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Quigley C, Stephenson KAJ, Kenna PF, Cassidy L. Peripapillary retinal nerve fibre layer thinning, perfusion changes and optic neuropathy in carriers of Leber hereditary optic neuropathy-associated mitochondrial variants. BMJ Open Ophthalmol 2024; 9:e001295. [PMID: 38471715 DOI: 10.1136/bmjophth-2023-001295] [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: 03/21/2023] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND We investigated Leber hereditary optic neuropathy (LHON) families for variation in peripapillary retinal nerve fibre layer thickness and perfusion, and associated optic nerve dysfunction. METHOD A group of LHON-affected patients (n=12) and their asymptomatic maternal relatives (n=16) underwent examination including visual acuity (VA), visual-evoked-potential and optic nerve imaging including optical coherence tomography (OCT) and OCT angiography of the peripapillary retinal nerve fibre layer (RNFL). A control sample was also examined (n=10). The software imageJ was used to measure perfusion by assessing vessel density (VD), and statistical software 'R' was used to analyse data. RESULTS The LHON-affected group (n=12) had significantly reduced peripapillary VD (median 7.9%, p=0.046). Overall, the LHON asymptomatic relatives (n=16) had no significant change in peripapillary VD (p=0.166), though three eyes had VD which fell below the derived normal range at 6% each, with variable VA from normal to blindness; LogMAR median 0, range 0-2.4. In contrast, RNFL thickness was significantly reduced in the LHON-affected group (median 51 µm, p=0.003), and in asymptomatic relatives (median 90 µm, p=0.01), compared with controls (median 101 µm). RNFL thinning had greater specificity compared with reduced perfusion for optic nerve dysfunction in asymptomatic carriers (92% vs 66%). CONCLUSION Overall, reduced peripapillary retinal nerve fibre layer perfusion was observed in those affected by LHON but was not reduced in their asymptomatic relatives, unlike RNFL thinning which was significantly reduced in both groups versus controls. The presence of RNFL changes was associated with signs of optic neuropathy in asymptomatic relatives.
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Affiliation(s)
- Clare Quigley
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital Dublin, Dublin, Ireland
| | - Kirk A J Stephenson
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital Dublin, Dublin, Ireland
| | - Paul F Kenna
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital Dublin, Dublin, Ireland
| | - Lorraine Cassidy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital Dublin, Dublin, Ireland
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Petrovic Pajic S, Fakin A, Sustar Habjan M, Jarc-Vidmar M, Hawlina M. Leber Hereditary Optic Neuropathy (LHON) in Patients with Presumed Childhood Monocular Amblyopia. J Clin Med 2023; 12:6669. [PMID: 37892808 PMCID: PMC10607696 DOI: 10.3390/jcm12206669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Most Leber hereditary optic neuropathy (LHON) cases are bilateral and sequential; however, there are rare unilateral examples, or those in which the delay of onset of vision loss between one and the other eye is longer. In the case of presumed childhood amblyopia in one eye, vision loss in the good eye may be the only symptom of bilateral disease, which was unnoticed in the previously amblyopic eye, or a preexisting episode of LHON in the "amblyopic" eye. The clinical decision in such cases may be difficult and suggestive of other forms of atypical optic neuropathy until confirmed by genetic testing. CASE SERIES We present three genetically confirmed (MT-ND1:m.3700G>A, MT-ND6:m14484 T>C, and MT-ND4:m.11778G>A) patients with subacute vision loss in the previously good eye, with the other eye believed to be amblyopic from childhood and their features different from what would be expected in true amblyopia. In all, electrophysiology testing showed a bilaterally reduced amplitude of PERG with low VEP P100 wave amplitudes and prolonged peak time in both eyes, also unusual for amblyopia. During follow-up, the pallor of the optic discs progressed in all eyes. Significant thinning of the peripapillary retinal nerve fiber layer (pRNFL; retinal nerve fiber layer around the optic disc) and ganglion cell complex (GCC) in the macular region was present. All three patients had a peculiar history. The first patient was treated for presumed hyperopic amblyopia that did not improve since childhood, experienced visual loss in the good eye at the age of 17, and was negative for the three typical LHON mutations. Extended testing confirmed an atypical pathogenic variant MT-ND1:m.3700G>A in homoplasmy. The second patient with presumed strabismic amblyopia had an unusual presentation of vision loss only at the age of 61, and after the exclusion of other causes, a typical MT-ND4:m.11778G>A pathogenic variant was found in homoplasmy. The third case was peculiar as he had presumed strabismic amblyopia since childhood and had some degree of disc pallor in the amblyopic eye upon presenting with loss of vision in the good eye at the age of 21, and a typical pathogenic variant m14484 T>C, p.Met64Val was subsequently confirmed. However, one year after disease onset, he started to experience significant spontaneous functional improvement in the non-amblyopic up to 1.0 Snellen whilst improvement in the presumed amblyopic eye was modest, suggesting preexisting amblyopia. This interestingly extensive improvement was carefully followed by electrophysiology as well as visual acuity and fields. CONCLUSIONS This report shows three different scenarios of presentation of LHON in patients with presumed uniocular amblyopia from childhood. In such cases, the diagnosis may be difficult, and detailed structural and functional evaluation of the optic nerve head is necessary to assess whether an earlier LHON episode was misdiagnosed as amblyopia or whether LHON presented bilaterally on both eyes whilst only being noticed in the previously good eye.
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Affiliation(s)
- Sanja Petrovic Pajic
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (S.P.P.); (A.F.); (M.S.H.); (M.J.-V.)
- Clinic for Eye Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ana Fakin
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (S.P.P.); (A.F.); (M.S.H.); (M.J.-V.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Maja Sustar Habjan
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (S.P.P.); (A.F.); (M.S.H.); (M.J.-V.)
| | - Martina Jarc-Vidmar
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (S.P.P.); (A.F.); (M.S.H.); (M.J.-V.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Marko Hawlina
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (S.P.P.); (A.F.); (M.S.H.); (M.J.-V.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Quigley C, Stephenson KAJ, Kenna P, Cassidy L. Optic Nerve Structural and Functional Changes in LHON-Affected and Asymptomatic Maternal Relatives: Association with H and HV Mitochondrial Haplogroups. Int J Mol Sci 2023; 24:ijms24021068. [PMID: 36674591 PMCID: PMC9864201 DOI: 10.3390/ijms24021068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/22/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023] Open
Abstract
Leber Hereditary Optic Neuropathy (LHON) affects a minority of carriers of causative mitochondrial DNA mutations. We investigated a cohort of patients with LHON, including m.11778G>A, m.3460G>A, m.14484T>C and DNAJC30 c.152A>G variants, and their asymptomatic maternal carrier relatives for additional potential associations with vision loss. We assessed visual acuity, optical coherence tomography (OCT) of the peripapillary retinal nerve fibre layer (RNFL), visually evoked potential including P-100 latency, and full mitochondrial genome sequencing. Comparison was made with a reference standard for OCT; European Descent, Heidelberg Engineering ©; and electrophysiology measurements with in-house normative ranges. RNFL was thinned overall in LHON patients (n = 12); median global RNFL −54 μm in the right eye (RE) and −50 μm in the left eye (LE) versus normal, and was found to be normal overall in asymptomatic carriers at +1 μm RE and −2 μm LE (n = 16). In four asymptomatic carriers there was RNFL thinning found either unilaterally or bilaterally; these cases were associated with isolated delay in P-100 latency (25%), delay and reduced visual acuity (50%), or reduced visual acuity without P-100 latency delay (25%). Optic nerve dysfunction was associated with mitochondrial haplogroup H and HV, versus non-H haplogroups, in the asymptomatic carriers (Fisher’s exact test, p = 0.05). Our findings suggest that optic nerve abnormalities may be identified in asymptomatic LHON mitochondrial mutation carriers, which may be associated with optic nerve dysfunction. For asymptomatic carriers these findings were associated with mitochondrial haplogroup H and HV.
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Barboni P, La Morgia C, Cascavilla ML, Hong EH, Battista M, Majander A, Caporali L, Starace V, Amore G, Renzo AD, Carbonelli M, Nucci P, Jurkute N, Chen BS, Panebianco R, De Negri AM, Sadun F, Parisi V, Bandello F, Sadun AA, Carelli V, Yu-Wai-Man P. Childhood-Onset Leber Hereditary Optic Neuropathy-Clinical and Prognostic Insights. Am J Ophthalmol 2022; 249:99-107. [PMID: 36543315 DOI: 10.1016/j.ajo.2022.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate the clinical and molecular genetic features of childhood-onset Leber hereditary optic neuropathy (LHON) to gain a better understanding of the factors influencing the visual outcome in this atypical form of the disease. DESIGN Retrospective cohort study. METHODS We retrospectively included 2 cohorts of patients with LHON with onset of visual loss before the age of 12 years from Italy and the United Kingdom. Ophthalmologic evaluation, including best-corrected visual acuity, orthoptic evaluation, slit-lamp biomicroscopy, visual field testing, and optical coherence tomography, was considered. Patients were classified based on both the age of onset and the pattern of visual loss. RESULTS A total of 68 patients were stratified based on the age of onset of visual loss: group 1 (<3 years): 14 patients (20.6%); group 2 (≥3 to <9 years): 27 patients (39.7%); and group 3 (≥9 to ≤12 years): 27 patients (39.7%). Patients in group 2 achieved a better visual outcome than those in group 3. Patients in groups 1 and 2 had better mean deviation on visual field testing than those in group 3. The mean ganglion cell layer thickness on optical coherence tomography in group 2 was higher than those in groups 1 and 3. Patients were also categorized based on the pattern of visual loss as follows: Subacute Bilateral: 54 patients (66.7%); Insidious Bilateral: 14 patients (17.3%); Unilateral: 9 patients (11.1%); and Subclinical Bilateral: 4 patients (4.9%). CONCLUSIONS Children who lose vision from LHON before the age of 9 years have a better visual prognosis than those who become affected in later years, likely representing a "form frustre" of the disease.
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Affiliation(s)
- Piero Barboni
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.); Department of ophthalmology, Studio Oculistico d'Azeglio (P.B., M.C.).
| | - Chiara La Morgia
- Department of ophthalmology, IRCCS Istituto delle Scienze Neurologiche di Bologna, (C.L.M., L.C., V.C.) Bologna, Italy
| | - Maria Lucia Cascavilla
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.)
| | - Eun Hee Hong
- Moorfields Eye Hospital, London, United Kingdom (E.H.H., A.M., N.J., P.Y-W-M.); Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea (E.H.H.)
| | - Marco Battista
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.)
| | - Anna Majander
- Moorfields Eye Hospital, London, United Kingdom (E.H.H., A.M., N.J., P.Y-W-M.); UCL Institute of Ophthalmology, University College London, London, United Kingdom (A.M., N.J., P.Y-W-M.); Department of Ophthalmology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland (A.M.)
| | - Leonardo Caporali
- Department of ophthalmology, IRCCS Istituto delle Scienze Neurologiche di Bologna, (C.L.M., L.C., V.C.) Bologna, Italy
| | - Vincenzo Starace
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.)
| | - Giulia Amore
- Unit of Neurology, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna (G.A., M.C., V.C.)
| | | | - Michele Carbonelli
- Department of ophthalmology, Studio Oculistico d'Azeglio (P.B., M.C.); Unit of Neurology, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna (G.A., M.C., V.C.)
| | - Paolo Nucci
- Department of Clinical Science and Community Health, University of Milan, Milan, (P.N.), Italy
| | - Neringa Jurkute
- Moorfields Eye Hospital, London, United Kingdom (E.H.H., A.M., N.J., P.Y-W-M.); UCL Institute of Ophthalmology, University College London, London, United Kingdom (A.M., N.J., P.Y-W-M.)
| | - Benson S Chen
- Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge (B.S.C., P.Y-W-M.); Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, (B.S.C., P.Y-W-M.), Cambridge, United Kingdom
| | | | | | | | - Vincenzo Parisi
- IRCCS G.B. Bietti Foundation I.R.C.C.S., Rome (A.D.R., V.P.)
| | - Francesco Bandello
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.)
| | - Alfredo A Sadun
- and Doheny Eye Institute/UCLA School of Medicine, Los Angeles, California, USA (A.A.S)
| | - Valerio Carelli
- Department of ophthalmology, IRCCS Istituto delle Scienze Neurologiche di Bologna, (C.L.M., L.C., V.C.) Bologna, Italy; Unit of Neurology, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna (G.A., M.C., V.C.)
| | - Patrick Yu-Wai-Man
- Moorfields Eye Hospital, London, United Kingdom (E.H.H., A.M., N.J., P.Y-W-M.); UCL Institute of Ophthalmology, University College London, London, United Kingdom (A.M., N.J., P.Y-W-M.); Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge (B.S.C., P.Y-W-M.); Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, (B.S.C., P.Y-W-M.), Cambridge, United Kingdom
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Sugiura K, Ishimaru S, Fukuda K. Atypical Leber hereditary optic neuropathy with a 34-year interval between vision loss in both eyes. Am J Ophthalmol Case Rep 2022; 25:101263. [PMID: 35112015 PMCID: PMC8790627 DOI: 10.1016/j.ajoc.2022.101263] [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] [Received: 06/01/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Leber hereditary optic neuropathy (LHON) is an inherited mitochondrial disease characterized by painless vision loss affecting both eyes. The disease usually develops in both eyes within weeks to months of onset. We report a case of LHON who presented with unilateral vision loss in childhood with an interval of more than 30 years between vision loss in the two eyes. Observation A 43-year-old man presented with a 1-month history of vision loss in his right eye. At 9 years of age, his visual acuity in the left eye declined, and he had been treated with glaucoma eyedrops bilaterally at his eye clinic. At his first visit to our hospital, his BCVA was 0.15 in the right eye and 0.1 in the left eye, and critical flicker frequency was 16 Hz in the right eye and 15 Hz in the left eye, and he was negative for a relative afferent pupillary defect. The Goldman visual field showed central scotoma in both eyes. Fundus examination revealed slight redness of the right optic disc with meandering retinal small vessels, and the left optic disc had a slight pallor. Fluorescein angiography could not be performed because of liver dysfunction. OCT showed prominent bilateral thinning of the RNFL and retinal ganglion cell layer. Enhancement of the optic nerve was not apparent on orbital gadolinium-enhanced magnetic resonance imaging. Hematologic analysis revealed macrocytic anemia and low levels of vitamin B12 and folate. His mother had a presumptive diagnosis of LHON but did not receive genetic testing. A male cousin also had severe vision loss. Based on the likely family history of LHON, we performed genetic testing, which revealed the 11778 mitochondrial point mutation associated with this condition. Conclusion and importance We report a case of LHON with 34 years interval in vision loss in the fellow eye. LHON may develop in the second eye decades after its onset in the first. Detailed medical interviews and scrutiny, such as examination of family history, are warranted in consideration of LHON.
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Affiliation(s)
- Kayo Sugiura
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku City, Kochi, Japan
| | | | - Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku City, Kochi, Japan
- Corresponding author. Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan.
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Winters J, Kini A, Othman BA, Lee AG. Leber hereditary optic neuropathy: 41-year interval between fellow eye involvement. CANADIAN JOURNAL OF OPHTHALMOLOGY 2019; 55:e44-e46. [PMID: 31712002 DOI: 10.1016/j.jcjo.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Jacob Winters
- Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | | | | | - Andrew G Lee
- Houston Methodist Hospital, Houston, TX; Weill Cornell Medicine, New York, NY; University of Texas Medical Branch, Galveston, TX; University of Texas MD Anderson Cancer Center, Houston, TX; Texas A and M College of Medicine, Bryan, TX; The University of Iowa Hospitals and Clinics, Iowa City, IA.
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A Case of Atypical Leber Hereditary Optic Neuropathy With Slow, Symmetrical Progression Over Three Years. J Neuroophthalmol 2018; 38:421-422. [PMID: 30106804 DOI: 10.1097/wno.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ruiz-Pesini E, Emperador S, López-Gallardo E, Hernández-Ainsa C, Montoya J. Increasing mtDNA levels as therapy for mitochondrial optic neuropathies. Drug Discov Today 2018; 23:493-498. [DOI: 10.1016/j.drudis.2018.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/15/2017] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
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Leruez S, Verny C, Bonneau D, Procaccio V, Lenaers G, Amati-Bonneau P, Reynier P, Scherer C, Prundean A, Orssaud C, Zanlonghi X, Rougier MB, Tilikete C, Miléa D. Cyclosporine A does not prevent second-eye involvement in Leber's hereditary optic neuropathy. Orphanet J Rare Dis 2018; 13:33. [PMID: 29454364 PMCID: PMC5816422 DOI: 10.1186/s13023-018-0773-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKRGROUND Evaluation of the efficacy of oral cyclosporine A as a prophylactic agent in preventing second-eye involvement in Leber's hereditary optic neuropathy (LHON) in a prospective, open-label, non-randomized, multicenter pilot study. Only LHON patients aged 18 years or more, with confirmed primary mitochondrial DNA mutations and strictly unilateral optic neuropathy occurring within 6 months prior to enrolment, were included in the study. All these patients, receiving treatment with oral cyclosporine (Neoral®, Novartis) at 2.5 mg/kg/day, were examined at three-month intervals for a year. The primary endpoint was the best corrected visual acuity in the unaffected eye; the secondary endpoints were the best corrected visual acuity in the first eye affected, the mean visual field defect on automated perimetry, the thickness of the perifoveal retinal ganglion cell inner plexiform layer, and the thickness of the peripapillary retinal nerve fiber layer in both eyes. RESULTS Among the 24 patients referred to our institution with genetically confirmed LHON, between July 2011 and April 2014, only five patients, four males and one female, fulfilled the inclusion criteria. Age at enrolment ranged from 19 to 42 years (mean: 27.2 years; median: 26 years), four patients harbored the m.11778G > A pathogenic variant, and one the m.14484 T > C pathogenic variant. The time-interval between the onset of symptoms and inclusion in the study ranged from 7 to 17 weeks (mean: 11.8 weeks; median: 9 weeks). Despite treatment with oral cyclosporine A, all patients eventually experienced bilateral eye involvement, occurring within 11-65 weeks after the initiation of treatment. Over the study time period, the average best corrected visual acuity worsened in the first eye affected; by the end of the study, both eyes were equally affected. CONCLUSIONS Oral cyclosporine, at 2.5 mg/kg/day, did not prevent second-eye involvement in patients with strictly unilateral Leber's hereditary optic neuropathy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02176733 . Registrated June 25, 2014.
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Affiliation(s)
- Stéphanie Leruez
- Service d'Ophtalmologie, CHU Angers, 49000, Angers, France.,Institut MITOVASC, UMR CNRS 6015-INSERM1083, Université d'Angers, 49000, Angers, France
| | - Christophe Verny
- Institut MITOVASC, UMR CNRS 6015-INSERM1083, Université d'Angers, 49000, Angers, France.,Centre de référence des maladies neurogénétiques, Service de Neurologie, CHU Angers, 49000, Angers, France
| | - Dominique Bonneau
- Institut MITOVASC, UMR CNRS 6015-INSERM1083, Université d'Angers, 49000, Angers, France
| | - Vincent Procaccio
- Institut MITOVASC, UMR CNRS 6015-INSERM1083, Université d'Angers, 49000, Angers, France
| | - Guy Lenaers
- Institut MITOVASC, UMR CNRS 6015-INSERM1083, Université d'Angers, 49000, Angers, France
| | | | - Pascal Reynier
- Institut MITOVASC, UMR CNRS 6015-INSERM1083, Université d'Angers, 49000, Angers, France
| | - Clarisse Scherer
- Institut MITOVASC, UMR CNRS 6015-INSERM1083, Université d'Angers, 49000, Angers, France.,Centre de référence des maladies neurogénétiques, Service de Neurologie, CHU Angers, 49000, Angers, France
| | - Adriana Prundean
- Institut MITOVASC, UMR CNRS 6015-INSERM1083, Université d'Angers, 49000, Angers, France.,Centre de référence des maladies neurogénétiques, Service de Neurologie, CHU Angers, 49000, Angers, France
| | - Christophe Orssaud
- Unité Fonctionnelle d'Ophtalmologie, Centre de référence des Maladies Rares en Ophtalmologie OPHTARA, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, 75015, Paris, France
| | - Xavier Zanlonghi
- Centre de compétence maladie rare, Clinique Jules Verne, 44300, Nantes, France
| | | | - Caroline Tilikete
- Unité de Neuro-Ophtalmologie, Hospices Civils de Lyon, Hôpital Neurologique, 69677, Bron, France
| | - Dan Miléa
- Service d'Ophtalmologie, CHU Angers, 49000, Angers, France. .,Singapore Eye Research Institute, Singapore National Eye Centre and Duke-NUS, Singapore, Singapore. .,Angers University Hospital, Angers, France.
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Guy J, Feuer WJ, Davis JL, Porciatti V, Gonzalez PJ, Koilkonda RD, Yuan H, Hauswirth WW, Lam BL. Gene Therapy for Leber Hereditary Optic Neuropathy: Low- and Medium-Dose Visual Results. Ophthalmology 2017. [PMID: 28647203 DOI: 10.1016/j.ophtha.2017.05.016] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the effects of AAV2(Y444,500,730F)-P1ND4v2 in patients with Leber hereditary optic neuropathy (LHON). DESIGN Prospective open-label, unilateral single-dose, intravitreal injection of AAV2(Y444,500,730F)-P1ND4v2 per participant. PARTICIPANTS Fourteen patients with visual loss and mutated G11778A mitochondrial DNA. METHODS Intravitreal injection with the gene therapy vector AAV2(Y444,500,730F)-P1ND4v2 into 1 eye. Six participants with chronic bilateral visual loss lasting more than 12 months (group 1), 6 participants with bilateral visual loss lasting less than 12 months (group 2), and 2 participants with unilateral visual loss (group 3) were treated. Nine patients had at least 12 months of follow-up. Clinical testing included visual acuity, visual fields, optical coherence tomography, pattern electroretinography, and neuro-ophthalmic examinations. Generalized estimating equation methods were used for longitudinal analyses. MAIN OUTCOME MEASURE Loss of visual acuity. RESULTS For groups 1 and 2, month 12 average acuity improvements with treatment relative to baseline were 0.24 logarithm of the minimum angle of resolution (logMAR). Fellow eyes had a 0.09-logMAR improvement. A post hoc comparison found that at month 12, the difference between study eye minus fellow eye improvement in group 2 patients of 0.53 logMAR was greater than that observed in our prior acute natural history patients of 0.21 logMAR (P = 0.053). At month 18, the difference between study eye minus fellow eye improvement in our acute group 2 gene therapy patients of 0.96 was more than that observed in our prior acute natural history patients (0.17 logMAR; P < 0.001). Two patients demonstrated asymptomatic uveitis that resolved without treatment. Optical coherence tomography of treated eyes showed an average temporal retinal nerve fiber layer thickness of 54 μm before injection and 55 μm at month 12. For fellow eyes before injection, it was 56 μm, decreasing to 50 μm at month 12 (P = 0.013). Generalized estimating equations suggested that PERG amplitudes worsened more in treated eyes than in fellow eyes by approximately 0.05 μV (P = 0.009 exchangeable). No difference between eyes in outcomes of other visual function measures was evident. CONCLUSIONS Allotopic gene therapy for LHON at low and medium doses seems to be safe and does not damage the temporal retinal nerve fiber layer, opening the door next for testing of the high dose.
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Affiliation(s)
- John Guy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| | - William J Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Vittorio Porciatti
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Phillip J Gonzalez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Rajeshwari D Koilkonda
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Huijun Yuan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William W Hauswirth
- Department of Ophthalmology University of Florida College of Medicine, Gainesville, Florida
| | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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11
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Lateral thinking - Interocular symmetry and asymmetry in neurovascular patterning, in health and disease. Prog Retin Eye Res 2017; 59:131-157. [PMID: 28457789 DOI: 10.1016/j.preteyeres.2017.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/24/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023]
Abstract
No biological system or structure is likely to be perfectly symmetrical, or have identical right and left forms. This review explores the evidence for eye and visual pathway asymmetry, in health and in disease, and attempts to provide guidance for those studying the structure and function of the visual system, where recognition of symmetry or asymmetry may be essential. The principal question with regards to asymmetry is not 'are the eyes the same?', for some degree of asymmetry is pervasive, but 'when are they importantly different?'. Knowing if right and left eyes are 'importantly different' could have significant consequences for deciding whether right or left eyes are included in an analysis or for examining the association between a phenotype and ocular parameter. The presence of significant asymmetry would also have important implications for the design of normative databases of retinal and optic nerve metrics. In this review, we highlight not only the universal presence of asymmetry, but provide evidence that some elements of the visual system are inherently more asymmetric than others, pointing to the need for improved normative data to explain sources of asymmetry and their impact on determining associations with genetic, environmental or health-related factors and ultimately in clinical practice.
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12
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Prado RCF, Moura FC. Leber Hereditary Optic Neuropathy with Interval of Visual Loss Greater Than 12 Months. Neuroophthalmology 2016; 40:243-246. [PMID: 27928414 DOI: 10.1080/01658107.2016.1213860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022] Open
Abstract
A 28-year-old man presented with severe left visual loss and normal right visual acuity. The left fundus examination showed temporal pallor and complete absence of the nerve fibre layer (NFL) of papillomacular bundle. Right fundus examination showed focal loss of inferotemporal NFL. Magnetic resonance and serum aquaporin-4 antibody were negative. After 14 months of the initial visual involvement, the patient suffered subacute visual loss in contralateral eye. Genetic study revealed the 11778 point mitochondrial DNA (mtDNA) mutation associated with Leber hereditary optic neuropathy (LHON). Although very rare, interval of involvement of second eye greater than 12 months can occurs in LHON. Detailed optic nerve examination and careful interpretation of optical coherence tomography (OCT) printout support the diagnosis.
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Affiliation(s)
| | - Frederico Castelo Moura
- Department of Ophthalmology, Faculty of Medical Science, University of Campinas (UNICAMP) , São Paulo, Brazil
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