenal syndrome, an autosomal-dominant syndrome of eye and kidney maldevelopment often associated with the PAX2 mutation. In the absence of a recognized family history, the diagnosis is typically not made until renal disease is evident. We report an infant whose characteristic fundus findings led to the early diagnosis of the papillorenal syndrome before the potential development of renal dysfunction.
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Affiliation(s)
- Arif O Khan
- Department of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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Duh EJ, Yao YG, Dagli M, Goldberg MF. Persistence of fetal vasculature in a patient with Knobloch syndrome: potential role for endostatin in fetal vascular remodeling of the eye. Ophthalmology 2004; 111:1885-8. [PMID: 15465551 DOI: 10.1016/j.ophtha.2004.03.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Accepted: 03/16/2004] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To report a child with Knobloch syndrome (KS) with features of persistent fetal vasculature (PFV) and to discuss the possible role of endostatin in vascular remodeling of the fetal eye. DESIGN Case report with enzyme-linked immunosorbent assay (ELISA) analysis of serum endostatin. MAIN OUTCOME MEASURES Ocular examination, fluorescein angiography, echography, ELISA analysis of serum endostatin, and typing for pathogenic mutations in COL18A1. RESULTS Slit-lamp examination in the left eye disclosed numerous findings of PFV, including an extensive persistent pupillary membrane, scarcity of iris crypts, and pigmented epicapsular stellate remnants on the anterior lens surface. Dilated fundus examination revealed a total posterior vitreous detachment, despite the young age of the patient, with numerous white intragel opacities that were compatible with remnants of the vasa hyaloidea propria. The fundus had a tesselated appearance with angiographically visible large choroidal vessels. There was a retinochoroidal staphyloma inferotemporal to the optic disc. There were no retinal vessels visible temporally, and there was no macular differentiation or foveal pit. Competitive ELISA analysis disclosed no detectable serum endostatin. None of the 8 reported pathogenic mutations in the COL18A1 gene was found in the patient. CONCLUSIONS Persistent fetal vasculature may be a clinical and important manifestation in some patients with KS and can be explained by a deficiency in endostatin. Endostatin deficiency may result in reduced or delayed regression of fetal blood vessels in the eye (including the intravitreal compartment), thereby resulting in incomplete development of the normal vasculature in the retina. Our typing results for the reported COL18A1 mutations confirm the genetic heterogeneity of KS.
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Affiliation(s)
- Elia J Duh
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Parsa CF, Goldberg MF, Hunter DG. No colobomas in "renal coloboma" syndrome. Ophthalmology 2003; 110:251; author reply 251-2. [PMID: 12578762 DOI: 10.1016/s0161-6420(02)01545-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Dureau P. No colobomas in “renal coloboma” syndrome: Author reply. Ophthalmology 2003. [DOI: 10.1016/s0161-6420(02)01571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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