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Petersen SD, Belmouhand M, Hertz JM, Fagerberg C, Brasch-Andersen C, Grauslund J, Munier FL, Larsen M. Frail inner limiting membrane maculopathy suggested to describe a new retinal Alport-like condition with two variants in three generations of females. Ophthalmic Genet 2024; 45:281-288. [PMID: 38197426 DOI: 10.1080/13816810.2023.2294844] [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: 03/04/2022] [Revised: 11/15/2023] [Accepted: 12/09/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND We report a three-generation family with isolated Alport-like retinal abnormalities in the absence of lenticonus, hearing loss, kidney disease, and detectable molecular genetic defects in known Alport-related genes. METHODS Clinical examination includes ocular biomicroscopy, fundus photography, optical coherence tomography, dipstick urinalysis, serum creatinine assessment, and molecular genetic analysis. RESULTS The proband, her mother, and her maternal grandmother had normal best-corrected visual acuity and normal visual fields in both eyes. The macula presented a petaloid stair-case profile with scarce vessels in both eyes of the proband and a flat temporal macula lacking a foveal avascular zone in her mother and her grandmother. No family member had renal symptoms, unexplained subnormal hearing, or lenticonus. Sequencing and MLPA found no defect in COL4A3, COL4A4, and COL4A5. Common SNPs around the genes ± 1Mb showed no segregation. Furthermore, none of the variants shared between the affected individuals in genes from a gene panel of genes relevant for ophthalmopathy nor whole exome- and genome sequencing explained the phenotype. CONCLUSION A new condition with two retinal Alport-like phenotypes was found. No abnormalities of the kidneys and lens were found, neither abnormalities of the type IV collagen genes related to Alport syndrome. Homology with retinal abnormalities seen in patients after surgical removal of the inner limiting membrane of the retina suggests that this is where the defect is located. We therefore suggest that the new retinal phenotypes and similar phenotypes can be described with the new definition "frail inner limiting membrane maculopathy."
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Affiliation(s)
- Sekita Dalsgård Petersen
- Faculty of Health and Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Mohamed Belmouhand
- Faculty of Health and Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Jens Michael Hertz
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Christina Fagerberg
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Charlotte Brasch-Andersen
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Vestfold University Trust, Tønsberg, Norway
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Michael Larsen
- Faculty of Health and Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
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Pfau K, Gross O, Bemme S, Meyer P, Take P, Boeckhaus J, Holz FG, Feltgen N. [Ocular alterations in patients with Alport syndrome-An update]. DIE OPHTHALMOLOGIE 2023:10.1007/s00347-022-01805-1. [PMID: 36752793 DOI: 10.1007/s00347-022-01805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Alport syndrome (AS) is a rare hereditary systemic disease that results in alterations of the kidneys, inner ear, and various structures of the eye. It is caused by mutations in one of the genes encoding collagen type IV. In recent years, new and innovative imaging techniques have added characteristics of ocular alterations in AS and provided new insights, including into the pathogenesis of the disease. The aim of this paper is to provide an overview of the current knowledge of ocular changes in AS, as well as to present the Alport ocular pass. METHOD Narrative review article. RESULTS Ocular manifestations of AS include changes in the cornea, lens, and retina. Specifically, posterior polymorphic corneal dystrophy, anterior lenticonus (pathognomonic for AS), and various retinal changes have been described, which have been further characterized in recent years by newer imaging techniques. In particular, foveal changes in AS may present as both a thickened central retina in the context of foveal hypoplasia or a staircase-like thinning of the fovea. Both lesions could provide further insights into the role of type IV collagen in ocular structures. CONCLUSION The AS can manifest in various structures of the eye. The staircase-like changes of the central retina in AS patients indicate the important role of collagen type IV in the homeostasis and regular function of the inner retinal layers. The often mild foveal hypoplasia may provide clues to the role of collagen type IV in retinal embryogenesis. While anterior lenticonus is pathognomonic for AS and can be treated easily by refractive lens exchange, the only option currently available for retinal alterations is close follow-up and, if necessary, treatment of systemic complications of AS.
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Affiliation(s)
- Kristina Pfau
- Universitäts-Augenklinik Bonn, Bonn, Deutschland.
- Augenklinik, Universitätsspital Basel, Mittlere Str. 91, 4056, Basel, Schweiz.
| | - Oliver Gross
- Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | | | - Peter Meyer
- Augenklinik, Universitätsspital Basel, Mittlere Str. 91, 4056, Basel, Schweiz
| | - Patricia Take
- Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Jan Boeckhaus
- Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Frank G Holz
- Universitäts-Augenklinik Bonn, Bonn, Deutschland
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