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Amaral RAS, Zin OA, Moraes RT, Porto FBO, Carricondo PC, Pimentel SLG, Kestelman BP, Watanabe SES, Sallum JMF. Posterior microphthalmos with retinal involvement related to MFRP gene: a report of 10 Brazilian patients. Ophthalmic Genet 2024:1-8. [PMID: 38557281 DOI: 10.1080/13816810.2024.2322650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/01/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND To describe the phenotype and genotype of 10 Brazilian patients with variants in MFRP, posterior microphthalmos and retinal findings. METHODS Complete ophthalmological evaluation was done at 4 different Brazilian centers. Genetic analysis was performed using commercial next generation sequencing panels for inherited retinal disorders. RESULTS Ages of the patients ranged from 10 to 65 years and visual acuities from 0,05 to no perception of light. All were hyperopes (+4,25 to + 17,50) with a short axial length (14,4 mm to 18 mm). Common posterior segment features, though not present in all, were optic disc drusen (5/10), foveoschisis (5/10) and retinal pigmentary changes (8/10). Isolated patients presented with macular atrophy, serous retinal detachment, and chorioretinal folds. The most common variant in MFRP found in our patients was a deletion in exon 5 (c.498delC; p.Asn267Thrfs *25), present in all except 2 patients. Other variants found were c.523C>T (p.Gln175*), c.298delG (p.Ala100Argfs *37), c.666del (p.Thr223Argfs *83) and the novel variant c.257C>A (p.Ala86Asp). CONCLUSIONS This is the first report of Brazilian patients with posterior microphthalmos and pathogenic variants in MFRP and the first describe of the variant p.Ala86Asp in literature. Our cases confirm the previously reported phenotype of high hyperopia, optic disc drusen, alterations in foveal architecture, retinal pigmentary changes with loss of photoreceptor function and visual field constriction. Report of such a rare condition is important to increase awareness to the phenotype of posterior microphthalmia with associated retinal conditions.
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Affiliation(s)
- Rebeca A S Amaral
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Instituto de Genética Ocular (IGO), São Paulo, Brazil
| | - Olivia A Zin
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Brazilian Institute of Ophthalmology (IBOL), Rio de Janeiro, Brazil
| | - Remo T Moraes
- Brazilian Institute of Ophthalmology (IBOL), Rio de Janeiro, Brazil
| | - Fernanda B O Porto
- INRET Clínica e Centro de Pesquisa, Brazil
- Centro Oftalmológico de Minas Gerais, Brazil
- Clínica de Olhos da Santa Casa de Belo Horizonte, Brazil
| | | | | | | | - Sung E S Watanabe
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Juliana M F Sallum
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Instituto de Genética Ocular (IGO), São Paulo, Brazil
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Fernández-Vigo JI, Gómez-de-Liaño CN, Rodríguez-Quet O, Burgos-Blasco B, Montolío-Marzo E, de-Pablo-Gómez-de-Liaño L, González-Martin-Moro J, García-Feijóo J. Clinical update in nanophthalmos: Features, diseases and complications associated. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:687-702. [PMID: 37813187 DOI: 10.1016/j.oftale.2023.10.003] [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: 07/11/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023]
Abstract
Nanophthalmos is a rare congenital condition of the eyeball that is characterised by a smaller size of the anterior and posterior segments without associated ocular malformations. Typical features that have traditionally been described in these eyes are short axial length, thickened sclera, cornea with a smaller diameter, narrow anterior chamber, and an increased lens to globe volume ratio. However, at present, there is still a lack of recognised diagnostic criteria for nanophthalmos and a classification of its severity. Its clinical relevance stems from the increased risk of multiple ocular conditions, such as high hyperopia, amblyopia, angle-closure glaucoma, retinal detachment, and cataracts. Likewise, in relation to surgery in these eyes, there are particularities in cataract and glaucoma surgery and with a greater risk of associated intra- and postoperative complications. In this way, the treatment of nanophthalmos focuses on controlling the associated eye conditions and reducing and controlling surgical complications. This review aims to update what has been published in recent years regarding nanophthalmos.
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Affiliation(s)
- J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| | - C N Gómez-de-Liaño
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - O Rodríguez-Quet
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - B Burgos-Blasco
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - E Montolío-Marzo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | | | - J González-Martin-Moro
- Departamento de Oftalmología, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - J García-Feijóo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
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Burstedt M, Whelan JH, Green JS, Holopigian K, Spera C, Greco E, Deslandes JY, Wald M, Grosskreutz C, Ni X, Normand G, Maker M, Charil A, Rosol M, He Y, Stasi K. Retinal Dystrophy Associated With RLBP1 Retinitis Pigmentosa: A Five-Year Prospective Natural History Study. Invest Ophthalmol Vis Sci 2023; 64:42. [PMID: 37883093 PMCID: PMC10615144 DOI: 10.1167/iovs.64.13.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/31/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose To assess the progression in functional and structural measures over a five-year period in patients with retinal dystrophy caused by RLBP1 gene mutation. Methods This prospective, noninterventional study included patients with biallelic RLBP1 mutations from two clinical sites in Sweden and Canada. Key assessments included ocular examinations, visual functional measures (best-corrected visual acuity [BCVA], contrast sensitivity [CS], dark-adaptation [DA] kinetics up to six hours for two wavelengths [450 and 632 nm], Humphrey visual fields [HVF], full-field flicker electroretinograms), and structural ocular assessments. Results Of the 45 patients enrolled, 38 completed the full five years of follow-up. At baseline, patients had BCVA ranging from -0.2 to 1.3 logMAR, poor CS, HVF defects, and prominent thinning in central foveal thickness. All patients had extremely prolonged DA rod recovery of approximately six hours at both wavelengths. The test-retest repeatability was high across all anatomic and functional endpoints. Cross-sectionally, poorer VA was associated with older age (right eye, correlation coefficient [CC]: 0.606; left eye, CC: -0.578; P < 0.001) and HVF MD values decreased with age (right eye, CC: -0.672, left eye, CC: -0.654; P < 0.001). However, no major changes in functional or structural measures were noted longitudinally over the five-year period. Conclusions This natural history study, which is the first study to monitor patients with RLBP1 RD for five years, showed that severely delayed DA sensitivity recovery, a characteristic feature of this disease, was observed in all patients across all age groups (17-69 years), making it a potentially suitable efficacy assessment for gene therapy treatment in this patient population.
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Affiliation(s)
- Marie Burstedt
- Clinical Sciences/Ophthalmology, University of Umeå, Umeå, Sweden
| | - James H. Whelan
- Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Jane S. Green
- Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Karen Holopigian
- Novartis Institutes for BioMedical Research, East Hanover, New Jersey, United States
| | | | - Erin Greco
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, United States
| | - Jean-Yves Deslandes
- Novartis Institutes for BioMedical Research, East Hanover, New Jersey, United States
| | - Michael Wald
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, United States
| | - Cynthia Grosskreutz
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, United States
| | - Xiao Ni
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, United States
| | - Guillaume Normand
- Novartis Institutes for BioMedical Research, East Hanover, New Jersey, United States
| | - Michael Maker
- Novartis Institutes for BioMedical Research, East Hanover, New Jersey, United States
| | - Arnaud Charil
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, United States
| | - Michael Rosol
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, United States
| | - Yunsheng He
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, United States
| | - Kalliopi Stasi
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, United States
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Venkatesh R, Mishra P, Nahata H, Reddy NG, Yadav NK, Chhablani J. Retinal arcades in posterior microphthalmos: biometric correlation. Clin Exp Optom 2023; 106:619-625. [PMID: 35878881 DOI: 10.1080/08164622.2022.2104628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 07/02/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022] Open
Abstract
CLINICAL RELEVANCE Posterior microphthalmos (PM) is a rare developmental disorder characterised by high hyperopia, short axial length, presence of retinal papillomacular fold and relatively normal anterior segment findings. BACKGROUND The purpose of the study was to compare the retinal arcade distance from fovea between PM cases and to correlate axial shortening in PM eyes with imaging findings. METHODS This retrospective, comparative case series included 24 eyes of 12 patients with PM as cases and an equal number of age- and sex-matched controls. Retinal findings on optical coherence tomography (OCT), OCT-angiography, Multicolour® image, axial length and corneal biometry were computed, compared and correlated between two groups. RESULTS Retinal papillomacular fold was noted in all 24 PM eyes. Retinal arcade narrowing was noted in PM (p < 0.001). The central retina (p < 0.001) and choroid (p = 0.003) was thick in PM. Corneal biometry showed shorter axial length (p < 0.001), high keratometry readings (p < 0.001) and small corneal diameters (p = 0.011) in PM. Vessel density (p = 0.031) on OCTA was denser and foveal avascular zone area (p = 0.033) reduced in PM. Strong negative correlation of axial length with spherical equivalent (r = > -0.804;p < 0.001), vessel density (r = > -0.803; p = <0.001) and K1 (r = > -0.76; p < 0.001) and K2 (r = > -0.67; p = 0.001) keratometry readings was noted in PM. Significant positive correlation was noted between axial length and anterior chamber depth (r = 0.75; p < 0.001), foveal avascular zone area (r = 0.56; p = 0.033) and corneal diameter (r = 0.65; p = 0.001). Vessel density on OCT-angiography correlated positively with central corneal thickness (r = 0.552;p = 0.005) and corneal powers K1 (r = 0.709; p = 0.001) and K2 (r = 0.56; p = 0.004) and negatively with corneal diameter (r = > -0.521; p = 0.033). CONCLUSION Increased choroidal thickening and retinal vascular arcade narrowing were two important, interesting observations noted with PM. Intercorrelation between the axial length, OCT, OCT-angiography and corneal biometry helped in understanding the pathogenesis and the structural and vascular changes in PM eyes.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Karnataka, India
| | - Pranjal Mishra
- Department of Retina and Vitreous, Narayana Nethralaya, Karnataka, India
| | - Harshita Nahata
- Department of Retina and Vitreous, Narayana Nethralaya, Karnataka, India
| | | | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Ozcelik F, Erdogdu E, Altan C. The Comparison of Soft HydroCone (Toris K) Silicone Hydrogel and Rigid Gas-Permeable Contact Lenses in Patients With Posterior Microphthalmos. Eye Contact Lens 2023; 49:168-171. [PMID: 36811834 DOI: 10.1097/icl.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To evaluate and compare soft HydroCone (Toris K) silicone hydrogel and rigid gas-permeable contact lenses (RGPCLs) in patients with posterior microphthalmos (PMs), for visual rehabilitation and comfort. METHODS The records of 11 patients who were followed up in our hospital with the diagnosis of PM and were fitted with both Toris K and RGPCLs in our contact lens department were reviewed retrospectively. Patient age, gender, axial length (AL), topographic keratometry (K) values and best-corrected visual acuity (BCVA) with both lens types and subjective lens comfort status were recorded. RESULTS A total of 22 eyes of 11 patients with a mean age of 20.9±11.1 years were included in the study. The mean AL were 16.01±0.1 and 15.9±0.2 mm in the right and left eyes, respectively. Mean K1 and K2 were 48.6±2.2 and 49.4±2.2 D, respectively. Mean logMAR BCVA of the 22 eyes before contact lens fitting was 0.63±0.56 with spectacle. After Toris K and RGPCLs fitting, mean logMAR BCVA were 0.43±0.20 and 0.35±0.25, respectively. Both lenses provided better visual acuity than spectacles; RGPCLs also provided significantly better visual acuity than HydroCone lens ( P <0.05). Eight of 11 patients (73%) had ocular discomfort with RGPLs, and there was no complaint with Toris K. CONCLUSIONS The corneal surfaces are steeper in patients with PMs than in normal population. For that reason, their vision should be rehabilitated by special design keratoconus lenses like Toris K and RGPCLs. Although vision rehabilitation seems better with RGPCLs, these patients prefer Toris K more because of discomfort.
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Affiliation(s)
- Ferah Ozcelik
- University of Health Sciences (F.O., E.E., C.A.), Istanbul, Turkey; and Beyoglu Eye Training and Research Hospital (F.O., E.E., C.A.), Istanbul, Turkey
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Vanden Heuvel C, Aldred B, Boulter T, Sullivan R, Ver Hoeve J, Schmitt M. MFRP variant results in nanophthalmos, retinitis pigmentosa, variability in foveal avascular zone. Ophthalmic Genet 2023; 44:83-88. [PMID: 35880649 DOI: 10.1080/13816810.2022.2103835] [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: 10/16/2022]
Abstract
BACKGROUND Membrane frizzled-related protein (MFRP) plays a critical role in ocular development. MFRP mutations are known to cause nanophthalmos and, in some cases, retinitis pigmentosa, foveoschisis, and/or optic nerve head (ONH) drusen. The broad clinical spectrum of MFRP mutations necessitates further investigation of specific genotype-phenotype relationships. MATERIALS AND METHODS We reviewed ophthalmologic and genetic medical records of two affected siblings and one unaffected sibling. RESULTS Genetic testing revealed variants MFRP c.855T>A, p.(Cys285*) and MFRP c.1235T>C, p.(Leu412Pro) in trans in the two affected siblings. In both cases, photopic and scotopic responses were markedly reduced on electroretinogram (ERG), with greater decrease in scotopic function. Optical coherence tomography for both siblings revealed non-cystoid thickening. Blunted foveal reflexes were also observed in both siblings. Notably, foveal avascular zone abnormalities were seen on fundus autofluorescence in only one affected sibling. CONCLUSIONS MFRP-related ocular disease may be underrecognized due to its presentation with high hyperopia and possibly subtle retinal findings. Presence of variants MFRP c.855T>A, p.(Cys285*) and MFRP c.1235T>C, p.(Leu412Pro) in trans resulted in nanophthalmos and retinitis pigmentosa without associated foveoschisis or ONH drusen in our patients, consistent with the incomplete phenotype previously described in Neri et al. Abnormalities in the foveal avascular zone have been noted in other case studies and were inconsistently associated with the variants described here, representing a potential area for future investigation.
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Affiliation(s)
- Claire Vanden Heuvel
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Breanna Aldred
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tyler Boulter
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Rachel Sullivan
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James Ver Hoeve
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Melanie Schmitt
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Ma L, Li Y, Zhang H, Li L, Deng G, Xu J, Li D. Abnormalities of the contralateral eye in unilateral congenital anophthalmic or blind microphthalmic patients. J AAPOS 2023; 27:34.e1-34.e4. [PMID: 36563895 DOI: 10.1016/j.jaapos.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE To describe the prevalence, distribution, and features of anterior and posterior segment abnormalities in the contralateral eye in cases unilateral of anophthalmia and blind microphthalmia. METHODS The medical records of patients with unilateral congenital anophthalmia and blind microphthalmia referred to Beijing Tongren Hospital between January 2017 and December 2021 were reviewed retrospectively to investigate the prevalence of abnormalities of the fellow eye. RESULTS A total of 168 patients were included. Of these, 28 (16.7%) had fellow eye abnormalities, 4 (2.4%) with anterior segment involvement in the contralateral eye. All 28 had fundus abnormalities. The most common posterior segment finding was coloboma (7.7%), followed by optic nerve dysplasia (3.0%), familial exudative vitreoretinopathy (FEVR) or FEVR-like fundus (1.8%), morning glory disk anomaly (1.8%), and retinal nerve fiber layer defect (1.2%). High myopia fundus changes (0.6%), retinal folds (0.6%), maculopathy (0.6%), peripapillary staphyloma (0.6%), and Bergmeister optic disk (0.6%) were also noted. CONCLUSIONS Patients with unilateral congenital anophthalmia or blind microphthalmia have a high probability of contralateral eye disease. The most common abnormality is coloboma.
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Affiliation(s)
- Lan Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
| | - Yang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
| | - Hanqiao Zhang
- Department of Ophthalmology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Liang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
| | - Guangda Deng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
| | - Jie Xu
- Beijing Institute of Ophthalmology, Capital Medical University, Beijing Tongren Hospital, Beijing, China
| | - Dongmei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China.
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Hanyu T, Ueki S, Hasegawa Y, Kiyokawa M, Fukuchi T. Posterior microphthalmos with achievement of good visual acuity and disappearance of papillomacular retinal folds: a case report. BMC Ophthalmol 2022; 22:424. [PMID: 36344972 PMCID: PMC9639268 DOI: 10.1186/s12886-022-02648-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Background Posterior microphthalmos (PM) is a rare condition with poor visual prognosis even after amblyopia treatment. We report a case of PM with achievement of good visual acuity and disappearance of papillomacular retinal folds (PFs) over a period of 7 years. Case presentation A girl aged 3 years and 5 months was referred to our hospital, after poor visual acuity was identified at a medical checkup for 3-year-olds. She had severe spherical hyperopia: + 17.25 D in the right eye (RE) and + 18 D in the left eye (LE). Her corrected visual acuity was 20/200 in the RE and 20/250 in the LE. PFs were observed in both eyes on optical coherence tomography (OCT), and the diagnosis of PM was made based on the normal corneal diameter and anterior chamber depth. During the course of the disease, a gradual decrease in the height of the PFs was observed on OCT. The corrected visual acuity at age 10 years was 20/20 in the RE and 20/25 in the LE. Conclusions The visual prognosis of PM is poor, and only one case with good visual acuity has been reported in the literature. The patient in the present case not only developed good visual acuity, but also showed improvement in macular morphology, which was not noted in previous reports. Early diagnosis of PM and early amblyopia treatment is important for the visual development in PM.
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Affiliation(s)
- Takako Hanyu
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan ,Hanyu Clinic, Igarashi-Higashi 1-1-15, Nishi-Ku, Niigata, 950-2045 Japan
| | - Satoshi Ueki
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan
| | - Yukari Hasegawa
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan
| | - Megumi Kiyokawa
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan ,Toshimi Eye Clinic, Katsubogawa 1-1-12, Sanjo City, Niigata, 955-0056 Japan
| | - Takeo Fukuchi
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan
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Effect of Combined Surgery in Patients with Complex Nanophthalmos. J Clin Med 2022; 11:jcm11195909. [PMID: 36233776 PMCID: PMC9571930 DOI: 10.3390/jcm11195909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: To evaluate the efficacy and safety of combined surgery (limited pars plana vitrectomy, anterior-chamber stabilized phacoemulsification, IOL implantation and posterior capsulotomy, LPPV + ACSP + IOL + PC) in complex nanophthalmos. (2) Methods: Patients with complex nanophthalmos were recruited to undergo LPPV + ACSP + IOL + PC from January 2017 to February 2021. Preoperative and post-operative intraocular pressure (IOP), best corrected visual acuity (BCVA), anterior chamber depth (ACD), and number of glaucoma medications were compared using the paired t-test or Wilcoxon signed rank sum tests. Surgical success rate was evaluated. Surgery-associated complications were documented. (3) Results: Forty-five eyes of 37 patients with complex nanophthalmos were enrolled. The mean follow-up period was 21.7 ± 10.6 months after surgery. Mean IOP decreased from 32.7 ± 8.7 mmHg before surgery to 16.9 ± 4.5 mmHg (p < 0.001) at the final follow-up visit, mean logMAR BCVA improved from 1.28 ± 0.64 to 0.96 ± 0.44 (p < 0.001), mean ACD significantly increased from 1.14 ± 0.51 mm to 3.07 ± 0.66 mm (p < 0.001), and the median number of glaucoma medications dropped from 3 (1, 4) to 2 (0, 4) (p < 0.001). The success rate was 88.9% (40 eyes) at the final follow-up visit. Two eyes had localized choroidal detachments which resolved with medical treatment. (4) Conclusions: LPPV + ACSP + IOL + PC is a safe and effective surgical procedure, which can decrease IOP, improve BCVA, deepen the anterior chamber, and reduce the number of glaucoma medications in patients with complex nanophthalmos. It can be considered as one of the first treatment in nanophthalmic eyes with complex conditions.
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Venkatesh R, Arora S, Reddy NG, Rubble M, Yadav NK, Chhablani J. Choroidal changes in posterior microphthalmos. Eur J Ophthalmol 2022:11206721221112806. [PMID: 35791500 DOI: 10.1177/11206721221112806] [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: 11/16/2022]
Abstract
PURPOSE To describe the choroidal variations in posterior microphthalmos (PM). METHODS In this observational case series, four eyes of two patients diagnosed as PM based on the characteristic clinical features were included. Multimodal retinal imaging with clinical fundus documentation using ultrawide field fundus camera, optical coherence tomography (OCT) and indocyanine green angiography (ICGA) was done for these cases. RESULTS Multimodal imaging of these cases confirmed the variations in the choroid in PM cases. In both cases, on OCT, the retina and choroid were thick. retinal papillomacular fold (RPMF) was noted in all four eyes. On ICGA, the dye transit time from the arm to choroid and retina were within normal limits. Choroidal vasculature in the far retinal periphery was reduced and was noted as hypocyanescent areas anterior to the equator while the density of choroidal vessels was significantly more posterior to the equator. Vortex veins were not visualised in both cases. CONCLUSION Choroidal structure and vessels undergo alterations in PM. Further validation of these findings is required in a larger cohort of PM cases.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sahil Arora
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Nikitha Gurram Reddy
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Mangla Rubble
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Rajendrababu S, Vaishali V, Senthilkumar VA, Ramesh S, Uduman MS. Comparison of clinical and biometric characteristics between nanophthalmic children and age-matched controls. Indian J Ophthalmol 2022; 70:2440-2445. [PMID: 35791127 PMCID: PMC9426193 DOI: 10.4103/ijo.ijo_2880_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: To compare the clinical and biometric characteristics of children presenting with nanophthalmos (NO group) with that of age-matched controls (CO group). Methods: Electronic medical records of 40 children (<18 years of age) with diagnosis of nanophthalmos (NO), presented to a tertiary center in Tamil Nadu between January 2010 and December 2019, were reviewed and compared with 30 age-matched controls (CO) presenting for routine eye examination between October 2019 and December 2019. Clinical parameters compared were best-corrected visual acuity (BCVA), axial length (AxL), keratometry (K), anterior chamber depth (ACD), lens thickness (LT), retinochoroidal scleral thickness (RCS), corneal diameter, central corneal thickness (CCT), intraocular pressure (IOP), lens axial length factor (LAF), and lens thickness/anterior chamber depth ratio (LT/ACD). Results: Mean age of the NO group was 8.95 ± 4.0 years. Mean spherical equivalent (SE) in NO group was 10.87 ± 3.1 D and was inversely correlated to AxL (r = −0.46, P value = 0.003). All biometric parameters (AxL, ACD, LT, RCS, LAF, and LT/ACD), except CCT were significantly different between NO and CO groups. NO group children had 52.5% visual impairment with BCVA ≤ 6/24 and 17.5% had esotropia. Common ocular associations in NO group were amblyopia (64.3%), primary angle-closure glaucoma (PACG) (17.8%), pigmentary retinopathy (14.3%), and retinal detachment (3.6%). Angle-closure disease was seen in 50% of NO group and 30% underwent laser peripheral iridotomy (LPI). There was a significant difference in SE, ACD, and LAF among NO children with AxL <17 mm or >17 mm. Multivariable regression analysis revealed a significant correlation of SE and ACD with AxL. Conclusion: Nanophthalmos in children often present as amblyopia with visual impairment and strabismus. NO group with AxL <17 mm, had angle-closure disease as a common association with significantly lower ACD, higher SE, and LAF. All morphometric characteristics, except CCT, were significantly different between NO and CO groups. Close monitoring with serial biometry in NO group is needed for the timely diagnosis and prompt intervention to avoid visual impairment, due to glaucoma.
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Affiliation(s)
- Sharmila Rajendrababu
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamil Nadu, India
| | - Venkatraman Vaishali
- Department of Medical Consultant, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamil Nadu, India
| | | | - Sujitha Ramesh
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamil Nadu, India
| | - Mohammed Sithiq Uduman
- Department of Biostatistics, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamil Nadu, India
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12
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Wen S, Min X, Zhu Y, Zhou X. Genetic analysis assists diagnosis of clinical systemic disease in children with excessive hyperopia. BMC Pediatr 2022; 22:305. [PMID: 35610621 PMCID: PMC9128117 DOI: 10.1186/s12887-021-02992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background A thorough examination (especially those including visual functional evaluation) is very important in children’s eye-development during clinical practice, when they encountered with unusual excessive hyperopia especially accompanied with other possible complications. Genetic testing would be beneficial for early differential diagnosis as blood sampling is more convenient than all other structural imaging capture tests or functional tests which need children to cooperate well. Thus genetic testing helps us to filter other possible multi-systemic diseases in children patients with eye disorder. Case presentation A 3-year-old and an 8-year-old boy, both Chinese children clinically manifested as bilateral excessive hyperopia (≥+10.00), severe amblyopia and exotropia, have been genetically diagnosed as Senior-Loken syndrome-5 (SLSN5) and isolated posterior microphthalmos (MCOP6), respectively. Conclusions This report demonstrates the importance of genetic diagnosis before a clinical consult. When children are too young to cooperate with examinations, genetic testing is valuable for predicting other systemic diseases and eye-related development and for implementing early interventions for the disease.
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Affiliation(s)
- Shijin Wen
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Xiaoshan Min
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan Province, China.
| | - Ying Zhu
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Xia Zhou
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan Province, China
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13
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Acón D, Hussain RM, Quan AV, Mendoza-Santiesteban C, Berrocal AM. Multimodal Imaging Findings in Two Children With Microphthalmos. Ophthalmic Surg Lasers Imaging Retina 2021; 52:444-446. [PMID: 34410185 DOI: 10.3928/23258160-20210727-06] [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: 11/20/2022]
Abstract
Microphthalmos, also called microphthalmia, is a rare developmental disorder of the eye that can be caused by genetic or chromosomal abnormalities or environmental factors. The spectrum of clinical presentation includes nanophthalmia and posterior microphthalmia. It affects approximately one in 1,000 individuals, although there is insufficient literature regarding the clinical and different imaging modalities findings. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:444-446.].
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14
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Müller PL, Treis T, Alsaedi A, Webster AR, Khaw P, Michaelides M, Wickham L, Siriwardena D, Foster P, Moosajee M, Pavesio C, Tufail A, Egan C. Foveal structure and visual function in nanophthalmos and posterior microphthalmos. Br J Ophthalmol 2021; 106:1164-1170. [PMID: 34301612 DOI: 10.1136/bjophthalmol-2020-318717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The reason for visual impairment in patients with nanophthalmos and posterior microphthalmos is not completely understood. Therefore, this study aims to investigate foveal structure, and the impact of demographic, clinical and imaging parameters on best-corrected visual acuity (BCVA) in these conditions. METHODS Sixty-two eyes of 33 patients with nanophthalmos (n=40) or posterior microphthalmos (n=22), and 114 eyes of healthy controls with high-resolution retinal imaging including spectral-domain or swept-source optical coherence tomography images were included in this cross-sectional case-control study. Foveal retinal layer thickness was determined by two independent readers. A mixed-effect model was used to perform structure-function correlations and predict the BCVA based on subject-specific variables. RESULTS Most patients (28/33) had altered foveal structure associated with loss of foveal avascular zone and impaired BCVA. However, widening of outer nuclear layer, lengthening of photoreceptor outer segments, normal distribution of macular pigment and presence of Henle fibres were consistently found. Apart from the presence of choroidal effusion, which had significant impact on BCVA, the features age, refractive error, axial length and retinal layer thickness at the foveal centre explained 61.7% of the variability of BCVA. CONCLUSION This study demonstrates that choroidal effusion, age, refractive error, axial length and retinal layer thickness are responsible for the majority of interindividual variability of BCVA as well as the morphological foveal heterogeneity in patients with nanophthalmos or posterior microphthalmos. This might give further insights into the physiology of foveal development and the process of emmetropisation, and support clinicians in the assessment of these disease entities.
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Affiliation(s)
- Philipp L Müller
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Department of Ophthalmology, University of Bonn, Bonn, Germany.,Macula Center, Suedblick Eye Centers, Augsburg, Germany.,Institute of Ophthalmology, University College London, London, UK
| | - Tim Treis
- Institute of Pharmacy and Molekular Biotechnology, University of Heidelberg, Heidelberg, Germany
| | - Abdulrahman Alsaedi
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,College of Medicine, Imam Muhammad bin Saud Islamic University, Riyadh, Saudi Arabia
| | - Andrew R Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Peng Khaw
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Michel Michaelides
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Louisa Wickham
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | | | - Paul Foster
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Mariya Moosajee
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Great Ormond Street Hospital for Children, London, UK
| | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Catherine Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK .,Institute of Ophthalmology, University College London, London, UK
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15
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Lang E, Koller S, Atac D, Pfäffli OA, Hanson JV, Feil S, Bähr L, Bahr A, Kottke R, Joset P, Fasler K, Barthelmes D, Steindl K, Konrad D, Wille D, Berger W, Gerth‐Kahlert C. Genotype-phenotype spectrum in isolated and syndromic nanophthalmos. Acta Ophthalmol 2021; 99:e594-e607. [PMID: 32996714 DOI: 10.1111/aos.14615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/01/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To (i) describe a series of patients with isolated or syndromic nanophthalmos with the underlying genetic causes, including novel pathogenic variants and their functional characterization and (ii) to study the association of retinal dystrophy in patients with MFRP variants, based on a detailed literature review of genotype-phenotype correlations. METHODS Patients with nanophthalmos and available family members received a comprehensive ophthalmological examination. Genetic analysis was based on whole-exome sequencing and variant calling in core genes including MFRP, BEST1, TMEM98, PRSS56, CRB1, GJA1, C1QTNF5, MYRF and FAM111A. A minigene assay was performed for functional characterization of a splice site variant. RESULTS Seven patients, aged between three and 65 years, from five unrelated families were included. Novel pathogenic variants in MFRP (c.497C>T, c.899-3C>A, c.1180G>A), and PRSS56 (c.1202C>A), and a recurrent de novo variant in FAM111A (c.1706G>A) in a patient with Kenny-Caffey syndrome type 2, were identified. In addition, we report co-inheritance of MFRP-related nanophthalmos and ADAR-related Aicardi-Goutières syndrome. CONCLUSION Nanophthalmos is a genetically heterogeneous condition, and the severity of ocular manifestations appears not to correlate with variants in a specific gene. However, retinal dystrophy is only observed in patients harbouring pathogenic MFRP variants. Furthermore, heterozygous carriers of MFRP and PRSS56 should be screened for the presence of high hyperopia. Identifying nanophthalmos as an isolated condition or as part of a syndrome has implications for counselling and can accelerate the interdisciplinary care of patients.
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Affiliation(s)
- Elena Lang
- Department of Ophthalmology University Hospital Zurich and University of Zurich Zurich Switzerland
- Institute of Medical Molecular Genetics University of Zurich Schlieren Switzerland
| | - Samuel Koller
- Institute of Medical Molecular Genetics University of Zurich Schlieren Switzerland
| | - David Atac
- Institute of Medical Molecular Genetics University of Zurich Schlieren Switzerland
| | - Oliver A. Pfäffli
- Department of Ophthalmology University Hospital Zurich and University of Zurich Zurich Switzerland
| | - James V.M. Hanson
- Department of Ophthalmology University Hospital Zurich and University of Zurich Zurich Switzerland
| | - Silke Feil
- Institute of Medical Molecular Genetics University of Zurich Schlieren Switzerland
| | - Luzy Bähr
- Institute of Medical Molecular Genetics University of Zurich Schlieren Switzerland
| | - Angela Bahr
- Institute of Medical Genetics University of Zurich Zurich Switzerland
| | - Raimund Kottke
- Department of Diagnostic Imaging University Children's Hospital Zurich Zurich Switzerland
| | - Pascal Joset
- Institute of Medical Genetics University of Zurich Zurich Switzerland
| | - Katrin Fasler
- Department of Ophthalmology University Hospital Zurich and University of Zurich Zurich Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology University Hospital Zurich and University of Zurich Zurich Switzerland
- Save Sight Institute The University of Sydney Sydney NSW Australia
| | - Katharina Steindl
- Institute of Medical Genetics University of Zurich Zurich Switzerland
| | - Daniel Konrad
- Department of Pediatric Endocrinology and Diabetology University Children’s Hospital Zurich Switzerland
| | | | - Wolfgang Berger
- Institute of Medical Molecular Genetics University of Zurich Schlieren Switzerland
- Zurich Center for Integrative Human Physiology University of Zurich Zurich Switzerland
- Neuroscience Center Zurich, University and ETH Zurich Zurich Switzerland
| | - Christina Gerth‐Kahlert
- Department of Ophthalmology University Hospital Zurich and University of Zurich Zurich Switzerland
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16
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Nanophthalmos: An Update on the Biological Parameters and Fundus Abnormalities. J Ophthalmol 2021; 2021:8853811. [PMID: 33777447 PMCID: PMC7972840 DOI: 10.1155/2021/8853811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/18/2020] [Accepted: 03/04/2021] [Indexed: 11/18/2022] Open
Abstract
Nanophthalmos is a clinical phenotype of simple microphthalmos, in which the anterior and posterior segments of the eyeball do not develop into a normal size without other major ocular or systemic anomalies. Typical clinical manifestations of nanophthalmos include short axial length, thickened sclera, small cornea, shallow anterior chamber, and increased lens-to-eye volume ratio. Currently, there is a lack of recognized diagnostic criteria for nanophthalmos. With the development of eye examination technologies, such as biological measurement and imaging examination, visualization and quantification of the eyeball's shape and structure in nanophthalmos can be realized. New clinical features have been reported, which are of great significance for diagnosing and treating nanophthalmos. This review introduces the related concepts of nanophthalmos and the new developments in its clinical characterization.
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17
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Raval N, Zhang C, Yao WJ, Lin J. Posterior segment abnormalities in posterior microphthalmos. Am J Ophthalmol Case Rep 2020; 20:100915. [PMID: 32964171 PMCID: PMC7490723 DOI: 10.1016/j.ajoc.2020.100915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose We report a case of posterior microphthalmos with characteristic papillomacular retinal folds, pigmentary retinopathy, and optic disc drusen. Observations A 19-year-old female presented with decreased visual acuity and was found to have bilateral posterior microphthalmos with the presence of papillomacular retinal folds, crowded optic nerves with buried disc drusen, and peripheral retinal pigmentary changes. Optical coherence tomography showed presence of retinal folds involving the inner retinal layers and loss of foveal contour. Conclusions and Importance Posterior microphthalmos can present with an array of unique clinical findings involving the posterior segment. It is important to recognize these findings as these patients often have decreased visual acuity and are at risk for the development of other posterior complications.
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Affiliation(s)
| | | | | | - James Lin
- Corresponding author. Department of Ophthalmology, Montefiore Medical Center 3332 Rochambeau Ave, 3rd Floor, 10467, Bronx, NY, USA.
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18
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C Parameswarappa D, Dogra A. Posterior microphthalmos with pigmentary retinopathy. BMJ Case Rep 2020; 13:13/11/e234443. [DOI: 10.1136/bcr-2020-234443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of 19-year-old man with gradual diminution of vision in both eyes since childhood. His best-corrected visual acuity was 20/160, N16 in the right eye and 20/200, N16 in the left eye. Slit-lamp biomicroscopic examination revealed normal cornea, anterior segment, intraocular pressure and lens. Fundus of both eyes showed crowded optic disc with pigmentary changes. Ancillary tests were performed to aid in the diagnosis. A-scan ultrasound revealed short axial lengths with normal corneal diameter, anterior chamber depth and lens thickness. Optical coherence tomography of both eyes showed inner retinal layer folds. Electroretinogram of both eyes showed extinguished photopic as well as scoptopic responses. A diagnosis of posterior microphthalmos with pigmentary retinopathy was made. The patient was counselled regarding nature of the disease and the condition was managed with low vision aids.
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19
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Sen P, Robson AG, Webster AR, Nicholson L, Sivaprasad S, Hykin PG. Long-term follow-up of a case of posterior microphthalmos (PRSS56) with hyperautofluorescent retinal pigment epithelial deposits. Eur J Ophthalmol 2020; 32:NP163-NP167. [PMID: 32806950 DOI: 10.1177/1120672120949756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of posterior microphthalomos (PM) related to PRSS56 gene mutation with long term follow up with multimodal imaging findings. METHODS Single retrospective case report. RESULTS A 43-year old male patient presented in 2009 with bilateral reduced vision. Clinical examination and multimodal imaging showed features consistent with posterior microphthalmos with prominent bilateral horizontal papillomacular retinal folds. Posterior pole hyperautofluorescent RPE deposits were present. Gradual worsening of visual acuity and rod and cone photoreceptor function more so on the left was demonstrated during the 8 years of follow up. CONCLUSION Hyperautofluorescent RPE deposits may occur in patients with posterior microphthalmos and such patient's may experience only gradual disease progression over long term follow up.
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Affiliation(s)
- Piyali Sen
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Anthony G Robson
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Andrew R Webster
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Luke Nicholson
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Sobha Sivaprasad
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Philip G Hykin
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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20
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The Pathogenesis and Treatment of Complications in Nanophthalmos. J Ophthalmol 2020; 2020:6578750. [PMID: 32765903 PMCID: PMC7387986 DOI: 10.1155/2020/6578750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/09/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022] Open
Abstract
Microphthalmos is a type of developmental disorder ophthalmopathy, which can occur isolated or combined with other ocular malformations and can occur secondary to a systemic syndrome. Nanophthalmos is one of the clinical phenotypes of microphthalmos. Due to the special and complex structure of nanophthalmic eyes, the disorder is often associated with many complications, including high hyperopia, angle-closure glaucoma, and uveal effusion syndrome. The management of these complications is challenging, and conventional therapeutic methods are often ineffective in treating them. The purpose of this paper was to review the concept of nanophthalmos and present the latest progress in the study of the pathogenesis and treatment of its complications. As it is considerably challenging for ophthalmologists to prevent or treat these nanophthalmos complications, timely diagnosis and a suitable clinical treatment plan are vital to ensure that nanophthalmos patients are treated and managed effectively.
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21
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Godinho G, Madeira C, Grangeia A, Neves-Cardoso P, Santos-Silva R, Brandão E, Carneiro Â, Falcão-Reis F, Estrela-Silva S. A novel MFRP gene variant in a family with posterior microphthalmos, retinitis pigmentosa, foveoschisis, and foveal hypoplasia. Ophthalmic Genet 2020; 41:474-479. [PMID: 32703043 DOI: 10.1080/13816810.2020.1795888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND To characterize the phenotype and genotype of a syndrome associating posterior microphthalmos (PM), retinitis pigmentosa (RP), foveoschisis, and foveal hypoplasia (FH) in a consanguineous Portuguese family. MATERIALS AND METHODS Three siblings were studied and underwent comprehensive eye examinations for best-corrected visual acuity, axial length, refractive error, B-mode ultrasound, electroretinography, retinography, fluorescein angiography (FA), kinetic visual field (VF), and optical coherence tomography (OCT). Molecular analysis was performed by Sanger sequencing of the entire coding region of the MFRP gene. RESULTS All members presented nyctalopia, decreased visual acuity, and constriction of the VF, as well as bilateral shortening of the posterior ocular segment and normal anterior segment dimensions. The fundoscopy and ERG results were compatible with RP. Macular OCT analysis revealed schisis of the outer retinal layer, FH, as well as retinal and choroidal folds. We identified a homozygous mutation in intron 9 of the membrane frizzled-related protein (MFRP) gene (c.1124 + 1 G > A). CONCLUSIONS Our study shows a family with PM and RP due to a mutation in the MFRP gene. The relationship has previously been proven, but this specific mutation has never been described. These gene mutations show wide phenotypic variability, being evident in the presence of foveoschisis, retinal and choroidal folds, and FH, other than PM and RP.
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Affiliation(s)
- Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar e Universitário São João , Porto, Portugal
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar e Universitário São João , Porto, Portugal
| | - Ana Grangeia
- Department of Genetic, Centro Hospitalar e Universitário São João , Porto, Portugal
| | - Pedro Neves-Cardoso
- Department of Ophthalmology, Centro Hospitalar e Universitário São João , Porto, Portugal
| | - Renato Santos-Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário São João , Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto , Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar e Universitário São João , Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar e Universitário São João , Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto , Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário São João , Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto , Porto, Portugal
| | - Sérgio Estrela-Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário São João , Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto , Porto, Portugal
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22
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Rajendrababu S, Shroff S, Uduman MS, Babu N. Clinical spectrum and treatment outcomes of patients with nanophthalmos. Eye (Lond) 2020; 35:825-830. [PMID: 32461562 DOI: 10.1038/s41433-020-0971-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To study the varied demographic, visual and clinical presentation of patients with nanophthalmos. METHODS Retrospective chart review of 144 consecutive subjects with nanophthalmos from January 2010 to January 2018 was done. Demographic details, visual acuity, refractive status, clinical parameters and surgical data were collected. RESULTS Mean age at presentation was 48.76 ± 15.99 years (5-74 years) and 55.6% were females. Median BCVA was 0.78 (6/36 Snellen equivalent) and median spherical equivalent was +10.0 (5.7-12.5) . Amblyopia was seen in 30.0% patients. Legal blindness was present in 16.7% of the study population. The mean IOP was 18.38 ± 9.38 mmHg. Angle closure disease was present in 67.7% and 35.7% had angle closure glaucoma. Presence of peripheral anterior synechia had higher odds (OR = 3.66; 95% CI, 1.71-7.84) of associated glaucoma. The mean axial length, 17.64 ± 1.74 mm was inversely correlated to the mean Retinochoroidal Sclera(RCS) thickness of 1.99 ± 0.25 mm (r = -0.28, p value < 0.001).All patients who had undergone surgery for glaucoma (n = 11) had associated intra or postoperative complication. Cataract surgery by manual small incision had more complications than Phacoemulsification (p value = 0.001). Occurrence of uveal effusion was significantly lower in eyes which underwent sclerostomy (p = 0.04) CONCLUSION: Nanophthalmos is a rare disorder with varying degree of visual impairment & amblyopia. High incidence of angle closure glaucoma was observed. Surgical management for glaucoma is often challenging with frequent complications. Cataract surgery by phacoemulsification had significantly lower complications than SICS and performing a concomitant sclerostomy reduced the occurrence of uveal effusions.
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Affiliation(s)
| | | | | | - Naresh Babu
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
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23
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Posterior microphthalmos with good visual acuity: A case report. Am J Ophthalmol Case Rep 2019; 16:100568. [PMID: 31763497 PMCID: PMC6859220 DOI: 10.1016/j.ajoc.2019.100568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 11/01/2019] [Accepted: 11/03/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose We report the case of an 11-year-old boy with posterior microphthalmos who exhibited normal and age appropriate development of visual acuity. Observations At the initial diagnosis, when he was 3 years old, the best-corrected visual acuity (BCVA) was 20/125 in the right eye (OD) and 20/200 in the left eye (OS) with high hyperopia (cycloplegic refraction +15.75 D sphere OD and +16.25 D sphere OS). Eight years after he began wearing hyperopic glasses, BCVA was 20/16 OD and 20/20 OS. Optical coherence tomography did not reveal a foveal pit in either eye throughout the observation period. However, elongation of the outer segment and widening of the outer nuclear layers were observed. Conclusion and Importance Many cases of posterior microphthalmos demonstrate subnormal BCVA due to an abnormal foveal structure (papillomacular retinal folds, absence of the foveal pit and avascular zone) and high hyperopia. However, if foveal maturity progresses, even if the foveal structure is abnormal, early aggressive amblyopia treatment can result in normal and age appropriate development of visual acuity.
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24
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Karkhaneh R, Masoumi A, Ebrahimiadib N, Chams H, Abrishami M. Multimodal imaging in posterior microphthalmos. J Curr Ophthalmol 2019; 31:335-338. [PMID: 31528771 PMCID: PMC6742752 DOI: 10.1016/j.joco.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/26/2018] [Accepted: 01/04/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the multimodal imaging including optical coherence tomography angiography (OCTA) findings in patients with posterior microphthalmos (PM). Methods In an observational case series, four eyes of two patients, eight and twenty-three years old, with clinical proven PM underwent complete ophthalmic examination, including refraction, fluorescein angiography, optical coherence tomography (OCT), OCTA, B-scan ultrasonography, axial length measurement using IOL Master optical measuring, and Pentacam evaluation. Results Both patients were high hyperopic with partial thickness retinal fold in macula, retinoschisis, and foveal hypoplasia. Axial length was less than 17 mm with scleral thickening in all eyes. OCTA showed absence of foveal avascular zone (FAZ) in both superficial and deep capillary plexuses. Pentacam showed corneal steepness, shallow anterior chamber, and low anterior chamber volume. Conclusion OCTA findings showed absence of avascular zone in both superficial and deep capillary plexuses, while OCT shows partial thickness retinal fold and retinoschisis.
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Affiliation(s)
- Reza Karkhaneh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Masoumi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hormoz Chams
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Venkatesh R, Jain K, Srinivasan P, Pereira A, Aseem A, Yadav NK. Retinal structural and vascular changes in posterior microphthalmos. Clin Exp Optom 2019; 103:634-640. [PMID: 31489720 DOI: 10.1111/cxo.12966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Posterior microphthalmos (PM) is a rare developmental disorder characterised by high hyperopia, short axial length, presence of retinal papillomacular fold and relatively normal anterior segment findings. The study objective is to describe the retinal structural and vascular changes in eyes with PM with spectral domain optical coherence tomography, optical coherence tomography angiography and multicolour imaging. METHODS In this retrospective, comparative case series, 10 eyes of five patients with PM as cases and 10 eyes of five age- and sex-matched controls were included. Structural changes, namely inner and outer retinal layer thicknesses, were measured using optical coherence tomography. Multicolour imaging findings were noted. Perifoveal vascular changes with qualitative and quantitative assessments were analysed using optical coherence tomography angiography. RESULTS The foveal dip was absent in all 10 eyes (100 per cent) with PM. There was an elevated retinal papillomacular fold in six eyes (60 per cent) and intraretinal cystoid spaces in two eyes (20 per cent) with PM. The inner retinal layers were thicker in PM. On multicolour imaging, foveal avascular zone and retinal wrinkles were identified in eyes with retinal papillomacular fold in blue and green reflectance images. Perifoveal vascular changes in optical coherence tomography angiography included foveal area size reduction in superficial and deep vascular networks. The foveal capillary vessel densities were higher in PM compared to the controls in both superficial (46.3 ± 3.7 per cent; p = 0.000) and deep (54.7 ± 3.5 per cent; p = 0.000) capillary plexuses. Flow areas in superficial (p = 0.693) and deep (p = 0.088) capillary plexuses were not statistically relevant. CONCLUSION The study suggests that in PM, retinal foreshortening occurs in one meridian leading to secondary changes such as loss of foveal dip, posterior bowing of the outer layers of the eye, thickening of the inner retina and ultimately, retinal papillomacular fold formation. The findings of the study need further validation in a larger series of patients with PM.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Kushagra Jain
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Priya Srinivasan
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Arpitha Pereira
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Aditya Aseem
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bangalore, India
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Morillo Sánchez MJ, Llavero Valero P, González-Del Pozo M, Ponte Zuñiga B, Antiñolo G, Ramos Jiménez M, Rodríguez De La Rúa Franch E. Posterior microphthalmos, retinitis pigmentosa, and foveoschisis caused by a mutation in the MFRP gene: a familial study. Ophthalmic Genet 2019; 40:288-292. [PMID: 31264930 DOI: 10.1080/13816810.2019.1633547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: To characterize the phenotype and genotype of a rare syndrome associating posterior microphthalmos (PM), retinitis pigmentosa (RP), and foveoschisis in a consanguineous Spanish family. Methods: The study involved five family members, consisting of three siblings and their parents. All members underwent comprehensive eye examinations for best corrected visual acuity, axial length and refractive error, electroretinography (ERG), fundus photography, retinal fluorescein angiography (FA), and optical coherence tomography (OCT). Clinical exome sequencing of more than 6,000 clinically relevant genes (SureSelect Focused Exome, Agilent) was performed using the Illumina HiSeq 3000 system. Candidate variants were validated and segregated by Sanger sequencing. Results: The affected siblings had bilateral shortening of the posterior ocular segment and normal anterior segment dimensions. The fundoscopy, ERG, and FA results were compatible with RP. Macular OCT analysis revealed schisis of the outer retinal layer. Our data analysis pipeline identified a homozygous frameshift mutation in exon 5 of the membrane frizzled-related protein (MFRP) gene (c.498delC; p.Asn167Thrfs*25). Conclusion: Our study confirmed the association of PM with RP as an autosomal recessive syndrome. Although this has previously been described, it seems that there are some constant (i.e., PM and RP) and some variable features (i.e., optic nerve drusen and foveoschisis). The MFRP mutation has also been detected in other studies associating PM with RP. Analysis of a larger series of cases at the clinical and genetic levels would certainly help us to better understand the phenotype-genotype correlations of this syndrome.
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Affiliation(s)
| | - Pilar Llavero Valero
- a Department of Ophthalmology , University Hospital Virgen Macarena , Seville , Spain
| | - María González-Del Pozo
- b Department of Maternofetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville , University Hospital Virgen del Rocío/CSIC/University of Seville , Seville , Spain.,c Rare Diseases Networking Biomedical Research Centre (CIBERER) , Seville , Spain
| | - Beatriz Ponte Zuñiga
- a Department of Ophthalmology , University Hospital Virgen Macarena , Seville , Spain.,d Retics Oftared , Institute of Health Carlos III , Madrid , Spain
| | - Guillermo Antiñolo
- b Department of Maternofetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville , University Hospital Virgen del Rocío/CSIC/University of Seville , Seville , Spain.,c Rare Diseases Networking Biomedical Research Centre (CIBERER) , Seville , Spain
| | - Manuel Ramos Jiménez
- e Department of Clinical Neurophysiology , University Hospital Vírgen Macarena , Seville , Spain
| | - Enrique Rodríguez De La Rúa Franch
- a Department of Ophthalmology , University Hospital Virgen Macarena , Seville , Spain.,d Retics Oftared , Institute of Health Carlos III , Madrid , Spain
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Novel truncation mutations in MYRF cause autosomal dominant high hyperopia mapped to 11p12-q13.3. Hum Genet 2019; 138:1077-1090. [PMID: 31172260 PMCID: PMC6745028 DOI: 10.1007/s00439-019-02039-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/04/2019] [Indexed: 12/15/2022]
Abstract
High hyperopia is a common and severe form of refractive error. Genetic factors play important roles in the development of high hyperopia but the exact gene responsible for this condition is mostly unknown. We identified a large Chinese family with autosomal dominant high hyperopia. A genome-wide linkage scan mapped the high hyperopia to chromosome 11p12-q13.3, with maximum log of the odds scores of 4.68 at theta = 0 for D11S987. Parallel whole-exome sequencing detected a novel c.3377delG (p.Gly1126Valfs*31) heterozygous mutation in the MYRF gene within the linkage interval. Whole-exome sequencing in other 121 probands with high hyperopia identified additional novel mutations in MYRF within two other families: a de novo c.3274_3275delAG (p.Leu1093Profs*22) heterozygous mutation and a c.3194+2T>C heterozygous mutation. All three mutations are located in the C-terminal region of MYRF and are predicted to result in truncation of that portion. Two patients from two of the three families developed angle-closure glaucoma. These three mutations were present in neither the ExAC database nor our in-house whole-exome sequencing data from 3280 individuals. No other truncation mutations in MYRF were detected in the 3280 individuals. Knockdown of myrf resulted in small eye size in zebrafish. These evidence all support that truncation mutations in the C-terminal region of MYRF are responsible for autosomal dominant high hyperopia in these families. Our results may provide useful clues for further understanding the functional role of the C-terminal region of this critical myelin regulatory factor, as well as the molecular pathogenesis of high hyperopia and its associated angle-closure glaucoma.
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Guo C, Zhao Z, Zhang D, Liu J, Li J, Zhang J, Sun N, Chen D, Zhang M, Fan Z. Anterior Segment Features in Nanophthalmos With Secondary Chronic Angle Closure Glaucoma: An Ultrasound Biomicroscopy Study. ACTA ACUST UNITED AC 2019; 60:2248-2256. [DOI: 10.1167/iovs.19-26867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Congcong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhenni Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dandan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jiafan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jianlong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jiamin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Nannan Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Denghui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Miao Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhigang Fan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Swept source-OCT and swept source-OCT angiography findings in posterior microphthalmos. Int Ophthalmol 2019; 39:2709-2719. [DOI: 10.1007/s10792-019-01115-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/30/2019] [Indexed: 01/06/2023]
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Comparison between Refractive Outcome of Primary Piggyback Intraocular Lens versus Secondary Lens Iris Claw Lens in Posterior Microphthalmos. J Ophthalmol 2019; 2019:1356982. [PMID: 30895155 PMCID: PMC6393898 DOI: 10.1155/2019/1356982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare the refractive outcome of 2 different methods of intraocular lens implantation in cases of posterior microphthalmos, primary piggyback IOLs versus secondary iris claw lenses. Methods This study was a retrospective interventional comparative study that included 60 eyes of 30 patients. The included patients had bilateral microphthalmos with high axial hyperopia and had undergone a lens-based surgical procedure for hyperopia correction. The included patients were equally divided into two groups. The first group had undergone refractive lens exchange (RLE) with primary piggyback IOL implantation. The second group undergone RLE with maximum available IOL power implanted followed by a secondary implantation of Artisan iris-fixated IOL (Ophtec B.V., Groningen, the Netherlands). Results The 2 groups were highly comparable to each other regarding the mean age, axial length (AL), manifest refraction (MR), and K readings. Postoperatively, there was a statistically significant difference between the 2 groups regarding the manifest refraction spherical equivalent (MRSE), mean absolute error (MAE), and uncorrected distance visual acuity (UDVA). There was no significant difference between the 2 groups regarding the CDVA. At 36 months, 20% and 73% of the eyes were within ±0.5 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively. Fifty-three percent and 93% of the eyes were within ±1.0 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively (p=0.001). Conclusion Secondary procedure with implantation of iris-fixated intraocular lens yielded very good results for treatment of axial hyperopia in cases of posterior microphthalmos. The primary piggyback IOL showed less satisfactory results with cases of under correction and the possible complication of interlenticular opacification. Both groups showed good safety parameters.
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Zor KR, Küçük E, Günaydın NT, Önder F. Ocular findings in posterior microphthalmos. Saudi J Ophthalmol 2019; 33:41-45. [PMID: 30930662 PMCID: PMC6424690 DOI: 10.1016/j.sjopt.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 09/07/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022] Open
Abstract
AIM To report a critical case series of six patients with posterior microphthalmos (PM). METHOD Complete ophthalmologic examinations of all patients were performed using best-corrected visual acuity (BCVA), cycloplegic refraction, applanation tonometry, slit lamp biomicroscopy of the anterior segment, fundoscopy, A and B mode ultrasonography (USG), keratometry, and optic coherence tomography (OCT). RESULTS The most significant clinical characteristics of male patients aged 10-25 years was the presence of shorter posterior segments (mean: 15.27-18.91 mm) accompanying high hyperopia (mean +9.00 - +18.50 diopter) despite the normal anterior segment findings. The BCVA ranged between 20/320 and 40/100. Retinal folds were detected bilaterally on the papillomacular band in all patients. Although neurosensory retina was included in the fold in OCT images, retinal pigment epithelium, choroid, and sclera were not included in the fold. Pigmentary retinopathy was detected in one patient. CONCLUSION Despite normal anterior segment, posterior microphthalmos is characterized with high hyperopia, and shorter axial length and bilateral papillomacular retinal fold. Refractive amblyopia, uveal effusion syndrome, retinal detachment and macular hole are complications that can be corrected. Posterior microphthalmos must be kept in mind in patients with a normal anterior segment, and high hyperopia.
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Affiliation(s)
- Kürsad Ramazan Zor
- Ophthalmology Department, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Erkut Küçük
- Ophthalmology Department, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Nesrin Tutaş Günaydın
- Ophthalmology Department, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Feyza Önder
- Ophthalmology Department, Haseki Training and Research Hospital, İstanbul, Turkey
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Liu JJ, Chen YY, Zhang X, Zhao PQ. Clinical features of posterior microphthalmic and nanophthalmic eyes. Int J Ophthalmol 2018; 11:1829-1834. [PMID: 30450315 DOI: 10.18240/ijo.2018.11.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/15/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To clinically differentiate nanophthalmos (NO) and posterior microphthalmos (PM) and to explore the mechanisms related to papillomacular folds (PMF). METHODS Medical records of 34 unrelated patients with microphthalmos (54 eyes) from April 2009 to October 2017 were retrospectively reviewed. RESULTS Fourteen eyes of 7 unrelated patients with NO and PM were included in the study. The presenting age of the NO cohort was significantly higher compared with the PM cohort (NO: 27±16y; PM: 3.7±0.6y). PMF was more likely to occur in cases with PM than in NO (25% in NO, 100% in PM). The anatomic features of PMF from optical coherence tomography (OCT) included: ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and outer nuclear layer. In eyes without an apparent PMF (these were all NO eyes), rudimentary fovea without a foveal pit was noted. Four eyes that were NO developed angle closure glaucoma. Three NO eyes developed exudative retinal detachment and were successfully treated with lamellar sclerectomy. CONCLUSION Posterior segment changes are pervasive both in PM and NO. Complications like angle closure glaucoma and exudative retinal detachment are likely to occur in eyes with NO but not with PM. Detailed OCT analysis found that PMF was partially a neural retinal issue, suggesting that redundancy of retinal issues involved only inner retinal layers.
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Affiliation(s)
- Jing-Jing Liu
- Department of Ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yi-Ye Chen
- Department of Ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xiang Zhang
- Department of Ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Pei-Quan Zhao
- Department of Ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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Funakoshi S, Yoshikawa T, Harada Y, Chikama T, Kiuchi Y. Absence of the foveal avascular zone in a nanophthalmic child revealed by optical coherence tomography angiography. Am J Ophthalmol Case Rep 2018; 13:34-37. [PMID: 30511032 PMCID: PMC6257928 DOI: 10.1016/j.ajoc.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/25/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose Optical coherence tomography angiography (OCTA) is a new non-invasive imaging technique that does not require the use of contrast agents and that allows the visualization of the retinal microvasculature in a layer-by-layer manner without bright light. This merit allows us to obtain the fundus image in children. Retinal vessels are typically absent from the center of the fovea, an area known as the foveal avascular zone (FAZ). The purpose of the present case study was to evaluate the FAZ in a nanophthalmic pediatric patient with OCTA. Obsevations A 6-year-old girl was referred to the Hiroshima University Hospital because of her poor vision. She had a best-corrected visual acuity of 20/125 in the right eye and of 20/100 in the left eye. The refractive errors after the administration of atropine sulfate eye drops were +13.00D in the right eye and +14.00D in the left eye. The axial lengths were 17.03 mm in the right eye and 16.90 mm in the left eye. At 9 years of age, the patient was diagnosed with nanophthalmos and OCTA was used to investigate the superficial and deep retinal layers. We demonstrated that the FAZ could not be observed in either eye, whereas the FAZ was readily observed in both eyes of a control subject of similar age. Conclusion and Importance OCTA is a useful technique to reveal the absence of the FAZ in cases of nanophthalmos. Because OCTA is a non-invasive and rapid procedure that is ideal for use with children.
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Affiliation(s)
- Shunsuke Funakoshi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tomoko Yoshikawa
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taiichiro Chikama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Mansour AM, Stewart MW, Yassine SW, Mehanna CJZ, Casella AMB, Hamam RN, Chhablani J, Lima LH, Shinojima A, Kaneko H, Younis MH, Shahin HK, Jalali S, Kucukerdonmez C, Saatci AO, Chakurkar R, Shields CL. Unmeasurable small size superficial and deep foveal avascular zone in nanophthalmos: the Collaborative Nanophthalmos OCTA Study. Br J Ophthalmol 2018; 103:1173-1178. [DOI: 10.1136/bjophthalmol-2018-312781] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/09/2018] [Accepted: 10/01/2018] [Indexed: 11/03/2022]
Abstract
AimTo study the macular structure and vasculature in consecutive nanophthalmic eyes using optical coherence tomography angiography.MethodsThis is a prospective, multicentre, cross-sectional study of patients with nanophthalmos (one or both eyes). The superficial and deep foveal avascular zones (FAZ) were measured both manually and with the machine’s built-in automated measurement tool. Correlations between best corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveolar choroidal thickness (SFCT) were calculated.ResultsSixty-five eyes of 35 subjects (16 men and 19 women) with a mean age of 37.4 years were analysed. The mean±SD of refractive error was 14.3±3.2 dioptres, axial length was 16.4±1.6 mm, CMT was 410.2±128.3 µm and SFCT was 450.1±108.3 µm. FAZ was unmeasurable small size in both the superficial and deep capillary plexus in all eyes, along with tortuosity of the superficial foveal capillaries and large vessels. Foveal folds were present in 29 eyes. Disc drusen was detected in 27 eyes and was absent in 31 eyes, while fundus autofluorescence was positive in 17 and negative in 24 eyes. BCVA varied from 20/20 to 20/800, with a mean of 20/76. Using Spearman’s correlation, logarithm of the minimum angle of resolution BCVA correlated negatively with axial length (r=−0.30; p=0.015).ConclusionsFAZ attenuation, capillary tortuosity, foveal folds and thickened subfoveal choroid characterise the nanophthalmic macula. These findings may result from a redundant retina and the absence of apoptotic foveolar retraction because of developmental arrest of the optic vesicle after closure of the embryonic fissure.
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Nanophthalmos: A Review of the Clinical Spectrum and Genetics. J Ophthalmol 2018; 2018:2735465. [PMID: 29862063 PMCID: PMC5971257 DOI: 10.1155/2018/2735465] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/20/2018] [Accepted: 04/08/2018] [Indexed: 11/28/2022] Open
Abstract
Nanophthalmos is a clinical spectrum of disorders with a phenotypically small but structurally normal eye. These disorders present significant clinical challenges to ophthalmologists due to a high rate of secondary angle-closure glaucoma, spontaneous choroidal effusions, and perioperative complications with cataract and retinal surgeries. Nanophthalmos may present as a sporadic or familial disorder, with autosomal-dominant or recessive inheritance. To date, five genes (i.e., MFRP, TMEM98, PRSS56, BEST1, and CRB1) and two loci have been implicated in familial forms of nanophthalmos. Here, we review the definition of nanophthalmos, the clinical and pathogenic features of the condition, and the genetics of this disorder.
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Erdöl H, Kola M, Türk A, Akyol N. Ultrasound Biomicroscopy and OCT Findings in Posterior Microphthalmos. Eur J Ophthalmol 2018; 18:479-82. [DOI: 10.1177/112067210801800331] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- H. Erdöl
- Department of Ophthalmology, Karadeniz Technical University, School of Medicine, Trabzon - Turkey
| | - M. Kola
- Department of Ophthalmology, Karadeniz Technical University, School of Medicine, Trabzon - Turkey
| | - A. Türk
- Department of Ophthalmology, Karadeniz Technical University, School of Medicine, Trabzon - Turkey
| | - N. Akyol
- Department of Ophthalmology, Karadeniz Technical University, School of Medicine, Trabzon - Turkey
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Collery RF, Volberding PJ, Bostrom JR, Link BA, Besharse JC. Loss of Zebrafish Mfrp Causes Nanophthalmia, Hyperopia, and Accumulation of Subretinal Macrophages. Invest Ophthalmol Vis Sci 2017; 57:6805-6814. [PMID: 28002843 PMCID: PMC5215506 DOI: 10.1167/iovs.16-19593] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Mutations in membrane frizzled-related protein (MFRP) are associated with nanophthalmia, hyperopia, foveoschisis, irregular patches of RPE atrophy, and optic disc drusen in humans. Mouse mfrp mutants show retinal degeneration but no change in eye size or refractive state. The goal of this work was to generate zebrafish mutants to investigate the loss of Mfrp on eye size and refractive state, and to characterize other phenotypes observed. Methods Clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 methods were used to generate multiple frameshift mutations in zebrafish mfrp causing premature translational stops in Mfrp. Spectral-domain optical coherence tomography (SD-OCT) was used to measure eye metrics and refractive state, and immunohistochemistry was used to study adult eyes. Gene expression levels were measured using quantitative PCR. Results Zebrafish Mfrp was shown to localize to apical and basal regions of RPE cells, as well as the ciliary marginal zone. Loss of Mfrp in mutant zebrafish was verified histologically. Zebrafish eyes that were mfrp mutant showed reduced axial length causing hyperopia, RPE folding, and macrophages were observed subretinally. Visual acuity was reduced in mfrp mutant animals. Conclusions Mutation of zebrafish mfrp results in hyperopia with subretinal macrophage infiltration, phenocopying aspects of human and mouse Mfrp deficiency. These mutant zebrafish will be useful in studying the onset and progression of Mfrp-related nanophthalmia, the cues that initiate the recruitment of macrophages, and the mechanisms of Mfrp function.
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Affiliation(s)
- Ross F Collery
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Peter J Volberding
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Jonathan R Bostrom
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Brian A Link
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Joseph C Besharse
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Abstract
PURPOSE To report a critical case series of five patients with posterior microphthalmos and the review of their clinical findings with the analyses of retinal imaging. METHOD Case series. Complete ophthalmological examinations including optical coherence tomography (OCT) were evaluated. RESULTS All patients had decreased visual acuity with high hyperopic refraction. Dilated fundus examination demonstrated that elevated papillomacular retinal folds with anterior segment were unremarkable. Total axial lengths measurements showed reduced axial lengths and B-scan ultrasonography revealed sclerochoroidal thickening. Moreover, papillomacular folds were confirmed by OCT. CONCLUSION Dilated fundus examination, fundus fluorescein angiography, orbital ultrasonography, and proper OCT evaluation will be helpful to reach a diagnosis.
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Affiliation(s)
- Kemal Tekin
- a Ankara Ulucanlar Eye Education and Research Hospital , Ankara , Turkey
| | - Mehmet Yasin Teke
- a Ankara Ulucanlar Eye Education and Research Hospital , Ankara , Turkey
| | - Mehmet Citirik
- a Ankara Ulucanlar Eye Education and Research Hospital , Ankara , Turkey
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Varenne F, Renouvin A, Ter Schiphorst T, Mahieu L, Soler V. Aspect en tomographie par cohérence optique de plis rétinien papillomaculaire chez un cas de microphtalmie postérieure. J Fr Ophtalmol 2017; 40:e59-e63. [DOI: 10.1016/j.jfo.2015.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 09/07/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
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Cortés-González V, Zenteno JC, Guzmán-Sánchez M, Giordano-Herrera V, Guadarrama-Vallejo D, Ruíz-Quintero N, Villanueva-Mendoza C. Tietz/Waardenburg type 2A syndrome associated with posterior microphthalmos in two unrelated patients with novel MITF gene mutations. Am J Med Genet A 2016; 170:3294-3297. [PMID: 27604145 DOI: 10.1002/ajmg.a.37937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/08/2016] [Indexed: 11/08/2022]
Abstract
Tietz syndrome and Waardenburg syndrome type 2A are allelic conditions caused by MITF mutations. Tietz syndrome is inherited in an autosomal dominant pattern and is characterized by congenital deafness and generalized skin, hair, and eye hypopigmentation, while Waardenburg syndrome type 2A typically includes variable degrees of sensorineural hearing loss and patches of de-pigmented skin, hair, and irides. In this paper, we report two unrelated families with MITF mutations. The first family showed an autosomal dominant pattern and variable expressivity. The second patient was isolated. MITF gene analysis in the first family demonstrated a c.648A>C heterozygous mutation in exon 8 c.648A>C; p. (R216S), while in the isolated patient, an apparently de novo heterozygous c.1183_1184insG truncating mutation was demonstrated in exon 10. All patients except one had bilateral reduced ocular anteroposterior axial length and a high hyperopic refractive error corresponding to posterior microphthalmos, features that have not been described as part of the disease. Our results suggest that posterior microphthalmos might be part of the clinical characteristics of Tietz/Waardenburg syndrome type 2A and expand both the clinical and molecular spectrum of the disease. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Vianney Cortés-González
- Department of Genetics, Hospital "Dr. Luis Sánchez Bulnes", Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Juan Carlos Zenteno
- Department of Biochemistry, National Autonomous University of Mexico, Mexico City, Mexico.,Research Unit and Genetics Department, Institute of Ophthalmology "Conde de Valenciana", Mexico City, Mexico
| | - Martín Guzmán-Sánchez
- Ophthalmology, Hospital "Dr. Luis Sánchez Bulnes", Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Verónica Giordano-Herrera
- Department of Retina, Hospital "Dr. Luis Sánchez Bulnes", Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Dalia Guadarrama-Vallejo
- Research Unit and Genetics Department, Institute of Ophthalmology "Conde de Valenciana", Mexico City, Mexico
| | - Narlly Ruíz-Quintero
- Department of Cornea, Hospital "Dr. Luis Sánchez Bulnes", Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Cristina Villanueva-Mendoza
- Department of Genetics, Hospital "Dr. Luis Sánchez Bulnes", Asociación para Evitar la Ceguera en México, Mexico City, Mexico
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41
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Hoffman RS, Vasavada AR, Allen QB, Snyder ME, Devgan U, Braga-Mele R. Cataract surgery in the small eye. J Cataract Refract Surg 2016; 41:2565-75. [PMID: 26703508 DOI: 10.1016/j.jcrs.2015.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/17/2015] [Accepted: 05/28/2015] [Indexed: 12/29/2022]
Abstract
UNLABELLED The surgical management of cataract in the small eye presents the ophthalmic surgeon with numerous challenges. An understanding of the anatomic classification in addition to a thorough preoperative assessment will help individualize each case and enable the surgeon to better prepare for the obstacles that might be encountered during surgery. Small eyes are especially challenging in terms of intraocular lens (IOL) calculations and possible current limitations of available IOL powers, which could necessitate alternative means of achieving emmetropia. Surgical strategies for minimizing complications and maximizing good outcomes can be developed from knowledge of the anatomic differences between various small-eye conditions and the pathologies that may be associated with each. A thorough understanding of the challenges inherent in these cases and the management of intraoperative and postoperative complications will ensure that surgeons approaching the correction of these eyes will achieve the best possible surgical results. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Richard S Hoffman
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada.
| | - Abhay R Vasavada
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
| | - Quentin B Allen
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
| | - Michael E Snyder
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
| | - Uday Devgan
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
| | - Rosa Braga-Mele
- From the Casey Eye Institute, Oregon Health and Science University (Hoffman), Portland, Oregon, USA; Iladevi Cataract & University of Cincinnati (Snyder), Cincinnati, Ohio, USA; Jules Stein Eye Institute, UCLA School of Medicine (Devgan), Los Angeles, California, USA; University of Toronto (Braga-Mele), Toronto, Ontario, Canada
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42
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Park SH, Ahn YJ, Shin SY, Lee YC. Clinical features of posterior microphthalmos associated with papillomacular fold and high hyperopia. Clin Exp Optom 2016; 99:590-593. [PMID: 27161391 DOI: 10.1111/cxo.12371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/20/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim was to evaluate the characteristic clinical features of posterior microphthalmos. METHODS Medical records of four patients (eight eyes) between the ages of three and 31 years with posterior microphthalmos were reviewed retrospectively. Thorough ocular examinations were performed, including visual acuity, intraocular pressure, ocular alignment, axial length, cycloplegic refraction, slitlamp biomicroscopy of the anterior segment and fundus and spectral-domain optical coherent tomography (SD-OCT). RESULTS All subjects had presented with high hyperopia (+11.0 to +15.75 D) and retinal papillomacular folds in both eyes. They also had reduced bilateral axial length (15.55-18.61 mm), with foreshortening of the posterior segment and a relatively normal anterior segment. Papillomacular retinal folds involving the inner retinal layers and sparing the outer retinal layers, along with the absence of foveal depression, were confirmed by macular SD-OCT. In three patients, we found esodeviations associated with posterior microphthalmos and one of these required strabismic surgery. Concomitant optic nerve hypoplasia and a newly-developed neurosensory retinal detachment were found in one patient. CONCLUSION Posterior microphthalmos is a developmental arrest of ocular growth. In addition to high hyperopia and retinal papillomacular folds, various types of esotropia, optic disc hypoplasia and neurosensory retinal detachment may accompany posterior microphthalmos. In particular, children with posterior microphthalmos require early appropriate management of the high refractive error and resultant esotropia.
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Affiliation(s)
- Shin Hae Park
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ye Jin Ahn
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Young Shin
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Chun Lee
- Department of Ophthalmology and Visual Science, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea.
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43
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Relhan N, Jalali S, Pehre N, Rao HL, Manusani U, Bodduluri L. High-hyperopia database, part I: clinical characterisation including morphometric (biometric) differentiation of posterior microphthalmos from nanophthalmos. Eye (Lond) 2015; 30:120-6. [PMID: 26493039 DOI: 10.1038/eye.2015.206] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/04/2015] [Indexed: 11/09/2022] Open
Abstract
UNLABELLED PURPOSE To characterise and differentiate posterior microphthalmos (PM) and nanophthalmos (NO) using morphometric parameters.Patients and methodsConsecutive case database of patients with hyperopia >+7.00 D sphere was analysed retrospectively for clinical and biometric characterisation. Thirty-eight consecutive high-hyperopic subjects (75 eyes) with axial lengths <20.5 mm underwent uniform comprehensive ocular evaluation. Twenty-five subjects were diagnosed as PM and 13 as NO based on the horizontal corneal diameter. Parameters analysed included visual acuity, refraction, horizontal corneal diameter, anterior chamber depth, lens thickness, axial length, fundus changes, and associated ocular pathology. PRIMARY OUTCOME MEASURES ocular biometry difference between PM and NO. SECONDARY OUTCOME MEASURES differences in associated ocular pathologies between PM and NO.RESULTS Hyperopia ranged from +7 to +17 D and was similar in the two groups. Lens thickness was statistically more in NO than in PM group (4.53±0.75 mm vs 3.82±0.48 mm, P <0.001), whereas anterior chamber depth was more in the PM than in NO group (3.26±0.36 mm, vs 2.59±0.37 mm, P<0.001). NO had higher association with angle-closure glaucoma (66.7% vs 0%) and pigmentary retinopathy (38.5 vs 8.0%) but lesser association with macular folds (0% vs 24%) as compared with PM. NO was associated with poorer visual acuity.CONCLUSION PM and NO have significant differences in lens thickness, anterior chamber depth, prevalence of glaucoma, pigmentary retinopathy, macular pathology, and visual acuity while being similar in hyperopic refraction.
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Affiliation(s)
- N Relhan
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - S Jalali
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - N Pehre
- Kode Venkatadri Chowdary, David Brown Children's Eye Care Centre, L V Prasad Eye Institute, Tadigadapa, Vijayawada, India
| | - H L Rao
- Center for Clinical Epidemiology and Biostatistics, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - U Manusani
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - L Bodduluri
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
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Albar AA, Nowilaty SR, Ghazi NG. Posterior microphthalmos and papillomacular fold-associated cystic changes misdiagnosed as cystoid macular edema following cataract extraction. Clin Ophthalmol 2015; 9:73-6. [PMID: 25609908 PMCID: PMC4293932 DOI: 10.2147/opth.s75771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Novel spectral-domain optical coherence tomography (SD-OCT) findings in posterior microphthalmos (PM) include cystoid changes in the papillomacular fold (PMF). These changes may be misdiagnosed as cystoid macular edema (CME) and may trigger unnecessary treatment including intravitreal injections. We report a case that underscores this scenario aiming to increase awareness of this entity among ophthalmologists. Method A case report. Results A 25-year-old male presented with a history of clear lens extraction in both eyes as a refractive procedure. Postoperatively, he was diagnosed with CME and received five intravitreal bevacizumab injections in each eye as well as oral diamox for persistent cystic spaces noted on OCT. He was referred to our institution with the diagnosis of non-responding CME. A complete ophthalmic evaluation, including ultrasonography and SD-OCT, confirmed the diagnosis of PM and PMF with cystic cavities in the PMF. A fluorescein angiogram disclosed absence of macular leakage or optic nerve head staining indicating that the cystic cavities seen on SD-OCT are not due to postoperative CME but are rather the intrinsic cystic changes commonly seen in eyes with PM and a PMF. These cystic cavities were incorrectly thought to represent postoperative CME, which triggered the unnecessary treatment and lack of response. Conclusion Cystic-like cavities are a component of the PMF in PM eyes and may be misdiagnosed as CME, especially in a postoperative setting. This case underscores the importance of understanding the intrinsic features of the PMF in eyes with PM and may help increase awareness among ophthalmologists of such a potentially confusing scenario.
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Affiliation(s)
- Ahmad A Albar
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sawsan R Nowilaty
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nicola G Ghazi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia ; Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
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Yu S, Gao Y, Liang X, Huang Y. Acquired retinoschisis resolved after 23Gage pars plana vitrectomy in posterior microphthalmos. BMC Ophthalmol 2014; 14:65. [PMID: 24884506 PMCID: PMC4045141 DOI: 10.1186/1471-2415-14-65] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/07/2014] [Indexed: 11/25/2022] Open
Abstract
Background Posterior microphthalmos combined with acquired retinoschisis is a rare entity. This report presents a case of acquired retinoschisis in a patient with posterior microphthalmos and discusses the management for such disease. The patient exhibited acquired peripheral retinal schisis in both eyes. Case presentation The patient presented with a fix scotoma and decrease in visual acuity for 2 weeks in his left eye. Ocular examination revealed that his best-corrected visual acuity was 0.6 in right eye and 0.2 in left eye. The patient had amblyopia because of hyperopia with spherical equivalent of +11.75 diopters in the right eye and +12.00 diopters in the left eye. The axial lengths were 18.41 mm in right and 18.43 mm in left eyes respectively. Slip lamp examination found normal anterior segments. Funduscopy showed bilateral retinoschisis in inferotemporal retina. The schisis in right eye was limited to peripheral retina whereas the schisis in left eye was bullous type. The schisis in the left eye extended from the periphery to the posterior macular region in left eye. A pars plana vitrectomy was performed in the left eye and visual acuity was restored to 0.6. Conclusion Posterior microphthalmos combined with retinoschisis is rare. When it appears in peripheral retina, the schisis remains stable. In cases where the schisis extends to posterior pole and affects the macula, surgery in the form of pars plana vitrectomy could be an option.
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Affiliation(s)
| | | | | | - Yongsheng Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54, S, Xianlie Road, Guangzhou 510060, P,R, China.
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Alkin Z, Ozkaya A, Karakucuk Y, Demirok A. Detailed ophthalmologic evaluation of posterior microphthalmos. Middle East Afr J Ophthalmol 2014; 21:186-8. [PMID: 24791113 PMCID: PMC4005186 DOI: 10.4103/0974-9233.129774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We performed various ophthalmic investigations in order to confirm the diagnosis and document the various features of posterior microphthalmos in a 21-year-old male. Ophthalmic examination revealed low vision with high hyperopia, papillomacular folds, midperipheral pigmentary changes and crowded optic discs. The optic discs were small and crowded with increased nerve fiber layer thickness. Fundus fluorescein angiography showed reduced diameter of a capillary free zone. Anterior segment (AS) optical coherence tomography demonstrated near normal anterior chamber depths, but markedly diminished anterior chamber angles. In spite of the increased corneal thickness and steep corneas, lens thickness and endothelial cell counts were normal. Sclerochoroidal thickening and foreshortening of the globes were detected with B-scan ultrasonography. Electroretinographic findings and visual field tests were similar to those in pigmentary retinopathy. Posterior microphthalmos is a complex eye disorder, which affects predominantly the posterior segment but also involves the AS of the eye.
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Affiliation(s)
- Zeynep Alkin
- Retina Clinic, Beyoglu Eye Research and Education Hospital, Istanbul, Turkey
| | - Abdullah Ozkaya
- Retina Clinic, Beyoglu Eye Research and Education Hospital, Istanbul, Turkey
| | - Yalcin Karakucuk
- Retina Clinic, Beyoglu Eye Research and Education Hospital, Istanbul, Turkey
| | - Ahmet Demirok
- Retina Clinic, Beyoglu Eye Research and Education Hospital, Istanbul, Turkey ; Istanbul Medeniyet University, Istanbul, Turkey
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47
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Olsen TW, Palejwala NV, Lee LB, Bergstrom CS, Yeh S. Chorioretinal folds: associated disorders and a related maculopathy. Am J Ophthalmol 2014; 157:1038-47. [PMID: 24531022 DOI: 10.1016/j.ajo.2014.02.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a series of chorioretinal folds (CRFs) representing a clinical sign that may be associated with multiple systemic, orbital, and ophthalmologic disorders. We report the associations with systemic disease and describe 3 stages of a CRF-related maculopathy. DESIGN Observational, retrospective case series. METHODS We reviewed 57 affected eyes from 40 patients with the clinical sign of CRF from 1 of 2 academic institutions. A careful review of the medical histories and systemic diagnostic evaluations were conducted. Imaging studies were conducted. RESULTS The mean age at diagnosis was 64 ± 17 years. Most eyes (n = 18) were hyperopic (+2.60 ± +2.90 diopters). There were 20 patients (50%) with some form of autoimmune disorder. Overall, the mean presenting visual acuity was 20/50, declining slightly to 20/60 over 19 ± 30 months. Ten eyes had stage 3 CRF-related maculopathy, more common in older individuals with more chronic CRFs. Four stage 3 eyes had associated choroidal neovascularization, and these eyes had 20/60 presenting visual acuity that decreased to 20/100 over approximately 1.5 years. Stage 3 eyes without choroidal neovascularization had a mean presenting visual acuity of 20/40 that decreased to 20/65 over 2.1 years. CONCLUSIONS CRFs are associated with numerous ophthalmic and systemic disorders. A careful medical history and evaluation are essential. We describe 3 stages of a unique CRF-related maculopathy. Stage 3 resembles occult choroidal neovascularization, occurs primarily in older individuals with chronic CRFs, and is accompanied by a slow deterioration in central acuity.
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48
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Pli rétinien bilatéral et forte hypermétropie familiale, à propos d’un cas. J Fr Ophtalmol 2013; 36:e177-9. [DOI: 10.1016/j.jfo.2013.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 02/12/2013] [Accepted: 03/05/2013] [Indexed: 11/21/2022]
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Toto L, Di Antonio L, Mastropasqua A, De Nicola C, Mastropasqua L. Rehabilitation with MP1 biofeedback training of a posterior microphthalmos case. Can J Ophthalmol 2013; 48:e107-11. [PMID: 24093198 DOI: 10.1016/j.jcjo.2013.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 02/02/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Lisa Toto
- Eye Clinic, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy.
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50
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Takkar B, Bhatia I, Chandra P, Ganguly A, Azad R. Bilateral macular folds as a diagnostic clue to late-presenting posterior microphthalmos. Semin Ophthalmol 2013; 29:169-71. [PMID: 23947423 DOI: 10.3109/08820538.2013.807848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Posterior microphthalmos with macular folds is a very uncommon condition. We report such an unusual late-presenting case of posterior microphthalmos where macular folds uncovered the diagnosis and discuss the possibility of worsening of macular folds with advancing age.
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Affiliation(s)
- Brijesh Takkar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi , India
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