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Zhang Q, Sun J, Liu Z, Wang H, Zhou H, Liu W, Jia H, Li N, Li T, Wang F, Sun X. Clinical and Molecular Characterization of AIPL1-Associated Leber Congenital Amaurosis/Early-Onset Severe Retinal Dystrophy. Am J Ophthalmol 2024; 266:235-247. [PMID: 38880373 DOI: 10.1016/j.ajo.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/07/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE This study aimed to characterize the clinical features, genetic findings, and genotype-phenotype correlations of patients with Leber congenital amaurosis (LCA) or early-onset severe retinal dystrophy (EOSRD) harboring biallelic AIPL1 pathogenic variants. DESIGN Retrospective case series. METHODS This study consecutively enrolled 51 patients from 47 families with a clinical diagnosis of LCA/EOSRD harboring disease-causing variants in the AIPL1 gene, from October 2021 to September 2023. Molecular genetic findings, medical history, and ophthalmic evaluation including visual acuity (VA), multimodal retinal imaging, and electrophysiologic assessment were reviewed. RESULTS Of the 51 patients (32 with LCA and 19 with EOSRD), 27 (53%) were females, and age at last review ranged from 0.5 to 58.4 years. We identified 28 disease-causing AIPL1 variants, with 18 being novel. In patients with EOSRD, the mean (range) VA was 1.3 (0.7-2.7) logMAR and 1.3 (0.5-2.3) logMAR for right and left eyes respectively, with an average annual decline of 0.03 logMAR (R2 = 0.7547, P < .01). For patients with LCA, the VA ranged from light perception to counting fingers. Optical coherence tomography imaging demonstrated preservation of foveal ellipsoid zone in the 5 youngest EOSRD patients and 9 LCA children. Electroretinography showed severe cone-rod patterns in 78.6% (11/14) of patients with EOSRD, while classical extinguished pattern was documented in all patients with LCA available for the examination. The most common mutation was the nonsense variants of c.421C>T, with an allele frequency of 53.9%. All patients with EOSRD carried at least one missense mutation, of whom 13 identified with c.152A>G and 5 with c.572T>C. Twenty-six patients with LCA harbored two null AIPL1 variants, while 18 were homozygous for c.421C>T and 6 were heterozygous for c.421C>T with another loss-of-function variant. CONCLUSIONS This study reveals distinct clinical features and variation spectrum between AIPL1-associated LCA and EOSRD. Patients harboring at least one nonnull mutation, especially c.152A>G and c.572T>C, were significantly more likely to have a milder EOSRD phenotype than those with two null mutations. Residual foveal outer retinal structure observed in the youngest proportion of patients suggests an early window for gene augmentation therapy.
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Affiliation(s)
- Quan Zhang
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China; National Clinical Research Center for Ophthalmic Diseases (QZ, JS, ZL, HW, WL, HJ, NL, TL, and XS), Shanghai, China
| | - Junran Sun
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China; National Clinical Research Center for Ophthalmic Diseases (QZ, JS, ZL, HW, WL, HJ, NL, TL, and XS), Shanghai, China
| | - Zishi Liu
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China; National Clinical Research Center for Ophthalmic Diseases (QZ, JS, ZL, HW, WL, HJ, NL, TL, and XS), Shanghai, China
| | - Hong Wang
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China; National Clinical Research Center for Ophthalmic Diseases (QZ, JS, ZL, HW, WL, HJ, NL, TL, and XS), Shanghai, China
| | - Hao Zhou
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China
| | - Wenjia Liu
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China; National Clinical Research Center for Ophthalmic Diseases (QZ, JS, ZL, HW, WL, HJ, NL, TL, and XS), Shanghai, China
| | - Huixun Jia
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China; National Clinical Research Center for Ophthalmic Diseases (QZ, JS, ZL, HW, WL, HJ, NL, TL, and XS), Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine (HJ, FW, and XS), Shanghai, China
| | - Ningdong Li
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China; National Clinical Research Center for Ophthalmic Diseases (QZ, JS, ZL, HW, WL, HJ, NL, TL, and XS), Shanghai, China
| | - Tong Li
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China; National Clinical Research Center for Ophthalmic Diseases (QZ, JS, ZL, HW, WL, HJ, NL, TL, and XS), Shanghai, China.
| | - Fenghua Wang
- Shanghai Engineering Center for Visual Science and Photomedicine (HJ, FW, and XS), Shanghai, China; Innostellar Biotherapeutics Co., Ltd (FW), Shanghai, China
| | - Xiaodong Sun
- From the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (QZ, JS, ZL, HW, HZ, WL, HJ, NL, TL, and XS), Shanghai, China; National Clinical Research Center for Ophthalmic Diseases (QZ, JS, ZL, HW, WL, HJ, NL, TL, and XS), Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine (HJ, FW, and XS), Shanghai, China; Shanghai Key Laboratory of Fundus Diseases (XS), Shanghai, China.
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Wang CT, Chang YH, Tan GSW, Lee SY, Chan RVP, Wu WC, Tsai ASH. Optical Coherence Tomography and Optical Coherence Tomography Angiography in Pediatric Retinal Diseases. Diagnostics (Basel) 2023; 13:diagnostics13081461. [PMID: 37189561 DOI: 10.3390/diagnostics13081461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
Indirect ophthalmoscopy and handheld retinal imaging are the most common and traditional modalities for the evaluation and documentation of the pediatric fundus, especially for pre-verbal children. Optical coherence tomography (OCT) allows for in vivo visualization that resembles histology, and optical coherence tomography angiography (OCTA) allows for non-invasive depth-resolved imaging of the retinal vasculature. Both OCT and OCTA were extensively used and studied in adults, but not in children. The advent of prototype handheld OCT and OCTA have allowed for detailed imaging in younger infants and even neonates in the neonatal care intensive unit with retinopathy of prematurity (ROP). In this review, we discuss the use of OCTA and OCTA in various pediatric retinal diseases, including ROP, familial exudative vitreoretinopathy (FEVR), Coats disease and other less common diseases. For example, handheld portable OCT was shown to detect subclinical macular edema and incomplete foveal development in ROP, as well as subretinal exudation and fibrosis in Coats disease. Some challenges in the pediatric age group include the lack of a normative database and the difficulty in image registration for longitudinal comparison. We believe that technological improvements in the use of OCT and OCTA will improve our understanding and care of pediatric retina patients in the future.
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Affiliation(s)
- Chung-Ting Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
| | - Yin-Hsi Chang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
| | - Gavin S W Tan
- Singapore National Eye Centre, Singapore, Singapore 168751, Singapore
- DUKE NUS Medical School, Singapore 169857, Singapore
| | - Shu Yen Lee
- Singapore National Eye Centre, Singapore, Singapore 168751, Singapore
- DUKE NUS Medical School, Singapore 169857, Singapore
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, IL 60612, USA
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Andrew S H Tsai
- Singapore National Eye Centre, Singapore, Singapore 168751, Singapore
- DUKE NUS Medical School, Singapore 169857, Singapore
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