Preserving eye function in prematurely born children with severe protein C deficiency

Ophthalmic manifestations of congenital protein C deficiency: a case report and mini review

Background

Homozygous protein C (PC) deficiency is a potentially fatal disease with ocular blinding presentation or sequela.

Case presentation

A 5 month-old boy was presented for evaluation of leukocoria. He had a history of frequent bruises and PC deficiency, treated with warfarin.

His intraocular pressure was normal. In the left eye leukoma with anterior segment dysgenesis, shallow anterior chamber, and cataract were observed. Fundus was not visible. B-scan revealed a closed funnel retinal detachment. His right eye had a normal anterior segment and a thin retina with anomalous retinal vascular branching at equator and peripheral retina. A fibrovascular tuft on the optic nerve head with induced traction on superior arcade was visible. Total loss of a and b wave of both were appreciated in electroretinography (ERG). Fluorescein angiography (FA) showed very severe leakage at the junction of the vascularized and non-vascularized retina and optic nerve head. Favorable outcome was achieved with lasering of avascular retina in the right eye.

Conclusion

The potential for protein C deficiency should be assessed in all infants with leukocoria, anterior segment dysgenesis, retinal detachment and retinal dysplasia. Early diagnosis could save the child’s life and vision.

Thrombosis and bleeding disorders outside Western countries

The rapidly developing countries of Asia are witnessing substantial progress in the awareness of bleeding and thrombotic disorders as important health care problems. It has been thought for a long time that venous thromboembolism is very rare in Asia. Recent large studies that involved the majority of Asian countries demonstrated that this is not true, so that the practice of not using thromboprophylaxis in high-risk medical and surgical cases should be abandoned. The management of hemophilia and allied coagulation disorders has also dramatically improved in several Asian countries, due to the increased availability of blood products for replacement therapy coupled with the leadership role exerted by a few charismatic physicians, particularly in India and Thailand. As to the future, countries such as China and India have the capacity and expertise in biotechnology to consider the production of recombinant factors and gene transfer as the best strategies to tackle the management of persons with hemophilia in these densely populated and huge countries.