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Skriapa-Manta A, Venkataraman AP, Olsson M, Nilsson M, Teär Fahnehjelm K. Characteristic deviations of the optic disc and macula in optic nerve hypoplasia based on OCT. Acta Ophthalmol 2024. [PMID: 38782817 DOI: 10.1111/aos.16722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the optic disc and macula in a large cohort of patients with different severity of optic nerve hypoplasia (ONH) using high-resolution spectral domain optical coherence tomography (SD-OCT). METHODS In total, 36 patients (52 ONH eyes and 17 fellow eyes in unilateral cases) and 45 healthy right eyes from 45 controls were evaluated. All patients underwent an examination to confirm the diagnosis. SD-OCT images of the disc and macula were obtained and analysed both quantitatively and qualitatively. RESULTS OCT in ONH eyes demonstrated a shorter disc diameter (1061 ± 375 μm vs. 1751 ± 221 μm, p < 0.001), shallower mean cup depth (427 ± 171 μm vs. 551 ± 152 μm, p = 0.01), thinner ganglion cell complex (GCC) perifoveally (47.3 ± 13.0 μm, 60.8 ± 6.0 μm, p < 0.001) and reduced foveal depth (61 ± 36 μm, 119 ± 19 μm, p < 0.001) compared to control eyes. Qualitative analysis showed that 1/3rd of ONH eyes lacked signs of an optic cup, and 2/3rd had reduced or no sign of a foveal pit. Fellow eyes had shorter disc diameter (1446 ± 404 μm vs. 1751 ± 221 μm, p = 0.004) and reduced foveal depth (93 ± 27 μm vs. 119 ± 19 μm, p < 0.001) but similar GCC thickness (60.8 ± 7.1 μm vs. 60.8 ± 6.0 μm, p = 0.738) compared to controls. Disc diameter showed the best correlation with visual acuity in ONH eyes (ρ = 0.517, p < 0.001). CONCLUSION ONH eyes have reduced GCC thickness and reduced or no foveal pit. Fellow eyes in presumed unilateral cases have a smaller disc diameter and reduced foveal depth compared to controls, suggesting the possibility of subclinical/mild disease. However, GCC thickness was normal. The correlation between structure and visual function is not always straightforward.
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Affiliation(s)
- Athanasia Skriapa-Manta
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Ophthalmology, Strabismus and Electrophysiology, St. Erik Eye Hospital, Stockholm, Sweden
| | - Abinaya Priya Venkataraman
- Unit of Optometry, Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Monica Olsson
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Ophthalmology, Strabismus and Electrophysiology, St. Erik Eye Hospital, Stockholm, Sweden
| | - Maria Nilsson
- Unit of Optometry, Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Teär Fahnehjelm
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Ophthalmology, Strabismus and Electrophysiology, St. Erik Eye Hospital, Stockholm, Sweden
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Kang MC, Park KA, Oh SY. Optical coherence tomography and optical coherence tomography angiography findings in optic nerve hypoplasia and their relationships with visual acuity. Sci Rep 2024; 14:7130. [PMID: 38532111 DOI: 10.1038/s41598-024-57118-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
This study aimed to quantitatively assess the thickness of the peripapillary retinal nerve fiber layer (pRNFL) thickness, as well as the microvascular alterations in the macula and peripapillary regions, in optic nerve hypoplasia (ONH) patients compared to normal controls. This was achieved through the utilization of spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA), with a specific focus on elucidating the association between these structural alterations and visual acuity. We included a total of 17 eyes of 12 ONH patients, and 34 eyes of age-matched 34 healthy controls. The pRNFL thickness was quantified using SD-OCT, while OCTA facilitated the visualization and measurement of the microvascular structure images of the superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), and radial peripapillary capillary (RPC) segment in the macula and peripapillary area. pRNFL thickness was measured for eight sectors (superior, temporal, inferior, nasal, superotemporal, superonasal, inferotemporal, and inferonasal). SRCP, DRCP, and RPC were measured for four sectors (superior, temporal, inferior, and nasal). Age, gender, and spherical equivalent refractive errors were statistically adjusted for the analysis. Associations of structural parameters with visual acuity in ONH patients were analyzed using Spearman correlation analysis. pRNFL thickness was significantly thinner in ONH patients than in controls for all sectors. Vessel densities of temporal and nasal sectors in DRCP were significantly higher in ONH patients, but vessel densities of the inferior sector in RPC were significantly lower than those in controls. For all sectors, pRNFL thickness was strongly associated with visual acuity in ONH patients. ONH patients showed significant pRNFL thinning and microvascular alterations compared to controls, and pRNFL thickness was strongly associated with visual function. OCT and OCTA are useful tools for evaluating optic disc hypoplasia and its functional status.
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Affiliation(s)
- Min Chae Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Eibenberger K, Rezar-Dreindl S, Briem J, Schmidt-Erfurth U, Stifter E. Patients with septo-optic dysplasia: General ophthalmologic assessment and retinal imaging. Eur J Ophthalmol 2023; 33:NP11-NP20. [PMID: 36163692 DOI: 10.1177/11206721221128865] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND To evaluate the functional development and, retinal and optic disc morphology using OCT in patients with septo-optic dysplasia (SOD). METHODS This retrospective case series included patients diagnosed with SOD between 2007 and 2020. Ophthalmologic assessment included visual acuity (VA) and funduscopy at the initial and last presentation. Retinal imaging included OCT of the macula analyzing the retinal morphology, central retinal thickness volume (CRT) and ganglion cell layer (GCL). Also, scans of the optic nerve head were taken to evaluate the retinal nerve fiber layer (RNFL) and global value. RESULTS 38 eyes of 19 children with a mean age 6.3 ± 5.3 years were included. 31.6% showed all 3 characteristics of SOD, whereof ONH, midline defects and endocrine dysfunctions were found in 94.7%, 89.5% and 47.4% respectively. The mean VA was 0.70 ± 0.66logMar in the right eye (RE) and 0.40 ± 0.55logMar in the left eye (LE) at the initial presentation. No change of vision (RE: 0.69 ± 0.71logMar; LE: 0.31 ± 0.57logMar) was found after a follow-up period of 6.3 ± 4.5years. Funduscopy showed an ONH in 79% (n = 30/38), tortuous retinal vessels in 36.8% (n = 14/38) and a double-ring sign in 15.8% (n = 6/38). Retinal imaging showed variable morphology. 6 eyes of 4 patients showed temporal retinal thinning with corresponding GCL attenuation. The optic nerve head appearance varied between no changes, sectoral and hemispherical reduction. CONCLUSIONS Patients suffering from SOD show diverse expression of retinal changes such as retinal, GCL and RNFL thinning in OCT. Furthermore, visual function remained stable during follow-up examinations, indicating no further alteration due to underlying pathology.
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Affiliation(s)
- Katharina Eibenberger
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
| | - Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
| | - Jakob Briem
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, MUV, Vienna, Austria
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Pang Y, Frantz KA, Yin HK. Comparison of Cirrus spectral domain OCT with disc-macula distance to disc diameter ratio in diagnosing congenital optic nerve hypoplasia. Ophthalmic Physiol Opt 2023. [PMID: 37052312 DOI: 10.1111/opo.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Diagnosis of congenital optic nerve hypoplasia (CONH) can be challenging in children or uncooperative individuals. Misdiagnosis can lead to inappropriate treatment; thus, it is important to identify an objective and reliable measurement. The purpose of this study was to evaluate whether Cirrus spectral domain optical coherence tomography (SD-OCT) is a valid test for diagnosing CONH by comparing it to the disc-macula distance to disc diameter (DM:DD) ratio. METHODS A total of 93 participants (64 controls and 29 CONH) underwent comprehensive eye examinations, fundus photography and Cirrus SD-OCT. Receiver operating characteristic (ROC) curves for the DM:DD ratio and OCT disc area were constructed for CONH and control eyes. RESULTS Mean (±SD) OCT disc area was 1.46 (±0.42) mm2 and 1.89 (±0.38) mm2 for CONH and control eyes, respectively (p < 0.0001). The area under the curve for the DM:DD ratio was 0.97 (95% confidence interval: 0.91-0.99) and 0.79 for OCT disc area (95% confidence interval: 0.70-0.86), which were significantly different (p = 0.0005). The optimal cut-off value for OCT disc area was 1.66 mm2 (76% sensitivity, 70% specificity), while the optimal cut-off for DM:DD ratio was 3.10 (85% sensitivity and 95% specificity). The Cirrus SD-OCT showed a tendency to overestimate disc size, especially in cases with no light perception (NLP) or segmental CONH. CONCLUSIONS Although the DM:DD ratio is superior to OCT in diagnosing CONH with a higher sensitivity and specificity, the ratio is subject to inter-examiner variability and can be challenging to obtain. We found the Cirrus SD-OCT to be a valid objective test for diagnosing CONH. Caution is advised when using SD-OCT in segmental CONH or in an eye with NLP. We suggest 1.66 mm2 as the optimal cut-off value for Cirrus SD-OCT disc area to differentiate a hypoplastic from a normal optic disc.
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Affiliation(s)
- Yi Pang
- Illinois College of Optometry, Chicago, Illinois, USA
| | | | - Huizi Kelly Yin
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Nadeem S. Ganglion cell complex thickness with spectral domain optical coherence tomography and correlations in a normative pediatric South Asian cohort. Microsc Res Tech 2023; 86:216-222. [PMID: 36440589 DOI: 10.1002/jemt.24257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/13/2022] [Accepted: 11/01/2022] [Indexed: 11/29/2022]
Abstract
Spectral domain optical coherence tomography (SD-OCT) was used to assess the perifoveal Ganglion cell complex (GCC) thickness in healthy Pakistani children. 174 eyes of 87 healthy children (3 to 16 years) were included after a thorough eye examination. Significant refractive error was excluded (>± 5 DS), glaucoma, ocular pathology, intraocular surgery, trauma, and systemic ailments. The perifoveal GCC analysis was done by Optopol Revo 80® high resolution SD-OCT. The average age was 11.1 ± 3.12 years. The average GCC thickness globally was 120.01 ± 76.74 μm, superiorly; 117.51 ± 8.77 μm, superonasally; 120.47 ± 8.78 μm, superotemporally, 103.83 ± 8.25 μm, inferiorly; 117.41 ± 8.71 μm, inferonasally 120.57 ± 8.88 μm, and inferotemporally; 107.15 ± 7.69 μm. The average GCC thickness was positively correlated with axial length (p = .02) and the GCC thickness in all sectors was significantly higher amongst males as compared to females (p < .05). Our study provides normative data for the macular GCC thickness in healthy children of our population. GCC thickness estimation is an important diagnostic parameter in glaucoma and optic neuropathies. Establishing a normative database for our pediatric population would help immensely in the diagnosis and monitoring of optic nerve disorders. RESEARCH HIGHLIGHTS: Spectral domain optical coherence tomography guided measurement of the ganglion cell complex thickness of the Pakistani pediatric population has not been done before. Our study provides normative data for the macular ganglion cell complex in healthy children of our population and studies its correlations with age, gender, intraocular pressure, axial length, refractive status, and corneal thickness. This will guide us in optic nerve and neurological disease diagnosis and monitoring.
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Affiliation(s)
- Sana Nadeem
- Department of Ophthalmology, Foundation University School of Health Sciences, Foundation University Islamabad, Fauji Foundation Hospital, Islamabad, Pakistan
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Skriapa-Manta A, Nilsson M, Svoboda J, Olsson M, Nilsson M, Teär Fahnehjelm K. Optical Coherence Tomography Can Predict Visual Acuity in Children with Optic Nerve Hypoplasia. Clin Ophthalmol 2022; 16:3785-3794. [DOI: 10.2147/opth.s387084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
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Thomas MG, Papageorgiou E, Kuht HJ, Gottlob I. Normal and abnormal foveal development. Br J Ophthalmol 2022; 106:593-599. [PMID: 33148537 DOI: 10.1136/bjophthalmol-2020-316348] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 01/06/2023]
Abstract
Normal foveal development begins in utero at midgestation with centrifugal displacement of inner retinal layers (IRLs) from the location of the incipient fovea. The outer retinal changes such as increase in cone cell bodies, cone elongation and packing mainly occur after birth and continue until 13 years of age. The maturity of the fovea can be assessed invivo using optical coherence tomography, which in normal development would show a well-developed foveal pit, extrusion of IRLs, thickened outer nuclear layer and long outer segments. Developmental abnormalities of various degrees can result in foveal hypoplasia (FH). This is a characteristic feature for example in albinism, aniridia, prematurity, foveal hypoplasia with optic nerve decussation defects with or without anterior segment dysgenesis without albinism (FHONDA) and optic nerve hypoplasia. In achromatopsia, there is disruption of the outer retinal layers with atypical FH. Similarly, in retinal dystrophies, there is abnormal lamination of the IRLs sometimes with persistent IRLs. Morphology of FH provides clues to diagnoses, and grading correlates to visual acuity. The outer segment thickness is a surrogate marker for cone density and in foveal hypoplasia this correlates strongly with visual acuity. In preverbal children grading FH can help predict future visual acuity.
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Affiliation(s)
- Mervyn G Thomas
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Eleni Papageorgiou
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece
| | - Helen J Kuht
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Irene Gottlob
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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Song MY, Hwang YH. Interocular symmetry of optical coherence tomography parameters in healthy children and adolescents. Sci Rep 2022; 12:653. [PMID: 35027614 PMCID: PMC8758748 DOI: 10.1038/s41598-021-04563-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/22/2021] [Indexed: 11/09/2022] Open
Abstract
Evaluation of interocular asymmetry of optical coherence tomography (OCT) parameters is important for the glaucoma and optic neuropathies. This study was performed to evaluate the interocular asymmetry of OCT parameters in healthy children and adolescents. The circumpapillary retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) parameters, and macular ganglion cell-inner plexiform layer (GCIPL) thickness were measured in 620 eyes of 310 healthy children and adolescents using Cirrus HD-OCT. The interocular asymmetry (right eye-left eye) in the OCT parameters was analyzed. The mean ± standard deviation age was 10.3 ± 3.7 years (range 5-17). The right eyes showed thinner superior quadrant RNFL, thicker nasal and temporal quadrant RNFL, lesser rim and disc areas, and thinner average, superior, and superonasal GCIPL than the left eyes (P < 0.05). The 2.5th and 97.5th percentile interocular difference tolerance limits were - 9.0 μm and 11.0 μm for average RNFL thickness, - 0.21 and 0.18 for average cup-to-disc ratio, and - 4.0 μm and 4.0 μm for average GCIPL thickness, respectively. Interocular differences were found in RNFL thickness, ONH parameters, and GCIPL thickness in healthy children and adolescents. These findings should be considered when comparing OCT parameters between the right and left eyes.
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Affiliation(s)
- Mi Yeon Song
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Republic of Korea
| | - Young Hoon Hwang
- Department of Ophthalmology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
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Yang JJ, Huang CH, Yang CH, Yang CM, Lin CW, Ho TC, Lin CP, Hsieh YT, Yeh PT, Lai TT, Chen PL, Chen TC. The Clinical Contribution of Full-Field Electroretinography and 8-Year Experiences of Application in a Tertiary Medical Center. J Pers Med 2021; 11:jpm11101022. [PMID: 34683163 PMCID: PMC8539721 DOI: 10.3390/jpm11101022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 12/15/2022] Open
Abstract
Electroretinography (ERG) is an important and well-established examination for retinal and visual pathway diseases. This study reviewed the medical records of patients who received full-field ERG (ffERG) at a single medical center between 2012 and 2019, which was an 8-year experience in the clinical contribution of ERG. Based on the indication for scheduling ffERG and the final diagnosis, patients could be classified into six groups: ‘retinal dystrophies’, ‘other retinal or macular diseases’, ‘optic neuropathies’, ‘visual complaints’, ‘systemic diseases’, and ‘others’. A total of 1921 full-field electroretinograms (ffERGs) (1655 patients) were included. The average number of ffERGs performed per year was 262 and the number of annual ffERGs was constant. The ‘retinal dystrophies’ group accounted for 36.5% of the studied population, followed by the ‘other retinal or macular diseases’ group (20.2%). The most common systemic disease was central nervous system disease. The rates of abnormal ffERGs in the ‘systemic diseases’, ‘optic neuropathies’, and ‘visual complaints’ groups were 27.3%, 22.6%, and 10.1%, respectively (p < 0.001). Higher rates were found in patients <20 years old in the ‘systemic diseases’ and ‘optic neuropathies’ groups; epilepsy and optic nerve atrophy were the most common diagnoses, respectively. In brief, by quantifying the functional response in the retina, ffERG is indispensable for diagnosis and prognosis in ophthalmologic and multidisciplinary practice.
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Affiliation(s)
- Jung-Je Yang
- Department of Medical Education, National Taiwan University Hospital, Taipei 10002, Taiwan;
| | - Chu-Hsuan Huang
- Department of Ophthalmology, Cathay General Hospital, Taipei 10002, Taiwan;
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (T.-C.H.); (C.-P.L.); (Y.-T.H.); (P.-T.Y.); (T.-T.L.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (T.-C.H.); (C.-P.L.); (Y.-T.H.); (P.-T.Y.); (T.-T.L.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (T.-C.H.); (C.-P.L.); (Y.-T.H.); (P.-T.Y.); (T.-T.L.)
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (T.-C.H.); (C.-P.L.); (Y.-T.H.); (P.-T.Y.); (T.-T.L.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (T.-C.H.); (C.-P.L.); (Y.-T.H.); (P.-T.Y.); (T.-T.L.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (T.-C.H.); (C.-P.L.); (Y.-T.H.); (P.-T.Y.); (T.-T.L.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Po-Ting Yeh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (T.-C.H.); (C.-P.L.); (Y.-T.H.); (P.-T.Y.); (T.-T.L.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (T.-C.H.); (C.-P.L.); (Y.-T.H.); (P.-T.Y.); (T.-T.L.)
| | - Pei-Lung Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan;
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 10002, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (T.-C.H.); (C.-P.L.); (Y.-T.H.); (P.-T.Y.); (T.-T.L.)
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan;
- Correspondence: ; Tel.: +886-2-23123456 (ext. 63783)
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Jiang Y, Li S, Xiao X, Sun W, Zhang Q. Genotype-Phenotype of Isolated Foveal Hypoplasia in a Large Cohort: Minor Iris Changes as an Indicator of PAX6 Involvement. Invest Ophthalmol Vis Sci 2021; 62:23. [PMID: 34415986 PMCID: PMC8383911 DOI: 10.1167/iovs.62.10.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Foveal hypoplasia (FVH) is defined as the lack of fovea with a relatively preserved neuroretina, occurring either as an isolated FVH (IFVH) condition or associated with other diseases. This study aimed to systemically molecularly characterize IFVH. Methods Genetic defects in 33 families with IFVH were analyzed by exome sequencing. Variants in three genes (PAX6, SLC38A8, and AHR) were selected and evaluated with multistep bioinformatic tools. Results Mutations in the three genes were identified in 69.7% (23/33) of families with IFVH and infantile nystagmus, including 18 families with PAX6 mutations, 5 with SLC38A8 mutations, but none with AHR mutations. Clinical data from 32 patients in the 23 families showed FVH, infantile nystagmus, and full iris. Careful follow-up visits revealed subtle changes in iris in 9 of 14 patients with PAX6 variants. The PAX6 variants of the 18 families (15 missense and one stop-loss) were mostly located in the C-terminal region of the paired box domain. Variants in AHR, SLC38A8, and PAX6 contributed to IFVH in one (2%), 25 (45%), and 30 (53%) families with identified genetic defects (23 families in this study and 33 reported previously), respectively. Conclusions PAX6 and SLC38A8 mutations are the main cause of IFVH based on our data and a systematic review. IFVH-associated PAX6 variants are mostly missense with a specific location, indicating a specific correlation of these variants with IFVH but not with typical aniridia. Full iris with subtle structural abnormalities is more common in patients with PAX6-associated IFVH, suggesting a potential diagnostic indicator.
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Affiliation(s)
- Yi Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shiqiang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xueshan Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenmin Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qingjiong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Landsend ECS, Lagali N, Utheim TP. Congenital aniridia - A comprehensive review of clinical features and therapeutic approaches. Surv Ophthalmol 2021; 66:1031-1050. [PMID: 33675823 DOI: 10.1016/j.survophthal.2021.02.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Congenital aniridia is a rare genetic eye disorder with total or partial absence of the iris from birth. In most cases the genetic origin of aniridia is a mutation in the PAX6 gene, leading to involvement of most eye structures. Hypoplasia of the fovea is usually present and is associated with reduced visual acuity and nystagmus. Aniridia-associated keratopathy, glaucoma, and cataract are serious and progressive complications that can further reduce visual function. Treatment of the ocular complications of aniridia is challenging and has a high risk of side effects. New approaches such as stem cell therapy may, however, offer better prognoses. We describe the various ocular manifestations of aniridia, with a special focus on conditions that commonly require treatment. We also review the growing literature reporting systemic manifestations of the disease.
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Affiliation(s)
| | - Neil Lagali
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tor P Utheim
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
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Abstract
Septo-optic dysplasia (SOD) or de Morsier's syndrome is a rare congenital disorder characterized by a classic triad of: (a) optic nerve hypoplasia, (b) agenesis of septum pellucidum and corpus callosum, and (c) hypoplasia of the hypothalamic-pituitary axis. This chapter will outline the key information regarding the etiology and epidemiology of this syndrome with a focus on its comprehensive management. Particular attention will be paid to the diagnostic stage and the most relevant differential diagnosis, before moving to the complexities of its treatment. In fact, although SOD is not curable, many aspects of this syndrome can be improved through a tailored multidisciplinary approach consisting in hormonal replacement, corrective ophthalmological surgery, management of epileptic seizures, and active neuropsychological support.
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Affiliation(s)
- Ieva Sataite
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Simon Cudlip
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jayaratnam Jayamohan
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
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Cole JD, Rodriguez C, Norat P, Gao J, Provencio I, Netland PA, Liu X. Neural damage and neuroprotection with glaucoma development in aniridia. CURRENT NEUROBIOLOGY 2021; 12:14-19. [PMID: 38125639 PMCID: PMC10732493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- James D Cole
- Department of Biology, University of Virginia, Charlottesville, VA, USA
- Neuroscience Graduate Program, University of Virginia, Charlottesville, VA, USA
| | - Carlos Rodriguez
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Pedro Norat
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Jingyi Gao
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Ignacio Provencio
- Department of Biology, University of Virginia, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Peter A Netland
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Xiaorong Liu
- Department of Biology, University of Virginia, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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Keles A, Ilhan C, Teke MY, Tekin K. Septo-optic dysplasia with fovea plana: A case report. Eur J Ophthalmol 2020; 30:NP36-NP40. [PMID: 32530711 DOI: 10.1177/1120672120934961] [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: 11/17/2022]
Abstract
Septo-optic dysplasia (SOD) is characterized by optic nerve hypoplasia, pituitary gland hypoplasia, and midline abnormalities of the brain. The phenotype of SOD is highly heterogeneous, and the existence of at least two features is considered sufficient for diagnosis. Fovea plana is the absence of a foveal pit in the central fovea, and despite being a developmental abnormality of the fovea, good visual acuity may be retained in some individuals. In this case, a 12-year-old female presented to the ophthalmology clinic with the complaint of blurred vision in her right eye. In dilated fundus examination, optic disc hypoplasia and no foveal light reflex were seen. Magnetic resonance imaging and optical coherence tomography revealed optic nerve, brain midline, and foveal abnormalities. The patient was diagnosed as having SOD with optic nerve hypoplasia and septum pellucidum agenesis, and fovea plana. Both SOD and fovea plana are rare conditions, and there are several reports in the literature that separately describe their clinical features. The most important aspect of this case report is to reveal the unusual co-existence of SOD and fovea plana in a young patient.
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Affiliation(s)
- Ali Keles
- Department of Ophthalmology, Cizre State Hospital, Sirnak, Turkey
| | - Cagri Ilhan
- Department of Ophthalmology, Hatay State Hospital, Hatay, Antakya, Turkey
| | - Mehmet Yasin Teke
- University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Kemal Tekin
- Department of Ophthalmology, Ercis State Hospital, Van, Turkey
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Kerr A, Patel PA, LaConte LEW, Liang C, Chen CK, Shah V, Fox MA, Mukherjee K. Non-Cell Autonomous Roles for CASK in Optic Nerve Hypoplasia. Invest Ophthalmol Vis Sci 2019; 60:3584-3594. [PMID: 31425583 PMCID: PMC6701874 DOI: 10.1167/iovs.19-27197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Heterozygous mutations in the essential X-linked gene CASK associate with optic nerve hypoplasia (ONH) and other retinal disorders in girls. CASK+/− heterozygous knockout mice with mosaic CASK expression exhibit ONH with a loss of retinal ganglion cells (RGCs) but no changes in retinal morphology. It remains unclear if CASK deficiency selectively affects RGCs or also affects other retinal cells. Furthermore, it is not known if CASK expression in RGCs is critical for optic nerve (ON) development and maintenance. Methods The visual behavior of CASK+/− mice was assessed and electroretinography (ERG) was performed. Using a mouse line with a floxed CASK gene that expresses approximately 40% CASK globally in all cells (hypomorph) under hemizygous and homozygous conditions, we investigated effects of CASK reduction on the retina and ON. CASK then was completely deleted from RGCs to examine its cell-autonomous role. Finally, for the first time to our knowledge, we describe a hemizygous CASK missense mutation in a boy with ONH. Results CASK+/− heterozygous mutant mice display reduced visual contrast sensitivity, but ERG is indistinguishable from wildtype. CASK hypomorph mice exhibit ONH, but deletion of CASK from RGCs in this background does not exacerbate the condition. The boy with ONH harbors a missense mutation (p.Pro673Leu) that destabilizes CASK and weakens the crucial CASK–neurexin interaction. Conclusions Our results demonstrate that mosaic or global reduction in CASK expression and/or function disproportionately affects RGCs. CASK expression in RGCs does not appear critical for cell survival, indicating a noncell autonomous role for CASK in the development of ON.
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Affiliation(s)
- Alicia Kerr
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, Virginia, United States
| | - Paras A Patel
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, Virginia, United States
| | - Leslie E W LaConte
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Chen Liang
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States
| | - Ching-Kang Chen
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States
| | - Veeral Shah
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States.,Texas Children's Hospital, Houston, Texas, United States
| | - Michael A Fox
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Department of Biological Sciences, Virginia Tech, Blacksburg, Virginia, United States.,Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Konark Mukherjee
- Center for Neurobiology Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
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Ganau M, Huet S, Syrmos N, Meloni M, Jayamohan J. Neuro-Ophthalmological Manifestations Of Septo-Optic Dysplasia: Current Perspectives. Eye Brain 2019; 11:37-47. [PMID: 31695544 PMCID: PMC6805786 DOI: 10.2147/eb.s186307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/24/2019] [Indexed: 01/17/2023] Open
Abstract
Septo-optic dysplasia (SOD), also known as de Morsier syndrome, is a rare congenital disorder belonging to the group of mid-line brain malformations. Despite the highly variable phenotypic penetration, its classical triad include a) optic nerve hypoplasia (ONH), b) agenesis of septum pellucidum and corpus callosum, and c) hypoplasia of the hypothalamo-pituitary axis. SOD has stringent diagnostic criteria requiring 2 or more features of the classic triad, therefore it represents a separate entity from other conditions such as ONH and achiasmia syndromes which share only some of these aspects, or SOD plus syndrome which is characterized by additional cortical abnormalities. Starting from its etiology and epidemiology, this narrative review focuses on the management of SOD patients, including their diagnosis, treatment and follow-up. To date, SOD is not curable; nonetheless, many of its symptoms can be improved through a tailored approach, consisting of hormonal replacement, corrective ophthalmological surgery and neuropsychological support.
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Affiliation(s)
- Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sibel Huet
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nikolaos Syrmos
- Department of Neurosurgery, School of Medicine, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Marco Meloni
- Department of Medicine and Surgery, Bicocca University, Milan, Italy
| | - Jayaratnam Jayamohan
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Landsend ECS, Pedersen HR, Utheim ØA, Rueegg CS, Baraas RC, Lagali N, Bragadóttir R, Moe MC, Utheim TP. Characteristics and Utility of Fundus Autofluorescence in Congenital Aniridia Using Scanning Laser Ophthalmoscopy. ACTA ACUST UNITED AC 2019; 60:4120-4128. [DOI: 10.1167/iovs.19-26994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Erlend C. S. Landsend
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde R. Pedersen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Øygunn A. Utheim
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Corina S. Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Rigmor C. Baraas
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Neil Lagali
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ragnheidur Bragadóttir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten C. Moe
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tor P. Utheim
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Ophthalmology, Sørlandet Hospital, Arendal, Norway
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Abstract
Foveal hypoplasia is a retinal disorder in which there is a lack of full development of the morphology of the fovea. The optical coherence tomography (OCT) and functional findings are presented in relation to the underlying genetic and developmental conditions. Recent advancements of high-resolution OCT imaging have unveiled characteristics of foveal hypoplasia that were not detected by conventional imaging methods. An absence of a foveal pit does not necessarily imply poor visual acuity, and the maturation of the cone photoreceptors is important for the visual acuity. Regardless of the degree of the development of the inner retinal layers, the visual acuity can be preserved as in diseases such as Stickler syndrome that is a newly identified retinal disorder associated with foveal hypoplasia.
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Affiliation(s)
- Hiroyuki Kondo
- Department of Ophthalmology, University of Occupational and Environmental Health, Kitakyushu, Japan
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19
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Congenital anomalies of the optic disc: insights from optical coherence tomography imaging. Curr Opin Ophthalmol 2017; 28:579-586. [PMID: 28817389 DOI: 10.1097/icu.0000000000000425] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Congenital anomalies of the optic nerve are rare but significant causes of visual dysfunction in children and adults. Accurate diagnosis is dependent on a thorough funduscopic examination, but can be enhanced by imaging information garnered from optical coherence tomography (OCT). We review common congenital optic nerve anomalies, including optic disc pit, optic nerve coloboma, morning glory disc anomaly, and hypoplasia of the optic nerve, review their systemic associations, and discuss insights from OCT imaging. RECENT FINDINGS Optic disc pits are a result of a defect in the lamina cribrosa and abnormal vitreomacular adhesions have been shown to cause maculopathy. In patients with optic nerve colobomas, OCT can be instrumental in diagnosing choroidal neovascularization, a rare but visually devastating complication. The pathogenesis of morning glory disc anomaly has been more clearly elucidated by OCT as occurring from a secondary postnatal mesenchymal abnormality rather than only the initial neuroectodermal dysgenesis of the terminal optic stalk in isolation. OCT studies of optic nerve hypoplasia have demonstrated significant thinning of the inner and outer retinal layers of the perifoveal region and thicker layers in the fovea itself, resulting in a foveal hypoplasia-like pathology, that is, significantly correlated to poorer visual outcomes. SUMMARY OCT provides detailed in-vivo analysis of these anatomic anomalies and their resulting pathologies, shedding new insights on the pathogenesis, diagnosis, and potential visual outcomes of these conditions in children. Further study employing OCT to elucidate structure-function relationships of congenital optic nerve anomalies will help expand the role of OCT in clinical practice related to diagnosis, prognosis, and management of these entities.
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