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Xia JL, Kadom N, Mansukhani SA, Couser NL, Lenhart PD. Magnetic Resonance Imaging Findings and Genetic Testing Results in Children With Congenital Corneal Opacities. Am J Ophthalmol 2024; 259:62-70. [PMID: 37907146 DOI: 10.1016/j.ajo.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE This study investigates brain and globe abnormalities identified on magnetic resonance imaging (MRI) in children with congenital corneal opacities (CCO). DESIGN Retrospective cohort study. METHODS Clinical notes, radiology records, and genetic testing results were reviewed for patients diagnosed with corneal opacification within the first 6 months of life at a tertiary referral academic center between August 2008 and January 2018. Ocular findings, systemic anomalies, neuroimaging, and genetic testing results were summarized. RESULTS A total of 135 patients presenting at age 1 day to 12 years (mean age, 1 year) were identified. Children with bilateral CCO were more likely to have systemic disease (P = 0.018). Of the entire cohort, 43 (31.8%) patients received MRI, of whom 27 (62.8%) had abnormal brain findings and 30 (69.7%) had abnormal orbital findings. The most common abnormal brain findings were ventriculomegaly (n = 16, 59.2%) and corpus callosum abnormalities (n = 10, 37.0%) followed by brainstem/pons anomalies (n = 5, 18.5%), and cerebellar anomalies (n = 2, 7.4%). Abnormal brain MRI findings were associated with the presence of neurologic (P = .003) and craniofacial (P = .034) disease. A total of 44 (32.1%) patients underwent genetic testing, of whom 29 (65.9%) had pathogenic results. CONCLUSIONS More than 60% of the children with CCO who underwent MRI had abnormal brain and orbit findings that were correlated with significant neurologic disease. Furthermore, almost two-thirds of patients with CCO who underwent genetic testing had pathogenic results. These data demonstrate the value of systemic workup in children with CCO, and highlight the role of ophthalmologists in facilitating the diagnosis of systemic comorbidities associated with CCO.
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Affiliation(s)
- Julia L Xia
- University of Colorado Sue Anschutz-Rodgers Eye Center (J.L.X.), Aurora, Colorado, USA.
| | - Nadja Kadom
- Department of Radiology (N.K.), Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Natario L Couser
- Department of Ophthalmology (N.L.C.), Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA; Department of Pediatrics (N.L.C.), Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA; Department of Human and Molecular Genetics (N.L.C.), Division of Clinical Genetics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Phoebe D Lenhart
- Emory Eye Center (P.D.L.), Emory University School of Medicine, Atlanta, Georgia, USA
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Miraldi Utz V, Brightman DS, Sandoval MA, Hufnagel RB, Saal HM. Systemic and ocular manifestations of a patient with mosaic ARID1A-associated Coffin-Siris syndrome and review of select mosaic conditions with ophthalmic manifestations. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:644-655. [PMID: 32888375 DOI: 10.1002/ajmg.c.31839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/16/2022]
Abstract
Mosaic genetic mutations may be somatic, germline, or "gonosomal" and have the potential to cause genetic syndromes, disorders, or malformations. Mutations can occur at any point in embryonic development and the timing determines the extent of distribution of the mutation throughout the body and different tissue types. The eye and visual pathway offer a unique opportunity to study somatic and gonosomal mosaic mutations as the eye consists of tissues derived from all three germ layers allowing disease pathology to be assessed with noninvasive imaging. In this review, we describe systemic and ocular manifestations in a child with mosaic Coffin-Siris syndrome. The patient presented with a significant medical history of accommodative esotropia and hyperopia, macrocephaly, polydactyly, global developmental delay, hypotonia, ureteropelvic junction (UPJ) obstruction, and brain MRI abnormalities. The ophthalmic findings in this patient were nonspecific, however, they are consistent with ocular manifestations reported in other patients with Coffin-Siris syndrome. We also review ophthalmic findings of select mosaic chromosomal and single-gene disorders. Ophthalmic assessment alongside clinical genetic testing may play an important role in diagnosis of genetic syndromes as well as understanding disease pathology, particularly when mosaicism plays a role.
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Affiliation(s)
- Virginia Miraldi Utz
- Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Diana S Brightman
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Monica A Sandoval
- Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert B Hufnagel
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Howard M Saal
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Mataftsi A, Islam L, Kelberman D, Sowden J, Nischal K. Chromosome abnormalities and the genetics of congenital corneal opacification. Mol Vis 2011; 17:1624-40. [PMID: 21738392 PMCID: PMC3123159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 06/10/2011] [Indexed: 11/06/2022] Open
Abstract
Congenital corneal opacification (CCO) encompasses a broad spectrum of disorders that have different etiologies, including genetic and environmental. Terminology used in clinical phenotyping is commonly not specific enough to describe separate entities, for example both the terms Peters anomaly and sclerocornea have been ascribed to a clinical picture of total CCO, without investigating the presence or absence of iridocorneal adhesions. This is not only confusing but also unhelpful in determining valid genotype-phenotype correlations, and thereby revealing clues for pathogenesis. We undertook a systematic review of the literature focusing on CCO as part of anterior segment developmental anomalies (ASDA), and analyzed its association specifically with chromosomal abnormalities. Genes previously identified as being associated with CCO are also summarized. All reports were critically appraised to classify phenotypes according to described features, rather than the given diagnosis. Some interesting associations were found, and are discussed.
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Affiliation(s)
- A. Mataftsi
- Clinical and Academic Department of Ophthalmology (CADO), Great Ormond Street Hospital, London, U.K.,IInd Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - L. Islam
- Clinical and Academic Department of Ophthalmology (CADO), Great Ormond Street Hospital, London, U.K.,Developmental Biology Unit, Institute of Child Health, University College London, London, U.K.,Ulverscroft Vision Research Group, UCL Institute of Child Health, London, U.K
| | - D. Kelberman
- Developmental Biology Unit, Institute of Child Health, University College London, London, U.K.,Ulverscroft Vision Research Group, UCL Institute of Child Health, London, U.K
| | - J.C. Sowden
- Developmental Biology Unit, Institute of Child Health, University College London, London, U.K.,Ulverscroft Vision Research Group, UCL Institute of Child Health, London, U.K
| | - K.K. Nischal
- Clinical and Academic Department of Ophthalmology (CADO), Great Ormond Street Hospital, London, U.K.,Developmental Biology Unit, Institute of Child Health, University College London, London, U.K.,Ulverscroft Vision Research Group, UCL Institute of Child Health, London, U.K
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5
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Koster R, Van Balen ATM. Congenital corneal opacity (Peters’ anomaly) combined with buphthalmos and aniridia. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13816818509004110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Trisomy 8 mosaicism can present with a wide variety of systemic and ophthalmologic manifestations. We report a patient with an extinguished electroretinogram and diffuse retinal pigment epithelial abnormalities suggestive of a rod-cone dystrophy, which has not been previously reported in association with trisomy 8. A finding that has been described in several patients with trisomy 8 is a central corneal opacity, but there are no data regarding the natural history of this finding; the corneal opacity in our patient spontaneously improved. This case expands the clinical spectrum of this rare entity.
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Affiliation(s)
- Donald U Stone
- Department of Ophthalmology, Dean A. McGee Eye Institute, University of Oklahoma, Oklahoma City 73104, USA
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Connell BJ, Wilkinson RM, Barbour JM, Scotter LW, Poulsen JL, Wirth MG, Essex RW, Savarirayan R, Mackey DA. Are Duane syndrome and infantile esotropia allelic? Ophthalmic Genet 2005; 25:189-98. [PMID: 15512995 DOI: 10.1080/13816810490498323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the clinical overlap of families with Duane syndrome and infantile esotropia to determine whether the identification of genes for Duane syndrome may explain some cases of infantile esotropia. METHODS Three separate groups of patients were evaluated. 1) Families with features of infantile esotropia were identified through the Strabismus Inheritance Study Tasmania (SIST). Clinical details of participants and their families were reviewed for any cases of Duane syndrome. 2) Cases of Duane syndrome were identified through the clinical diagnostic database at the Royal Children's Hospital, Melbourne, and private ophthalmology clinics in Melbourne and Tasmania. Previous medical notes were reviewed and family history of strabismus noted. All affected individuals were invited for re-examination in cases where a positive family history of strabismus was reported; siblings, parents, and other family members, where appropriate, were invited to be examined for signs of Duane syndrome or infantile esotropia. 3) Cases of mosaic trisomy 8, which has been associated with Duane syndrome and infantile esotropia, were reviewed for signs of strabismus. RESULTS A total of 133 families from the SIST were reviewed, but no 'pure' families of Duane syndrome were identified. Two families with infantile esotropia had several members affected with Duane syndrome. Of the 40 index cases with Duane syndrome whose families agreed to be involved in the study, 21 had a family history of ocular motility disorders, but only two of these families had multiple cases of Duane syndrome. From 24 cases with mosaic trisomy 8, one individual case had Duane syndrome and another had mild congenital cataracts and infantile esotropia. CONCLUSIONS There is clinical overlap in families with Duane syndrome and infantile esotropia. We confirmed the previous association of mosaic trisomy 8 with both Duane syndrome and infantile esotropia. These data suggest that the two conditions may be allelic and may be due to a gene on chromosome 8.
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Affiliation(s)
- Benjamin J Connell
- CERA, University of Melbourne, Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Australia
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8
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Alvi F, Alonso A, Brewood AFM. Upper limb abnormalities in mosaic trisomy 8 syndrome. Arch Orthop Trauma Surg 2004; 124:718-9. [PMID: 15365716 DOI: 10.1007/s00402-004-0736-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Skeletal abnormalities are known to be a characteristic feature of the trisomy 8 syndrome, and radiological malformations are often more characteristic than the clinical features. CASE PRESENTATION We report a mentally retarded male known to have mosaic trisomy 8 syndrome who presented with radial deviation of his right wrist. Radiographs showed an open ulna epiphysis with a closed radial epiphysis. Surgery was postponed until an older age as his ulna epiphysis had not yet closed, but clinical correction was achieved with a wrist brace. CONCLUSION This is the first report of radial deviation of the wrist in a patient with mosaic trisomy 8.
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Merdassi A, Dureau P, Putterman M, Edelson C, Caputo G, De Laage De Meux P. Corneal choristoma associated with trisomy 8 mosaic syndrome: a clinicopathologic report. J AAPOS 2004; 8:204-5. [PMID: 15088063 DOI: 10.1016/j.jaapos.2003.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ahlem Merdassi
- Department of Pediatric Ophthalmology, Fondation Ophtalmologique Adolphe de Rothschild, 25-29 Rue Main, 75940 Paris Cedex 19, France
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Abstract
Trisomy 8 mosaicism can present with a varied clinical picture. A significant number of cases have ocular manifestations. The most commonly reported in the literature have been corneal abnormalities and strabismus. We present a case of trisomy 8 mosaic syndrome with very different ophthalmic manifestations, some of which are previously unreported in the literature. The patient who was known to have trisomy 8 mosaic syndrome was referred with concerns about his visual abilities. He had a characteristic facial dysmorphism and other systemic features associated with this condition. Ophthalmic features included bilateral Duane's syndrome, bilateral myopic astigmatism, congenital pendular nystagmus, and macula hypoplasia. Electrodiagnostic tests confirmed extensive abnormality of cone function in both eyes. This case is discussed in relation to a review of the literature.
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Affiliation(s)
- S Anwar
- Department of Ophthalmology, Addenbrookes Hospital, Cambridge, UK
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Habecker-Green J, Naeem R, Goh W, Pflueger S, Murray M, Cohn G. Reproduction in a patient with trisomy 8 mosaicism: Case report and literature review. ACTA ACUST UNITED AC 1998. [DOI: 10.1002/(sici)1096-8628(19980203)75:4<382::aid-ajmg6>3.0.co;2-s] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Kapaun P, Kabisch H, Held KR, Walter TA, Hegewisch S, Zander AR. Atypical chronic myelogenous leukemia in a patient with trisomy 8 mosaicism syndrome. Ann Hematol 1993; 66:57-8. [PMID: 8431524 DOI: 10.1007/bf01737691] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 17-year-old woman was admitted for bone marrow transplantation with the diagnosis of atypical Philadelphia-negative chronic myelogenous leukemia (aCML), cytogenetically characterized by trisomy 8 as the sole chromosome aberration. A striking feature was a congenital opacity of the right cornea. Chromosomal analysis of skin fibroblasts were performed and revealed a mosaic for trisomy 8. Commonly, a distinct clinical picture leads to the diagnosis of trisomy 8 mosaicism syndrome (T8ms), but an extreme phenotypic variability has been observed. To our knowledge the development of an aCML in a patient with T8ms has not been reported. A review of the literature revealed that an association to other hematological disorders had been described in two cases. The question of whether our patient's aCML was a random event or not is discussed. The patient is now 24 months post transplant and shows no evidence of disease. Her Karnofsky score is 100%. We conclude that it might be worthwhile to look for an associated constitutional trisomy 8 mosaicism in all patients with trisomy 8 leukemia.
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MESH Headings
- Abnormalities, Multiple/genetics
- Adolescent
- Chromosomes, Human, Pair 8/physiology
- Female
- Humans
- Learning Disabilities/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/complications
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/genetics
- Mosaicism
- Syndrome
- Trisomy
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Affiliation(s)
- P Kapaun
- Department of Pediatric Hematology and Oncology, University Hospital Eppendorf, Hamburg, Federal Republic of Germany
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Bottani A, Xie YG, Binkert F, Schinzel A. A case of Hirschsprung disease with a chromosome 13 microdeletion, del(13)(q32.3q33.2): potential mapping of one disease locus. Hum Genet 1991; 87:748-50. [PMID: 1937482 DOI: 10.1007/bf00201741] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A mentally retarded boy with discrete physical findings, Hirschsprung disease (HD) and a microdeletion of 13q,del(13)(q32.3q33.2) is described. Band 13q33.1 was consistently missing in all cells. There have been, to date, 4 published cases of deletions involving the long arm of chromosome 13 associated with HD: the interstitial deletion reported here is much smaller than, and it partially overlaps with, the previously reported deletions; it could be helpful for mapping one of the genes involved in this disease.
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Affiliation(s)
- A Bottani
- Institut für Medizinische Genetik der Universität, Zürich, Switzerland
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Warburg M, Friedrich U. Coloboma and microphthalmos in chromosomal aberrations. Chromosomal aberrations and neural crest cell developmental field. OPHTHALMIC PAEDIATRICS AND GENETICS 1987; 8:105-18. [PMID: 3309769 DOI: 10.3109/13816818709028526] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A survey of more than 500 reports on patients with autosomal chromosomal aberrations associated with microphthalmos and/or coloboma shows that these anomalies are unspecific. Anterior chamber anomalies were common as were abnormal ears, preauricular pits and tags, cleft lip-palate, micrognathia, urogenital malformations, congenital heart disease, atresia of the anus and minor malformations of the hands and feet. It is proposed that the chromosomal aberrations induce faulty development of neural crest cells and rostral neural plate derivatives.
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Affiliation(s)
- M Warburg
- Clinic for the Multiply Handicapped, Gentofte Hospital, Denmark
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Stark DJ, Gilmore DW, Vance JC, Pearn JH. A corneal abnormality associated with trisomy 8 mosaicism syndrome. Br J Ophthalmol 1987; 71:29-31. [PMID: 3814568 PMCID: PMC1041079 DOI: 10.1136/bjo.71.1.29] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Eye abnormalities are a significant feature of trisomy 8 mosaicism syndrome. This paper gives the first account of the specific histopathology of a corneal opacity which is characteristic of this syndrome. The importance of early recognition is stressed because of potential therapeutic visual improvement. The necessity of including mosaic trisomy 8 in the differential diagnosis of such corneal opacities is illustrated by this case.
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