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Lim HW, Hwang B, Archambault C, Lambert SR. Rates of Reoperation in Duane Retraction Syndrome. OPHTHALMOLOGY SCIENCE 2024; 4:100479. [PMID: 38827492 PMCID: PMC11141251 DOI: 10.1016/j.xops.2024.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/07/2023] [Accepted: 01/22/2024] [Indexed: 06/04/2024]
Abstract
Purpose To investigate the types of strabismus surgeries performed and the reoperation rate in patients with Duane retraction syndrome (DRS). Design Retrospective cohort analysis. Participants An insurance claims data set was used to identify patients diagnosed with DRS between 2007 and 2021. Methods We recorded the type of strabismus surgery performed and the timing and frequency of reoperations. The hazard ratios (HRs) for reoperation were estimated according to the surgical methods using Cox regression analysis. Results Of the 9435 patients diagnosed with DRS, 1023 (10.8%) underwent ≥ 1 strabismus operation. The median age at surgery was 5.0 years, and patients were followed for an average of 3.8 ± 3.0 years after their initial strabismus surgery. Most of the surgeries only involved horizontal muscle(s) (n = 734 [71.7%]). However, some patients underwent surgeries on vertical muscle(s) (n = 132 [12.9%]), vertical muscle(s) with transposition (n = 102 [10.0%]), and horizontal muscle with transposition (n = 51 [5.0%]). The estimated 5-year rate of reoperation was 18.2% (95% confidence interval [CI], 15.0%-22.2%). Compared with surgery on horizontal muscle(s) only, vertical muscle surgery (HR, 2.01; 95% CI, 1.30-3.11; P = 0.002) and vertical muscle surgery coupled with transposition (HR, 1.79; 95% CI, 1.06-3.02; P = 0.03) had an increased risk of reoperation. Conclusions Strabismus surgery on ≥ 1 horizontal muscles is the most common type of strabismus surgery performed on patients with DRS. Approximately 1 in 7 patients with DRS who had strabismus surgery underwent a reoperation. Patients who underwent vertical muscle surgery had a higher risk of undergoing a reoperation. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Han Woong Lim
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
- Department of Ophthalmology, Hanyang University School of Medicine, Seoul, Republic of Korea
| | - Bryce Hwang
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Cyril Archambault
- Department of Ophthalmology, Université de Montréal, Montreal, Canada
| | - Scott R. Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Yang T, Li X, Wang K, Zhang Q, Hao R, Zhang W. MRI evaluation of cranial nerve abnormalities and extraocular muscle fibrosis in duane retraction syndrome and congenital extraocular muscle fibrosis. Graefes Arch Clin Exp Ophthalmol 2024; 262:2633-2642. [PMID: 38530452 DOI: 10.1007/s00417-024-06454-5] [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: 06/23/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE To investigate the alterations in extraocular muscles (EOMs) by magnetic resonance imaging (MRI) among patients diagnosed with Duane retraction yndrome (DRS) and congenital fibrosis of the extraocular muscles (CFEOM), who present with various cranial nerve anomalies in an attempt to enhance the clinical diagnostic process. METHODS A case-control study was conducted to evaluate 27 patients with DRS and 14 patients with CFEOM. All patients underwent MRI scans of the brainstem and orbital examination. Neurodevelopmental assessments were conducted through MRI, and maximum cross-sectional area and volumes of EOMs were obtained. Three types of models were constructed using machine learning decision tree algorithms based on EOMs to predict disease diagnosis, cranial nerve abnormalities, and clinical subtypes. RESULTS Patients with bilateral CN VI abnormalities had smaller volumes of LR, MR, and IR muscles compared to those with unilateral involvement (P < 0.05). Similarly, patients with CFEOM and unilateral third cranial nerve abnormalities had a smaller maximum cross-section of the affected eye's SR compared to the contralateral eye (P < 0.05). In patients with both CN III and CN VI abnormalities, the volume of SR was smaller than in patients with CN III abnormalities alone (P < 0.05). The prediction model using EOMs volume showed a diagnostic precision of 82.5% for clinical cases and 60.1% for predicting cranial nerve abnormalities. Nonetheless, the precision for identifying clinical subtypes was relatively modest, at only 41.7%. CONCLUSION The distinctive volumetric alterations in EOMs among individuals exhibiting distinct cranial nerve anomalies associated with DRS or CFEOM provide valuable diagnostic insights into to Congenital Cranial Neurodevelopmental Disorders (CCDDs). MRI analysis of EOMs should thus be regarded as a crucial diagnostic modality.
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Affiliation(s)
- Tiantian Yang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No. 4, Gansu Road, Heping District, Tianjin, 300022, China
| | - Xiaotong Li
- Nankai University Affiliated Tianjin Eye Hospital, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No. 4, Gansu Road, Heping District, Tianjin, 300022, China
| | - Kailei Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No. 4, Gansu Road, Heping District, Tianjin, 300022, China
| | - Quan Zhang
- Department of Radiology, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Rui Hao
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.
- Nankai University Affiliated Tianjin Eye Hospital, Tianjin, China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No. 4, Gansu Road, Heping District, Tianjin, 300022, China.
| | - Wei Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.
- Nankai University Affiliated Tianjin Eye Hospital, Tianjin, China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No. 4, Gansu Road, Heping District, Tianjin, 300022, China.
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Zhang R, Jia H, Chang Q, Zhang Z, Peng C, Ma Q, Liang Y, Yang S, Jiao Y. Two novel CHN1 variants identified in Duane retraction syndrome pedigrees disrupt development of ocular motor nerves in zebrafish. J Hum Genet 2024; 69:33-39. [PMID: 37853116 DOI: 10.1038/s10038-023-01201-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
Duane retraction syndrome (DRS) is a rare congenital eye movement disorder causing by the dysplasia of abducens nerve, and has highly variable phenotype. MRI can reveal the endophenotype of DRS. Most DRS cases are sporadical and isolated, while some are familial or accompanied by other ocular disorders and systemic congenital abnormalities. CHN1 was the most common causative gene for familial DRS. Until now, 13 missense variants of CHN1 have been reported. In this study, we enrolled two unrelated pedigrees with DRS. Detailed clinical examinations, MRI, and the whole exome sequencing (WES) were performed to reveal their clinical and genetic characteristics. Patients from pedigree-1 presented with isolated DRS, and a novel heterozygous variant c.650 A > G, p. His217Arg was identified in CHN1 gene. Patients from pedigree-2 presented with classic DRS and abnormalities in auricle morphology, and the pedigree segregated another novel heterozygous CHN1 variant c.637 T > C, p. Phe213Leu. A variety of bioinformatics software predicted that the two variants had deleterious or disease-causing effects. After injecting of two mutant CHN1 mRNAs into zebrafish embryos, the dysplasia of ocular motor nerves (OMN) was observed. Our present findings expanded the phenotypic and genotypic spectrum of CHN1 related DRS, as well as provided new insights into the role of CHN1 in OMN development. Genetic testing is strongly recommended for patients with a DRS family history or accompanying systemic congenital abnormalities.
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Affiliation(s)
- Ranran Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
- Beijing Ophthalmology and Visual Science Key Lab, 100730, Beijing, China
| | - Hongyan Jia
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
- Beijing Ophthalmology and Visual Science Key Lab, 100730, Beijing, China
| | - Qinglin Chang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
| | - Zongrui Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
| | - Chuzhi Peng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
- Beijing Ophthalmology and Visual Science Key Lab, 100730, Beijing, China
| | - Qian Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
- Beijing Ophthalmology and Visual Science Key Lab, 100730, Beijing, China
| | - Yi Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
- Beijing Ophthalmology and Visual Science Key Lab, 100730, Beijing, China
| | - Shuyan Yang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, 100020, Beijing, China.
| | - Yonghong Jiao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China.
- Beijing Ophthalmology and Visual Science Key Lab, 100730, Beijing, China.
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Alnosair G, Alhashim H, Alhamoud M, Alturki H. Congenital Ptosis Associated With Adduction as a Dysinnervation Disorder: A Report of a Rare Case. Cureus 2023; 15:e40422. [PMID: 37456445 PMCID: PMC10348428 DOI: 10.7759/cureus.40422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
The levator palpebrae superioris is the primary muscle responsible for elevation of the eyelid. This muscle is innervated by the third intracranial nerve. Any pathology affecting the muscle or the supplying nerve can lead to blepharoptosis. In this study, we share our experience of a two-year-old baby boy patient who presented with a rare congenital disorder manifested as blepharoptosis increased with adduction bilaterally with no limitation of ocular muscles action except bilateral underaction of inferior oblique muscles. To our knowledge, this unusual presentation has not been previously reported in the literature. We aim in this report to build more knowledge on such a rare clinical presentation. Based on the findings, this could be a case of congenital innervation dysgenesis syndrome (CID)/congenital cranial dysinnervation disorders (CCDDs). CCDDs/CID is a group of conditions that includes blepharoptosis as part of their clinical presentation. This group of conditions includes Duane's retraction syndrome, congenital fibrosis of extraocular muscles, and monocular elevation defect.
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Affiliation(s)
- Ghadah Alnosair
- Pediatric Ophthalmology and Strabismus, Dammam Medical Complex, Dammam, SAU
| | - Hassan Alhashim
- Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Mustafa Alhamoud
- Ophthalmology, King Fahd Hospital of the University, Khobar, SAU
| | - Hissah Alturki
- Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, SAU
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Jang Y, Kwak E, An JY, Jung JH. Infantile esotropia in a family with TUBB3 mutation associated congenital fibrosis of extraocular muscles. Ophthalmic Genet 2022; 43:716-719. [PMID: 35765833 DOI: 10.1080/13816810.2022.2092753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The TUBB3 gene has been reported to be associated with type 3 congenital fibrosis of the extraocular muscles (CFEOM). The clinical features of CFEOM3 that are linked to TUBB3 mutations are diverse, ranging from mild ptosis and limitation of extraocular movement to severe ocular motility problems and central nervous system abnormalities. MATERIALS AND METHODS This was a single retrospective case report. RESULT This case report describes a patient with infantile esotropia, who had a heterozygous variant in TUBB3 c.904 G > A (p.A302T) known to cause CFEOM3 and her family members, who presented with manifestations associated with CFEOM3. CONCLUSION Given the diverse clinical features of CFEOM3, the possibility of the occurrence of CFEOM3 should be considered when there is a congenital abnormality of extraocular muscle movement and a positive family history.
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Affiliation(s)
- Yeonji Jang
- Department of Ophthalmology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - Eunseo Kwak
- School of Biosystems and Biomedical Sciences, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Joon-Yong An
- School of Biosystems and Biomedical Sciences, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, and Seoul National University College of Medicine, Seoul, Republic of Korea
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Amran A, Pigatto L, Pocock R, Gopal S. Functions of the extracellular matrix in development: Lessons from Caenorhabditis elegans. Cell Signal 2021; 84:110006. [PMID: 33857577 DOI: 10.1016/j.cellsig.2021.110006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 12/30/2022]
Abstract
Cell-extracellular matrix interactions are crucial for the development of an organism from the earliest stages of embryogenesis. The main constituents of the extracellular matrix are collagens, laminins, proteoglycans and glycosaminoglycans that form a network of interactions. The extracellular matrix and its associated molecules provide developmental cues and structural support from the outside of cells during development. The complex nature of the extracellular matrix and its ability for continuous remodeling poses challenges when investigating extracellular matrix-based signaling during development. One way to address these challenges is to employ invertebrate models such as Caenorhabditis elegans, which are easy to genetically manipulate and have an invariant developmental program. C. elegans also expresses fewer extracellular matrix protein isoforms and exhibits reduced redundancy compared to mammalian models, thus providing a simpler platform for exploring development. This review summarizes our current understanding of how the extracellular matrix controls the development of neurons, muscles and the germline in C. elegans.
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Affiliation(s)
- Aqilah Amran
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Lara Pigatto
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Roger Pocock
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Sandeep Gopal
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia; Department of Experimental Medical Science, Lund University, Lund, Sweden.
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Wakabayashi T. Transmembrane Collagens in Neuromuscular Development and Disorders. Front Mol Neurosci 2021; 13:635375. [PMID: 33536873 PMCID: PMC7848082 DOI: 10.3389/fnmol.2020.635375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/28/2020] [Indexed: 11/13/2022] Open
Abstract
Neuromuscular development is a multistep process and involves interactions among various extracellular and transmembrane molecules that facilitate the precise targeting of motor axons to synaptogenic regions of the target muscle. Collagenous proteins with transmembrane domains have recently emerged as molecules that play essential roles in multiple aspects of neuromuscular formation. Membrane-associated collagens with interrupted triple helices (MACITs) are classified as an unconventional subtype of the collagen superfamily and have been implicated in cell adhesion in a variety of tissues, including the neuromuscular system. Collagen XXV, the latest member of the MACITs, plays an essential role in motor axon growth within the developing muscle. In humans, loss-of-function mutations of collagen XXV result in developmental ocular motor disorders. In contrast, collagen XIII contributes to the formation and maintenance of neuromuscular junctions (NMJs), and disruption of its function leads to the congenital myasthenic syndrome. Transmembrane collagens are conserved not only in mammals but also in organisms such as C. elegans, where a single MACIT, COL-99, has been documented to function in motor innervation. Furthermore, in C. elegans, a collagen-like transmembrane protein, UNC-122, is implicated in the structural and functional integrity of the NMJ. This review article summarizes recent advances in understanding the roles of transmembrane collagens and underlying molecular mechanisms in multiple aspects of neuromuscular development and disorders.
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Affiliation(s)
- Tomoko Wakabayashi
- Department of Innovative Dementia Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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8
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A reformed “release hypothesis” for Marcus Gunn Syndrome, based on newer clinic observations and experimental evidences. Med Hypotheses 2020; 144:110210. [DOI: 10.1016/j.mehy.2020.110210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022]
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Identification of a novel CHN1 p.(Phe213Val) variant in a large Han Chinese family with congenital Duane retraction syndrome. Sci Rep 2020; 10:16225. [PMID: 33004823 PMCID: PMC7531002 DOI: 10.1038/s41598-020-73190-1] [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: 11/07/2019] [Accepted: 09/06/2020] [Indexed: 11/08/2022] Open
Abstract
Duane retraction syndrome (DRS) is a neuromuscular dysfunction of the eyes. Although many causative genes of DRS have been identified in Europe and the United States, few reports have been published in regard to Chinese DRS. The aim of the present study was to explore the genetic defect of DRS in a Chinese family. Exome sequencing was used to identify the disease-causing gene for the two affected family members. Ophthalmic and physical examinations, as well as genetic screenings for variants in chimerin 1 (CHN1), were performed for all family members. Functional analyses of a CHN1 variant in 293T cells included a Rac-GTP activation assay, α2-chimaerin translocation assay, and co-immunoprecipitation assay. Genetic analysis revealed a NM_001822.7: c.637T > G variant in the CHN1 gene, which resulted in the substitution of a highly conserved C1 domain with valine at codon 213 (NP_001813.1: p.(Phe213Val)) (ClinVar Accession Number: SCV001335305). In-silico analysis revealed that the p.(Phe213Val) substitution affected the protein stability and connections among the amino acids of CHN1 in terms of its tertiary protein structure. Functional studies indicated that the p.(Phe213Val) substitution reduced Rac-GTP activity and enhanced membrane translocation in response to phorbol-myristoyl acetate (PMA). Together with previous studies, our present findings demonstrate that CHN1 may be an important causative gene for different ethnicities with DRS.
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Maynard TM, Zohn IE, Moody SA, LaMantia AS. Suckling, Feeding, and Swallowing: Behaviors, Circuits, and Targets for Neurodevelopmental Pathology. Annu Rev Neurosci 2020; 43:315-336. [PMID: 32101484 DOI: 10.1146/annurev-neuro-100419-100636] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
All mammals must suckle and swallow at birth, and subsequently chew and swallow solid foods, for optimal growth and health. These initially innate behaviors depend critically upon coordinated development of the mouth, tongue, pharynx, and larynx as well as the cranial nerves that control these structures. Disrupted suckling, feeding, and swallowing from birth onward-perinatal dysphagia-is often associated with several neurodevelopmental disorders that subsequently alter complex behaviors. Apparently, a broad range of neurodevelopmental pathologic mechanisms also target oropharyngeal and cranial nerve differentiation. These aberrant mechanisms, including altered patterning, progenitor specification, and neurite growth, prefigure dysphagia and may then compromise circuits for additional behavioral capacities. Thus, perinatal dysphagia may be an early indicator of disrupted genetic and developmental programs that compromise neural circuits and yield a broad range of behavioral deficits in neurodevelopmental disorders.
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Affiliation(s)
- Thomas M Maynard
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia 24016, USA;
| | - Irene E Zohn
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA.,Center for Genetic Medicine Research, Children's National Health System, Washington, DC 20037, USA
| | - Sally A Moody
- Department of Anatomy and Cell Biology, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Anthony-S LaMantia
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia 24016, USA; .,Department of Biological Sciences, Virginia Tech, Blacksburg, Virginia 24061, USA
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Gunduz A, Ozsoy E, Ulucan PB. Duane Retraction Syndrome: Clinical Features and a Case Group-Specific Surgical Approach. Semin Ophthalmol 2018; 34:52-58. [PMID: 30516080 DOI: 10.1080/08820538.2018.1554746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the clinical features of patients with Duane retraction syndrome (DRS) and evaluate the outcomes of surgical approaches based on the characteristics of each patient. METHODS The records of 38 Caucasian subjects with DRS were retrospectively reviewed. The patients were classified as type I, II, or III based on the Huber Classification. Ten patients underwent unilateral medial rectus (MR) recession due to abnormal head posture (AHP) and/or esotropia. Four patients underwent Y-splitting and recession of the lateral rectus (LR) with MR recession due to AHP and/or esotropia, upshoot, and globe retraction. RESULTS There was a preponderance of unilaterality, female gender, left eye, type I, orthotropia, upshoot, and low refractive error. All patients demonstrated globe retraction and fissure narrowing. AHP was only present in unilateral cases. Nine patients had amblyopia. More than half of the patients over 5 years of age had decreased stereopsis. MR recession decreased AHP to less than 8° in all patients. Y-splitting and recession of the LR eliminated upshoot in all four patients. One patient who underwent an 8-mm MR recession demonstrated -2 adduction limitation. CONCLUSIONS The DRS patients in our study demonstrated features that are consistent with previous reports in the literature. This study emphasizes the need to consider disease classification in the surgical management of DRS patients.
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Affiliation(s)
- Abuzer Gunduz
- a Department of Ophthalmology , Inonu University School of Medicine , Malatya , Turkey
| | - Ercan Ozsoy
- b Department of Ophthalmology, Haseki Training and Research Hospital , University of Health Sciences , Istanbul , Turkey
| | - Pamuk Betul Ulucan
- a Department of Ophthalmology , Inonu University School of Medicine , Malatya , Turkey
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12
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Choi Y, Jang S, Choi SY, Kim SH, Suh YW. Adhesion after Y-split procedure can affect its mechanism for treating overshoots in Duane's syndrome. Graefes Arch Clin Exp Ophthalmol 2018; 257:391-395. [PMID: 30382338 DOI: 10.1007/s00417-018-4181-8] [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: 08/17/2018] [Revised: 10/19/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To investigate the extent of adhesion and changes in the Y configuration after the Y-split procedure, compared with the posterior fixation suture. METHODS Twelve New Zealand white rabbits were included in the study. The 10-mm Y-split procedure was performed in the superior rectus muscle (SR) of one eye, and the 10-mm posterior fixation suture was made in the SR of the other eye. Six weeks after surgery, the Y arm lengths and lengths of adherence to the sclera were measured. If the adhesion involved the whole Y arm, the distance between the original SR insertion and most proximal part of the adhered SR was measured. In the eyes with posterior fixation suture, the distance between the SR insertion and most proximal part of the adhered SR was evaluated. RESULTS The average nasal and temporal Y arm lengths were 6.37 ± 0.65 and 6.54 ± 0.63 mm, respectively, a significant decrease from those measured immediately after surgery (P = 0.002 and 0.002, respectively). Adhesions involved the entire Y arms in 11 of 12 SRs (91.7%), with an average adhesion length of 7.01 ± 1.04 mm. In SRs with posterior fixation sutures, the average adhesion was 9.18 ± 0.62 mm from the insertion, which was only 2.17 mm posterior to proximal portion of adhesion in Y-split SR (P < 0.001). CONCLUSIONS Healing process reduces the Y arm length. Adhesion may involve the entire Y arm and could weaken or alter the therapeutic mechanism after the Y-split procedure.
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Affiliation(s)
- Young Choi
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Sungmin Jang
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Soo Youn Choi
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Young-Woo Suh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea. .,Department of Ophthalmology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, South Korea.
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Sedarous F, Chan TYB, Makar I. Alternating Hypotropia with Pseudoptosis: A New Phenotype of Congenital Cranial Dysinnervation Disorder. Case Rep Ophthalmol 2018; 9:96-101. [PMID: 29643789 PMCID: PMC5892332 DOI: 10.1159/000485832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/29/2017] [Indexed: 12/03/2022] Open
Abstract
Congenital cranial dysinnervation disorders, also known as CCDDs, are characterized by aberrant innervation to extraocular and facial muscles resulting in unusual forms of incomitant strabismus. Anomalous innervation to extraocular muscles can result in a wide variety of phenotypes causing various clinical conditions such as Duane syndrome, congenital fibrosis of the extraocular muscles, and Möbius syndrome. We report a case of bilateral dysinnervation disorder causing atypical ocular movements in both eyes as the patient changes fixation from one eye to the other and from right gaze to left gaze that fits with the wider diagnosis of CCDDs.
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Affiliation(s)
| | - Toby Y B Chan
- McMaster University, Waterloo Regional Campus, Kitchener, Ontario, Canada
| | - Inas Makar
- Ivey Eye Institute, University of Western Ontario, London, Ontario, Canada
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Nagata K, Takahashi M, Kiryu-Seo S, Kiyama H, Saido TC. Distinct functional consequences of ECEL1/DINE missense mutations in the pathogenesis of congenital contracture disorders. Acta Neuropathol Commun 2017; 5:83. [PMID: 29132416 PMCID: PMC5683451 DOI: 10.1186/s40478-017-0486-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/26/2017] [Indexed: 11/10/2022] Open
Abstract
Endothelin-converting enzyme-like 1 (ECEL1, also termed DINE in rodents), a membrane-bound metalloprotease, has been identified as a gene responsible for distal arthrogryposis (DA). ECEL1-mutated DA is generally characterized by ocular phenotypes in addition to the congenital limb contractures that are common to all DA subtypes. Until now, the consequences of the identified pathogenic mutations have remained incompletely understood because of a lack of detailed phenotypic analyses in relevant mouse models. In this study, we generated a new knock-in mouse strain that carries an ECEL1/DINE pathogenic G607S missense mutation, based on a previous study reporting atypical DA hindlimb phenotypes in two siblings with the mutation. We compared the morphological phenotypes of G607S knock-in mice with C760R knock-in mice that we previously established. Both C760R and G607S knock-in mouse embryos showed similar axonal arborization defects with normal trajectory patterns from the spinal cord to the target hindlimb muscles, as well as axon guidance defects of the abducens nerves. Intriguingly, distinct phenotypes in DINE protein localization and mRNA expression were identified in these knock-in mouse lines. For G607S, DINE mRNA and protein expression was decreased or almost absent in motor neurons. In the C760R mutant mice DINE was expressed and localized in the somata of motor neurons but not in axons. Our mutant mouse data suggest that ECEL1/DINE G607S and C760R mutations both lead to motor innervation defects as primary causes in ECEL1-mutated congenital contracture disorders. However, the functional consequences of the two mutations are distinct, with loss of axonal transport of ECEL1/DINE in C760R mutants and mRNA expression deficits in G607S mutants.
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15
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Abu-Amero KK, Kondkar AA, Khan AO. A microdeletion in the GRHL2 Gene in two unrelated patients with congenital fibrosis of the extra ocular muscles. BMC Res Notes 2017; 10:562. [PMID: 29110737 PMCID: PMC5674732 DOI: 10.1186/s13104-017-2888-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/31/2017] [Indexed: 12/13/2022] Open
Abstract
Objective Congenital fibrosis of the extraocular muscles type 1 (CFEOM1) is known to be caused by mutations in KIF21A or TUBB3 or other known genes (SALL4, CHN1, HOXA1). However, affected children may harbor other genetic defects. Therefore, a candidate gene analysis (KIF21A, TUBB3 SALL4, CHN1, HOXA1) and a high-resolution array comparative genomic hybridization (arrayCGH) was performed in two unrelated children with sporadic CFEOM1. Results Two unrelated Saudi patients did not have any mutation(s) after sequencing the full coding regions of SALL4, CHN1, HOXA1, and TUBB3 genes; and exons 8, 20, and 21 of the KIF21A gene. However, arrayCGH revealed a 3.17 Kb deletion at chromosome 8p22 with copy number state equal to 1, indicating a heterozygous deletion. This deletion was absent in proband’s mother or father or 220 unrelated healthy individuals of similar ethnicity. The deletion encompassed only one functional gene, GRHL2, which encodes a transcription factor. In humans, defects in this gene are a cause of non-syndromic sensorineural deafness, autosomal dominant type 28 (DFNA28). We speculate that GRHL2 gene may have a role in orbital innervations and the defect in this gene (deletion) may be related to the CFEOM1 phenotype in these two children.
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Affiliation(s)
- Khaled K Abu-Amero
- Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA.
| | - Altaf A Kondkar
- Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Arif O Khan
- Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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16
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Kekunnaya R, Negalur M. Duane retraction syndrome: causes, effects and management strategies. Clin Ophthalmol 2017; 11:1917-1930. [PMID: 29133973 PMCID: PMC5669793 DOI: 10.2147/opth.s127481] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Duane retraction syndrome (DRS) is a congenital eye movement anomaly characterized by variable horizontal duction deficits, with narrowing of the palpebral fissure and globe retraction on attempted adduction, occasionally accompanied by upshoot or down-shoot. The etiopathogenesis of this condition can be explained by a spectrum of mechanical, innervational, neurologic and genetic abnormalities occurring independently or which influence each other giving rise to patterns of clinical presentations along with a complex set of ocular and systemic anomalies. Huber type I DRS is the most common form of DRS with an earlier presentation, while Huber type II is the least common presentation. Usually, patients with unilateral type I Duane syndrome have esotropia more frequently than exotropia, those with type II have exotropia and those with type III have esotropia and exotropia occurring equally common. Cases of bilateral DRS may have variable presentation depending upon the type of presentation in each eye. As regards its management, DRS classification based on primary position deviation as esotropic, exotropic or orthotropic is more relevant than Huber’s classification before planning surgery. Surgical approach to these patients is challenging and must be individualized based on the amount of ocular deviation, abnormal head position, associated globe retraction and overshoots.
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Affiliation(s)
- Ramesh Kekunnaya
- Pediatric Ophthalmology and Strabismus Services, Child Sight Institute, Jasti V Ramannama Children's Eye Care Center, KAR Campus, Hyderabad, India
| | - Mithila Negalur
- Pediatric Ophthalmology and Strabismus Services, Child Sight Institute, Jasti V Ramannama Children's Eye Care Center, KAR Campus, Hyderabad, India
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17
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Akbari MR, Manouchehri V, Mirmohammadsadeghi A. Surgical treatment of Duane retraction syndrome. J Curr Ophthalmol 2017; 29:248-257. [PMID: 29270470 PMCID: PMC5735239 DOI: 10.1016/j.joco.2017.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/02/2017] [Accepted: 08/10/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose Surgical treatment in Duane retraction syndrome (DRS) can be very challenging even for the strabismus specialists because of a wide spectrum of diversity in clinical manifestations. The purpose of this article is to review these different surgical treatments. Methods A comprehensive search was performed using PubMed database with the different keywords of "Duane retraction syndrome" and "surgery". Articles were selected from original English papers published since 2000. The full text of the selected articles was reviewed, and some articles were added based upon the references of the initial articles. We also provided selected case examples about some of these procedures. Results 125 articles were found in the initial search of which 37 articles were mostly related to the topic of this review. The number finally increased to 59 articles after considering the relative references of the initial articles. Different surgical methods performed on horizontal and vertical rectus muscles (recession, resection, transposition, Y splitting, periosteal fixation and posterior fixation suture) are reviewed. Careful selection of the surgical technique is important to achieve optimal results. Conclusion With accurate diagnosis of patients with DRS and proper surgical management, several adverse situations associated with this syndrome (amblyopia, abnormal head posture, upshoot, downshoot, and muscle underaction) can be prevented.
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Affiliation(s)
- Mohammad Reza Akbari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahideh Manouchehri
- Department of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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18
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Mari L, Blacklock BT, Stavinohova R, De Risio L. Extraocular muscle dysinnervation disorder resembling Duane retraction syndrome in a 9-month-old French Bulldog. Vet Ophthalmol 2017; 20:472-476. [DOI: 10.1111/vop.12396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lorenzo Mari
- Neurology/Neurosurgery Service; Centre for Small Animal Studies; Animal Health Trust; Newmarket UK
| | - Benjamin T. Blacklock
- Ophthalmology Service; Centre for Small Animal Studies; Animal Health Trust; Newmarket UK
| | - Renata Stavinohova
- Ophthalmology Service; Centre for Small Animal Studies; Animal Health Trust; Newmarket UK
| | - Luisa De Risio
- Neurology/Neurosurgery Service; Centre for Small Animal Studies; Animal Health Trust; Newmarket UK
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19
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Demer JL, Clark RA, Suh SY, Giaconi JA, Nouri-Mahdavi K, Law SK, Bonelli L, Coleman AL, Caprioli J. Magnetic Resonance Imaging of Optic Nerve Traction During Adduction in Primary Open-Angle Glaucoma With Normal Intraocular Pressure. Invest Ophthalmol Vis Sci 2017; 58:4114-4125. [PMID: 28829843 PMCID: PMC5566384 DOI: 10.1167/iovs.17-22093] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose We used magnetic resonance imaging (MRI) to ascertain effects of optic nerve (ON) traction in adduction, a phenomenon proposed as neuropathic in primary open-angle glaucoma (POAG). Methods Seventeen patients with POAG and maximal IOP ≤ 20 mm Hg, and 31 controls underwent MRI in central gaze and 20° to 30° abduction and adduction. Optic nerve and sheath area centroids permitted computation of midorbital lengths versus minimum paths. Results Average mean deviation (±SEM) was −8.2 ± 1.2 dB in the 15 patients with POAG having interpretable perimetry. In central gaze, ON path length in POAG was significantly more redundant (104.5 ± 0.4% of geometric minimum) than in controls (102.9 ± 0.4%, P = 2.96 × 10−4). In both groups the ON became significantly straighter in adduction (28.6 ± 0.8° in POAG, 26.8 ± 1.1° in controls) than central gaze and abduction. In adduction, the ON in POAG straightened to 102.0% ± 0.2% of minimum path length versus 104.5% ± 0.4% in central gaze (P = 5.7 × 10−7), compared with controls who straightened to 101.6% ± 0.1% from 102.9% ± 0.3% in central gaze (P = 8.7 × 10−6); and globes retracted 0.73 ± 0.09 mm in POAG, but only 0.07 ± 0.08 mm in controls (P = 8.8 × 10−7). Both effects were confirmed in age-matched controls, and remained significant after correction for significant effects of age and axial globe length (P = 0.005). Conclusions Although tethering and elongation of ON and sheath are normal in adduction, adduction is associated with abnormally great globe retraction in POAG without elevated IOP. Traction in adduction may cause mechanical overloading of the ON head and peripapillary sclera, thus contributing to or resulting from the optic neuropathy of glaucoma independent of IOP.
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Affiliation(s)
- Joseph L Demer
- Department of Ophthalmology, University of California, Los Angeles, California, United States.,Stein Eye Institute, University of California, Los Angeles, California, United States.,Biomedical Engineering Interdepartmental Program, University of California, Los Angeles, California, United States.,Neuroscience Interdepartmental Program, University of California, Los Angeles, California, United States.,Department of Neurology, University of California, Los Angeles, California, United States
| | - Robert A Clark
- Department of Ophthalmology, University of California, Los Angeles, California, United States.,Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Soh Youn Suh
- Department of Ophthalmology, University of California, Los Angeles, California, United States
| | - JoAnn A Giaconi
- Department of Ophthalmology, University of California, Los Angeles, California, United States.,Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Kouros Nouri-Mahdavi
- Department of Ophthalmology, University of California, Los Angeles, California, United States.,Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Simon K Law
- Department of Ophthalmology, University of California, Los Angeles, California, United States.,Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Laura Bonelli
- Department of Ophthalmology, University of California, Los Angeles, California, United States.,Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Anne L Coleman
- Department of Ophthalmology, University of California, Los Angeles, California, United States.,Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Joseph Caprioli
- Department of Ophthalmology, University of California, Los Angeles, California, United States.,Stein Eye Institute, University of California, Los Angeles, California, United States
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20
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Fazeli W, Herkenrath P, Stiller B, Neugebauer A, Fricke J, Lang-Roth R, Nürnberg G, Thoenes M, Becker J, Altmüller J, Volk AE, Kubisch C, Heller R. A TUBB6 mutation is associated with autosomal dominant non-progressive congenital facial palsy, bilateral ptosis and velopharyngeal dysfunction. Hum Mol Genet 2017; 26:4055-4066. [DOI: 10.1093/hmg/ddx296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/23/2017] [Indexed: 01/06/2023] Open
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21
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Salman MS, Clark IH. Eyelid Retraction in Isolated Unilateral Congenital Blepharoptosis. Front Neurol 2017; 8:190. [PMID: 28529498 PMCID: PMC5418841 DOI: 10.3389/fneur.2017.00190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022] Open
Abstract
Isolated unilateral congenital ptosis is encountered relatively infrequently in clinical practice. It typically consists of a unilateral droopy eyelid, weak levator palpebrae superioris muscle function, lid lag, and an absent upper lid crease with no other abnormalities on examination. We present a four-and-a-half-year-old girl with isolated and mild unilateral congenital ptosis who unexpectedly demonstrated a static upper eyelid on downgaze in conjunction with a well-formed upper lid skin crease. We attribute this uncommon sign in congenital ptosis to stiffness and presumed fibrosis of the levator muscle. Examining the function of the eyelids in all directions of gaze is important in patients with abnormalities of lid position, since additional useful information can be gleaned about the status of the levator muscle including, aberrant regeneration or fibrosis.
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Affiliation(s)
- Michael S Salman
- Section of Pediatric Neurology, Children's Hospital, University of Manitoba, Winnipeg, MB, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ian H Clark
- Section of Pediatric Ophthalmology, Children's Hospital, University of Manitoba, Winnipeg, MB, Canada.,Department of Ophthalmology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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22
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Chilton JK, Guthrie S. Axons get ahead: Insights into axon guidance and congenital cranial dysinnervation disorders. Dev Neurobiol 2017; 77:861-875. [DOI: 10.1002/dneu.22477] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 11/12/2022]
Affiliation(s)
- John K. Chilton
- Wellcome Wolfson Centre for Medical Research; University of Exeter Medical School, Wellcome-Wolfson Centre for Medical Research; Exeter EX2 5DW United Kingdom
| | - Sarah Guthrie
- School of Life Sciences; University of Sussex; Falmer Brighton, BN1 9QG
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23
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Synergistic innervational downshoot: a distinct vertical dysinnervation pattern and its unique management. Can J Ophthalmol 2017; 52:e31-e38. [PMID: 28237170 DOI: 10.1016/j.jcjo.2016.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 07/28/2016] [Indexed: 11/22/2022]
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24
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Vogel M, Velleuer E, Schmidt-Jiménez LF, Mayatepek E, Borkhardt A, Alawi M, Kutsche K, Kortüm F. Homozygous HOXB1 loss-of-function mutation in a large family with hereditary congenital facial paresis. Am J Med Genet A 2016; 170:1813-9. [PMID: 27144914 DOI: 10.1002/ajmg.a.37682] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 04/11/2016] [Indexed: 11/07/2022]
Abstract
Hereditary congenital facial paresis (HCFP) belongs to the congenital cranial dysinnervation disorders. HCFP is characterized by the isolated dysfunction of the seventh cranial nerve and can be associated with hearing loss, strabismus, and orofacial anomalies. Möbius syndrome shares facial palsy with HCFP, but is additionally characterized by limited abduction of the eye(s). Genetic heterogeneity has been documented for HCFP as one locus mapped to chromosome 3q21-q22 (HCFP1) and a second to 10q21.3-q22.1 (HCFP2). The only known causative gene for HCFP is HOXB1 (17q21; HCFP3), encoding a homeodomain-containing transcription factor of the HOX gene family, which are master regulators of early developmental processes. The previously reported HOXB1 mutations change arginine 207 to another residue in the homeodomain and alter binding capacity of HOXB1 for transcriptional co-regulators and DNA. We performed whole exome sequencing in HCFP-affected individuals of a large consanguineous Moroccan family. The homozygous nonsense variant c.66C>G/p.(Tyr22*) in HOXB1 was identified in the four patients with HCFP and ear malformations, while healthy family members carried the mutation in the heterozygous state. This is the first disease-associated HOXB1 mutation with a likely loss-of-function effect suggesting that all HOXB1 variants reported so far also have severe impact on activity of this transcriptional regulator. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Markus Vogel
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Eunike Velleuer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Leon F Schmidt-Jiménez
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Malik Alawi
- University Medical Center Hamburg-Eppendorf, Bioinformatics Service Facility, Hamburg, Germany
- Center for Bioinformatics, University of Hamburg, Hamburg, Germany
- Heinrich-Pette-Institute, Leibniz-Institute for Experimental Virology, Virus Genomics, Hamburg, Germany
| | - Kerstin Kutsche
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fanny Kortüm
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Karpinski BA, Bryan CA, Paronett EM, Baker JL, Fernandez A, Horvath A, Maynard TM, Moody SA, LaMantia AS. A cellular and molecular mosaic establishes growth and differentiation states for cranial sensory neurons. Dev Biol 2016; 415:228-241. [PMID: 26988119 DOI: 10.1016/j.ydbio.2016.03.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/02/2016] [Accepted: 03/13/2016] [Indexed: 02/06/2023]
Abstract
We compared apparent origins, cellular diversity and regulation of initial axon growth for differentiating cranial sensory neurons. We assessed the molecular and cellular composition of the developing olfactory and otic placodes, and cranial sensory ganglia to evaluate contributions of ectodermal placode versus neural crest at each site. Special sensory neuron populations-the olfactory and otic placodes, as well as those in vestibulo-acoustic ganglion- are entirely populated with cells expressing cranial placode-associated, rather than neural crest-associated markers. The remaining cranial sensory ganglia are a mosaic of cells that express placode-associated as well as neural crest-associated markers. We found two distinct populations of neural crest in the cranial ganglia: the first, as expected, is labeled by Wnt1:Cre mediated recombination. The second is not labeled by Wnt1:Cre recombination, and expresses both Sox10 and FoxD3. These populations-Wnt1:Cre recombined, and Sox10/Foxd3-expressing- are proliferatively distinct from one another. Together, the two neural crest-associated populations are substantially more proliferative than their placode-associated counterparts. Nevertheless, the apparently placode- and neural crest-associated populations are similarly sensitive to altered signaling that compromises cranial morphogenesis and differentiation. Acute disruption of either Fibroblast growth factor (Fgf) or Retinoic acid (RA) signaling alters axon growth and cell death, but does not preferentially target any of the three distinct populations. Apparently, mosaic derivation and diversity of precursors and early differentiating neurons, modulated uniformly by local signals, supports early cranial sensory neuron differentiation and growth.
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Affiliation(s)
- Beverly A Karpinski
- Department of Pharmacology and Physiology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA; Department of Anatomy and Regenerative Biology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA; The GW Institute for Neuroscience, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
| | - Corey A Bryan
- Department of Pharmacology and Physiology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA; The GW Institute for Neuroscience, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
| | - Elizabeth M Paronett
- Department of Pharmacology and Physiology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA; The GW Institute for Neuroscience, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
| | - Jennifer L Baker
- Center for the Advanced Study of Human Paleobiology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
| | - Alejandra Fernandez
- Department of Pharmacology and Physiology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA; The GW Institute for Neuroscience, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
| | - Anelia Horvath
- Department of Pharmacology and Physiology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA; The GW Institute for Neuroscience, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
| | - Thomas M Maynard
- Department of Pharmacology and Physiology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA; The GW Institute for Neuroscience, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
| | - Sally A Moody
- Department of Anatomy and Regenerative Biology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA; The GW Institute for Neuroscience, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
| | - Anthony-S LaMantia
- Department of Pharmacology and Physiology, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA; The GW Institute for Neuroscience, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
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26
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Bosley TM, Salih MA, Alkhalidi H, Oystreck DT, El Khashab HY, Kondkar AA, Abu-Amero KK. Duane retraction syndrome in a patient with Duchenne muscular dystrophy. Ophthalmic Genet 2016; 37:276-80. [PMID: 26849454 DOI: 10.3109/13816810.2015.1039139] [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] [Indexed: 11/13/2022]
Abstract
PURPOSE We describe the clinical features of a boy with bilateral Duane retraction syndrome (DRS), Duchenne muscular dystrophy (DMD), and other medical problems. METHODS The child was followed-up for five years; his chart was reviewed, including the results of a muscle biopsy and genetic testing. Multiplex ligation-dependent probe amplification (MLPA) was used to interrogate deletions/duplications in the dystrophin gene. RESULTS The proband had bilateral DRS with otherwise normal ocular motility; he also had developmental delay, mild mental retardation, and seizures. Clinical diagnosis of DMD included progressive proximal weakness, highly elevated creatine kinase levels, and a muscle biopsy showing significant dystrophic changes including contracted, degenerative, and regenerative fibers, and negative dystrophin immunostaining. MLPA documented duplication of exons 3 and 4 of the dystrophin gene. CONCLUSIONS This boy is the third patient to be reported with DRS and DMD, the second with bilateral DRS and the only one with other neurologic features. Mutated dystrophin is present in extraocular muscles and in the central nervous system (CNS) in DMD, leaving open the question of whether this co-occurrence is the result of the genetic muscle abnormality, CNS effects caused by dystrophin mutations, or chance.
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Affiliation(s)
- Thomas M Bosley
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Mustafa A Salih
- b Department of Pediatrics (Neurology Division) , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Hisham Alkhalidi
- c Department of Pathology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Darren T Oystreck
- d Division of Ophthalmology, Faculty of Health Sciences , University of Stellenbosch , Tygerberg , South Africa
| | - Heba Y El Khashab
- b Department of Pediatrics (Neurology Division) , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Altaf A Kondkar
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Khaled K Abu-Amero
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia.,e Department of Ophthalmology , College of Medicine, University of Florida , Jacksonville , Florida , USA
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27
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Abu-Amero KK, Kondkar AA, Hellani AM, Bosley TM, Khan AO. Chromosome 6 microdeletion in a patient with syndromic congenital cranial dysinnervation disorder. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2016; 21:72-4. [PMID: 26818173 PMCID: PMC5224418 DOI: 10.17712/nsj.2016.1.20150098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Khaled K. Abu-Amero
- From the Department of Ophthalmology (Abu-Amero, Kondkar, Bosley), the Glaucoma Research Chair (Abu-Amero, Kondkar), College of Medicine, King Saud University, the Division of Pediatric Ophthalmology (Khan), King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia, and the Viafet Genomic Center (Hellani), Sydney, Australia, and the Department of Ophthalmology (Abu-Amero), College of Medicine, Jacksonville, Florida, USA,Address correspondence and reprint request to: Dr. Khaled K. Abu-Amero, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
| | - Altaf A. Kondkar
- From the Department of Ophthalmology (Abu-Amero, Kondkar, Bosley), the Glaucoma Research Chair (Abu-Amero, Kondkar), College of Medicine, King Saud University, the Division of Pediatric Ophthalmology (Khan), King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia, and the Viafet Genomic Center (Hellani), Sydney, Australia, and the Department of Ophthalmology (Abu-Amero), College of Medicine, Jacksonville, Florida, USA
| | - Ali M. Hellani
- From the Department of Ophthalmology (Abu-Amero, Kondkar, Bosley), the Glaucoma Research Chair (Abu-Amero, Kondkar), College of Medicine, King Saud University, the Division of Pediatric Ophthalmology (Khan), King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia, and the Viafet Genomic Center (Hellani), Sydney, Australia, and the Department of Ophthalmology (Abu-Amero), College of Medicine, Jacksonville, Florida, USA
| | - Thomas M. Bosley
- From the Department of Ophthalmology (Abu-Amero, Kondkar, Bosley), the Glaucoma Research Chair (Abu-Amero, Kondkar), College of Medicine, King Saud University, the Division of Pediatric Ophthalmology (Khan), King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia, and the Viafet Genomic Center (Hellani), Sydney, Australia, and the Department of Ophthalmology (Abu-Amero), College of Medicine, Jacksonville, Florida, USA
| | - Arif O. Khan
- From the Department of Ophthalmology (Abu-Amero, Kondkar, Bosley), the Glaucoma Research Chair (Abu-Amero, Kondkar), College of Medicine, King Saud University, the Division of Pediatric Ophthalmology (Khan), King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia, and the Viafet Genomic Center (Hellani), Sydney, Australia, and the Department of Ophthalmology (Abu-Amero), College of Medicine, Jacksonville, Florida, USA
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LaMantia AS, Moody SA, Maynard TM, Karpinski BA, Zohn IE, Mendelowitz D, Lee NH, Popratiloff A. Hard to swallow: Developmental biological insights into pediatric dysphagia. Dev Biol 2015; 409:329-42. [PMID: 26554723 DOI: 10.1016/j.ydbio.2015.09.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 12/16/2022]
Abstract
Pediatric dysphagia-feeding and swallowing difficulties that begin at birth, last throughout childhood, and continue into maturity--is one of the most common, least understood complications in children with developmental disorders. We argue that a major cause of pediatric dysphagia is altered hindbrain patterning during pre-natal development. Such changes can compromise craniofacial structures including oropharyngeal muscles and skeletal elements as well as motor and sensory circuits necessary for normal feeding and swallowing. Animal models of developmental disorders that include pediatric dysphagia in their phenotypic spectrum can provide mechanistic insight into pathogenesis of feeding and swallowing difficulties. A fairly common human genetic developmental disorder, DiGeorge/22q11.2 Deletion Syndrome (22q11DS) includes a substantial incidence of pediatric dysphagia in its phenotypic spectrum. Infant mice carrying a parallel deletion to 22q11DS patients have feeding and swallowing difficulties that approximate those seen in pediatric dysphagia. Altered hindbrain patterning, craniofacial malformations, and changes in cranial nerve growth prefigure these difficulties. Thus, in addition to craniofacial and pharyngeal anomalies that arise independently of altered neural development, pediatric dysphagia may result from disrupted hindbrain patterning and its impact on peripheral and central neural circuit development critical for feeding and swallowing. The mechanisms that disrupt hindbrain patterning and circuitry may provide a foundation to develop novel therapeutic approaches for improved clinical management of pediatric dysphagia.
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Affiliation(s)
- Anthony-Samuel LaMantia
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Sally A Moody
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Thomas M Maynard
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Beverly A Karpinski
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Irene E Zohn
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Center for Neuroscience Research, Children's National Health System, Washington D.C., USA
| | - David Mendelowitz
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Norman H Lee
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Anastas Popratiloff
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
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Liang H, Song J, Shen D, Qiao Y, Zhang J. Co-firing of levator palpebrae and masseter muscles links the masticatory and oculomotor system in humans. J Biomed Res 2015; 29:316-20. [PMID: 26243518 PMCID: PMC4547380 DOI: 10.7555/jbr.29.20150084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 07/07/2015] [Indexed: 11/22/2022] Open
Abstract
Simultaneous co-firing of the levator palpebrae (LP) and pterygoid muscles were recorded in Marcus Gann Syndrome (MGS) patients in early clinical studies. “Release hypothesis” proposed an intrinsic masticatory oculomotor neural circuit and this kind circuit, which, however, has been observed only in amphibian. On the other hand, congenital miswiring hypothesis has overwhelmed other interpretations. However, the same phenomenon visualized in MGS cases was unveiled in human subjects without any sign of congenital oculomotor disorder. To further study co-firing of the upper eyelid and jaw muscles, we applied non-invasive EMG recording of the upper eyelid and ipsilateral masseter muscle belly in nine healthy volunteers. LP activity was determined initially by looking upward and active retraction of upper eyelid with head fixed. Then, dual channel inputs from upper eyelid and masseter muscle was recorded during tooth occlusion motivated by isometric masseter muscle contraction without jaw and face moving. The EMG recorded from upper eyelid when the subjects retracted eyelid with head fixed exhibited the same pattern as that collected during tooth occlusion, but the pattern was completely different from EMG of active eye closure. This reflects tooth occlusion evoked LP activity. Then, simultaneous co-firing of the LP and masseter muscle was recorded simultaneously during tooth occlusion without jaw movement. Finally, the aforementioned co-firing was recorded when the subjects conducted rhythmic occlusion and synchronous EMG from both muscles was acquired. In conclusions, humans may also have an intrinsic masticatory oculomotor circuit and release hypothesis may apply, at least, to some cases of MGS.
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Affiliation(s)
- Houcheng Liang
- Shaanxi Provincial Eye Research Institute and Xi'an Eye Hospital, Xian First Hospital, 30 Nanda Street, Xi'an, Shannxi 710002, China.,Department of Ophthalmology, 2nd Affiliated Hospital, Xi'an Jiao-Tong University, Xi'an, Shannxi 710002, China. lianghc1@163com
| | - Jinxin Song
- Shaanxi Provincial Eye Research Institute and Xi'an Eye Hospital, Xian First Hospital, 30 Nanda Street, Xi'an, Shannxi 710002, China
| | - Di Shen
- Shaanxi Provincial Eye Research Institute and Xi'an Eye Hospital, Xian First Hospital, 30 Nanda Street, Xi'an, Shannxi 710002, China
| | - Ying Qiao
- Shaanxi Provincial Eye Research Institute and Xi'an Eye Hospital, Xian First Hospital, 30 Nanda Street, Xi'an, Shannxi 710002, China
| | - Jingdong Zhang
- Shaanxi Provincial Eye Research Institute and Xi'an Eye Hospital, Xian First Hospital, 30 Nanda Street, Xi'an, Shannxi 710002, China.,Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE68198, USA. ,
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Shawky RM, Gamal R, Abdelsattar Mohammad S. Moebius syndrome with macular hyperpigmentation, skeletal anomalies, and hypoplasia of pectoralis major muscle in an Egyptian child. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2015. [DOI: 10.1016/j.ejmhg.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Al-Haddad CE, Abdulaal M. Transposition surgery for inferior rectus fibrosis. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e1-3. [PMID: 25735010 DOI: 10.3928/01913913-20150224-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 01/13/2015] [Indexed: 11/20/2022]
Abstract
Congenital fibrosis of the extraocular muscles is a rare hereditary strabismus disorder. A case of congenital fibrosis of the inferior rectus muscles with severe chin-up posture and bilateral limitation of up gaze is reported. Bilateral large recessions of the tight inferior rectus muscles provided only partial improvement. Residual head posture and hypotropia were successfully corrected with bilateral horizontal rectus muscle transpositions toward the superior rectus muscles, despite persistently tight inferior rectus muscles at the time of surgery.
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Mendes S, Beselga D, Campos S, Neves A, Campos J, Carvalho S, Silva E, Castro Sousa JP. Possible rare congenital dysinnervation disorder: congenital ptosis associated with adduction. Strabismus 2015; 23:33-5. [PMID: 25581513 DOI: 10.3109/09273972.2014.999797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ptosis is defined as an abnormally low position of the upper eyelid margin. It can be congenital or acquired, uni or bilateral, and isolated or associated with other ocular and nonocular defects. We report a case of a female child, aged 8 years, with congenital right ptosis increased on right adduction and with left ptosis on left adduction. There was no horizontal ocular movement limitation. Apparent underaction of the right inferior oblique muscle was also present. We believe that within the possible mechanisms it is more likely that it is a congenital innervation dysgenesis syndrome (CID)/congenital cranial dysinnervation disorder (CCDD).
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Affiliation(s)
- Sílvia Mendes
- Ophthalmology Department , Leiria Hospital Center, Leiria , Portugal and
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Olawoye OO, Olusanya BA, Baiyeroju AM. Duane retraction syndrome in a Nigerian child. Pan Afr Med J 2014; 19:96. [PMID: 25722769 PMCID: PMC4337376 DOI: 10.11604/pamj.2014.19.96.4641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/14/2014] [Indexed: 11/28/2022] Open
Abstract
We report a case of a four year old Nigerian girl who presented to the paediatric unit of our eye clinic with complaints of a squint on looking to the right side and reduction in the size of the right eye when looking to the left. On examination, she had right exotropia in the primary position of gaze. There was limitation of abduction and widening of the palpebral fissure of the right eye on right gaze. On left gaze there was narrowing of the palpebral fissure of the right eye with marked limitation of adduction and an upshoot, or occasionally a downshoot, of the eyeball. This report demonstrates that Duane's syndrome occurs in West Africa. Therefore, detailed examination of all patients with squints is important to ensure accurate diagnosis and appropriate management of the patient's condition.
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The ECEL1-related strabismus phenotype is consistent with congenital cranial dysinnervation disorder. J AAPOS 2014; 18:362-7. [PMID: 25173900 DOI: 10.1016/j.jaapos.2014.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/20/2014] [Accepted: 03/23/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Congenital cranial dysinnervation disorders (CCDDs) are phenotypes of congenital incomitant strabismus and/or ptosis related to orbital dysinnervation. CCDDs have been associated with dominant or recessive monogenic mutations in at least 7 different genes (CHN1, SALL4, HOXA1, KIF21A, PHOX2A, TUBB3, ROBO3) that cause phenotypes such as Duane retraction syndrome, congenital fibrosis of the extraocular muscles, and horizontal gaze palsy with progressive scoliosis. Recently, arthrogryposis with or without strabismus has been shown to be caused by recessive mutations in ECEL1, a gene likely involved in neuromuscular junction formation. The strabismus phenotype in ECEL1-related cases has not always been detailed but may be a form of CCDD. To better define the ECEL1-related ophthalmic phenotype, we detail ophthalmic findings in 4 affected siblings from a consanguineous family and review documented ophthalmic findings for other reported mutation-positive cases. METHODS Affected family members were prospectively examined and the relevant literature was reviewed. RESULTS Ophthalmic findings were present in 3 of the 4 siblings with ECEL1-related distal arthrogryposis: bilateral ptosis with bilateral congenital fibrosis of the extraocular muscles, right ptosis with ipsilateral Y exotropia (exotropia increasing in upgaze), and right ptosis with ipsilateral Duane retraction syndrome. The fourth affected sibling, who had the mildest arthrogryposis, had no ophthalmic abnormalities. Of 26 other reported recessive ECEL1 mutation cases (14 families), all had arthrogryposis, 19 had documented ptosis, and 4 had documented complex strabismus. One of these cases had both documented ptosis and complex strabismus. CONCLUSIONS Our clinical findings are consistent with recessive ECEL1 mutations causing variably penetrant orbital dysinnervation phenotypes (ptosis and/or complex strabismus with abnormal synkinesis) in the context of arthrogryposisis, that is, with the ECEL1-related ophthalmic phenotype being a form of CCDD.
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Nascimento J, Pinto F. Asymmetric elevation of the eyes. Clin Pediatr (Phila) 2014; 53:911-3. [PMID: 24803636 DOI: 10.1177/0009922814533415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- João Nascimento
- Universidade do Porto, Porto, Portugal / Centro Hospitalar Porto
| | - Fátima Pinto
- Universidade do Porto, Porto, Portugal / Centro Hospitalar Porto
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Ali Z, Xing C, Anwar D, Itani K, Weakley D, Gong X, Pascual JM, Mootha VV. A novel de novo KIF21A mutation in a patient with congenital fibrosis of the extraocular muscles and Möbius syndrome. Mol Vis 2014; 20:368-75. [PMID: 24715754 PMCID: PMC3976685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 03/26/2014] [Indexed: 11/02/2022] Open
Abstract
PURPOSE To describe the phenotypic characteristics and clinical course of a sporadic case of congenital fibrosis of the extraocular muscles (CFEOM) and Möbius syndrome with a de novo mutation in the KIF21A gene encoding a kinesin motor protein. METHODS An individual with the rare combination of CFEOM and Möbius syndrome underwent comprehensive ophthalmologic and neurological evaluations. Magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) tractigraphy at 3T field strength was used to evaluate orbital, encephalic, and intracranial nerve integrity. The proband and her healthy parents underwent screening for mutations in the KIF21A, PHOX2A, and TUBB3 genes. RESULTS The patient exhibited congenital, nonprogressive, bilateral external ophthalmoplegia, bilateral ptosis, bilateral facial palsy, and developmental delay. Her inability to blink resulted in severe exposure keratopathy and subsequent corneal perforation requiring a penetrating keratoplasty. MRI revealed an unremarkable configuration of the axial central nervous system and preservation of the intracranial portion of cranial nerves I, II, III, V, VI, VII, and VIII (cranial nerve IV is not normally visualized by MRI). A novel and de novo heterozygous KIF21A mutation (c.1056C>G, p.Asp352Glu) in a highly conserved region of the gene was present in the proband. CONCLUSIONS The reported KIF21A D352E mutation and associated phenotype further expand the clinical and mutational spectrum of CFEOM and Möbius syndrome.
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Affiliation(s)
- Zahra Ali
- University of Texas Southwestern Medical Center, Department of Ophthalmology, Dallas, TX
| | - Chao Xing
- University of Texas Southwestern Medical Center, McDermott Center for Human Growth and Development / Center for Human Genetics, Dallas, TX
| | - Didar Anwar
- University of Texas Southwestern Medical Center, Department of Ophthalmology, Dallas, TX
| | - Kamel Itani
- University of Texas Southwestern Medical Center, Department of Ophthalmology, Dallas, TX
| | - David Weakley
- University of Texas Southwestern Medical Center, Department of Ophthalmology, Dallas, TX
| | - Xin Gong
- University of Texas Southwestern Medical Center, Department of Ophthalmology, Dallas, TX
| | - Juan M. Pascual
- University of Texas Southwestern Medical Center, Rare Brain Disorders Program, Departments of Neurology and Neurotherapeutics, Physiology and Pediatrics, Dallas, TX
| | - V. Vinod Mootha
- University of Texas Southwestern Medical Center, Department of Ophthalmology, Dallas, TX,University of Texas Southwestern Medical Center, McDermott Center for Human Growth and Development / Center for Human Genetics, Dallas, TX
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Abu-Amero KK, Bosley TM, Kondkar AA, Oystreck DT, Khan AO. CCDD Phenotype Associated with a Small Chromosome 2 Deletion. Semin Ophthalmol 2014; 30:435-42. [PMID: 24475916 DOI: 10.3109/08820538.2013.874474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Some individuals are born with congenital limitation of ocular motility, often associated with ptosis and retraction of the globe. Many of these disorders are now known as the congenital cranial dysinnervation disorders (CCDDs). While several genes have been associated with CCDD phenotypes, there are still patients for whom the genetic basis has not been identified. METHODS Clinical evaluation and neuroimaging, sequencing of candidate genes, and array comparative genomic hybridization (array CGH). RESULTS The patient was a four-year-old girl with mild dysmorphism; bilateral mild ptosis; substantial limitation of abduction OS with milder limitations of abduction OD, adduction OS, and vertical gaze OS; and retraction OS > OD on attempted adduction. No mutations were detected in the HOXA1, KIF21A, SALL4, TUBB3, and CHN1 genes. Array CGH revealed a 8 Kb de novo deletion on chromosome 2 (2q24.3) that encompassed a portion of only one gene, the Xin Actin-binding Repeat containing 2 (Gene Symbol XIRP2; NM_001079810). This gene encodes a protein that is involved in muscle development and protecting actin filaments from depolymerization. It interacts functionally with 10 other proteins playing a similar role in muscle development. CONCLUSIONS This patient's chromosomal abnormality affected only one gene that currently seems involved only in muscle development. All other genes currently associated with the CCDDs affect neurologic development. Genetic information from this patient implies that genes involved in development and maintenance of extraocular muscles can cause congenital ocular motility disorders as well.
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Affiliation(s)
- Khaled K Abu-Amero
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia .,b Department of Ophthalmology , College of Medicine, University of Florida , Jacksonville , Florida , USA
| | - Thomas M Bosley
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Altaf A Kondkar
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Darren T Oystreck
- a Department of Ophthalmology , College of Medicine, King Saud University , Riyadh , Saudi Arabia .,c Division of Ophthalmology, Faculty of Health Sciences , University of Stellenbosch , Tygerberg , South Africa , and
| | - Arif O Khan
- d Division of Pediatric Ophthalmology , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
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Kaeser PF, Brodsky MC. Fourth cranial nerve palsy and Brown syndrome: two interrelated congenital cranial dysinnervation disorders? Curr Neurol Neurosci Rep 2013; 13:352. [PMID: 23636931 DOI: 10.1007/s11910-013-0352-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Based on neuroimaging data showing absence of the trochlear nerve, congenital superior oblique palsy is now classified as a congenital cranial dysinnervation disorder. A similar absence of the abducens nerve is accompanied by misinnervation to the lateral rectus muscle from a branch of oculomotor nerve in the Duane retraction syndrome. This similarity raises the question of whether some cases of Brown syndrome could arise from a similar synkinesis between the inferior and superior oblique muscles in the setting of congenital superior oblique palsy. This hypothesis has gained support from the confluence of evidence from a number of independent studies. Using Duane syndrome as a model, we critically review the accumulating evidence that some cases of Brown syndrome are ultimately attributable to dysgenesis of the trochlear nerve.
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Affiliation(s)
- Pierre-François Kaeser
- Jules Gonin Eye Hospital, University of Lausanne, Avenue de France 15, 1004, Lausanne, Switzerland.
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Chalvatzis NT, Tzamalis AK, Ziakas N, Kalantzis G, Dimitrakos SA, Harrad RA. Congenital ptosis associated with combined superior rectus, lateral rectus, and levator palpebrae synkinesis: the first reported case. Eye (Lond) 2013; 27:1107-9. [DOI: 10.1038/eye.2013.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Merino P, Gómez de Liaño P, Fukumitsu H, Franco G, Ruiz Y. Congenital fibrosis of the extraocular muscles: magnetic resonance imaging findings and surgical treatment. Strabismus 2013; 21:183-9. [DOI: 10.3109/09273972.2013.811605] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Comitant strabismus: Perspectives, present and future. Saudi J Ophthalmol 2013; 26:265-70. [PMID: 23961004 DOI: 10.1016/j.sjopt.2012.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 05/08/2012] [Accepted: 05/15/2012] [Indexed: 11/24/2022] Open
Abstract
Comitant strabismus is a common condition affecting infants, children and adults. Its impact on the affected patient may be severe resulting in visual loss, lack of binocularity, diplopia, social stigma and multiple corrective surgeries within the affected individual's lifespan. It is therefore important that this prevalent disorder should be better understood. We review the current understanding of the demographics and what is known of the etiology, risk factors and genetics of strabismus. We stress the importance of careful clinical assessment in classifying strabismus, and the common pitfalls in the measurement and pre-operative sensory work-up of the strabismic patient. The fact strabismus is comitant does not indicate it is benign: acute onset of comitant esotropia may be a presenting sign of pontine or cerebellar tumor. Lastly, we review the impact of genetics on our understanding of strabismus. While the causes of many types of congenital incomitant strabismus have been elucidated through careful observation and genetic screening, the genetics of comitant strabismus are more complex and multifactorial. Only through careful study and recruitment of large groups of affected individuals and families can we start to answer the question: why is this group of patients pre-disposed to develop strabismus. Doing so will help identify patients at risk, to spare them from the significant morbidity associated with this common disorder.
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Shaaban S, Duzcan F, Yildirim C, Chan WM, Andrews C, Akarsu NA, Engle EC. Expanding the phenotypic spectrum of ECEL1-related congenital contracture syndromes. Clin Genet 2013; 85:562-7. [PMID: 23808592 DOI: 10.1111/cge.12224] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/25/2013] [Accepted: 06/21/2013] [Indexed: 02/06/2023]
Abstract
Using a combination of homozygosity mapping and whole-exome sequencing (WES), we identified a novel missense c.1819G>A mutation (G607S) in the endothelin-converting enzyme-like 1 (ECEL1) gene in a consanguineous pedigree of Turkish origin presenting with a syndrome of camptodactyly, scoliosis, limited knee flexion, significant refractive errors and ophthalmoplegia. ECEL1 mutations were recently reported to cause recessive forms of distal arthrogryposis. This report expands on the molecular basis and the phenotypic spectrum of ECEL1-associated congenital contracture syndromes.
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Affiliation(s)
- S Shaaban
- Department of Neurology; F.B. Kirby Neurobiology Center; Program in Genomics; Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Dubai Harvard Foundation for Medical Research, Boston, MA, USA
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Schröder JC, Läßig AK, Galetzka D, Peters A, Castle JC, Diederich S, Zechner U, Müller-Forell W, Keilmann A, Bartsch O. A boy with homozygous microdeletion of NEUROG1 presents with a congenital cranial dysinnervation disorder [Moebius syndrome variant]. Behav Brain Funct 2013; 9:7. [PMID: 23419067 PMCID: PMC3599919 DOI: 10.1186/1744-9081-9-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/23/2013] [Indexed: 01/20/2023] Open
Abstract
Background We report on a 6-year-old Turkish boy with profound sensorineural deafness, balance disorder, severe disorder of oral motor function, and mild developmental delay. Further findings included scaphocephaly, plagiocephaly, long palpebral fissures, high narrow palate, low-set posteriorly rotated ears, torticollis, hypoplastic genitalia and faulty foot posture. Parents were consanguineous. Methods and results Computed tomography and magnetic resonance imaging showed bilateral single widened cochlear turn, narrowing of the internal auditory canal, and bilateral truncation of the vestibulo-cochlear nerve. Microarray analysis and next generation sequencing showed a homozygous deletion of chromosome 5q31.1 spanning 115.3 kb and including three genes: NEUROG1 (encoding neurogenin 1), DCNP1 (dendritic cell nuclear protein 1, C5ORF20) and TIFAB (TIFA-related protein). The inability to chew and swallow, deafness and balance disorder represented congenital palsies of cranial nerves V (trigeminal nerve) and VIII (vestibulo-cochlear nerve) and thus a congenital cranial dysinnervation disorder. Conclusions Based on reported phenotypes of neurog1 null mutant mice and other vertebrates, we strongly propose NEUROG1 as the causative gene in this boy. The human NEUROG1 resides within the DFNB60 locus for non-syndromic autosomal recessive deafness on chromosome 5q22-q31, but linkage data have excluded it from being causative in the DFNB60 patients. Given its large size (35 Mb, >100 genes), the 5q22-q31 area could harbor more than one deafness gene. We propose NEUROG1 as a new gene for syndromic autosomal recessive hearing loss and congenital cranial dysinnervation disorder including cranial nerves V and VIII.
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Affiliation(s)
- Julia C Schröder
- Institute of Human Genetics, University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, D-55101, Mainz, Germany.
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Tawfik HA, Rashad MA. Surgical management of hypotropia in congenital fibrosis of extraocular muscles (CFEOM) presented by pseudoptosis. Clin Ophthalmol 2013; 7:1-6. [PMID: 23277737 PMCID: PMC3532037 DOI: 10.2147/opth.s35557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To describe the demographics, characteristics, management pitfalls, and outcomes of pseudoptosis associated with congenital fibrosis of the extraocular muscles (CFEOM). Methods A retrospective review was performed of eight patients presenting with ptosis and hypotropia to oculoplastic service. All patients underwent full ocular evaluation and magnetic resonance imaging of brain and orbit. Five of these patients underwent stepwise correction of hypotropia by single-stage adjustable strabismus surgery (SSASS), followed by a frontalis sling if needed. Results Eight patients had congenital strabismus with severe ptosis and a positive forced duction test. There was a highly significant improvement from preoperative mean hypotropia angle of 30 prism diopters (PD) to 9 PD mean postoperative angle (P = 0.006). Surgery for ptosis was not needed in 80% of eyes. Conclusion CFEOM involving both ptosis and hypotropia could be properly managed with the correct sequence of surgical steps. Proper vertical alignment by correction of hypotropia utilizing SSASS may alleviate the need for ptosis surgery.
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Affiliation(s)
- Hatem A Tawfik
- Oculoplastic Service, Ophthalmology Department, Ain Shams University, Cairo, Egypt
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Tawfik HA, Rashad MA. Surgically mismanaged ptosis in a patient with congenital fibrosis of the extraocular muscles type I. Middle East Afr J Ophthalmol 2012; 19:416-8. [PMID: 23248547 PMCID: PMC3519132 DOI: 10.4103/0974-9233.102764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Fibrosis syndromes comprise a rare form of severe limitation of ocular motility. An 11-year-old girl was referred for the correction of eyelid retraction. The eyelid retraction occurred immediately following levator resection surgery performed by a plastic surgeon who missed the restrictive extraocular muscle abnormalities. On examination, both eyes were fixed in an infraducted position (20 prism diopters (Δ)), with a chin-up position and significant lagophthalmos. Bilateral 12-mm inferior rectus recession with adjustable sutures was performed, which resulted in significant reduction of lagophthalmos and elimination of the head tilt.
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Affiliation(s)
- Hatem A Tawfik
- Department of Ophthalmology, Ain-Shams University, Cairo, Egypt
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Webb B, Shaaban S, Gaspar H, Cunha L, Schubert C, Hao K, Robson C, Chan WM, Andrews C, MacKinnon S, Oystreck D, Hunter D, Iacovelli A, Ye X, Camminady A, Engle E, Jabs E. HOXB1 founder mutation in humans recapitulates the phenotype of Hoxb1-/- mice. Am J Hum Genet 2012; 91:171-9. [PMID: 22770981 DOI: 10.1016/j.ajhg.2012.05.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 04/30/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022] Open
Abstract
Members of the highly conserved homeobox (HOX) gene family encode transcription factors that confer cellular and tissue identities along the antero-posterior axis of mice and humans. We have identified a founder homozygous missense mutation in HOXB1 in two families from a conservative German American population. The resulting phenotype includes bilateral facial palsy, hearing loss, and strabismus and correlates extensively with the previously reported Hoxb1(-/-) mouse phenotype. The missense variant is predicted to result in the substitution of a cysteine for an arginine at amino acid residue 207 (Arg207Cys), which corresponds to the highly conserved Arg5 of the homeodomain. Arg5 interacts with thymine in the minor groove of DNA through hydrogen bonding and electrostatic attraction. Molecular modeling and an in vitro DNA-protein binding assay predict that the mutation would disrupt these interactions, destabilize the HOXB1:PBX1:DNA complex, and alter HOXB1 transcriptional activity.
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Das VE. Responses of cells in the midbrain near-response area in monkeys with strabismus. Invest Ophthalmol Vis Sci 2012; 53:3858-64. [PMID: 22562519 DOI: 10.1167/iovs.11-9145] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate whether neuronal activity within the supraoculomotor area (SOA-monosynaptically connected to medial rectus motoneurons and encode vergence angle) of strabismic monkeys was correlated with the angle of horizontal misalignment and therefore helps to define the state of strabismus. METHODS Single-cell neural activity was recorded from SOA neurons in two monkeys with exotropia as they performed eye movement tasks during monocular viewing. RESULTS Horizontal strabismus angle varied depending on eye of fixation (dissociated horizontal deviation) and the activity of SOA cells (n = 35) varied in correlation with the angle of strabismus. Both near-response (cells that showed larger firing rates for smaller angles of exotropia) and far-response (cells that showed lower firing rates for smaller angles of exotropia) cells were identified. SOA cells showed no modulation of activity with changes in conjugate eye position as tested during smooth-pursuit, thereby verifying that the responses were related to binocular misalignment. SOA cell activity was also not correlated with change in horizontal misalignment due to A-patterns of strabismus. Comparison of SOA population activity in strabismic animals and normal monkeys (described in the literature) show that both neural thresholds and neural sensitivities are altered in the strabismic animals compared with the normal animals. CONCLUSIONS SOA cell activity is important in determining the state of horizontal strabismus, possibly by altering vergence tone in extraocular muscle. The lack of correlated SOA activity with changes in misalignment due to A/V patterns suggest that circuits mediating horizontal strabismus angle and those that mediate A/V patterns are different.
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Affiliation(s)
- Vallabh E Das
- College of Optometry, University of Houston, TX 77204, USA.
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