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Fernández-Vigo JI, Gómez-de-Liaño CN, Rodríguez-Quet O, Burgos-Blasco B, Montolío-Marzo E, de-Pablo-Gómez-de-Liaño L, González-Martin-Moro J, García-Feijóo J. Clinical update in nanophthalmos: Features, diseases and complications associated. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:687-702. [PMID: 37813187 DOI: 10.1016/j.oftale.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023]
Abstract
Nanophthalmos is a rare congenital condition of the eyeball that is characterised by a smaller size of the anterior and posterior segments without associated ocular malformations. Typical features that have traditionally been described in these eyes are short axial length, thickened sclera, cornea with a smaller diameter, narrow anterior chamber, and an increased lens to globe volume ratio. However, at present, there is still a lack of recognised diagnostic criteria for nanophthalmos and a classification of its severity. Its clinical relevance stems from the increased risk of multiple ocular conditions, such as high hyperopia, amblyopia, angle-closure glaucoma, retinal detachment, and cataracts. Likewise, in relation to surgery in these eyes, there are particularities in cataract and glaucoma surgery and with a greater risk of associated intra- and postoperative complications. In this way, the treatment of nanophthalmos focuses on controlling the associated eye conditions and reducing and controlling surgical complications. This review aims to update what has been published in recent years regarding nanophthalmos.
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Affiliation(s)
- J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| | - C N Gómez-de-Liaño
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - O Rodríguez-Quet
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - B Burgos-Blasco
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - E Montolío-Marzo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | | | - J González-Martin-Moro
- Departamento de Oftalmología, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - J García-Feijóo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
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Muns SM, Villegas VM, Schwartz SG. Clinical spectrum of blunted foveal contour. Ther Adv Ophthalmol 2022; 14:25158414211070864. [PMID: 35083420 PMCID: PMC8785340 DOI: 10.1177/25158414211070864] [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: 01/10/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
Foveal hypoplasia is the absence of a foveal depression and the presence of the ganglion cell layer in the foveola. A spectrum of clinical characteristics, including normal or variably decreased visual acuity, has been described in patients with blunted foveal contours. Multiple systemic and ophthalmologic conditions including albinism, aniridia, nanophthalmos, prematurity, and fovea plana have been associated with this anomaly. This article illustrates select clinical conditions characterized by a blunted foveal contour. Given the heterogeneity of findings, a thorough medical history and detailed physical and ocular examinations are usually sufficient for the clinician to make the correct diagnosis.
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Affiliation(s)
- Sofía M. Muns
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Victor M. Villegas
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- Department of Ophthalmology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Surgery, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Stephen G. Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 3880 Tamiami Trail North, Naples, FL 34103, USA
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Nanophthalmos: An Update on the Biological Parameters and Fundus Abnormalities. J Ophthalmol 2021; 2021:8853811. [PMID: 33777447 PMCID: PMC7972840 DOI: 10.1155/2021/8853811] [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] [Received: 09/19/2020] [Revised: 12/18/2020] [Accepted: 03/04/2021] [Indexed: 11/18/2022] Open
Abstract
Nanophthalmos is a clinical phenotype of simple microphthalmos, in which the anterior and posterior segments of the eyeball do not develop into a normal size without other major ocular or systemic anomalies. Typical clinical manifestations of nanophthalmos include short axial length, thickened sclera, small cornea, shallow anterior chamber, and increased lens-to-eye volume ratio. Currently, there is a lack of recognized diagnostic criteria for nanophthalmos. With the development of eye examination technologies, such as biological measurement and imaging examination, visualization and quantification of the eyeball's shape and structure in nanophthalmos can be realized. New clinical features have been reported, which are of great significance for diagnosing and treating nanophthalmos. This review introduces the related concepts of nanophthalmos and the new developments in its clinical characterization.
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Abstract
PURPOSE To evaluate the fovea in nanophthalmic eyes using spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA), and to investigate the relationship between the macular microstructure and visual acuity. METHODS This is a retrospective case series of five nanophthalmic patients. The foveal avascular zone (FAZ) area was measured in superficial and deep vascular layers with OCTA. The thickness of the inner retinal layer (IRL) was measured with SD-OCT. The ratio of the foveal and parafoveal IRL thickness (fIRL/pIRL ratio) was calculated. The relationship between these parameters and visual acuity was then investigated. RESULTS Eight eyes were identified as nanophthalmic with a mean axial length of 17.19 ± 1.44 mm (range: 15.71 to 19.88 mm). The mean best-corrected visual acuity (BCVA) in the logarithm of the minimum angle of resolution (logMAR) was 0.12 ± 0.18 (range: - 0.18 to 0.40). OCTA showed that FAZs were either absent or undeveloped in the superficial and deep capillary plexuses. Two patients did not show any visual impairments despite small FAZ and a shallow foveal depression. Although the BCVA was significantly correlated with the deep FAZ size, it did not correlate with the superficial FAZ size, axial length, or fIRL/pIRL ratio. However, the refractive error, axial length, and deep FAZ size were all significantly correlated with the fIRL/pIRL ratio. CONCLUSIONS The FAZs were commonly found to be small in the superficial and deep capillary plexuses. Although the deep FAZ size correlated with visual acuity, it is unclear whether the retinal microstructure and the FAZ size are responsible for the visual impairments observed in the same individuals.
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The majority of autosomal recessive nanophthalmos and posterior microphthalmia can be attributed to biallelic sequence and structural variants in MFRP and PRSS56. Sci Rep 2020; 10:1289. [PMID: 31992737 PMCID: PMC6987234 DOI: 10.1038/s41598-019-57338-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 12/09/2019] [Indexed: 01/07/2023] Open
Abstract
This study aimed to genetically and clinically characterize a unique cohort of 25 individuals from 21 unrelated families with autosomal recessive nanophthalmos (NNO) and posterior microphthalmia (MCOP) from different ethnicities. An ophthalmological assessment in all families was followed by targeted MFRP and PRSS56 testing in 20 families and whole-genome sequencing in one family. Three families underwent homozygosity mapping using SNP arrays. Eight distinct MFRP mutations were found in 10/21 families (47.6%), five of which are novel including a deletion spanning the 5' untranslated region and the first coding part of exon 1. Most cases harbored homozygous mutations (8/10), while a compound heterozygous and a monoallelic genotype were identified in the remaining ones (2/10). Six distinct PRSS56 mutations were found in 9/21 (42.9%) families, three of which are novel. Similarly, homozygous mutations were found in all but one, leaving 2/21 families (9.5%) without a molecular diagnosis. Clinically, all patients had reduced visual acuity, hyperopia, short axial length and crowded optic discs. Retinitis pigmentosa was observed in 5/10 (50%) of the MFRP group, papillomacular folds in 12/19 (63.2%) of MCOP and in 3/6 (50%) of NNO cases. A considerable phenotypic variability was observed, with no clear genotype-phenotype correlations. Overall, our study represents the largest NNO and MCOP cohort reported to date and provides a genetic diagnosis in 19/21 families (90.5%), including the first MFRP genomic rearrangement, offering opportunities for gene-based therapies in MFRP-associated disease. Finally, our study underscores the importance of sequence and copy number analysis of the MFRP and PRSS56 genes in MCOP and NNO.
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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: 4] [Impact Index Per Article: 0.7] [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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Lee A, Montezuma SR. A 61-year-old man with cystoid macular edema and chorioretinal folds after cataract surgery. Digit J Ophthalmol 2017; 23:81-84. [PMID: 29162993 DOI: 10.5693/djo.03.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Andrew Lee
- Department of Ophthalmology and Visual Neuroscience, University of Minnesota
| | - Sandra R Montezuma
- Department of Ophthalmology and Visual Neuroscience, University of Minnesota
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Collery RF, Volberding PJ, Bostrom JR, Link BA, Besharse JC. Loss of Zebrafish Mfrp Causes Nanophthalmia, Hyperopia, and Accumulation of Subretinal Macrophages. Invest Ophthalmol Vis Sci 2017; 57:6805-6814. [PMID: 28002843 PMCID: PMC5215506 DOI: 10.1167/iovs.16-19593] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Mutations in membrane frizzled-related protein (MFRP) are associated with nanophthalmia, hyperopia, foveoschisis, irregular patches of RPE atrophy, and optic disc drusen in humans. Mouse mfrp mutants show retinal degeneration but no change in eye size or refractive state. The goal of this work was to generate zebrafish mutants to investigate the loss of Mfrp on eye size and refractive state, and to characterize other phenotypes observed. Methods Clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 methods were used to generate multiple frameshift mutations in zebrafish mfrp causing premature translational stops in Mfrp. Spectral-domain optical coherence tomography (SD-OCT) was used to measure eye metrics and refractive state, and immunohistochemistry was used to study adult eyes. Gene expression levels were measured using quantitative PCR. Results Zebrafish Mfrp was shown to localize to apical and basal regions of RPE cells, as well as the ciliary marginal zone. Loss of Mfrp in mutant zebrafish was verified histologically. Zebrafish eyes that were mfrp mutant showed reduced axial length causing hyperopia, RPE folding, and macrophages were observed subretinally. Visual acuity was reduced in mfrp mutant animals. Conclusions Mutation of zebrafish mfrp results in hyperopia with subretinal macrophage infiltration, phenocopying aspects of human and mouse Mfrp deficiency. These mutant zebrafish will be useful in studying the onset and progression of Mfrp-related nanophthalmia, the cues that initiate the recruitment of macrophages, and the mechanisms of Mfrp function.
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Affiliation(s)
- Ross F Collery
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Peter J Volberding
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Jonathan R Bostrom
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Brian A Link
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Joseph C Besharse
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Relhan N, Jalali S, Pehre N, Rao HL, Manusani U, Bodduluri L. High-hyperopia database, part I: clinical characterisation including morphometric (biometric) differentiation of posterior microphthalmos from nanophthalmos. Eye (Lond) 2015; 30:120-6. [PMID: 26493039 DOI: 10.1038/eye.2015.206] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/04/2015] [Indexed: 11/09/2022] Open
Abstract
UNLABELLED PURPOSE To characterise and differentiate posterior microphthalmos (PM) and nanophthalmos (NO) using morphometric parameters.Patients and methodsConsecutive case database of patients with hyperopia >+7.00 D sphere was analysed retrospectively for clinical and biometric characterisation. Thirty-eight consecutive high-hyperopic subjects (75 eyes) with axial lengths <20.5 mm underwent uniform comprehensive ocular evaluation. Twenty-five subjects were diagnosed as PM and 13 as NO based on the horizontal corneal diameter. Parameters analysed included visual acuity, refraction, horizontal corneal diameter, anterior chamber depth, lens thickness, axial length, fundus changes, and associated ocular pathology. PRIMARY OUTCOME MEASURES ocular biometry difference between PM and NO. SECONDARY OUTCOME MEASURES differences in associated ocular pathologies between PM and NO.RESULTS Hyperopia ranged from +7 to +17 D and was similar in the two groups. Lens thickness was statistically more in NO than in PM group (4.53±0.75 mm vs 3.82±0.48 mm, P <0.001), whereas anterior chamber depth was more in the PM than in NO group (3.26±0.36 mm, vs 2.59±0.37 mm, P<0.001). NO had higher association with angle-closure glaucoma (66.7% vs 0%) and pigmentary retinopathy (38.5 vs 8.0%) but lesser association with macular folds (0% vs 24%) as compared with PM. NO was associated with poorer visual acuity.CONCLUSION PM and NO have significant differences in lens thickness, anterior chamber depth, prevalence of glaucoma, pigmentary retinopathy, macular pathology, and visual acuity while being similar in hyperopic refraction.
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Affiliation(s)
- N Relhan
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - S Jalali
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - N Pehre
- Kode Venkatadri Chowdary, David Brown Children's Eye Care Centre, L V Prasad Eye Institute, Tadigadapa, Vijayawada, India
| | - H L Rao
- Center for Clinical Epidemiology and Biostatistics, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - U Manusani
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - L Bodduluri
- Srimati Kannuri Santhamma Centre for Vitreo- Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
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Hu PH, Gao GP, Yu Y, Pei CG, Zhou Q, Huang X, Zhang Y, Shao Y. Analysis of corneal topography in patients with pure microphthalmia in Eastern China. J Int Med Res 2015; 43:834-40. [PMID: 26378068 DOI: 10.1177/0300060515594195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine the typical corneal changes in pure microphthalmia using a corneal topography system and identify characteristics that may assist in early diagnosis. METHODS Patients with pure microphthalmia and healthy control subjects underwent corneal topography analysis (Orbscan IIZ® Corneal Topography System; Bausch and Lomb, Bridgewater, NJ, USA) to determine degree of corneal astigmatism (mean A), simulation of corneal astigmatism (sim A), mean keratometry (mean K), simulated keratometry (sim K), irregularities in the 3 - and 5-mm zone, and mean thickness of nine distinct corneal regions. RESULTS Patients with pure microphthalmia (n = 12) had significantly higher mean K, sim K, mean A, sim A, 3.0 mm irregularity and 5.0 mm irregularity, and exhibited significantly more false keratoconus than controls (n = 12). There was a significant between-group difference in the morphology of the anterior corneal surface and the central curvature of the cornea. CONCLUSIONS Changes in corneal morphology observed in this study could be useful in borderline situations to confirm the diagnosis of pure microphthalmia.
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Affiliation(s)
- Pei-Hong Hu
- Department of Ophthalmology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Gui-Ping Gao
- Department of Ophthalmology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Yao Yu
- Department of Endocrinology and Metabolism, Third Hospital of Nanchang City, Nanchang, Jiangxi Province, China
| | - Chong-Gang Pei
- Department of Ophthalmology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Qiong Zhou
- Department of Ophthalmology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xin Huang
- Department of Ophthalmology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Ying Zhang
- Department of Ophthalmology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Yi Shao
- Department of Ophthalmology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
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Optical coherence tomography of bilateral nanophthalmos with macular folds and high hyperopia. Case Rep Ophthalmol Med 2014; 2014:173853. [PMID: 25197593 PMCID: PMC4145547 DOI: 10.1155/2014/173853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/29/2014] [Indexed: 12/01/2022] Open
Abstract
Importance. There is a conflict about the content of the macular folds in nanophthalmic eyes in the literature. Our study clearly demonstrated that papillomacular folds seen in nanophthalmos or posterior microphthalmos were only composed of neurosensory retina without involvement of retinal pigment epithelium and choroid. Observations. This is a report of two consecutive nanophthalmic patients with macular folds at Maltepe University School of Medicine, Department of Ophthalmology, from January to June 2012. Anterior segment dimensions were near normal. The axial lengths of the eyes were short with markedly shortened posterior segment. A macular fold extending from the center of the fovea towards the optic nerve head was present in all eyes. Optic coherence tomography clearly demonstrated that folds were only composed of neurosensory retina. Binocular visual acuities and refractive errors of the cases were 0.3, 0.2 and +16.00, +15.75 diopters, respectively. Conclusions and Relevance. Our study proposes a surgical option to treat these folds like serous retinal detachments by showing the true content of the folds, although there is not any surgical operation accepted for this condition yet. Further studies dealing with the surgical interventions of these folds should be performed to support this option.
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Wasmann RA, Wassink-Ruiter JSK, Sundin OH, Morales E, Verheij JBGM, Pott JWR. Novel membrane frizzled-related protein gene mutation as cause of posterior microphthalmia resulting in high hyperopia with macular folds. Acta Ophthalmol 2014; 92:276-81. [PMID: 23742260 DOI: 10.1111/aos.12105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE We present a genetic and clinical analysis of two sisters, 3 and 4 years of age, with nanophthalmos and macular folds. METHODS Ophthalmological examination, general paediatric examination and molecular genetic analysis of the MFRP gene were performed in both affected siblings. RESULTS Clinical analysis showed high hyperopia (+11 D and +12 D), short axial lengths (15 mm) and the presence of macular folds and optic nerve head drusen. Autofluorescence of the retina was generally normal with subtle macular abnormalities. Sequence analysis showed compound heterozygosity for severe MFRP mutations in both sisters: a previously reported p.Asn167fs (c.498dupC) and a novel stop codon mutation p.Gln91X (c.271C>T). CONCLUSION These are the youngest nanophthalmos patients in the literature identified with severe loss of MFRP function, showing already the known structural abnormalities for this disease. Adult patients affected by homozygous or compound heterozygous MFRP mutations generally show signs of retinal dystrophy, with ERG disturbances and RPE abnormalities on autofluorescence imaging. ERG examination could not be performed in these children, but extensive RPE abnormalities were not seen at this young age.
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Affiliation(s)
- Rosemarie A Wasmann
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsDepartment of Clinical Genetics, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsDepartment of Biomedical Sciences Center of Excellence for Neuroscience, Foster School of Medicine, Texas Tech Health Sciences Center, El Paso, Texas, USA
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Demircan A, Altan C, Osmanbasoglu OA, Celik U, Kara N, Demirok A. Subfoveal choroidal thickness measurements with enhanced depth imaging optical coherence tomography in patients with nanophthalmos. Br J Ophthalmol 2013; 98:345-9. [DOI: 10.1136/bjophthalmol-2013-303465] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nowilaty SR, Mousa A, Ghazi NG. The Posterior Pole and Papillomacular Fold in Posterior Microphthalmos. Ophthalmology 2013; 120:1656-64. [DOI: 10.1016/j.ophtha.2013.01.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 01/11/2013] [Accepted: 01/11/2013] [Indexed: 10/26/2022] Open
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Nowilaty SR, Khan AO, Aldahmesh MA, Tabbara KF, Al-Amri A, Alkuraya FS. Biometric and molecular characterization of clinically diagnosed posterior microphthalmos. Am J Ophthalmol 2013; 155:361-372.e7. [PMID: 23127749 DOI: 10.1016/j.ajo.2012.08.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 08/24/2012] [Accepted: 08/27/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE To biometrically and molecularly characterize clinically diagnosed posterior microphthalmos. DESIGN Prospective case series. METHODS Twenty-five affected patients from 13 families diagnosed by ophthalmologists experienced with the condition at the King Khaled Eye Specialist Hospital were studied. All participants underwent axial length measurement, keratometry, corneal pachymetry, and candidate gene analysis (MFRP, PRSS56). Main outcome measures were the results of ocular biometry and gene analysis. RESULTS All patients (2-47 years of age) had high hyperopia, normal-appearing anterior segments, posterior chamber foreshortening, and characteristic papillomacular folds/wrinkles. For the right eye, mean cycloplegic refraction was +15.09 diopters (D) (range 9.88-18.75). Axial length (mean 16.25 mm [range 14.88-19.88]) had strong inverse correlation (Pearson coefficient -0.88, P < .0001) with corneal power (mean 48.89 D [range 41.91-52.25]) and a positive correlation with corneal diameter (Pearson 0.64, P = .001). Corneal thickness and anterior chamber dimensions were within normal ranges. Left eye data were similar. Nineteen Saudi patients (8/13 families) harbored 4 different homozygous PRSS56 mutations, 1 Indian and 1 Saudi patient harbored 2 different homozygous MFRP mutations, and 4 Saudi patients (3/13 families) had no detectable mutation in either gene. Patients with MFRP mutations were not clinically different from patients with PRSS56 mutations or no identified mutation. Truncating PRSS56 mutations were associated with shorter axial lengths (mean 15.72 mm) than missense PRSS56 mutations (mean 16.37 mm) or no identified mutation (mean 17.57 mm). CONCLUSIONS These data define posterior microphthalmos biometrically and reveal that corneal steepening proportional to the degree of axial foreshortening is part of the phenotype. Corneal diameter decreases with decreasing axial length, suggesting posterior microphthalmos and nanophthalmos represent a spectrum of high hyperopia rather than distinct phenotypes. In the Saudi population PRSS56 mutations are the major cause, and in our cohort truncating mutations were associated with a more severe phenotype.
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Affiliation(s)
- Sawsan R Nowilaty
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
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Optical coherence tomography findings of retinal folds in nanophthalmos. Case Rep Ophthalmol Med 2012; 2011:491894. [PMID: 22606463 PMCID: PMC3350234 DOI: 10.1155/2011/491894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 12/25/2011] [Indexed: 12/05/2022] Open
Abstract
Aim. To report the optical coherence tomography (OCT) findings in three members of the same family with nanophthalmos associated with elevated papillomacular retinal fold. Methods. Complete ophthalmic examination as well as ultrasonography and OCT was performed in all patients. Results. Axial lengths ranged from 16.75 mm to 17.48 mm and refractive errors ranged from +17.50 D to +20.50 D. Main fundus findings were the hyperopic crowded, cupless optic disc, and retinal fold through papillomacular region. Macular OCT scans revealed retinal fold with normal retinal pigment epithelium and choriocapillaris. Interpretation. It is presumed that the retinal folds in nanophthalmos result from a redundancy of the retinal layer caused by retarded growth of the scleral, choroidal, and retinal pigment epithelial layers. The anatomic information provided by the current study is consistent with this thesis.
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Kim SJ, Kim GN, Han YS, Chung IY, Seo SW, Yoo JM, Park JM. Scleral Window Surgery with Mitomycin C for Nanophthalmic Uveal Effusion: Case Report. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.8.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seong Jae Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Gyu Nam Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yong Seop Han
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Seong Wook Seo
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Ji Myong Yoo
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jong Moon Park
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Fabry A, Blanckaert J, Leys A. Chronic central serous choroidopathy with severe visual loss in hyperopic microphthalmic identical twins. GMS OPHTHALMOLOGY CASES 2011; 1:Doc05. [PMID: 27625927 PMCID: PMC5015606 DOI: 10.3205/oc000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report chronic central serous choroidopathy with severe visual loss in hyperopic microphthalmic identical twins. METHODS The index patient was first examined in 1994, at age 31, and has been followed up closely for 17 years. He had repeated fluorescein and indocyanine green angiograms, OCT, ultrasound biometry, and recently also autofluorescence and EDI OCT. His twin brother was first examined in 2010, at age 47, and had a similar extensive exploration. RESULTS The index patient had a mean refractive error of +6 D OU and VA was 20/32++ in the RE and 20/200 in the LE in 1994. Vision slowly went down to 20/800+ in the RE and 20/600 in the LE in 2011. His twin brother has a mean refractive error of +6 D OU and VA 20/400 OU. Both have a short axial length of the eye, a thick choroid with dilated vessels, and central serous choroidopathy with cystic degeneration of the macula and retina in the posterior pole. CONCLUSIONS We add to the reported complications of microphthalmos, chronic central serous choroidopathy.
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Affiliation(s)
- Annelies Fabry
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Johan Blanckaert
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Anita Leys
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium,*To whom correspondence should be addressed: Anita Leys, Department of Ophthalmology, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium, E-mail:
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Orr A, Dubé MP, Zenteno JC, Jiang H, Asselin G, Evans SC, Caqueret A, Lakosha H, Letourneau L, Marcadier J, Matsuoka M, Macgillivray C, Nightingale M, Papillon-Cavanagh S, Perry S, Provost S, Ludman M, Guernsey DL, Samuels ME. Mutations in a novel serine protease PRSS56 in families with nanophthalmos. Mol Vis 2011; 17:1850-61. [PMID: 21850159 PMCID: PMC3137557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 07/05/2011] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Nanophthalmos is a rare genetic ocular disorder in which the eyes of affected individuals are abnormally small. Patients suffer from severe hyperopia as a result of their markedly reduced axial lengths, but otherwise are capable of seeing well unlike other more general forms of microphthalmia. To date one gene for nanophthalmos has been identified, encoding the membrane-type frizzled related protein MFRP. Identification of additional genes for nanophthalmos will improve our understanding of normal developmental regulation of eye growth. METHODS We ascertained a cohort of families from eastern Canada and Mexico with familial nanophthalmos. We performed high density microsatellite and high density single nucleotide polymorphism (SNP) genotyping to identify potential chromosomal regions of linkage. We sequenced coding regions of genes in the linked interval by traditional PCR-based Sanger capillary electrophoresis methods. We cloned and sequenced a novel cDNA from a putative causal gene to verify gene structure. RESULTS We identified a linked locus on chromosome 2q37 with a peak logarithm (base 10) of odds (LOD) score of 4.7. Sequencing of coding exons of all genes in the region identified multiple segregating variants in one gene, recently annotated as serine protease gene (PRSS56), coding for a predicted trypsin serine protease-like protein. One of our families was homozygous for a predicted pathogenic missense mutation, one family was compound heterozygous for two predicted pathogenic missense mutations, and one family was compound heterozygous for a predicted pathogenic missense mutation plus a frameshift leading to obligatory truncation of the predicted protein. The PRSS56 gene structure in public databases is based on a virtual transcript assembled from overlapping incomplete cDNA clones; we have now validated the structure of a full-length transcript from embryonic mouse brain RNA. CONCLUSIONS PRSS56 is a good candidate for the causal gene for nanophthalmos in our families.
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Affiliation(s)
- Andrew Orr
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Juan C. Zenteno
- Department of Biochemistry, Faculty of Medicine, National Autonomous University of Mexico (UNAM), and Department of Genetics-Research Unit, Institute of Ophthalmology "Conde de Valenciana", Mexico City, Mexico
| | - Haiyan Jiang
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Susan C. Evans
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Aurore Caqueret
- Centre de Recherche du CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Hesham Lakosha
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Louis Letourneau
- McGill University and Génome Québec Innovation Centre, Montréal, Quebec, Canada
| | - Julien Marcadier
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Makoto Matsuoka
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Macgillivray
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mathew Nightingale
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Scott Perry
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Mark Ludman
- Department of Pediatrics, Division of Medical Genetics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada,Maritime Medical Genetics Service, IWK Health Centre, Halifax, Nova Scotia
| | - Duane L. Guernsey
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark E. Samuels
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada,Centre de Recherche du CHU Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
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Autosomal-recessive posterior microphthalmos is caused by mutations in PRSS56, a gene encoding a trypsin-like serine protease. Am J Hum Genet 2011; 88:382-90. [PMID: 21397065 DOI: 10.1016/j.ajhg.2011.02.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 02/08/2011] [Accepted: 02/17/2011] [Indexed: 12/27/2022] Open
Abstract
Posterior microphthalmos (MCOP) is a rare isolated developmental anomaly of the eye characterized by extreme hyperopia due to short axial length. The population of the Faroe Islands shows a high prevalence of an autosomal-recessive form (arMCOP) of the disease. Based on published linkage data, we refined the position of the disease locus (MCOP6) in an interval of 250 kb in chromosome 2q37.1 in two large Faroese families. We detected three different mutations in PRSS56. Patients of the Faroese families were either homozygous for c.926G>C (p.Trp309Ser) or compound heterozygous for c.926G>C and c.526C>G (p.Arg176Gly), whereas a homozygous 1 bp duplication (c.1066dupC) was identified in five patients with arMCOP from a consanguineous Tunisian family. In one patient with MCOP from the Faroe Islands and in another one from Turkey, no PRSS56 mutation was detected, suggesting nonallelic heterogeneity of the trait. Using RT-PCR, PRSS56 transcripts were detected in samples derived from the human adult retina, cornea, sclera, and optic nerve. The expression of the mouse ortholog could be first detected in the eye at E17 and was maintained into adulthood. The predicted PRSS56 protein is a 603 amino acid long secreted trypsin-like serine peptidase. The c.1066dupC is likely to result in a functional null allele, whereas the two point mutations predict the replacement of evolutionary conserved and functionally important residues. Molecular modeling of the p.Trp309Ser mutant suggests that both the affinity and reactivity of the enzyme toward in vivo protein substrates are likely to be substantially reduced.
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Beral L, Donnio A, Jean-Charles A, Merle H. Pseudopapilledema in Kenny-Caffey syndrome. J Pediatr Ophthalmol Strabismus 2011; 48 Online:e1-3. [PMID: 19791716 DOI: 10.3928/01913913-20090918-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 04/13/2009] [Indexed: 11/20/2022]
Abstract
A 21-year-old man with Kenny-Caffey syndrome had been observed since 1993 for hyperopia. Fundus examination revealed swollen optic disks. Further examinations (fluorescein angiography, B-scan ultrasonography, and optical coherence tomography) confirmed the optic nerve head elevation. The authors report a rare case of Kenny-Caffey syndrome with extreme pseudopapilledema. Although uncommon, ophthalmologists should be mindful of this disorder when a patient presents with characteristic findings because severe electrolyte disturbances may complicate the clinical course.
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Affiliation(s)
- Laurence Beral
- Service d’Ophtalmologie, Centre Hospitalier Universitaire de Fort de France, Hôpital Pierre Zobda-Quitman, BP 632, 97261 Fort de France Cedex, Martinique, France
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Hwang JH, Yeom DJ, Kim JS, Lee JH. A Case of Acute Angle-Closure Glaucoma in a Nanophthalmos Patient. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.2.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Je Hyung Hwang
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Dong Ju Yeom
- Department of Ophthalmology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Suk Kim
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Joo Hwa Lee
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Casteels I, Gobin CV. Choroidal Effusion with Serous Retinal Detachment as a Complication of Strabismus Surgery. J Pediatr Ophthalmol Strabismus 2009. [PMID: 19928705 DOI: 10.3928/01913913-20091118-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 07/27/2009] [Indexed: 11/20/2022]
Abstract
A 12-year-old girl was referred because of unilateral visual loss in the right eye 5 days after uneventful strabismus surgery for a divergent squint. She had hypermetropia of +8 diopters and the axial length of both eyes was below normal for that age. Investigation with funduscopy, central visual field examination, optical coherence tomography, and fluorescein angiography revealed choroidal edema in the affected eye. The macular edema responded well to parabulbar and topical steroids and vision recovered completely within 2 weeks. Strabismus surgery in highly hypermetropic eyes with a small axial length can be complicated by choroidal edema.
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Fuchs J, Holm K, Vilhelmsen K, Rosenberg T, Scherfig E, Fledelius HC. Hereditary High Hypermetropia in the Faroe Islands. Ophthalmic Genet 2009; 26:9-15. [PMID: 15823920 DOI: 10.1080/13816810590918406] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To characterize the phenotype of two families with high hypermetropia from the Faroe Islands. METHODS Ophthalmologic evaluation including ultrasound oculometry and anthropometric measurements. RESULTS Of the 40 examined family members, 15 individuals (8 males, 7 females; ages: 6-77 years; mean: 36.5 years) had small deep-set eyes with high hypermetropia (median: + 16.5 D; range: + 7.75 to + 22), short axial eye length (< 21 mm), and a thickened eye wall. The median corrected visual acuity was 0.4 (0.2-0.9). Ocular complications included angle-closure glaucoma in six eyes, uveal effusion in three eyes, cataract in two eyes, and esotropia with amblyopia in three eyes. An emergency case of uveal effusion and retinal detachment after Yag iridotomy eventually responded to systemic corticosteroids and scleral resection surgery with a slow visual recovery. No associated ocular or systemic malformations were found in the series. In addition to the two examined families, six smaller Faroese families with high hypermetropia are briefly reported. CONCLUSIONS The study highlights the signs and symptoms of a rare hereditary phenotype characterized by a short axial length mainly confined to the posterior segment of the eye, a shallow anterior chamber, and a thickened eye wall. The morphological characteristics predispose for sight-threatening complications such as angle-closure glaucoma, chorioretinal pathology including uveal effusion, and amblyopia. Regular ophthalmic follow-up is therefore of obvious importance in families known to have small eyes/high hypermetropia. An endemic high prevalence in the Faroe Islands suggests the presence of a founder effect, and further genetic research would probably indicate pseudodominant rather than dominant transmission
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Affiliation(s)
- Josefine Fuchs
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark.
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Abstract
PURPOSE To describe the optical coherence tomography (OCT) findings for nanophthalmic eyes. METHODS : In this retrospective, single-center, observational case series, 15 patients (28 eyes) with axial lengths of <or=20.5 mm were included. Ultrasonography (A- and B-scans), keratometry, and OCT were performed. The main outcome measures were average foveal thickness, foveal center point thickness, total macular volume, and a new quantitative measure of foveal depression, relative foveal depression (RFD). Reference values for RFD were obtained by examining 57 healthy eyes with axial lengths of 21.5 mm to 27 mm. RESULTS The foveae of nanophthalmic eyes had diminished foveal depression due to thickened outer retinal layers. One patient with papillomacular folds was identified as having posterior microphthalmos. There was a good correlation between axial length on one hand and foveal thickness, foveal center point thickness, macula volume, and RFD on the other hand (r = -0.58, -0.61, -0.56, and -0.70 with P = 0.003, 0.001, 0.004, and 0.000, respectively). The average RFD for eyes with normal axial lengths was 0.43. CONCLUSIONS OCT findings for nanophthalmic eyes with foveal underdevelopment are different from posterior microphthalmos and foveal hypoplasia seen in other disorders. The new measure RFD is a useful tool in ocular tomography.
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Sundin OH, Dharmaraj S, Bhutto IA, Hasegawa T, McLeod DS, Merges CA, Silval ED, Maumenee IH, Lutty GA. Developmental basis of nanophthalmos: MFRP Is required for both prenatal ocular growth and postnatal emmetropization. Ophthalmic Genet 2008; 29:1-9. [PMID: 18363166 DOI: 10.1080/13816810701651241] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nanophthalmos is a genetic disorder characterized by very small, hyperopic eyes that are without gross structural defects. Recessive nanophthalmos is caused by severe mutations in the MFRP gene, which encodes a Frizzled-related transmembrane protein that is selectively expressed in the retinal pigment epithelium (RPE) and ciliary body. RESULTS For two MFRP -/- adults, we have obtained records of refraction that begin in early childhood. At the age of 6 months, one patient's eyes already had a refractive error of +12.25 D, and over the next 20 years this slowly increased to +17.50 D. Adults homozygous for null mutations in MFRP have eyes with axial lengths shorter than those of normal newborns. Furthermore, the unusually high curvature of their corneas is consistent with eyes that had been smaller than normal during late fetal development. MFRP protein was first detected at 14 weeks of gestation, when it was restricted to the posterior pole RPE. By 20 weeks gestation, MFRP expression had spread laterally, and was found throughout the RPE. MFRP protein was detected in both posterior and lateral RPE of the adult eye. CONCLUSIONS Embryonic function of the MFRP gene appears necessary for the eye to reach its full size at birth. Its onset of expression in the RPE during mid-gestation suggests that MFRP does not participate in early formation of the optic cup, and is consistent with a role in later growth and development of the eye. Patients without MFRP gene function exhibit no correction of refractive error during childhood, which suggests that this gene is essential for emmetropization, a complex process by which vision regulates axial growth of the eye.
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Affiliation(s)
- Olof H Sundin
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-92889, USA.
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Walsh MK, Goldberg MF. Abnormal foveal avascular zone in nanophthalmos. Am J Ophthalmol 2007; 143:1067-1068. [PMID: 17524786 DOI: 10.1016/j.ajo.2007.01.051] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Revised: 01/18/2007] [Accepted: 01/24/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the foveas of nanophthalmic patients. DESIGN Retrospective observational case series. METHODS Four nanophthalmic patients examined between April 2005 and April 2006 were included. Visual acuity (VA), refractive correction, axial length, corneal diameter, presence or lack of foveal light reflex, as well as fluorescein angiograms (FAs), and optical coherence tomography (OCT) scans of the maculae were evaluated. RESULTS None of the eight eyes had a foveal light reflex, corresponding to lack of a normal foveal pit on OCT. Fluorescein angiography showed no normal foveal avascular zones; all were either completely absent or small and rudimentary. CONCLUSIONS Nanophthalmic patients rarely have best-corrected visual acuity (BCVA) better than 20/40 at any point in their lives, even with an absence of known complications, such as uveal effusion or glaucoma. In many patients, this visual deficiency may correspond to an absent or rudimentary foveal avascular zone and lack of a normal foveal pit.
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Affiliation(s)
- Mark K Walsh
- Wilmer Ophthalmological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Characterization of optical coherence topography findings in Kenny-Caffey syndrome. J AAPOS 2007; 11:291-3. [PMID: 17360206 DOI: 10.1016/j.jaapos.2006.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Accepted: 09/11/2006] [Indexed: 11/21/2022]
Abstract
An unusual congenital syndrome was first reported in 1966 by Kenny and Linarelli, who described two patients with dwarfism, cortical thickening of the long bones, transient hypocalcemia, and normal intelligence,(1) the radiological features in the condition being reported by Caffey.(2) The constellation of dwarfism, medullary stenosis, transient hypocalcemia, and ophthalmologic abnormalities has been classically recognized as Kenny-Caffey syndrome with additional manifestations ranging from hypoplastic nails, persistent neutropenia, abnormal T-cell function, and neonatal liver disease.(3) Ocular findings range from uncomplicated nanophthalmos with hypermetropia to extreme pseudopapilloedema, vascular tortuosity, and macular crowding. Other reported ophthalmic findings include bilateral band keratopathy,(4) bilateral optic atrophy,(5) and myelinated nerve fibers.(6) We report two cases of Kenny-Caffey syndrome with an ellipsoid macular fold orientated horizontally involving the fovea and document this unusual feature with optical coherence topography (OCT).
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Tay T, Smith JEH, Berman Y, Adès L, Missotte I, Saglibène H, Martin F, Mitchell P, Taylor D. Nanophthalmos in a Melanesian population. Clin Exp Ophthalmol 2007; 35:348-54. [PMID: 17539787 DOI: 10.1111/j.1442-9071.2007.01484.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize the ophthalmic features and causes of visual loss in a cohort of Melanesians living in New Caledonia with nanophthalmos. METHODS In this observational study, axial length, visual acuity (VA), cycloplegic autorefraction were assessed and dilated fundus examination was performed. Visual impairment was defined as VA<6/12 in the better eye, hypermetropia as >+1.0 dioptre (D), astigmatism as >or=1.0 D and anisometropia as >or=1.0 D difference between both eyes. Unilateral amblyopia was defined as at least a two-line difference in VA between both eyes and bilateral amblyopia as VA<6/12 in both eyes which was not adequately explained by refractive error and macular folds. RESULTS Seventeen community-dwelling participants (aged 1.1-45.3 years) with short axial length (range from 16.1 to 21.6 mm) were identified. Of the 17 subjects, 14 were found to have crowded optic discs, three with papillomacular folds, three with a papillomacular band and three with macular radial folds. Further, all subjects demonstrated bilateral hypermetropia (range from +1.3 D to +15.1 D). A high proportion of subjects had astigmatism (12) and anisometropia (nine) in at least one eye. Visual impairment was found in nine subjects: five bilateral and four unilateral. Causes of visual impairment included amblyopia (seven), ametropia (seven) and macular folds (two). Amblyopia was attributed to several factors, including hypermetropia, anisometropia, astigmatism and esotropia. CONCLUSIONS In this sample of Melanesians with nanophthalmos, a spectrum of ophthalmic features that was consistent with intraocular crowding was found. Over half of the subjects were visually impaired, mostly due to amblyopia and ametropia. Further characterization of the underlying genetic cause of nanophthalmos in this cohort will be the focus of future studies.
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Affiliation(s)
- Tien Tay
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, and Discipline of Paediatrics and Child Health, University of Sydney, New South Wales, Australia
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Yalvac IS, Satana B, Ozkan G, Eksioglu U, Duman S. Management of glaucoma in patients with nanophthalmos. Eye (Lond) 2007; 22:838-43. [PMID: 17293784 DOI: 10.1038/sj.eye.6702742] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIMS In this retrospective study, we aimed to evaluate the results of glaucoma surgery in patients with nanophthalmos. METHODS Twenty-eight bilateral nanophthalmic patients, of whom 20 patients underwent trabeculectomy+Mitomycin-C (MMC)+inferior sclerotomy between 1996 and 2004, were included in this study. Records of patients with nanophthalmos were reviewed. Intraocular pressure (IOP), glaucoma medications, surgical success, visual acuity and complications were analyzed. RESULTS The mean IOP was 34.6+/-5.3 mm Hg preoperatively. At the final follow-up visit, the mean IOP dropped to 21.41+/-7.34 mm Hg (P<0.05). The cumulative probability of success was 85% at 1 year, 78.5% at 2 years, 76.9% at 3 years, 70.6% at 4 years and 47% at 5 years after surgery. Visual acuity decreased in 13 (65%) patients but no eye lost vision. Sequels of choroidal detachment (five patients 25%) and retinal folds (four patients 20%) were the most frequent reason for visual decrease. Uveal effusion (10 patients 50%) and cataract formation (seven patients 35%) were major late postoperative complications. CONCLUSIONS Results indicate that trabeculectomy+MMC+inferior sclerotomy procedure was effective and safe for glaucoma control in patients with nanophthalmos, but uveal effusion is a major problem and cataract surgery is expected in the long run.
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Affiliation(s)
- I S Yalvac
- Glaucoma Department Ankara Education and Research Hospital, Ankara, Turkey.
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Sharan S, Grigg JR, Higgins RA. Nanophthalmos: Ultrasound biomicroscopy and Pentacam assessment of angle structures before and after cataract surgery. J Cataract Refract Surg 2006; 32:1052-5. [PMID: 16814070 DOI: 10.1016/j.jcrs.2006.02.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 11/07/2005] [Indexed: 10/24/2022]
Abstract
We report a case of nanophthalmos with intractable secondary glaucoma. Bilateral cataract extraction with intraocular lens implantation was used as definitive treatment for the chronic angle-closure glaucoma. The changes in angle and ciliary body anatomy were well documented with preoperative and postoperative Pentacam assessment (Oculus Optikgeräte GmbH) and ultrasound biomicroscopy (Paradigm Medical Industries) images. We believe these are the first diagnostic and prognostic images of this kind in a nanophthalmic eye.
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Affiliation(s)
- Sapna Sharan
- Save Sight Institute, Department of Clinical Ophthalmology, Sydney, Australia
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Young LHY, Gross JG, Lai JC, Shakin JL, Thompson JT. Diagnostic and Therapeutic Challenges. Retina 2005; 25:930-5. [PMID: 16205574 DOI: 10.1097/00006982-200510000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lucy H Y Young
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Sundin OH, Leppert GS, Silva ED, Yang JM, Dharmaraj S, Maumenee IH, Santos LC, Parsa CF, Traboulsi EI, Broman KW, Dibernardo C, Sunness JS, Toy J, Weinberg EM. Extreme hyperopia is the result of null mutations in MFRP, which encodes a Frizzled-related protein. Proc Natl Acad Sci U S A 2005; 102:9553-8. [PMID: 15976030 PMCID: PMC1172243 DOI: 10.1073/pnas.0501451102] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nanophthalmos is a rare disorder of eye development characterized by extreme hyperopia (farsightedness), with refractive error in the range of +8.00 to +25.00 diopters. Because the cornea and lens are normal in size and shape, hyperopia occurs because insufficient growth along the visual axis places these lensing components too close to the retina. Nanophthalmic eyes show considerable thickening of both the choroidal vascular bed and scleral coat, which provide nutritive and structural support for the retina. Thickening of these tissues is a general feature of axial hyperopia, whereas the opposite occurs in myopia. We have mapped recessive nanophthalmos to a unique locus at 11q23.3 and identified four independent mutations in MFRP, a gene that is selectively expressed in the eye and encodes a protein with homology to Tolloid proteases and the Wnt-binding domain of the Frizzled transmembrane receptors. This gene is not critical for retinal function, as patients entirely lacking MFRP can still have good refraction-corrected vision, produce clinically normal electro-retinograms, and show only modest anomalies in the dark adaptation of photoreceptors. MFRP appears primarily devoted to regulating axial length of the eye. It remains to be determined whether natural variation in its activity plays a role in common refractive errors.
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Affiliation(s)
- Olof H Sundin
- Laboratory of Developmental Genetics, The Johns Hopkins University, Baltimore, MD 21287, USA.
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Fledelius HC, Fuchs HJ, Rosenberg T. Oculometric Characteristics of Extreme Hypermetropia in Two Faroese Families. Optom Vis Sci 2004; 81:762-8. [PMID: 15557850 DOI: 10.1097/00006324-200410000-00008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe and analyze the oculometric features of small eyes with high hypermetropia in two Faroese families, with emphasis on refractive components. METHODS Members of the two families (N=40; age, 1 to 77 years), including 15 cases of extreme hypermetropia (+7.5 to +19.25 D), had an ophthalmic evaluation including refractometry, keratometry, and axial ocular measurements using A-scan ultrasound. Eye-wall thickness was assessed using B-scan. Nonparametric statistics were used, mainly the Mann-Whitney U test. RESULTS In the two families, there were six and nine probands, respectively, with hypermetropia more than +7 D and short eyes as defined by axial eye lengths <21 mm. The median corrected visual acuity was 0.4 (range, 0.2 to 0.9). Gross fundus abnormalities were not observed. All 15 had a short posterior segment with a thick eye wall and a relatively thick lens. Furthermore, steep and rather small corneas were present. In one of the families, 70% of the affected had a corneal curvature radius of < or =7.0 mm. Five probands from family 2 were labeled as possibly affected because of hypermetropia and borderline axial length findings (21 to 22 mm). The remaining 20 subjects had visual acuity and oculometric findings within physiologic limits. CONCLUSIONS The axial measurement features in our series of highly hypermetropic eyes mainly presented as an extension downward from the hypermetropic bottom line of the normal distribution. The axial shortness of the eyes was primarily the result of a short posterior eye segment ("posterior microphthalmos"). A steep cornea was a feature in most small eyes in our series, particularly in one family branch.
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Sener EC, Mocan MC, Saraç OI, Gedik S, Sanaç AS. Management of strabismus in nanophthalmic patients: a long-term follow-up report. Ophthalmology 2003; 110:1230-6. [PMID: 12799252 DOI: 10.1016/s0161-6420(03)00267-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The purpose of this study is to identify the characteristics of strabismus that coexist with nanophthalmos and to report the results of strabismus surgery performed on these small eyes. DESIGN Retrospective, consecutive, noncomparative interventional case series. PARTICIPANTS Fifteen bilateral nanophthalmic patients, of whom five underwent horizontal muscle surgery, were included in this study. METHODS Chart review. The clinical examination included visual acuity assessments using the linear Snellen and the Lea charts, slit-lamp and fundus examinations, intraocular pressure, and axial length measurements. The orthoptic examination consisted of measurements of ocular deviations using the prism cover test with an accommodative target at both near and distance with and without refractive correction, assessment of ocular motility with ductions and versions, binocularity with Worth's four-dot test, and the Titmus test. Amblyopia was treated with part-time occlusion. Surgery for the correction of esotropia included bilateral medial rectus recessions or recess-resect procedures. MAIN OUTCOME MEASURES Magnitude of strabismic deviation, best-corrected visual acuity, and the level of binocular vision achieved were monitored. RESULTS The average age of enrollment in the study was 4.7 (range, 1-12) years. The patients were followed for an average of 7.0 (range, 4-14) years. The mean axial length was determined as 18.4 mm (range, 15.5-20.7). The mean refractive error in spherical equivalents was measured as +9.9 and ranged between +4.0 and +15.0 diopters. Five patients (33%) had nonaccommodative esotropia, four (27%) had partially refractive esotropia, four (27%) had microesotropia, and two (13%) had exotropia. Five patients, all having nonaccommodative esotropia, underwent surgery for the correction of ocular misalignment. Diminishing the surgical dose in these small eyes resulted in undercorrections. Despite patching, 3 patients (20%) had unilateral and 12 patients (80%) had bilateral amblyopia at the conclusion of the study. CONCLUSIONS Strabismus in nanophthalmos usually manifests as nonaccommodative and partially refractive esotropia. Medial rectus recession should be applied with care to prevent adduction deficit and convergence insufficiency. Otherwise, there seems to be no need for decreasing the surgical dose with regard to the smaller axial length. Amblyopia tends to be persistent in these patients.
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Affiliation(s)
- Emin Cumhur Sener
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
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Reddy MA, Francis PJ, Berry V, Bradshaw K, Patel RJ, Maher ER, Kumar R, Bhattacharya SS, Moore AT. A clinical and molecular genetic study of a rare dominantly inherited syndrome (MRCS) comprising of microcornea, rod-cone dystrophy, cataract, and posterior staphyloma. Br J Ophthalmol 2003; 87:197-202. [PMID: 12543751 PMCID: PMC1771505 DOI: 10.1136/bjo.87.2.197] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To phenotype and genetically map the disease locus in a family presenting with autosomal dominant microcornea, rod-cone dystrophy, cataract, and posterior staphyloma. METHODS Six affected and three unaffected members of the pedigree were examined. All individuals provided a history and underwent a full clinical examination with A-scan and B-scan ultrasonography and electrophysiological testing where appropriate. PCR based microsatellite marker genotyping using a positional candidate gene approach was then performed on DNA samples extracted from venous blood provided by each subject. RESULTS The disorder is inherited as an autosomal dominant trait with variable expressivity and has a complex phenotype. Affected individuals had bilateral microcornea, pulverulent-like lens opacities, a rod-cone dystrophy and posterior staphyloma (MRCS). Using a positional candidate gene approach, the authors have evidence suggestive of linkage of this disorder to a region on 11q13 within the nanophthalmos 1 (NNO1) genetic interval. The small family size militates against achieving a LOD score of 3, but the haplotype data and the position of the putative MRCS locus within a known nanophthalmos locus are suggestive of linkage. A candidate gene within this region (ROM1) was screened and no mutations were found in affected members of the family. CONCLUSION This rare developmental disorder has some phenotypic similarities to nanophthalmos and possibly maps to a locus within the genetic interval encompassing the NNO1 locus. Screening of candidate genes within this region continues.
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Affiliation(s)
- M A Reddy
- Institute of Ophthalmology, London, UK.
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