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Macriz-Romero N, Vera-Duarte GR, Guerrero-Becerril J, Chacón-Camacho OF, Astiazarán MC, Zenteno JC, Graue-Hernandez EO. Ophthalmic findings in patients with autosomal recessive lamellar ichthyosis due to TGM1 mutations in an isolated population. Int Ophthalmol 2023; 43:3659-3665. [PMID: 37542530 PMCID: PMC10504104 DOI: 10.1007/s10792-023-02774-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/22/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To describe the ocular clinical characteristics of a group of Mexican patients with lamellar ichthyosis (LI) arising from TGM1 pathogenic variants. METHODS Ophthalmological exploration, pedigree analysis and genetic screening were performed in patients with an established clinical diagnosis of lamellar ichthyosis from families located in a small community in the Southeast of Mexico. RESULTS Nine patients with LI in five families were identified. There were six affected females. All patients (9/9) demonstrated eye lid abnormalities with eight patients showing lid margin abnormalities. Madarosis was present in only three individuals and corneal scarring was documented in two. All nine individuals carried biallelic TGM1 variants, either homozygously or as compound heterozygous. CONCLUSION Ocular anomalies are common in individuals with TGM1-related LI. The occurrence of a variety of private or rare mutations hampers the identification of a genotype-phenotype correlation for ocular anomalies in this disorder.
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Affiliation(s)
- Nicole Macriz-Romero
- Department of Cornea, External Disease and Refractive Surgery, Institute of Ophthalmology "Conde de Valenciana", Chimalpopoca #14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico
| | - Guillermo Raul Vera-Duarte
- Department of Cornea, External Disease and Refractive Surgery, Institute of Ophthalmology "Conde de Valenciana", Chimalpopoca #14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico
| | - Jesus Guerrero-Becerril
- Department of Cornea, External Disease and Refractive Surgery, Institute of Ophthalmology "Conde de Valenciana", Chimalpopoca #14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico
| | - Oscar Francisco Chacón-Camacho
- Department of Genetics, Institute of Ophthalmology "Conde de Valenciana", Mexico City, Mexico
- Iztacala Faculty of Superior Studies, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Mirena C Astiazarán
- Department of Genetics, Institute of Ophthalmology "Conde de Valenciana", Mexico City, Mexico
| | - Juan Carlos Zenteno
- Department of Genetics, Institute of Ophthalmology "Conde de Valenciana", Mexico City, Mexico
- Biochemistry Department, Faculty Medicine, National Autonomous University of Mexico, Mexico City, Mexico
- Rare Diseases Diagnostic Unit, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Enrique O Graue-Hernandez
- Department of Cornea, External Disease and Refractive Surgery, Institute of Ophthalmology "Conde de Valenciana", Chimalpopoca #14, Colonia Obrera, Cuauhtémoc, 06800, Mexico City, Mexico.
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Subramanian N, Nivean PD, Alam MS. Combined medical and surgical management for cicatricial ectropion in lamellar ichthyosis: A report of three cases. Indian J Ophthalmol 2021; 68:2615-2617. [PMID: 33120713 PMCID: PMC7774180 DOI: 10.4103/ijo.ijo_855_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ichthyosis is a rare inherited skin disorder characterized by abnormal keratinization of the epidermis. Cicatricial ectropion is the most common ophthalmic feature of congenital ichthyosis. Progressive subepithelial cicatrization and abnormal cornification of eyelid skin cause progressive ectropion in both eyelids, leading to lagophthalmos and corneal exposure. Surgical correction of cicatricial ectropion in these cases is challenging with unsatisfactory results. Proper processing of the donor and recipient site with lubricants and topical retinoids before surgery makes grafting easier and its survival better. We present three cases of lamellar ichthyosis with cicatricial ectropion managed with combined preoperative topical therapy followed by surgery. All patients had extremely good surgical outcomes, with none of them requiring repeat surgery.
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Affiliation(s)
- Nirmala Subramanian
- Department of Orbit Oculoplasty and Reconstructive Surgery, Medical Research Foundation, Chennai, Tamil Nadu, India
| | | | - Md Shahid Alam
- Orbit Oculoplasty Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, (A Unit of Medical Research Foundation, Chennai), Kolkata, West Bengal, India
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Abstract
INTRODUCTION Lash ptosis is often an overlooked sign that may coexist with congenital and acquired blepharoptosis. This is a report of case series of patients presented in an oculoplastic clinic with visual field loss associated with lash ptosis. On examination, the primary pathology was attributed to lash ptosis dehiscence. METHODS All patients underwent anterior lamellar repositioning and were followed for an average of 15 (10-24) months. RESULTS All patients had resolution of visual field loss and heaviness of eyelids. CONCLUSIONS Lash ptosis is associated with abnormalities such as floppy eyelid syndrome. However it may be a primary condition, with no background eyelid pathology and no external explanation for the eyelash ptosis. The condition might result from anatomical changes in the orbicularis oculi, Riolan's muscle, and tarsal plate. Patients in this series complained of upper lid visual field restriction. Anterior lamellar repositioning resulted in complete resolution of complaints. Additional studies are needed to learn about the pathophysiology of this entity.
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Eyelash Ptosis in Unilateral Myogenic and Aponeurotic Blepharoptosis: A Prospective, Controlled, Before- and After-Study. Ann Plast Surg 2018; 81:637-641. [PMID: 30161045 DOI: 10.1097/sap.0000000000001599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSES The purposes of this study were to compare lash ptosis (LP) with contralateral eyelid in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis before and after the ptosis repair and to assess the correlation between postoperative eyelid height and LP symmetry. METHODS Patients older than 5 years were included from June 2015 to April 2017. Eyelid examination, LP grading (0-3), and photography were performed before and at least 6 months after ptosis repair. Success of ptosis repair (levator resection) was defined as margin reflex distance 1 within 0.5 mm of the contralateral eyelid; LP improvement, as at least 1 grade improvement at the last follow-up; and LP symmetry, as 2 eyelids being within 1 grade. RESULTS There were 58 patients with MP and 20 with AP, with mean age of 19.2 and 49.5 years and median follow-up of 10 months. Lash ptosis was observed in 89.5% of ptotic and 33.3% of control eyelids. Mean LP grade was significantly higher in the MP (1.5) than in the AP (1.1), which significantly improved to 0.6 and 0.4, respectively. However, it persisted in 50.9% of MP and 31.2% of AP postoperatively. Lash ptosis symmetry was observed in 97.4% of patients, which was not correlated with margin reflex distance 1 symmetry. Lower levator function was the only significant factor correlated with LP. CONCLUSION Lash ptosis was significantly worse in MP than in AP. Lower LF was correlated with more severe LP. Ptosis repair resulted in significant improvement of LP and its symmetry with the contralateral eyelid. Lash ptosis symmetry did not correlate with eyelid height symmetry postoperatively.
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De Piedade Sequeira LG, Bubanale S, Kurbet B. Spontaneous subconjunctival abscess in congenital lamellar ichthyosis. Indian J Ophthalmol 2018; 66:856-858. [PMID: 29786003 PMCID: PMC5989517 DOI: 10.4103/ijo.ijo_1171_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Congenital lamellar ichthyosis is an autosomal recessive, heterogeneous disorder presenting at birth with generalized skin involvement. The most common ophthalmic manifestation noted is bilateral ectropion of the lower eyelids. A 1-month-old female neonate, the second born of a nonconsanguineous marriage, presented with 4 days’ history of redness, discharge, and swelling in the right eye. There was severe right upper eyelid ectropion, conjunctival injection, chemosis, a subconjunctival mass on the temporal bulbar conjunctiva spontaneously draining pus and corneal haze. The anterior chamber, iris, lens and fundus appeared normal. Congenital lamellar ichthyosis was suspected because of scaling and excessive dryness of the entire body. The occurrence of a spontaneous subconjunctival abscess is not known in lamellar ichthyosis. We thus report the management of a rare case of unilateral upper eyelid ectropion, subconjunctival abscess with orbital cellulitis in congenital lamellar ichthyosis.
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Hanson B, Becker L, Hook K, Polcari I, Areaux RG, Maguiness S. Ectropion Improvement with Topical Tazarotene in Children with Lamellar Ichthyosis. Pediatr Dermatol 2017; 34:584-589. [PMID: 28815772 DOI: 10.1111/pde.13240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Lamellar ichthyosis (LI) is a well-described phenotypic subtype of autosomal recessive congenital ichthyosis (ARCI). The condition typically presents at birth with collodion membrane and leads to thick, plate-like scaling of the skin throughout the body, alopecia, and prominent ocular manifestations. Ocular complications include bilateral cicatricial ectropion and lagophthalmos. These ocular complications can lead to chronic exposure keratitis and in some cases corneal ulceration and blindness. No cure for ichthyosis exists. Treatment of ocular complications in LI includes surgical correction, systemic retinoids, and a variety of topical therapies such as emollients, keratolytics, and retinoids. METHODS Five children with LI cared for at our institution were identified and included. Patient age at the start of therapy ranged from 2 weeks to 9 years. Electronic medical records were reviewed and data from pediatric dermatologist and pediatric ophthalmologist visits were obtained. Data were collected before and after treatment of daily or twice-daily 0.05% to 0.1% tazarotene cream applied to the face and eyelids. RESULTS All patients had improvement in the degree of ectropion, with complete resolution in two of the five patients. The two patients with lagophthalmos at the time of tazarotene initiation experienced complete resolution. No adverse effects were reported. CONCLUSIONS Tazarotene cream appears to be effective in the management of ectropion and lagophthalmos in the setting of LI in children, even in the neonatal period.
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Affiliation(s)
- Brooke Hanson
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lauren Becker
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Kristen Hook
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Ingrid Polcari
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Raymond G Areaux
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota
| | - Sheilagh Maguiness
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
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Abstract
Genetic skin diseases, or genodermatoses, often have extracutaneous manifestations. Ocular manifestations in particular can have significant clinical implications, like blindness. Other manifestations, such as the corneal opacities that occur in X-linked ichthyosis, are asymptomatic but characteristic of a particular genodermatosis. Ophthalmologic examination can aid in diagnosis when characteristic findings are seen. The genodermatoses with ocular manifestations will be reviewed, but neurocutaneous, syndromes, genetic pigmentary disorders, and genetic metabolic diseases are not included because they are covered elsewhere in this issue.
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Affiliation(s)
- Melinda Jen
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia; Departments of Pediatrics and Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3550 Market St, Second floor, Philadelphia, PA, 19104.
| | - Sudha Nallasamy
- The Vision Center, Children's Hospital Los Angeles; Department of Ophthalmology, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, MS #88, Los Angeles, CA, 90027
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The spectrum of oculocutaneous disease. J Am Acad Dermatol 2014; 70:795.e1-25. [DOI: 10.1016/j.jaad.2013.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/18/2013] [Accepted: 12/28/2013] [Indexed: 12/30/2022]
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Palamar M, Onay H, Ertam I, Ates EA, Dereli T, Ozkinay F, Yagci A. Genotype and Anterior Segment Phenotype in a Cohort of Turkish Patients with Lamellar Ichthyosis. Ophthalmic Genet 2014; 36:229-33. [DOI: 10.3109/13816810.2013.870215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hernández-Martin A, Aranegui B, Martin-Santiago A, Garcia-Doval I. A systematic review of clinical trials of treatments for the congenital ichthyoses, excluding ichthyosis vulgaris. J Am Acad Dermatol 2013; 69:544-549.e8. [PMID: 23870202 DOI: 10.1016/j.jaad.2013.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 05/13/2013] [Accepted: 05/17/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ichthyoses comprise a group of inherited disorders of keratinization. Because of the need for lifelong treatment, it is important that therapies are beneficial, safe, and well tolerated. OBJECTIVES We sought to review the evidence on existing treatments for the congenital ichthyoses, excluding ichthyosis vulgaris. METHOD We undertook a systematic review using the methodology of the Cochrane Collaboration. Articles published in MEDLINE, EMBASE, and CENTRAL and registered clinical trials were screened. Randomized controlled trials involving patients with the inherited ichthyoses, either syndromic or nonsyndromic but excluding ichthyosis vulgaris, were considered. RESULTS Six trials met the inclusion criteria. Topical treatments including 5% urea, 20% propylene glycol alone or in combination with 5% lactic acid, calcipotriol ointment, and liarozole 5% cream showed therapeutic benefit. Oral liarozole, a retinoic acid metabolism blocking agent, showed no advantage over oral acitretin. LIMITATIONS Most studies were performed on a small sample of patients and lacked methodological and reporting quality. The small number of trials and the nearly constant positive results make publication bias likely. The absence of standardization of outcome measures precluded the comparison of studies. CONCLUSIONS Topical treatments including emollients, calcipotriol ointment, and liarozole cream seem to have therapeutic benefit and a good safety profile, although the use of topical calcipotriol is limited by a maximum weekly dose of 100 g. The advantage of oral liarozole over acitretin is uncertain. Multicenter trials comparing oral and topical interventions and evaluation of long-term outcomes are needed.
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Handzel DM, Zubcov-Iwantscheff AA, Aral H. [Lagophthalmos and ectropion of the upper eyelids in congenital ichthyosis]. Ophthalmologe 2013; 110:975-7. [PMID: 23552854 DOI: 10.1007/s00347-012-2775-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This report concerns the case of a 10-year-old female patient with congenital ichthyosis who developed bilateral ectropion of the upper eyelids resulting in massive ocular surface alterations due to lagophthalmos. A complex surgical approach with partial excision, tarsal strip refixation and a free skin graft led to normalization of the eyelid positioning and healing of the ocular surface.
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Affiliation(s)
- D M Handzel
- Augenärztliches Operationszentrum Fulda, Kothenbachweg 2-4, 36041, Fulda, Deutschland,
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Diaz LZ, Browning JC, Smidt AC, Rizzo WB, Levy ML. Complications of ichthyosis beyond the skin. Dermatol Ther 2013; 26:39-45. [DOI: 10.1111/j.1529-8019.2012.01517.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lucia Z. Diaz
- Department of Dermatology; University of Texas Health Science Center-Houston; Houston; Texas
| | - John C. Browning
- Department of Pediatrics and Division of Dermatology; University of Texas Health Science Center at San Antonio; San Antonio; Texas
| | - Aimee C. Smidt
- Departments of Dermatology and Pediatrics; University of New Mexico School of Medicine; Albuquerque; New Mexico
| | - William B. Rizzo
- Department of Pediatrics; University of Nebraska Medical Center; Omaha; Nebraska
| | - Moise L. Levy
- Pediatric Dermatology; Dell Children's Medical Center; Austin; Texas
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Ozgur OR, Akcay L, Tutas N, Ozkurt Y. Cicatricial upper and lower eyelid ectropion in an ichthyosis patient. Surgical correction. J Dermatol Case Rep 2011; 5:27-9. [PMID: 21894252 DOI: 10.3315/jdcr.2011.1068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/10/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Surgical correction of bilateral cicatricial upper and lower eyelid ectropion in an ichthyosis patient remains a challenge in clinical practice. MAIN OBSERVATIONS A 24-year-old female patient presented to our clinic with bilateral upper and lower eyelid ectropion. Her skin over her entire body and face was dry and scaly. The diagnosis was cicatricial ectropion related in a patient with ichthyosis. The upper eyelids were treated by retroauricular full thickness skin grafts and upper eyelid lateral tarsal strip procedure. And lower eyelids were treated by cheek transposition grafts and lower eyelid lateral tarsal strip procedure. The upper and lower eyelids were corrected successfully with these surgical procedures. CONCLUSIONS In patients with ichthyosis skin alterations in the eyelid cause shortening of the anterior lamella, subsequently resulting with ectropion. Successful surgical correction with skin grafts or transposition flaps can be performed to lenghten anterior lamella. Adding lateral tarsal strip procedure to skin grafting helps to maintain a beter lid margin apposition.
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Affiliation(s)
- Ozlen Rodop Ozgur
- Dr. Lutfi Kirdar Kartal Training And Research Hospital, 1st Eye Clinic, Kartal, Istanbul, Turkey
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Diseases of Periocular Hair. Surv Ophthalmol 2011; 56:416-32. [DOI: 10.1016/j.survophthal.2011.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 11/23/2022]
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Unilateral superior pellucid marginal degeneration in a case with ichthyosis. Cont Lens Anterior Eye 2011; 34:45-8. [DOI: 10.1016/j.clae.2010.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/04/2010] [Accepted: 09/06/2010] [Indexed: 11/22/2022]
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Khan R, Arora S, El-Hindy N, Chang BYP. Repair of cicatricial ectropion in a harlequin baby. J AAPOS 2009; 13:415-6. [PMID: 19683196 DOI: 10.1016/j.jaapos.2009.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 05/01/2009] [Accepted: 05/05/2009] [Indexed: 11/25/2022]
Abstract
The ichthyoses are a collection of scaling skin diseases or keratinizing skin disorders giving the appearance of "fish skin," of which harlequin ichthyosis is the most severe form. It is characterized by profound thickening of the keratin skin layer, armorlike scales that cover the body, and contraction abnormalities of the eyes, ears, and mouth. We report a case of a 6-week-old boy with harlequin ichthyosis and severe bilateral upper and lower eyelid cicatricial ectropion who underwent surgical repair with full-thickness postauricular skin autografts. To our knowledge, this is the youngest reported case and the only case of harlequin ichthyosis in which postauricular skin grafts were used.
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Affiliation(s)
- Rehna Khan
- St. James University Hospital, Leeds, UK
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