Juvenile cataract in association with tuberous sclerosis complex

Ocular manifestations of renal ciliopathies

Renal ciliopathies are a common cause of kidney failure in children and adults, and this study reviewed their ocular associations. Genes affected in renal ciliopathies were identified from the Genomics England Panels. Ocular associations were identified from Medline and OMIM, and the genes additionally examined for expression in the human retina ( https://www.proteinatlas.org/humanproteome/tissue ) and for an ocular phenotype in mouse models ( http://www.informatics.jax.org/ ). Eighty-two of the 86 pediatric-onset renal ciliopathies (95%) have an ocular phenotype, including inherited retinal degeneration, oculomotor disorders, and coloboma. Diseases associated with pathogenic variants in ANK6, MAPKBP1, NEK8, and TCTN1 have no reported ocular manifestations, as well as low retinal expression and no ocular features in mouse models. Ocular abnormalities are not associated with the most common adult-onset "cystic" kidney diseases, namely, autosomal dominant (AD) polycystic kidney disease and the AD tubulointerstitial kidney diseases (ADTKD). However, other kidney syndromes with cysts have ocular features including papillorenal syndrome (optic disc dysplasia), Hereditary Angiopathy Nephropathy, Aneurysms and muscle Cramps (HANAC) (tortuous retinal vessels), tuberous sclerosis (retinal hamartomas), von Hippel-Lindau syndrome (retinal hemangiomas), and Alport syndrome (lenticonus, fleck retinopathy). Ocular abnormalities are associated with many pediatric-onset renal ciliopathies but are uncommon in adult-onset cystic kidney disease. However the demonstration of ocular manifestations may be helpful diagnostically and the features may require monitoring or treatment.

Treatment of Aggressive Retinal Astrocytic Hamartoma with Oral mTOR Inhibition

OBJECTIVE OR PURPOSE

To describe the clinical course and outcomes of aggressive retinal astrocytic hamartoma (RAH) treated with oral mTOR inhibitors (mTORi).

DESIGN

Retrospective clinical case series.

SUBJECTS, PARTICIPANTS, AND/OR CONTROLS

Five patients with genetically confirmed TSC and visually significant RAH due to tumor growth or exudation.

METHODS, INTERVENTION, OR TESTING

Review of the electronic medical record in this retrospective clinical case series was performed to determine baseline and follow-up ophthalmologic examination characteristics along with ancillary imaging findings, in patients receiving off-label treatment with either oral sirolimus or everolimus for symptomatic RAH.

MAIN OUTCOME MEASURES

Visual acuity, change in tumor size, degree of exudation, and adverse effects of mTORi were evaluated.

RESULTS

The five patients in this series ranged in age from 8 months to 54 years. Four were treated with sirolimus, and one received everolimus. In all cases, tumor height was stable or decreased following treatment (median follow-up: 39 months, range 11-73 months). Exudation improved following treatment in all cases. In the 8-month-old infant, frequent upper respiratory tract infections prompted cessation of treatment. In one patient, the mTORi was temporarily held due to elevated liver enzymes. No other significant adverse effects were noted.

CONCLUSIONS

Sirolimus and everolimus should be considered in the management of vision-threatening RAH, particularly in the setting of exudative and rapidly growing tumors. Four out of five patients in this series tolerated oral mTORi and continued on therapy. There were no serious complications.