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Gaier ED, Jaimes C, Gise RA, Armstrong-Javors AE, Kadzielski SM. Case 25-2024: A 12-Year-Old Boy with Autism and Decreased Vision. N Engl J Med 2024; 391:641-650. [PMID: 39141857 DOI: 10.1056/nejmcpc2309726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Affiliation(s)
- Eric D Gaier
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
| | - Camilo Jaimes
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
| | - Ryan A Gise
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
| | - Amy E Armstrong-Javors
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
| | - Sarah M Kadzielski
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
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Scott DA, Wang MT, Danesh-Meyer HV, Hull S. Optic atrophy in prematurity: pathophysiology and clinical features. Clin Exp Optom 2024; 107:245-254. [PMID: 37867148 DOI: 10.1080/08164622.2023.2256734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 09/05/2023] [Indexed: 10/24/2023] Open
Abstract
Optic atrophy is an important cause of visual impairment in children, and the aetiological profile has changed over time. Technological advancements led by neuroimaging of the visual pathway and imaging of the optic nerve with optical coherence tomography have accelerated the understanding of this condition. In the new millennium, an increasing prevalence of prematurity as a cause of optic atrophy in children has been highlighted. This new shift has been linked with increasing rates of premature births and improved neonatal survival of preterm infants. The available literature is limited to hospital and registry-based cohorts with modest sample sizes, methodological heterogeneity and selection bias limitations. Larger studies that are better designed are required to better understand the contribution of prematurity to the disease burden. In addition to considering other life-threatening aetiologies, screening for premature birth should be covered as part of a comprehensive history when evaluating a child with paediatric optic atrophy.
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Affiliation(s)
- Daniel Ar Scott
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Michael Tm Wang
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | | | - Sarah Hull
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Gilhooley MJ, Raoof N, Yu-Wai-Man P, Moosajee M. Inherited Optic Neuropathies: Real-World Experience in the Paediatric Neuro-Ophthalmology Clinic. Genes (Basel) 2024; 15:188. [PMID: 38397177 PMCID: PMC10888158 DOI: 10.3390/genes15020188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
Inherited optic neuropathies affect around 1 in 10,000 people in England; in these conditions, vision is lost as retinal ganglion cells lose function or die (usually due to pathological variants in genes concerned with mitochondrial function). Emerging gene therapies for these conditions have emphasised the importance of early and expedient molecular diagnoses, particularly in the paediatric population. Here, we report our real-world clinical experience of such a population, exploring which children presented with the condition, how they were investigated and the time taken for a molecular diagnosis to be reached. A retrospective case-note review of paediatric inherited optic neuropathy patients (0-16 years) in the tertiary neuro-ophthalmology service at Moorfields Eye Hospital between 2016 and 2020 identified 19 patients. Their mean age was 9.3 ± 4.6 (mean ± SD) years at presentation; 68% were male, and 32% were female; and 26% had comorbidities, with diversity of ethnicity. Most patients had undergone genetic testing (95% (n = 18)), of whom 43% (n = 8) received a molecular diagnosis. On average, this took 54.8 ± 19.5 weeks from presentation. A cerebral MRI was performed in 70% (n = 14) and blood testing in 75% (n = 15) of patients as part of their workup. Continual improvement in the investigative pathways for inherited optic neuropathies will be paramount as novel therapeutics become available.
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Affiliation(s)
- Michael James Gilhooley
- Institute of Ophthalmology, University College London, 11 Bath Street, London EC1V 9EL, UK; (M.J.G.)
- Moorfields Eye Hospital, 162, City Road, London EC1V 2PD, UK
| | - Naz Raoof
- Institute of Ophthalmology, University College London, 11 Bath Street, London EC1V 9EL, UK; (M.J.G.)
- Moorfields Eye Hospital, 162, City Road, London EC1V 2PD, UK
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
| | - Patrick Yu-Wai-Man
- Institute of Ophthalmology, University College London, 11 Bath Street, London EC1V 9EL, UK; (M.J.G.)
- Moorfields Eye Hospital, 162, City Road, London EC1V 2PD, UK
- Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
- Mitochondrial Biology Unit, MRC and Cambridge Centre for Brain Repair, Cambridge University, Forvie Way, Cambridge CB2 0QQ, UK
| | - Mariya Moosajee
- Institute of Ophthalmology, University College London, 11 Bath Street, London EC1V 9EL, UK; (M.J.G.)
- Moorfields Eye Hospital, 162, City Road, London EC1V 2PD, UK
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
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Kowsalya A, S. Jasti D, Bhaskaran S, Jayasri K, Thanemozhi S, Kumar M. Optic atrophy in paediatric patients: A clinical review. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_181_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Scleral buckling surgery for stage 4A and 4B retinopathy of prematurity in critically ill neonates. Int Ophthalmol 2021; 42:1093-1100. [PMID: 34724137 DOI: 10.1007/s10792-021-02095-3] [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: 07/12/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the efficacy of scleral buckling in eyes with stage 4A and 4B retinopathy of prematurity (ROP). METHODS Seven eyes of five premature infants underwent scleral buckling for stage 4 ROP in zone II. Five eyes had stage 4A ROP, and two eyes had stage 4B ROP. Six eyes had previous diode laser photocoagulation, and one eye had received an intravitreal ranibizumab injection. Scleral buckling was the procedure of choice due to lack of access to specialized pediatric vitrectomy instrumentation. Average age at surgery was 3.4 months. Postoperative anatomic retinal status, visual acuity outcome and refractive error were assessed. RESULTS The scleral buckle was removed on average 8 months after surgery. Retinal reattachment was achieved in all seven eyes. At final follow-up one eye had macular ectopia and disc dragging, one eye had a macular traction fold and two eyes had optic disc pallor. Average myopic error after buckle removal was -7.5 D. CONCLUSION Scleral buckling can be performed safely and effectively in 4A and 4B stage ROP in critically ill infants, when access to specialized pediatric vitrectomy instrumentation is limited. This surgical technique may provide adequate relief of vitreoretinal traction with improved visual potential.
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Boets S, Johannesen KM, Destree A, Manti F, Ramantani G, Lesca G, Vercueil L, Koenig MK, Striano P, Møller RS, Cooper E, Weckhuysen S. Adult phenotype of KCNQ2 encephalopathy. J Med Genet 2021; 59:528-535. [PMID: 33811133 DOI: 10.1136/jmedgenet-2020-107449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pathogenic KCNQ2 variants are a frequent cause of developmental and epileptic encephalopathy. METHODS We recruited 13 adults (between 18 years and 45 years of age) with KCNQ2 encephalopathy and reviewed their clinical, EEG, neuroimaging and treatment history. RESULTS While most patients had daily seizures at seizure onset, seizure frequency declined or remitted during childhood and adulthood. The most common seizure type was tonic seizures (early) infancy, and tonic-clonic and focal impaired awareness seizures later in life. Ten individuals (77%) were seizure-free at last follow-up. In 38% of the individuals, earlier periods of seizure freedom lasting a minimum of 2 years followed by seizure recurrence had occurred. Of the 10 seizure-free patients, 4 were receiving a single antiseizure medication (ASM, carbamazepine, lamotrigine or levetiracetam), and 2 had stopped taking ASM. Intellectual disability (ID) ranged from mild to profound, with the majority (54%) of individuals in the severe category. At last contact, six individuals (46%) remained unable to walk independently, six (46%) had limb spasticity and four (31%) tetraparesis/tetraplegia. Six (46%) remained non-verbal, 10 (77%) had autistic features/autism, 4 (31%) exhibited aggressive behaviour and 4 (31%) destructive behaviour with self-injury. Four patients had visual problems, thought to be related to prematurity in one. Sleep problems were seen in six (46%) individuals. CONCLUSION Seizure frequency declines over the years and most patients are seizure-free in adulthood. Longer seizure-free periods followed by seizure recurrence are common during childhood and adolescence. Most adult patients have severe ID. Motor, language and behavioural problems are an issue of continuous concern.
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Affiliation(s)
- Stephanie Boets
- Neurology Department, University Hospital Antwerp, Antwerp, Belgium
| | - Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre Filadelfia, Dianalund, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anne Destree
- Department of Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Filippo Manti
- Department of Human Neuroscience, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland
| | - Gaetan Lesca
- Department of Genetics, University Hospitals of Lyon, Lyon, France.,Neuroscience Research Center, Claude Bernard Lyon I University, Lyon, France
| | - Laurent Vercueil
- Grenoble Institute of Neurosciences (GIN), University Grenoble Alpes, La Tronche, France
| | - Mary Kay Koenig
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G Gaslini" Institute, Genova, Italy.,Pediatric Neurology and Muscular Diseases Unit, IRCCS' G Gaslini" Institute, Genova, Italy
| | - Rikke Steensbjerre Møller
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre Filadelfia, Dianalund, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Edward Cooper
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah Weckhuysen
- Neurology Department, University Hospital Antwerp, Antwerp, Belgium .,Applied & Translational Neurogenomics Group, VIB-Center for Molecular Neurology, VIB, Antwerp, Belgium.,Translational Neuroscience Group, University of Antwerp, Antwerp, Belgium
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Jones R, Al-Hayouti H, Oladiwura D, Karim R, Sawczenko A, Dahlmann-Noor A. Optic atrophy in children: Current causes and diagnostic approach. Eur J Ophthalmol 2020; 30:1499-1505. [PMID: 31910664 DOI: 10.1177/1120672119899378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Optic atrophy is one of the leading causes of sight impairment in children. It frequently poses a diagnostic challenge, as it can be caused by many ocular and systemic conditions. We aimed to determine the current causes of optic atrophy at our centre and to describe the use of investigations, including molecular genetic testing. METHODS We reviewed the medical records of children with optic atrophy seen at Moorfields Eye Hospital between 2010 and 2015. We recorded demographic data, reason for referral, history, investigations and diagnosis. RESULTS We studied 143 cases aged below 16 years. A cause could be identified in all cases. Taking a full history was the most important part of the diagnostic workup, identifying a cause in 96 (67%) children. A developmental disorder of the brain and/or optic nerve, sometimes with retinal involvement, was the commonest cause (n = 33, 23%), followed by inheritable optic neuropathies (n = 27, 19%). Other causes included perinatal insults (n = 18, 13%), post-infectious or post-inflammatory conditions (n = 18, 13%), accidental or abusive trauma (n = 14, 10%) and inheritable retinal dystrophies (n = 13, 9%). Rare conditions included neurodegenerative disorders (n = 7, 5%), skeletal developmental disorders such as rickets (n = 4, 3%), tumours (n = 4, 3%), ischaemic events including large optic nerve head drusen (n = 4, 3%) and toxic events/metabolic conditions (n = 1, 0.7%). CONCLUSION In this series, an underlying cause could be identified in all cases. Taking a comprehensive antenatal, perinatal, postnatal and family history will indicate a probable diagnosis in two-thirds of children, and targeted ancillary tests may identify the cause in most remaining cases.
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Affiliation(s)
| | - Huda Al-Hayouti
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | | | - Rushmia Karim
- Paediatric Service, Moorfields Eye Hospital, London, UK
| | | | - Annegret Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Paediatric Service, Moorfields Eye Hospital, London, UK
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9
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Mbekeani JN, Fattah MA, Poulsen DM, Hazzaa SA, Dababo MA, Eldali A, Ahmed M. Etiology of optic atrophy: a prospective observational study from Saudi Arabia. Ann Saudi Med 2017; 37:232-239. [PMID: 28578363 PMCID: PMC6150579 DOI: 10.5144/0256-4947.2017.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Optic atrophy (OA) represents permanent retinal ganglion cell loss warranting study to establish etiology. OBJECTIVES To describe neurogenic causes of OA. DESIGN Prospective, observational. SETTING Tertiary care center, Riyadh, Saudi Arabia. PATIENTS AND METHODS We included consecutive patients of all ages with OA caused by lesions affecting the visual pathways who were referred over a 9-month period (November 2013 to July 2014). Diagnosis was based on visual acuity, ophthalmoscopic features and ancillary tests. Patient demographics, results of a clinical examination, test data and etiology were recorded. For each cause of OA, both gender and age group were analyzed as potential risk factors using simple univariate logistic regression. OA associated with glaucoma and retinal diseases was excluded. MAIN OUTCOME MEASURE Description of causes of OA. RESULTS Two hundred and four patients and 353 eyes met inclusion criteria. The median age was 27 years (range 3 months-77 years; interquartile range, 27 years) among 111(54.4%) females and 93(45.6%) males, with no statistically significant difference in age of presentation between the genders. The majority of lesions were bilateral (n=151, 74%). Tumors were the most common cause, accounting for 127 (62.2%) cases. These occurred mostly in adults (72.4%) compared to the pediatric group (OR=3.3, 95% CI: 1.79-6.03; P < .001). Hereditary neoplasia (OR=5.55; 95% CI: 1.67-18.42; P=.005) and metabolic diseases (OR=17.57; 95% CI: 2.15-143.62; P=.007) were more common causes in the pediatric group. There were no significant associations between gender or visual acuity and etiology of OA. In developed nations, OA is frequently the result of ischemia and neuritis. We found many other causes, especially orbital and intracranial tumors. CONCLUSIONS The frequency of tumors as the cause of OA may represent a higher incidence of aggressive tumors coupled with poor recognition/acknowledgement of symptoms and limited access, resulting in late presentations. LIMITATIONS These findings may reflect bias from selective referrals to a tertiary center and may not represent all of Saudi Arabia.
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Affiliation(s)
- Joyce N Mbekeani
- Dr. Joyce N. Mbekeani, Department of Surgery (Ophthalmology),, Jacobi Medical Center,, 5N, 1400 Pelham Parkway, Bronx NY 10461, USA, T: 718-918-4784;, F: 718-918-7379, , ORCID: http://orcid.org/0000-0002-8801-4110
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10
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Chinta S, Wallang BS, Sachdeva V, Gupta A, Patil-Chhablani P, Kekunnaya R. Etiology and clinical profile of childhood optic nerve atrophy at a tertiary eye care center in South India. Indian J Ophthalmol 2016; 62:1003-7. [PMID: 25449935 PMCID: PMC4278110 DOI: 10.4103/0301-4738.145996] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Optic nerve atrophy is an important ophthalmological sign that may be associated with serious systemic conditions having a significant bearing on the overall morbidity of the child. Studies specific to etiology of childhood optic atrophy are scarce, this being the first such study from India to the best of our knowledge. Aim: The aim was to analyze the clinical features and etiology of diagnosed cases of optic nerve atrophy in children <16 years of age. Materials and Methods: Retrospective review of records of children diagnosed with optic nerve atrophy between the ages of 0 and 16 years from 2006 to 2011. Results: A total of 324 children (583 eyes) were identified. Among these 160 (49%) presented with defective vision, 71 (22%) with strabismus, 18 (6%) with only nystagmus. Rest had a combination of two or three of the above symptoms. Sixty-five patients (20%) had a unilateral affection. Hypoxic ischemic encephalopathy seen in 133 patients (41%) was the most frequent cause of childhood optic atrophy, followed by idiopathic in 98 (30%), hydrocephalus in 24 (7%), compressive etiology in 18 (5%), infective in 19 (6%), congenital in 6 (2%), inflammatory in 5 (2%) patients, respectively. Conclusion: Hypoxic ischemic encephalopathy appears to be the most common cause of optic atrophy in children in this series. The most common presenting complaint was defective vision.
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Affiliation(s)
| | | | | | | | | | - Ramesh Kekunnaya
- Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, KAR Campus, Banjara Hills, Hyderabad, India
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Zheng L, Do HHJ, Sandercoe T, Jamieson RV, Grigg JR. Changing patterns in paediatric optic atrophy aetiology: 1979 to 2015. Clin Exp Ophthalmol 2016; 44:574-581. [DOI: 10.1111/ceo.12734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Linda Zheng
- Department of Ophthalmology; The Children's Hospital at Westmead; Westmead Australia
| | - Helen Hyun-Jin Do
- Discipline of Ophthalmology, Save Sight Institute; University of Sydney; Sydney New South Wales Australia
| | - Trent Sandercoe
- Discipline of Ophthalmology, Save Sight Institute; University of Sydney; Sydney New South Wales Australia
| | - Robyn V Jamieson
- Eye Genetics Research Group; Children's Medical Research Institute, The Children's Hospital at Westmead; Westmead Australia
- Discipline of Ophthalmology, Save Sight Institute; University of Sydney; Sydney New South Wales Australia
| | - John R Grigg
- Department of Ophthalmology; The Children's Hospital at Westmead; Westmead Australia
- Eye Genetics Research Group; Children's Medical Research Institute, The Children's Hospital at Westmead; Westmead Australia
- Discipline of Ophthalmology, Save Sight Institute; University of Sydney; Sydney New South Wales Australia
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12
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Á Rogvi R, Forman JL, Greisen G. Prematurity, smallness-for-gestational age and later hospital admissions: a nation-wide registry study. Early Hum Dev 2015; 91:299-306. [PMID: 25813556 DOI: 10.1016/j.earlhumdev.2015.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 01/28/2015] [Accepted: 02/23/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Being born premature or small for gestational age (SGA) is known to be associated with diseases later in life, such as gestational diabetes, hypertension and pre-eclampsia. In this study we examined the association between being born premature or SGA and all diseases diagnosed during hospital admissions later in life. METHODS Using Danish nation-wide registries we created a cohort of 1,348,106 persons born 1974-1996 and assessed all unique diagnoses registered in the Danish Patient Registry (DPR) for hospital admissions in the period 1994-2007 (n=27,910,558). We determined the odds ratios for persons born premature or SGA using multivariate logistic regression. RESULTS A total of 15,059 unique ICD-10 diagnosis codes were represented in the period. Only diagnoses used at least 100 times were included in the analysis (n=4175). Of these 838 showed an odds ratio that was statistically significantly different from unity for people born premature or SGA. After correcting for multiple testing, 250 remained significant. The diagnoses covered diseases in most organ systems, including cardiovascular, endocrinological, infectious, neurological/neurosurgical, obstetric, orthopedic, psychiatric, lung & urological diseases, and occurred throughout childhood and early adulthood. Novel findings included increased risks for delayed puberty, neurofibromatosis type 1 and ileus and decreased risks of mononucleosis, peritonsillar abscesses, chronic hypothyroidism and several types of fractures and contusions later in life. CONCLUSION Being born premature or SGA was associated with significantly altered risks of being admitted to a hospital with a wide range of diseases later in life, affecting almost all organ systems throughout childhood and early adulthood. Our findings may motivate testing in other cohorts and search for novel mechanisms of pathogenesis.
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Affiliation(s)
- Rasmus Á Rogvi
- Department of Neonatology, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Julie Lyng Forman
- Department of Biostatistics, Copenhagen University, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital, Copenhagen, Denmark
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Song YP, Chen ZS, Mo GY, Ding Q, Zhu L, Yan M. Optic atrophy differentially diagnosed as spinocerebellar ataxia from Leber hereditary optic neuropathy by gene mutation analysis. J Int Med Res 2012. [PMID: 23206485 DOI: 10.1177/030006051204000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Optic atrophy describes a group of diseases of retinal ganglion cells and axons that eventually lead to loss of vision. Optic atrophy has both congenital and acquired causes, and its diagnosis (or differential diagnosis) is complicated. This case report describes a 20-year-old man who presented with a 1-year history of progressive vision loss in both eyes and no obvious systemic symptoms. Fundus examination revealed bilateral optic atrophy. Based on clinical characteristics, visual field analysis and pattern visual evoked potential examination, the presumptive diagnosis was Leber hereditary optic neuropathy (LHON). Analysis of mitochondrial DNA indicated the absence of all of three common mutations associated with LHON (m.3460G>A, m.11778G>A, m.14484T>C). Detailed questioning of the patient revealed a history of prolonged language development and poor balance. Neurological examination indicated abnormal co-ordination, suggesting the presence of inherited spinocerebellar ataxia (SCA). Analysis of the SCA7 gene revealed a high number of trinucleotide repeats [(CAG)(n), n > 64], confirming the diagnosis of SCA. The aetiology of optic atrophies is complicated and the molecular genetic detection approach provides the best information for diagnosing these diseases.
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Affiliation(s)
- Y P Song
- Department of Ophthalmology, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China
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Capo H, Repka MX, Edmond JC, Drack AV, Blumenfeld L, Siatkowski RM. Optic nerve abnormalities in children: a practical approach. J AAPOS 2011; 15:281-90. [PMID: 21683634 DOI: 10.1016/j.jaapos.2011.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 02/25/2011] [Accepted: 02/26/2011] [Indexed: 10/18/2022]
Abstract
Evaluation of children with optic nerve abnormalities is challenging. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, and genetic testing are helpful in the diagnosis and management of these patients. Importantly, many optic nerve problems are not isolated but occur in association with systemic and central nervous system anomalies. The ophthalmologist thus plays a critical role in recognizing patients who warrant systemic and neurologic assessment.
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Affiliation(s)
- Hilda Capo
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida 33136, USA.
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Sughrue ME, Yang I, Kane AJ, Fang S, Clark AJ, Aranda D, Barani IJ, Parsa AT. Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma. J Neurooncol 2011; 101:463-76. [PMID: 20535527 PMCID: PMC3024496 DOI: 10.1007/s11060-010-0265-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 05/30/2010] [Indexed: 11/24/2022]
Abstract
Craniopharyngiomas are locally aggressive tumors which typically are focused in the sellar and suprasellar region near a number of critical neural and vascular structures mediating endocrinologic, behavioral, and visual functions. The present study aims to summarize and compare the published literature regarding morbidity resulting from treatment of craniopharyngioma. We performed a comprehensive search of the published English language literature to identify studies publishing outcome data of patients undergoing surgery for craniopharyngioma. Comparisons of the rates of endocrine, vascular, neurological, and visual complications were performed using Pearson's chi-squared test, and covariates of interest were fitted into a multivariate logistic regression model. In our data set, 540 patients underwent surgical resection of their tumor. 138 patients received biopsy alone followed by some form of radiotherapy. Mean overall follow-up for all patients in these studies was 54 ± 1.8 months. The overall rate of new endocrinopathy for all patients undergoing surgical resection of their mass was 37% (95% CI = 33-41). Patients receiving GTR had over 2.5 times the rate of developing at least one endocrinopathy compared to patients receiving STR alone or STR + XRT (52 vs. 19 vs. 20%, χ(2) P < 0.00001). On multivariate analysis, GTR conferred a significant increase in the risk of endocrinopathy compared to STR + XRT (OR = 3.45, 95% CI = 2.05-5.81, P < 0.00001), after controlling for study size and the presence of significant hypothalamic involvement. There was a statistical trend towards worse visual outcomes in patients receiving XRT after STR compared to GTR or STR alone (GTR = 3.5% vs. STR 2.1% vs. STR + XRT 6.4%, P = 0.11). Given the difficulty in obtaining class 1 data regarding the treatment of this tumor, this study can serve as an estimate of expected outcomes for these patients, and guide decision making until these data are available.
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Affiliation(s)
- Michael E. Sughrue
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Isaac Yang
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Ari J. Kane
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Shanna Fang
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Aaron J. Clark
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Derrick Aranda
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Igor J. Barani
- Department of Radiation Oncology, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
| | - Andrew T. Parsa
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117 USA
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Aisengart B, Kajiwara JK, Veríssimo Meira K, da Silva Lopes L. Morphometric analysis of the optic nerve in experimental hydrocephalus-induced rats. Pediatr Neurosurg 2011; 47:342-8. [PMID: 22572607 DOI: 10.1159/000337728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 03/02/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE It was the aim of this study to investigate changes caused to the optic nerve of rats submitted to experimental hydrocephalus through morphometric analysis. METHOD At postnatal day 7, the rats underwent injection of kaolin into the cisterna magna, were sacrificed at postnatal day 14, 21 or 28, and the right optic nerves were dissected. We analyzed the area, minor diameter, densities of oligodendrocytes and astrocytes, total and damaged fibers as well as the relationship between damaged and total fibers. RESULTS At postnatal day 14, there was a reduction in the density of astrocytes and damaged fibers when compared to the controls. At postnatal day 21, the area and the minor diameter were reduced compared to the controls, and the densities of oligodendrocytes and damaged fibers were increased compared to the controls. At postnatal day 28, there was a reduction in the area and the minor diameter and an increase in the densities of oligodendrocytes, astrocytes and damaged fibers when compared to controls. CONCLUSION The optic nerve of rats submitted to experimental hydrocephalus suffers morphometric changes.
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Affiliation(s)
- Betina Aisengart
- Department of Surgery and Anatomy, University of Sao Paulo, Ribeirao Preto, Brazil. betina77 @ gmail.com
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Yang I, Sughrue ME, Rutkowski MJ, Kaur R, Ivan ME, Aranda D, Barani IJ, Parsa AT. Craniopharyngioma: a comparison of tumor control with various treatment strategies. Neurosurg Focus 2010; 28:E5. [PMID: 20367362 DOI: 10.3171/2010.1.focus09307] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Craniopharyngiomas have a propensity to recur after resection, potentially causing death through their aggressive local behavior in their critical site of origin. Recent data suggest that subtotal resection (STR) followed by adjuvant radiotherapy (XRT) may be an appealing substitute for gross-total resection (GTR), providing similar rates of tumor control without the morbidity associated with aggressive resection. Here, the authors summarize the published literature regarding rates of tumor control with various treatment modalities for craniopharyngiomas. METHODS The authors performed a comprehensive search of the English language literature to identify studies publishing outcome data on patients undergoing surgery for craniopharyngioma. Rates of progression-free survival (PFS) and overall survival (OS) were determined through Kaplan-Meier analysis. RESULTS There were 442 patients who underwent tumor resection. Among these patients, GTR was achieved in 256 cases (58%), STR in 101 cases (23%), and STR+XRT in 85 cases (19%). The 2- and 5-year PFS rates for the GTR group versus the STR+XRT group were 88 versus 91%, and 67 versus 69%, respectively. The 5- and 10-year OS rates for the GTR group versus the STR+XRT group were 98 versus 99%, and 98 versus 95%, respectively. There was no significant difference in PFS (log-rank test) or OS with GTR (log-rank test). CONCLUSIONS Given the relative rarity of craniopharyngioma, this study provides estimates of outcome for a variety of treatment combinations, as not all treatments are an option for all patients with these tumors.
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Affiliation(s)
- Isaac Yang
- Department of Neurological Surgery, University of California, San Francisco, California, USA
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Abstract
This article provides an outline of the congenital and acquired conditions encountered in the practice of pediatric neuro-ophthalmology. Although some entities can be effectively evaluated clinically, CT and MR imaging studies may prove instrumental in many instances for detailed evaluation, narrowing of the differential diagnosis, or exclusion of underlying central nervous system pathologic findings.
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Affiliation(s)
- Vito LaRocca
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 West Taylor Street, MC 648, Chicago, IL 60612, USA
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Repka MX. Ophthalmological problems of the premature infant. MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2003; 8:249-57. [PMID: 12454901 DOI: 10.1002/mrdd.10045] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Preterm infants are more likely than term infants to have significant abnormalities of all parts of the visual system leading to reduced vision. The most common problem is retinopathy of prematurity (ROP). The frequency and severity of this disorder is inversely related to gestational age. Damage ranges from minor to catastrophic. Preterm infants also have higher rates of amblyopia, strabismus, refractive error, and cortical visual impairment. The later problem is largely associated with neonatal brain injury. Years later, these children may develop glaucoma and retinal detachments.
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Affiliation(s)
- Michael X Repka
- Department of Ophthalmology, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland 21287-9028, USA.
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