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Pichi F, Freund KB, Ciardella A, Morara M, Abboud EB, Ghazi N, Dackiw C, Choudhry N, Souza EC, Cunha LP, Arevalo JF, Liu TYA, Wenick A, He L, Villarreal G, Neri P, Sarraf D. Congenital Retinal Macrovessel and the Association of Retinal Venous Malformations With Venous Malformations of the Brain. JAMA Ophthalmol 2019; 136:372-379. [PMID: 29494725 DOI: 10.1001/jamaophthalmol.2018.0150] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Importance Congenital retinal macrovessel (CRM) is a rarely reported venous malformation of the retina that is associated with venous anomalies of the brain. Objective To study the multimodal imaging findings of a series of eyes with congenital retinal macrovessel and describe the systemic associations. Design, Setting, and Participants In this cross-sectional multicenter study, medical records were retrospectively reviewed from 7 different retina clinics worldwide over a 10-year period (2007-2017). Patients with CRM, defined as an abnormal, large, macular vessel with a vascular distribution above and below the horizontal raphe, were identified. Data were analyzed from December 2016 to August 2017. Main Outcomes and Measures Clinical information and multimodal retinal imaging findings were collected and studied. Pertinent systemic information, including brain magnetic resonance imaging findings, was also noted if available. Results Of the 49 included patients, 32 (65%) were female, and the mean (SD) age at onset was 44.0 (20.9) years. A total of 49 eyes from 49 patients were studied. Macrovessel was unilateral in all patients. Color fundus photography illustrated a large aberrant dilated and tortuous retinal vein in all patients. Early-phase frames of fluorescein angiography further confirmed the venous nature of the macrovessel in 40 of 40 eyes. Optical coherence tomography angiography, available in 17 eyes (35%), displayed microvascular capillary abnormalities around the CRM, which were more evident in the deep capillary plexus. Of the 49 patients with CRM, 39 (80%) did not illustrate any evidence of ophthalmic complications. Ten patients (20%) presented with retinal complications, typically an incidental association with CRM. Twelve patients (24%) were noted to have venous malformations of the brain with associated magnetic resonance imaging. Of these, location of the venous anomaly in the brain was ipsilateral to the CRM in 10 patients (83%) and contralateral in 2 patients (17%), mainly located in the frontal lobe in 9 patients (75%). Conclusions and Relevance Our study has identified an association between macrovessels in the retina and venous anomalies of the brain (24% compared with 0.2% to 6.0% in the normal population). Thus, we recommend new guidelines for the systemic workup of patients with CRM to include brain magnetic resonance imaging with contrast. These lesions may be more accurately referred to as retinal venous malformations, which may raise awareness regarding potential cerebral associations.
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Affiliation(s)
- Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | - Emad B Abboud
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Nicola Ghazi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Christine Dackiw
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, Toronto, Ontario, Canada.,Cleveland Clinic Canada, Toronto, Ontario, Canada.,Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Cunha Souza
- Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.,University of São Paulo, São Paulo, São Paulo, Brazil
| | - Leonardo Provetti Cunha
- Department of Ophthalmology, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.,University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - J Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - T Y Alvin Liu
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adam Wenick
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lingmin He
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Guadalupe Villarreal
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Piergiorgio Neri
- The Ocular Immunology Service, The Eye Clinic, Polytechnic University of Marche, Ancona, Italy
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles.,Greater Los Angeles VA Healthcare Center, Los Angeles, California
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Abdolrahimzadeh B, Piraino DC, Albanese G, Cruciani F, Rahimi S. Neurofibromatosis: an update of ophthalmic characteristics and applications of optical coherence tomography. Clin Ophthalmol 2016; 10:851-60. [PMID: 27257370 PMCID: PMC4874640 DOI: 10.2147/opth.s102830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Neurofibromatosis (NF) is a multisystem disorder and tumor predisposition syndrome caused by genetic mutation on chromosome 17-17q11.2 in NF type 1 (NF1), and on chromosome 22-22q12.2 in NF type 2. The disorder is characterized by considerable heterogeneity of clinical expression. NF1 is the form with the most characteristic ocular manifestations. Lisch nodules of the iris are among the well-known diagnostic criteria for the disease. Glaucoma and associated globe enlargement have been described in a significant proportion of patients with NF1 and orbital–facial involvement. Optic nerve glioma may cause strabismus and proptosis, and palpebral neurofibroma may reach considerable size and occasionally show malignant transformation. Near infrared reflectance has greatly contributed to enhancing our knowledge on choroidal alterations in NF1. Indeed, some authors have proposed to include these among the diagnostic criteria. Optical coherence tomography has given new insight on retinal alterations and is a noninvasive tool in the management of optic nerve gliomas in children. Ocular manifestations in NF type 2 can range from early-onset cataracts in up to 80% of cases to optic nerve hamartomas and combined pigment epithelial and retinal hamartomas.
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Affiliation(s)
| | - Domenica Carmen Piraino
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Giorgio Albanese
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Filippo Cruciani
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Siavash Rahimi
- Pathology Centre, Queen Alexandra Hospital, Portsmouth, UK
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Makino S, Tampo H, Arai Y, Obata H. Correlations between choroidal abnormalities, Lisch nodules, and age in patients with neurofibromatosis type 1. Clin Ophthalmol 2013; 8:165-8. [PMID: 24403820 PMCID: PMC3883548 DOI: 10.2147/opth.s56327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To evaluate correlations between choroidal abnormalities, Lisch nodules, and age in patients with neurofibromatosis type 1 (NF1), we examined ten cases with NF1 using near-infrared reflectance imaging. Patients ranged in age from 4 to 39 years. The angle used for near-infrared reflectance imaging was 55°. We counted the total number of choroidal abnormalities in an area within a 55° angle centered on the fovea and the total number of Lisch nodules on the iris by slit-lamp examination. No positive correlation was found between the number of Lisch nodules and patient age (Spearman’s rank correlation coefficient ρ=0.117, P=0.7414). Choroidal abnormalities tended to increase with age (ρ=0.6150), but this difference was not statistically significant (P=0.0650). A positive correlation was found between the number of choroidal abnormalities and Lisch nodules (ρ=0.783, P=0.0267). In conclusion, choroidal abnormalities tend to increase with patient age and are correlated with the number of Lisch nodules.
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Affiliation(s)
- Shinji Makino
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hironobu Tampo
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yusuke Arai
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroto Obata
- Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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