1
|
Khasnavis A, Fernandes M. Peters anomaly: An overview. Taiwan J Ophthalmol 2023; 13:434-442. [PMID: 38249502 PMCID: PMC10798386 DOI: 10.4103/tjo.tjo-d-23-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/16/2023] [Indexed: 01/23/2024] Open
Abstract
Peters anomaly (PA) is a rare, often bilateral, congenital corneal opacity, usually with a sporadic inheritance pattern, characterized by corneal opacities and irido-corneal or lenticular-corneal adhesions with a defect in the Descemet's membrane, occurring due to anterior segment dysgenesis during fetal development. Due to other ocular and systemic comorbidities, a team comprising pediatric cornea, glaucoma, and strabismus specialists in addition to a pediatrician and geneticist is necessary for the appropriate management of these children. Since the outcome of pediatric penetrating keratoplasty is variable and has a higher chance of failure when accompanied by additional procedures, such as lensectomy and vitrectomy, minimally invasive alternatives are increasingly being offered to these patients. Of note is the recently reported novel procedure: selective endothelialectomy for PA, which avoids the need for a corneal transplant and results in gradual clearing of the corneal opacity over time. In this overview, we aimed to describe the etiology, classification, pathophysiology, histopathology, clinical features, and management of PA.
Collapse
Affiliation(s)
- Arpita Khasnavis
- Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Cornea and Anterior Segment Service, Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Merle Fernandes
- Cornea and Anterior Segment Service, Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
2
|
Kurihara T, Endo T, Obata S, Hotta T, Nishio N, Iwaibara T, Hirata K, Kuge S, Konishi Y, Yoshida D, Yanagi T, Taga T, Wada K, Wada N, Ohga S, Kusaka S. Surgical treatment of traction retinal detachment associated with compound heterozygous congenital protein C deficiency. Am J Ophthalmol Case Rep 2023; 30:101854. [PMID: 37206621 PMCID: PMC10188544 DOI: 10.1016/j.ajoc.2023.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/06/2023] [Accepted: 04/22/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose Congenital protein C deficiency leads to a prothrombotic state that may result in potentially sight- and life-threatening thromboembolic attacks. In this report, we report two cases of infants with compound heterozygous protein C deficiency who underwent lensectomies and vitrectomies for the treatment of traction retinal detachments (TRDs). Observations One two-month-old and one three-month-old female neonates with leukocoria and purpura fulminans received a diagnosis of protein C deficiency and were referred to ophthalmology. In both cases, the right eye had a total retinal detachment that was considered inoperable, while the left eye had a partial TRD for which surgery was performed. Of the two operated eyes, one resulted in a total retinal detachment, while the other eye has remained stable with no retinal detachment progression three months after surgery. Conclusions Compound heterozygous congenital protein C deficiency may lead to the rapid development of severe TRDs with poor visual and anatomical prognoses. Early diagnosis and surgery for the treatment of partial TRDs with low disease activity may help prevent progression towards total retinal detachments in these infants.
Collapse
Affiliation(s)
- Tomoki Kurihara
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 589-8511, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takao Endo
- Department of Ophthalmology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Shumpei Obata
- Department of Ophthalmology, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Taeko Hotta
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan
| | - Naoki Nishio
- Department of Neonatology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Takayuki Iwaibara
- Department of Neonatology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Katsuya Hirata
- Department of Neonatology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Sakina Kuge
- Department of Neonatology, Kindai University Faculty of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yuhei Konishi
- Department of Neonatology, Kindai University Faculty of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Daisuke Yoshida
- Department of Pediatrics, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Takahide Yanagi
- Department of Pediatrics, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Takashi Taga
- Department of Pediatrics, Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Kazuko Wada
- Department of Neonatology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Norihisa Wada
- Department of Neonatology, Kindai University Faculty of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shunji Kusaka
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2 Onohigashi, Osakasayama, Osaka, 589-8511, Japan
- Corresponding author. 377-2 Onohigashi, Osakasayama, Osaka, 589-8511, Japan.
| |
Collapse
|
3
|
Alotaibi MD, Albakri AS, Alsulaiman SM. Pediatric Retinal Detachment in Homozygous Protein C Deficiency: Genetic and Phenotypic Description of a Single Family. Ophthalmic Surg Lasers Imaging Retina 2022; 53:293-296. [PMID: 35575743 DOI: 10.3928/23258160-20220414-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Homozygous protein C deficiency is a rare hypercoagulability disorder. This study describes the ocular manifestations and the genetic background in a family with two affected children. This is a retrospective review of ophthalmic examinations, investigations, genetic testing, and blood work-up of two children with homozygous protein C deficiency from a single family. A family with a positive history of consanguineous marriage was found to have two affected children with homozygous protein C deficiency. Abnormal visual behavior was the presenting symptom. Both children had bilateral total tractional retinal detachments at presentation. Skin manifestations included episodes of discoloration and bruising. Laboratory work-up revealed absent protein C activity. Genetic testing confirmed the presence of a homozygous pathogenic mutation in protein C gene (NM_000312.3: c.1297G>A: p.Gly433Ser). Homozygous protein C deficiency should be considered in the differential diagnosis of early-onset tractional retinal detachment in infancy. Although rare, the ophthalmologist may be the first to encounter the condition, and treatment with protein C replacement or anticoagulants may be life-saving. Examination under anesthesia with fluorescein angiography and laser treatment early in life may be warranted to preserve vision. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:293-296.].
Collapse
|
4
|
The 2021 Congress of the International Society for Twin Studies: Twin Research at the Cutting Edge/Twin Research: Maternal Bonding with Twins; Twins with Peters Anomaly; Selective Termination in Dichorionic Twin Pairs; Neuropsychological Function in Twins with Neurofibromatosis/News Reports: World's Most Premature Survivor - A Twin; Twins Confuse Giants' Baseball Fans; Malaysian Twins Switched at Birth; 'Biracial' Twins. Twin Res Hum Genet 2022; 25:56-61. [PMID: 35193725 DOI: 10.1017/thg.2022.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Selected highlights from the 2021 Congress of the International Society for Twin Studies are reviewed. The perspectives of a new graduate student member to the society are also included. Timely research covering issues related to maternal bonding with twins, twins with Peters anomaly, selective termination in dichorionic twin pairs and neuropsychological functioning in twins with neurofibromatosis is reviewed. The final part of this article includes interesting and informative media reports related to the world's most premature survivor who is a twin, identical male baseball players, Malaysian twins switched at birth and a pair of the so-called 'biracial' twins.
Collapse
|
5
|
Thau A, Saffren B, Anderst JD, Carpenter SL, Levin AV. A review on clotting disorders and retinal hemorrhages: Can they mimic abuse? CHILD ABUSE & NEGLECT 2021; 118:105070. [PMID: 34049052 DOI: 10.1016/j.chiabu.2021.105070] [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: 08/19/2020] [Revised: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The characteristic findings of abusive head trauma (AHT) include retinal hemorrhages (RH). RH have many etiologies in childhood, which should be considered in the differential diagnosis of possible child abuse. The relationship between RH and thrombophilia in children is not well established. OBJECTIVE In this literature review, we sought to assess whether retinal findings in pediatric patients with thrombophilia could mimic those of AHT. METHODS A literature search was performed to identify all cases of thrombophilia in children less than 18 years old with ocular manifestations. Disorders of thrombophilia including protein C and S deficiency, factor V Leiden (FVL), prothrombin variant, MTHFR mutation, hyperhomocysteinemia, elevated factor VIII, and elevated lipoprotein (a) were considered. All cases of pediatric thrombophilia with retinal examination or intraocular bleeding were included. If provided, descriptions of the RH were reviewed. RESULTS Our initial search yielded 514 results. Forty-three articles met our inclusion criteria. We identified 3 children with RH within the AHT usual age range (<5 years old), ages 5 weeks and 7 weeks old, in the setting of thrombophilia. One child had ocular findings that could potentially mimic abuse. No other indicators of abuse were present in this case. CONCLUSIONS Based on previous reports, thrombophilia alone has not been shown to clearly mimic abusive head trauma. In reported cases of thrombophilia with RH, the clinical picture and ophthalmic findings are usually distinct from abuse.
Collapse
Affiliation(s)
- Avrey Thau
- Thomas Jefferson University, Philadelphia, PA, USA; Department of Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, PA, USA
| | - Brooke Saffren
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - James D Anderst
- Division of Child Adversity and Resilience, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shannon L Carpenter
- Department of Hematology, Oncology, and Bone Marrow Transplantation, Children's Mercy Hospital, Kansas City, MO, USA
| | - Alex V Levin
- Thomas Jefferson University, Philadelphia, PA, USA; Department of Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, PA, USA.
| |
Collapse
|
6
|
Darbari E, Zare-Abdollahi D, Alavi A, Rezaei Kanavi M, Feizi S, Hosseini SB, Baradaran-Rafii A, Ahmadieh H, Issazadeh-Navikas S, Elahi E. A mutation in DOP1B identified as a probable cause for autosomal recessive Peters anomaly in a consanguineous family. Mol Vis 2020; 26:757-765. [PMID: 33273802 PMCID: PMC7700884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Peters anomaly (PA) is a heterogeneous developmental disorder characterized by central corneal opacity and iridocorneal or corneolenticular adhesions. Although many causative genes have been identified, most screened patients do not have mutations in the known genes. We aimed to identify the genetic cause of Peters anomaly in a pedigree with three affected individuals. METHODS Slit-lamp biomicroscopy and ultrasound biomicroscopy were performed for definitive diagnosis. Exome sequencing was conducted on the DNA of all three patients. After identification of a candidate causative gene, expression of the gene was assessed with real-time PCR in various ocular tissues of three human embryos and three adults. RESULTS The patients were affected with isolated PA. The parents of the patients were related to one another. Inheritance of PA was autosomal recessive. After appropriate filtering of the exome data, a homozygous variation in DOP1B remained as the only candidate genetic cause of PA in the pedigree. The variant segregated with disease status in the pedigree and was absent among 800 control Iranians. The variant has been reported in various databases at frequencies of 0.006 or less only in the heterozygous state in some cohorts of African origin. The p.Val1660 amino acid affected by the mutation is completely conserved in mammals and birds during evolution. Expression of DOP1B was shown in all adult and embryonic lens, iris, cornea, sclera, and retina tissues that were tested. CONCLUSIONS DOP1B that encodes DOP1 leucine zipper like protein B was identified as the putative PA-causing gene in pedigree PA-101. As DOP1B is positioned within the Down syndrome chromosomal region on chromosome 21, until now this gene has mostly been studied with respect to brain functions. However, members of the Dopey gene family have been shown to have roles in development in other organisms. Evidence of the expression of DOP1B in various PA-relevant eye tissues, which, to the best of our knowledge, is shown here for the first time, is to be noted. However, this finding does not necessarily implicate a specific role for DOP1B in eye development as the gene is expressed in many tissues. Ultimately, definitive assessment of the contribution of DOP1B to PA pathology awaits identification of mutations in the gene in unrelated patients with PA and functional studies.
Collapse
Affiliation(s)
- Ensieh Darbari
- School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Davood Zare-Abdollahi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Afagh Alavi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepehr Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Alireza Baradaran-Rafii
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shohreh Issazadeh-Navikas
- Neuroinflammation Unit, Biotech Research and Innovation Centre (BRIC), Faculty of Health and Medical Sciences, Copenhagen Biocentre, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Elahe Elahi
- School of Biology, College of Science, University of Tehran, Tehran, Iran
| |
Collapse
|
7
|
Ghassemi F, Abdi F, Esfahani M. Ophthalmic manifestations of congenital protein C deficiency: a case report and mini review. BMC Ophthalmol 2020; 20:282. [PMID: 32660449 PMCID: PMC7358193 DOI: 10.1186/s12886-020-01424-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Homozygous protein C (PC) deficiency is a potentially fatal disease with ocular blinding presentation or sequela. Case presentation A 5 month-old boy was presented for evaluation of leukocoria. He had a history of frequent bruises and PC deficiency, treated with warfarin. His intraocular pressure was normal. In the left eye leukoma with anterior segment dysgenesis, shallow anterior chamber, and cataract were observed. Fundus was not visible. B-scan revealed a closed funnel retinal detachment. His right eye had a normal anterior segment and a thin retina with anomalous retinal vascular branching at equator and peripheral retina. A fibrovascular tuft on the optic nerve head with induced traction on superior arcade was visible. Total loss of a and b wave of both were appreciated in electroretinography (ERG). Fluorescein angiography (FA) showed very severe leakage at the junction of the vascularized and non-vascularized retina and optic nerve head. Favorable outcome was achieved with lasering of avascular retina in the right eye. Conclusion The potential for protein C deficiency should be assessed in all infants with leukocoria, anterior segment dysgenesis, retinal detachment and retinal dysplasia. Early diagnosis could save the child’s life and vision.
Collapse
Affiliation(s)
- Fariba Ghassemi
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, IR, Iran. .,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR, Iran. .,Department of Ophthalmology, Farabi Hospital Medical University Hospital, Tehran University of Medical Sciences, Tehran, IR, Iran.
| | - Fatemeh Abdi
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, IR, Iran.,Department of Ophthalmology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, IR, Iran
| | - Mandana Esfahani
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, IR, Iran
| |
Collapse
|
8
|
Samara A, Eldaya RW. Ocular and brain imaging findings in Peters' anomaly: A case report and literature review. Radiol Case Rep 2020; 15:863-866. [PMID: 32382368 PMCID: PMC7200615 DOI: 10.1016/j.radcr.2020.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 11/28/2022] Open
Abstract
Peters’ anomaly is a rare congenital eye condition characterized by anterior segment dysgenesis and commonly presents as unilateral or bilateral corneal opacity in the early neonatal period. Peters’ anomaly is often associated with congenital brain and skull abnormalities, which are frequently overlooked. In this paper, we present a case of a 5-day-old female neonate with Peters’ anomaly, and review the literature for similar reports that describe associated brain imaging findings. In our case, imaging studies show abnormalities involving the anterior segments of both globes with absent intracranial manifestations. Although Peters’ anomaly is a condition of interest for ophthalmologists, radiological studies should be performed, and neuroradiologists should be aware of the imaging findings associated with this rare entity.
Collapse
Affiliation(s)
- Amjad Samara
- Department of Psychiatry, Washington University School of Medicine, 4525 Scott Ave, St. Louis, MO 63110, United States
| | - Rami W Eldaya
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| |
Collapse
|
9
|
Salik I, Gupta A, Tara A, Zaidman G, Barst S. Peters anomaly: A 5-year experience. Paediatr Anaesth 2020; 30:577-583. [PMID: 32107814 DOI: 10.1111/pan.13843] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Peters anomaly is a rare, congenital eye malformation characterized by an opaque cornea and blurred vision. Central corneal opacification can lead to delayed progression of visual development caused by defects in Descemet membrane and the posterior stroma. These children require several anesthetics for multiple eye examinations under anesthesia and corneal transplantation. AIMS We sought to review the anesthetic management of patients with Peters anomaly for ophthalmologic procedures at Westchester Medical Center, a major referral center for Peters anomaly. METHODS A retrospective chart review was completed which included pediatric patients who underwent ophthalmologic procedures related to Peters anomaly from 2013-2018. RESULTS The charts of 35 patients with Peters anomaly were reviewed: 14 patients with Peters anomaly Type I, 10 patients with Peters anomaly Type II, and 11 patients with Peters plus syndrome. Thirty patients required three procedures on average, two examinations under anesthesia pre- and post-transplant, and anesthesia for the corneal transplant itself. The youngest patient encountered for examination under anesthesia was 39-week postconceptual age. Anesthetic time for examination under anesthesia averaged 31 minutes using a laryngeal mask airway while corneal transplant averaged 104 minutes utilizing endotracheal intubation. Postanesthesia care unit stay averaged 51 minutes following examination under anesthesia and 65 minutes after corneal transplant. All examinations under anesthesia were successfully completed without adverse events with the use of a laryngeal mask airway. This case series includes two patients with Goldenhar syndrome and Al-Gazali syndrome accompanying Peters anomaly. CONCLUSION Although limited by its retrospective nature, this case series describes the cardiac and systemic implications of patients undergoing anesthesia with Peters anomaly. Our experience indicates that general anesthesia and airway manipulation are tolerated with minor postoperative concerns in these infants. Pediatric patients with Peters anomaly require multiple anesthetics for repeated ophthalmologic interventions. The laryngeal mask airway can be routinely utilized in infants less than 3 months of age for an eye examination under anesthesia with no airway complications noted. Perioperative providers should be aware of the multisystemic implications in patients with Peters plus syndrome.
Collapse
Affiliation(s)
- Irim Salik
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Abhishek Gupta
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Arjun Tara
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Gerald Zaidman
- Department of Ophthalmology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Samuel Barst
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| |
Collapse
|