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Liu S, Ren Y, Wang D, Xiao D, Li Z, Xu D, Sun Y, Wang Z, Pang J. Case report: Familial foveal retinoschisis caused by CRB1 gene mutation in a family with recessive inheritance. Front Med (Lausanne) 2023; 10:1220075. [PMID: 37636578 PMCID: PMC10451074 DOI: 10.3389/fmed.2023.1220075] [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] [Received: 05/10/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
X-linked retinoschisis is more common in male children and rare in females. Clinically, male patients mainly present with early onset visual impairment or vision loss, and retinal retinoschisis due to division of the inner retina. We report a long-term observation of a female patient with familial foveal retinoschisis (FFR) caused by CRB1 gene with complex heterozygotic mutation. The initial symptoms of the female patient reported in this study were very similar to some early manifestations of X-linked retinoschisis (XLRS) caused by RS1 mutations involving macular fovea. However, as time going on, the splitting height at retinal fovea of FFR gradually decreased, and the splitting extent at retinal fovea of FFR gradually decreased.
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Affiliation(s)
- Shu Liu
- Shenyang He Eye Specialist Hospital, Shenyang, China
- Liaoning Provincial Innovation Center of Ophthalmology, Shenyang, China
| | - Yue Ren
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Di Wang
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Dan Xiao
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Zhuang Li
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Dan Xu
- Shenyang Weijing Biotechnology Co., Ltd., Shenyang, China
| | - Yan Sun
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Zhuoshi Wang
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Jijing Pang
- Shenyang He Eye Specialist Hospital, Shenyang, China
- Shenyang Weijing Biotechnology Co., Ltd., Shenyang, China
- Institute of Innovation Research for Precision Medical Treatment, He University, Shenyang, China
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Bloch E, Flores-Sánchez B, Georgiadis O, Sundaram V, Saihan Z, Mahroo OA, Webster AR, da Cruz L. AN ASSOCIATION BETWEEN STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS, PERIPHERAL RETINOSCHISIS, AND POSTERIOR HYALOID ATTACHMENT. Retina 2021; 41:2361-2369. [PMID: 33840784 PMCID: PMC7611880 DOI: 10.1097/iae.0000000000003191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Stellate nonhereditary idiopathic foveomacular retinoschisis is a disorder characterized by splitting of the retina at the macula, without a known underlying mechanical or inherited cause. This study investigates demographic, anatomical, and functional characteristics of subjects with stellate nonhereditary idiopathic foveomacular retinoschisis, to explore potential underlying mechanisms. METHODS In this single-site, retrospective, and cross-sectional, observational study, data were collected from 28 eyes from 24 subjects with stellate nonhereditary idiopathic foveomacular retinoschisis. Descriptive statistics were reported, based on the observed anatomico-functional features. RESULTS The visual acuity remained stable (median 20/20) in all subjects over a median follow-up of 17 months. All cases demonstrated foveomacular retinoschisis within Henle's fiber layer, at the junction of the outer plexiform and outer nuclear layers. This schisis cavity extended beyond the limits of the macular OCT temporally in all eyes. In most affected eyes, there were documented features of peripheral retinoschisis and broad attachment of the posterior hyaloid at the macula. Functional testing in a cross-sectional subset demonstrated normal retinal sensitivity centrally but an absolute scotoma peripherally. CONCLUSION Stellate nonhereditary idiopathic foveomacular retinoschisis seems to be associated with peripheral retinoschisis and anomalous or incomplete posterior hyaloid detachment. Despite chronic manifestation, this does not significantly affect central visual function but can manifest with profound loss of peripheral visual function.
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Affiliation(s)
- Edward Bloch
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
| | - Blanca Flores-Sánchez
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Odysseas Georgiadis
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Venki Sundaram
- Department of Ophthalmology, Luton and Dunstable University Hospital, United Kingdom
| | - Zubin Saihan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Omar A. Mahroo
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Andrew R. Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Lyndon da Cruz
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
- Wellcome EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
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Roshandel D, Thompson JA, Heath Jeffery RC, Sampson DM, Chelva E, McLaren TL, Lamey TM, De Roach JN, Durkin SR, Chen FK. Multimodal Retinal Imaging and Microperimetry Reveal a Novel Phenotype and Potential Trial End Points in CRB1-Associated Retinopathies. Transl Vis Sci Technol 2021; 10:38. [PMID: 34003923 PMCID: PMC7910635 DOI: 10.1167/tvst.10.2.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose Biallelic crumbs cell polarity complex component 1 (CRB1) mutations can present as Leber congenital amaurosis (LCA), retinitis pigmentosa (RP), or cystic maculopathy. This study reports a novel phenotype of asymptomatic fenestrated slit maculopathy (AFSM) and examines macular volume profile and microperimetry as clinical trial end points in CRB1-associated retinopathies. Methods Twelve patients from nine families with CRB1 mutation were recruited. Ultra-widefield (UWF) color fundus photography and autofluorescence (AF), spectral-domain optical coherence tomography (SD-OCT), microperimetry, and adaptive optics (AO) imaging were performed. Macular volume profiles were compared with age-matched healthy controls. Genotyping was performed using APEX genotyping microarrays, targeted next-generation sequencing, and Sanger sequencing. Results We identified one patient with LCA, five patients with RP, and four patients with macular dystrophy (MD) with biallelic CRB1 mutations. Two siblings with compound heterozygote genotype (c.[2843G>A]; [498_506del]) had AFSM characterized by localized outer retinal disruption on SD-OCT and parafoveal cone loss on AO imaging despite normal fundus appearance, visual acuity, and foveal sensitivity. UWF AF demonstrated preserved para-arteriolar retinal pigment epithelium (PPRPE) in all patients with RP. Microperimetry documented preserved central retinal function in six patients. The ratio of perifoveal-to-foveal retinal volume was greater than controls in 89% (8/9) of patients with RP or MD, whereas central subfield and total macular volume were outside normal limits in 67% (6/9). Conclusions AO imaging was helpful in detecting parafoveal cone loss in asymptomatic patients. Macular volume profile and microperimetry parameters may have utility as CRB1 trials end points. Translational Relevance Macular volume and sensitivity can be used as structural and functional end points for trials on CRB1-associated RP and MD.
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Affiliation(s)
- Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
| | - Jennifer A Thompson
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rachael C Heath Jeffery
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Danuta M Sampson
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Surrey Biophotonics, Centre for Vision, Speech and Signal Processing and School of Biosciences and Medicine, The University of Surrey, Guildford, UK
| | - Enid Chelva
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Terri L McLaren
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Tina M Lamey
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - John N De Roach
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Shane R Durkin
- Discipline of Ophthalmology and Visual Science, The University of Adelaide, South Australia, Australia.,Department of Ophthalmology, The Royal Adelaide and Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Abstract
PURPOSE To describe a foveomacular retinoschisis that has not been described. METHODS Patients with foveomacular retinoschisis were included. Exclusion criteria included refractive error over -6.00 diopters, presence of posterior staphyloma, positive RS1-gene mutation, family history of retinoschisis, optic disk abnormalities, or glaucoma. Vitrectomy was performed on eyes with functional or structural deterioration. RESULTS Seventeen eyes from 10 patients (15-30 years old, 8 females and 2 males) with foveoschisis were recruited, with bilateral involvement in 7 patients and unilateral in 3 patients. Vitrectomy was performed in 13 eyes (13/17, 76.5%). Seven eyes (6 patients) were operated soon after the first presentation because of poor vision and severe foveoschisis. Six eyes (6 patients) were operated 2 weeks to 13 months later because of deterioration of vision and foveoschisis. Preoperative vision was 20/134 ± 20/165, and postoperative vision was 20/25 ± 20/57, with visual improvement of 6.9 (4-14) lines. The mean postoperative follow-up period was 36.5 (15-69) months. Four eyes (4 patients) were asymptomatic, despite progression of foveoschisis. Three eyes (3 patients) maintained normal macula structures. CONCLUSION We report a foveomacular retinoschisis characterized by young age of onset, female predominant, no highly myopia, mostly bilateral involvement, and rapid progression of foveoschisis and visual acuity. Vitrectomy is effective in restoring anatomical structure and stabilize vision.
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Molday RS, Kellner U, Weber BHF. X-linked juvenile retinoschisis: clinical diagnosis, genetic analysis, and molecular mechanisms. Prog Retin Eye Res 2012; 31:195-212. [PMID: 22245536 PMCID: PMC3334421 DOI: 10.1016/j.preteyeres.2011.12.002] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 01/07/2023]
Abstract
X-linked juvenile retinoschisis (XLRS, MIM 312700) is a common early onset macular degeneration in males characterized by mild to severe loss in visual acuity, splitting of retinal layers, and a reduction in the b-wave of the electroretinogram (ERG). The RS1 gene (MIM 300839) associated with the disease encodes retinoschisin, a 224 amino acid protein containing a discoidin domain as the major structural unit, an N-terminal cleavable signal sequence, and regions responsible for subunit oligomerization. Retinoschisin is secreted from retinal cells as a disulphide-linked homo-octameric complex which binds to the surface of photoreceptors and bipolar cells to help maintain the integrity of the retina. Over 190 disease-causing mutations in the RS1 gene are known with most mutations occurring as non-synonymous changes in the discoidin domain. Cell expression studies have shown that disease-associated missense mutations in the discoidin domain cause severe protein misfolding and retention in the endoplasmic reticulum, mutations in the signal sequence result in aberrant protein synthesis, and mutations in regions flanking the discoidin domain cause defective disulphide-linked subunit assembly, all of which produce a non-functional protein. Knockout mice deficient in retinoschisin have been generated and shown to display most of the characteristic features found in XLRS patients. Recombinant adeno-associated virus (rAAV) mediated delivery of the normal RS1 gene to the retina of young knockout mice result in long-term retinoschisin expression and rescue of retinal structure and function providing a 'proof of concept' that gene therapy may be an effective treatment for XLRS.
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Affiliation(s)
- Robert S Molday
- Department of Biochemistry and Molecular Biology, Centre of Macular Research, University of British Columbia, 2350 Health Sciences Mall, Vancouver, B.C. V6T 1Z3, Canada.
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