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Cohen SY, Chowers I, Nghiem-Buffet S, Mrejen S, Souied E, Gaudric A. Subretinal autofluorescent deposits: A review and proposal for clinical classification. Surv Ophthalmol 2023; 68:1050-1070. [PMID: 37392968 DOI: 10.1016/j.survophthal.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
Subretinal autofluorescent deposits (SADs) may be found in the posterior pole, associated with very various conditions. These disorders usually present a typical pattern of autofluorescent lesions seen on short-wavelength fundus autofluorescence. We describe SADs according to their putative pathophysiological origin and also according to their clinical pattern, i.e., number, shape, and usual location. Five main putative pathophysiological origins of SADs were identified in disorders associated with an intrinsic impairment of phagocytosis and protein transportation, with excess of retinal pigment epithelium phagocytic capacity, with direct or indirect retinal pigment epithelium injury, and/or disorders associated with long-standing serous retinal detachment with mechanical separation between the retinal pigment epithelium and the photoreceptor outer segments. Clinically, however, they could be classified into eight subclasses of SADs, as observed on fundus autofluorescence as follows: single vitelliform macular lesion, multiple roundish or vitelliform lesions, multiple peripapillary lesions, flecked lesions, leopard-spot lesions, macular patterned lesions, patterned lesions located in the same area as the causal disorder, or nonpatterned lesions. Thus, if multimodal imaging may be required to diagnose the cause of SADs, the proposed classification based on noninvasive, widely available short-wavelength fundus autofluorescence could guide clinicians in making their diagnosis decision tree before considering the use of more invasive tools.
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Affiliation(s)
- Salomon Yves Cohen
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France.
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Hospital, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Sarah Mrejen
- Ophthalmology Center for Imaging and Laser, Paris, France
| | - Eric Souied
- Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France
| | - Alain Gaudric
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, AP-HP, Hôpital Lariboisière, Université Paris Cité, Paris, France
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Venkatesh R, Mishra P, Nahata H, Reddy NG, Yadav NK, Chhablani J. Retinal arcades in posterior microphthalmos: biometric correlation. Clin Exp Optom 2023; 106:619-625. [PMID: 35878881 DOI: 10.1080/08164622.2022.2104628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 07/02/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022] Open
Abstract
CLINICAL RELEVANCE Posterior microphthalmos (PM) is a rare developmental disorder characterised by high hyperopia, short axial length, presence of retinal papillomacular fold and relatively normal anterior segment findings. BACKGROUND The purpose of the study was to compare the retinal arcade distance from fovea between PM cases and to correlate axial shortening in PM eyes with imaging findings. METHODS This retrospective, comparative case series included 24 eyes of 12 patients with PM as cases and an equal number of age- and sex-matched controls. Retinal findings on optical coherence tomography (OCT), OCT-angiography, Multicolour® image, axial length and corneal biometry were computed, compared and correlated between two groups. RESULTS Retinal papillomacular fold was noted in all 24 PM eyes. Retinal arcade narrowing was noted in PM (p < 0.001). The central retina (p < 0.001) and choroid (p = 0.003) was thick in PM. Corneal biometry showed shorter axial length (p < 0.001), high keratometry readings (p < 0.001) and small corneal diameters (p = 0.011) in PM. Vessel density (p = 0.031) on OCTA was denser and foveal avascular zone area (p = 0.033) reduced in PM. Strong negative correlation of axial length with spherical equivalent (r = > -0.804;p < 0.001), vessel density (r = > -0.803; p = <0.001) and K1 (r = > -0.76; p < 0.001) and K2 (r = > -0.67; p = 0.001) keratometry readings was noted in PM. Significant positive correlation was noted between axial length and anterior chamber depth (r = 0.75; p < 0.001), foveal avascular zone area (r = 0.56; p = 0.033) and corneal diameter (r = 0.65; p = 0.001). Vessel density on OCT-angiography correlated positively with central corneal thickness (r = 0.552;p = 0.005) and corneal powers K1 (r = 0.709; p = 0.001) and K2 (r = 0.56; p = 0.004) and negatively with corneal diameter (r = > -0.521; p = 0.033). CONCLUSION Increased choroidal thickening and retinal vascular arcade narrowing were two important, interesting observations noted with PM. Intercorrelation between the axial length, OCT, OCT-angiography and corneal biometry helped in understanding the pathogenesis and the structural and vascular changes in PM eyes.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Karnataka, India
| | - Pranjal Mishra
- Department of Retina and Vitreous, Narayana Nethralaya, Karnataka, India
| | - Harshita Nahata
- Department of Retina and Vitreous, Narayana Nethralaya, Karnataka, India
| | | | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Hanyu T, Ueki S, Hasegawa Y, Kiyokawa M, Fukuchi T. Posterior microphthalmos with achievement of good visual acuity and disappearance of papillomacular retinal folds: a case report. BMC Ophthalmol 2022; 22:424. [PMID: 36344972 PMCID: PMC9639268 DOI: 10.1186/s12886-022-02648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Background Posterior microphthalmos (PM) is a rare condition with poor visual prognosis even after amblyopia treatment. We report a case of PM with achievement of good visual acuity and disappearance of papillomacular retinal folds (PFs) over a period of 7 years. Case presentation A girl aged 3 years and 5 months was referred to our hospital, after poor visual acuity was identified at a medical checkup for 3-year-olds. She had severe spherical hyperopia: + 17.25 D in the right eye (RE) and + 18 D in the left eye (LE). Her corrected visual acuity was 20/200 in the RE and 20/250 in the LE. PFs were observed in both eyes on optical coherence tomography (OCT), and the diagnosis of PM was made based on the normal corneal diameter and anterior chamber depth. During the course of the disease, a gradual decrease in the height of the PFs was observed on OCT. The corrected visual acuity at age 10 years was 20/20 in the RE and 20/25 in the LE. Conclusions The visual prognosis of PM is poor, and only one case with good visual acuity has been reported in the literature. The patient in the present case not only developed good visual acuity, but also showed improvement in macular morphology, which was not noted in previous reports. Early diagnosis of PM and early amblyopia treatment is important for the visual development in PM.
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Affiliation(s)
- Takako Hanyu
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan ,Hanyu Clinic, Igarashi-Higashi 1-1-15, Nishi-Ku, Niigata, 950-2045 Japan
| | - Satoshi Ueki
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan
| | - Yukari Hasegawa
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan
| | - Megumi Kiyokawa
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan ,Toshimi Eye Clinic, Katsubogawa 1-1-12, Sanjo City, Niigata, 955-0056 Japan
| | - Takeo Fukuchi
- grid.260975.f0000 0001 0671 5144Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi-Dori 1-757, Chuo-Ku, Niigata, 951-8510 Japan
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Venkatesh R, Arora S, Reddy NG, Rubble M, Yadav NK, Chhablani J. Choroidal changes in posterior microphthalmos. Eur J Ophthalmol 2022:11206721221112806. [PMID: 35791500 DOI: 10.1177/11206721221112806] [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: 11/16/2022]
Abstract
PURPOSE To describe the choroidal variations in posterior microphthalmos (PM). METHODS In this observational case series, four eyes of two patients diagnosed as PM based on the characteristic clinical features were included. Multimodal retinal imaging with clinical fundus documentation using ultrawide field fundus camera, optical coherence tomography (OCT) and indocyanine green angiography (ICGA) was done for these cases. RESULTS Multimodal imaging of these cases confirmed the variations in the choroid in PM cases. In both cases, on OCT, the retina and choroid were thick. retinal papillomacular fold (RPMF) was noted in all four eyes. On ICGA, the dye transit time from the arm to choroid and retina were within normal limits. Choroidal vasculature in the far retinal periphery was reduced and was noted as hypocyanescent areas anterior to the equator while the density of choroidal vessels was significantly more posterior to the equator. Vortex veins were not visualised in both cases. CONCLUSION Choroidal structure and vessels undergo alterations in PM. Further validation of these findings is required in a larger cohort of PM cases.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sahil Arora
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Nikitha Gurram Reddy
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Mangla Rubble
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, 80219Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Wen S, Min X, Zhu Y, Zhou X. Genetic analysis assists diagnosis of clinical systemic disease in children with excessive hyperopia. BMC Pediatr 2022; 22:305. [PMID: 35610621 PMCID: PMC9128117 DOI: 10.1186/s12887-021-02992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background A thorough examination (especially those including visual functional evaluation) is very important in children’s eye-development during clinical practice, when they encountered with unusual excessive hyperopia especially accompanied with other possible complications. Genetic testing would be beneficial for early differential diagnosis as blood sampling is more convenient than all other structural imaging capture tests or functional tests which need children to cooperate well. Thus genetic testing helps us to filter other possible multi-systemic diseases in children patients with eye disorder. Case presentation A 3-year-old and an 8-year-old boy, both Chinese children clinically manifested as bilateral excessive hyperopia (≥+10.00), severe amblyopia and exotropia, have been genetically diagnosed as Senior-Loken syndrome-5 (SLSN5) and isolated posterior microphthalmos (MCOP6), respectively. Conclusions This report demonstrates the importance of genetic diagnosis before a clinical consult. When children are too young to cooperate with examinations, genetic testing is valuable for predicting other systemic diseases and eye-related development and for implementing early interventions for the disease.
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Affiliation(s)
- Shijin Wen
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Xiaoshan Min
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan Province, China.
| | - Ying Zhu
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Xia Zhou
- Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, Hunan Province, China
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Raval N, Zhang C, Yao WJ, Lin J. Posterior segment abnormalities in posterior microphthalmos. Am J Ophthalmol Case Rep 2020; 20:100915. [PMID: 32964171 PMCID: PMC7490723 DOI: 10.1016/j.ajoc.2020.100915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose We report a case of posterior microphthalmos with characteristic papillomacular retinal folds, pigmentary retinopathy, and optic disc drusen. Observations A 19-year-old female presented with decreased visual acuity and was found to have bilateral posterior microphthalmos with the presence of papillomacular retinal folds, crowded optic nerves with buried disc drusen, and peripheral retinal pigmentary changes. Optical coherence tomography showed presence of retinal folds involving the inner retinal layers and loss of foveal contour. Conclusions and Importance Posterior microphthalmos can present with an array of unique clinical findings involving the posterior segment. It is important to recognize these findings as these patients often have decreased visual acuity and are at risk for the development of other posterior complications.
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Affiliation(s)
| | | | | | - James Lin
- Corresponding author. Department of Ophthalmology, Montefiore Medical Center 3332 Rochambeau Ave, 3rd Floor, 10467, Bronx, NY, USA.
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Posterior microphthalmos with good visual acuity: A case report. Am J Ophthalmol Case Rep 2019; 16:100568. [PMID: 31763497 PMCID: PMC6859220 DOI: 10.1016/j.ajoc.2019.100568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 11/01/2019] [Accepted: 11/03/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose We report the case of an 11-year-old boy with posterior microphthalmos who exhibited normal and age appropriate development of visual acuity. Observations At the initial diagnosis, when he was 3 years old, the best-corrected visual acuity (BCVA) was 20/125 in the right eye (OD) and 20/200 in the left eye (OS) with high hyperopia (cycloplegic refraction +15.75 D sphere OD and +16.25 D sphere OS). Eight years after he began wearing hyperopic glasses, BCVA was 20/16 OD and 20/20 OS. Optical coherence tomography did not reveal a foveal pit in either eye throughout the observation period. However, elongation of the outer segment and widening of the outer nuclear layers were observed. Conclusion and Importance Many cases of posterior microphthalmos demonstrate subnormal BCVA due to an abnormal foveal structure (papillomacular retinal folds, absence of the foveal pit and avascular zone) and high hyperopia. However, if foveal maturity progresses, even if the foveal structure is abnormal, early aggressive amblyopia treatment can result in normal and age appropriate development of visual acuity.
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Kumar V, Azad SV, Vohra R, Venkatesh P. Serous macular detachment in nanophthalmos: A manifestation of pachychoroid spectrum. Am J Ophthalmol Case Rep 2019; 15:100522. [PMID: 31384695 PMCID: PMC6661461 DOI: 10.1016/j.ajoc.2019.100522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose The purpose of this article is to report serous macular detachment (SMD) similar to that seen in central serous chorioretinopathy (CSCR) in patients with nanophthalmos. Observation It is a retrospective case series from a tertiary eye care center in India. Multi modal imaging features of eyes with serous macular detachment in patients with nanophthalmos including colour fundus photographs, short wave autofluorescence, fundus fluorescein angiography and optical coherence tomography were studied. In addition axial length, anterior chamber depth, lens thickness and subfoveal choroidal thickness were measured. The eyes were treated with laser photocoagulation to the focal leak seen on fluorescein angiography. The patients were followed up for 12–18 months. Results Three eyes of three patients having serous macular detachment in nanophthalmos were identified. All three eyes had axial length <21mm, subfoveal choroidal thickness >450 microns and a focal leak on fluorescein angiography. Two eyes had serous pigment epithelial detachments underneath the SMD as well. Two eyes had peripheral pigmentary changes due to resolved subretinal fluid. The SMD resolved completely in two eyes and partially in one eye following focal laser photocoagulation. Conclusion and importance Serous macular detachments bearing features similar to that of CSCR can occur in the setting of nanophthalmos. These may represent manifestation of thick choroid or may represent forme fruste choroidal effusion.
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Novel truncation mutations in MYRF cause autosomal dominant high hyperopia mapped to 11p12-q13.3. Hum Genet 2019; 138:1077-1090. [PMID: 31172260 PMCID: PMC6745028 DOI: 10.1007/s00439-019-02039-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/04/2019] [Indexed: 12/15/2022]
Abstract
High hyperopia is a common and severe form of refractive error. Genetic factors play important roles in the development of high hyperopia but the exact gene responsible for this condition is mostly unknown. We identified a large Chinese family with autosomal dominant high hyperopia. A genome-wide linkage scan mapped the high hyperopia to chromosome 11p12-q13.3, with maximum log of the odds scores of 4.68 at theta = 0 for D11S987. Parallel whole-exome sequencing detected a novel c.3377delG (p.Gly1126Valfs*31) heterozygous mutation in the MYRF gene within the linkage interval. Whole-exome sequencing in other 121 probands with high hyperopia identified additional novel mutations in MYRF within two other families: a de novo c.3274_3275delAG (p.Leu1093Profs*22) heterozygous mutation and a c.3194+2T>C heterozygous mutation. All three mutations are located in the C-terminal region of MYRF and are predicted to result in truncation of that portion. Two patients from two of the three families developed angle-closure glaucoma. These three mutations were present in neither the ExAC database nor our in-house whole-exome sequencing data from 3280 individuals. No other truncation mutations in MYRF were detected in the 3280 individuals. Knockdown of myrf resulted in small eye size in zebrafish. These evidence all support that truncation mutations in the C-terminal region of MYRF are responsible for autosomal dominant high hyperopia in these families. Our results may provide useful clues for further understanding the functional role of the C-terminal region of this critical myelin regulatory factor, as well as the molecular pathogenesis of high hyperopia and its associated angle-closure glaucoma.
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Comparison between Refractive Outcome of Primary Piggyback Intraocular Lens versus Secondary Lens Iris Claw Lens in Posterior Microphthalmos. J Ophthalmol 2019; 2019:1356982. [PMID: 30895155 PMCID: PMC6393898 DOI: 10.1155/2019/1356982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare the refractive outcome of 2 different methods of intraocular lens implantation in cases of posterior microphthalmos, primary piggyback IOLs versus secondary iris claw lenses. Methods This study was a retrospective interventional comparative study that included 60 eyes of 30 patients. The included patients had bilateral microphthalmos with high axial hyperopia and had undergone a lens-based surgical procedure for hyperopia correction. The included patients were equally divided into two groups. The first group had undergone refractive lens exchange (RLE) with primary piggyback IOL implantation. The second group undergone RLE with maximum available IOL power implanted followed by a secondary implantation of Artisan iris-fixated IOL (Ophtec B.V., Groningen, the Netherlands). Results The 2 groups were highly comparable to each other regarding the mean age, axial length (AL), manifest refraction (MR), and K readings. Postoperatively, there was a statistically significant difference between the 2 groups regarding the manifest refraction spherical equivalent (MRSE), mean absolute error (MAE), and uncorrected distance visual acuity (UDVA). There was no significant difference between the 2 groups regarding the CDVA. At 36 months, 20% and 73% of the eyes were within ±0.5 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively. Fifty-three percent and 93% of the eyes were within ±1.0 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively (p=0.001). Conclusion Secondary procedure with implantation of iris-fixated intraocular lens yielded very good results for treatment of axial hyperopia in cases of posterior microphthalmos. The primary piggyback IOL showed less satisfactory results with cases of under correction and the possible complication of interlenticular opacification. Both groups showed good safety parameters.
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Zor KR, Küçük E, Günaydın NT, Önder F. Ocular findings in posterior microphthalmos. Saudi J Ophthalmol 2019; 33:41-45. [PMID: 30930662 PMCID: PMC6424690 DOI: 10.1016/j.sjopt.2018.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 09/07/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022] Open
Abstract
AIM To report a critical case series of six patients with posterior microphthalmos (PM). METHOD Complete ophthalmologic examinations of all patients were performed using best-corrected visual acuity (BCVA), cycloplegic refraction, applanation tonometry, slit lamp biomicroscopy of the anterior segment, fundoscopy, A and B mode ultrasonography (USG), keratometry, and optic coherence tomography (OCT). RESULTS The most significant clinical characteristics of male patients aged 10-25 years was the presence of shorter posterior segments (mean: 15.27-18.91 mm) accompanying high hyperopia (mean +9.00 - +18.50 diopter) despite the normal anterior segment findings. The BCVA ranged between 20/320 and 40/100. Retinal folds were detected bilaterally on the papillomacular band in all patients. Although neurosensory retina was included in the fold in OCT images, retinal pigment epithelium, choroid, and sclera were not included in the fold. Pigmentary retinopathy was detected in one patient. CONCLUSION Despite normal anterior segment, posterior microphthalmos is characterized with high hyperopia, and shorter axial length and bilateral papillomacular retinal fold. Refractive amblyopia, uveal effusion syndrome, retinal detachment and macular hole are complications that can be corrected. Posterior microphthalmos must be kept in mind in patients with a normal anterior segment, and high hyperopia.
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Affiliation(s)
- Kürsad Ramazan Zor
- Ophthalmology Department, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Erkut Küçük
- Ophthalmology Department, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Nesrin Tutaş Günaydın
- Ophthalmology Department, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey
| | - Feyza Önder
- Ophthalmology Department, Haseki Training and Research Hospital, İstanbul, Turkey
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Liu JJ, Chen YY, Zhang X, Zhao PQ. Clinical features of posterior microphthalmic and nanophthalmic eyes. Int J Ophthalmol 2018; 11:1829-1834. [PMID: 30450315 DOI: 10.18240/ijo.2018.11.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/15/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To clinically differentiate nanophthalmos (NO) and posterior microphthalmos (PM) and to explore the mechanisms related to papillomacular folds (PMF). METHODS Medical records of 34 unrelated patients with microphthalmos (54 eyes) from April 2009 to October 2017 were retrospectively reviewed. RESULTS Fourteen eyes of 7 unrelated patients with NO and PM were included in the study. The presenting age of the NO cohort was significantly higher compared with the PM cohort (NO: 27±16y; PM: 3.7±0.6y). PMF was more likely to occur in cases with PM than in NO (25% in NO, 100% in PM). The anatomic features of PMF from optical coherence tomography (OCT) included: ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and outer nuclear layer. In eyes without an apparent PMF (these were all NO eyes), rudimentary fovea without a foveal pit was noted. Four eyes that were NO developed angle closure glaucoma. Three NO eyes developed exudative retinal detachment and were successfully treated with lamellar sclerectomy. CONCLUSION Posterior segment changes are pervasive both in PM and NO. Complications like angle closure glaucoma and exudative retinal detachment are likely to occur in eyes with NO but not with PM. Detailed OCT analysis found that PMF was partially a neural retinal issue, suggesting that redundancy of retinal issues involved only inner retinal layers.
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Affiliation(s)
- Jing-Jing Liu
- Department of Ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yi-Ye Chen
- Department of Ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xiang Zhang
- Department of Ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Pei-Quan Zhao
- Department of Ophthalmology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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Smirnov VM, Zeitz C, Soumittra N, Audo I, Defoort-Dhellemmes S. Retinal findings in a patient of French ancestry with CABP4-related retinal disease. Doc Ophthalmol 2018. [PMID: 29525873 DOI: 10.1007/s10633-018-9629-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION CABP4-related retinal dysfunction is a cone-rod synaptic transmission disorder with electronegative electroretinogram (ERG) waveform. It is a rare retinal dysfunction that can be classified into the incomplete form of congenital stationary night blindness. Absent foveal reflex and overall foveal thinning were previously reported, but in most cases the fundus appearance was described as nearly normal. We report here peculiar macular changes in a patient of French ancestry harbouring CABP4 mutations. METHODS Complete ocular examination and full-field ERG were performed at the initial presentation and follow-up. Multimodal fundus imagining, including spectral-domain optical coherence tomography, colour, infrared reflectance and short-wavelength autofluorescence photographs, was performed during follow-up visits. RESULTS A 7-month-old infant was addressed to our department for visual unresponsiveness and nystagmus. ERG had an electronegative waveform, even for light-adapted stimuli, thus supporting the diagnosis of photoreceptor-bipolar cell transmission disorder. Genetic investigations discovered a compound heterozygous mutation in CABP4: c.646C > T, p.Arg216*/c.673C > T, p.Arg225*. Multimodal fundus imaging, performed at follow-up visits, showed fine radial folds at the vitreomacular interface and dark foveal dots in both eyes. Optic coherence tomography revealed a focal foveal ellipsoid zone gap. DISCUSSION Initial presentation was misleading with Leber congenital amaurosis. The electronegative ERG waveform reoriented the genetic investigations and thus establishing a correct diagnosis. To the best of our knowledge, the peculiar fundus changes observed in our patient were never reported before. We hypothesized that a foveal ellipsoid zone interruption discovered in our patient could reflect mostly a cone dysfunction. It was unclear whether the fine radial folds in both maculae were linked with high hyperopia or were an intrinsic feature of the retinal disease. CONCLUSION CABP4-related retinal disease is a cone-rod system disorder with possible foveal abnormalities.
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Affiliation(s)
- Vasily Mikhaïlovitch Smirnov
- Exploration of Vision and Neuro-Ophthalmology Department, Lille University Hospital, Rue Emilie Laine, 59037, Lille Cedex, France. .,Faculté de Médecine, Université de Lille, 1, Place de Verdun, 59000, Lille Cedex, France.
| | - Christina Zeitz
- UPMC Univ Paris 06, INSERM U968, CNRS UMR 7210, Institut de la Vision, Sorbonne Universités, Paris, France
| | - Nagasamy Soumittra
- SN ONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Chennai, India
| | - Isabelle Audo
- UPMC Univ Paris 06, INSERM U968, CNRS UMR 7210, Institut de la Vision, Sorbonne Universités, Paris, France.,DHU ViewMaintain, INSERM-DHOS CIC 1423, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.,University College London Institute of Ophthalmology, London, UK
| | - Sabine Defoort-Dhellemmes
- Exploration of Vision and Neuro-Ophthalmology Department, Lille University Hospital, Rue Emilie Laine, 59037, Lille Cedex, France
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