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Mack HG, Colville DJ, Harraka P, Savige JA, Invernizzi A, Fraser-Bell S. Retinal findings in glomerulonephritis. Clin Exp Optom 2021; 105:474-486. [PMID: 34877922 DOI: 10.1080/08164622.2021.2003691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The complement system is part of the innate immune system activated by three distinct pathways: classical, lectin and alternative. It is also involved in retinal development and homoeostasis. Dense deposit disease is a rare renal disease associated with mutations in Complement factor H and overactivity of the alternative complement pathway. As well as glomerulonephritis, many affected individuals have retinal drusen and may be at risk of vision loss due to macular atrophy or choroidal neovascularisation. We discuss the reclassification of dense deposit disease as a type of C3 glomerulonephropathy, and hypothesise on the mechanisms of retinal abnormalities. Drusen have also been described in individuals with other types of glomerulonephritis involving abnormalities of the classical (membranoproliferative glomerulonephritis type 1) or lectin (IgA nephropathy, lupus nephritis) complement pathways. Although drusen are found in abnormalities of all three complement pathways, the age at onset, aetiology, and the threat to vision differs. This review describes drusen and other retinal abnormalities associated with the glomerulonephritides due to abnormal activation in each of the three complement activation pathways, and provides the first report of drusen occurring in a patient with the recently reclassified C3 glomerulonephritis with homozygous variant V62I in complement factor H. Optometric management of young patients presenting with retinal drusen is discussed, and complement-based therapies for visual loss are reviewed.
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Affiliation(s)
- Heather G Mack
- Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia.,Department of Ophthalmology, Melbourne Health, Melbourne, Australia.,Centre for Eye Research, University of Melbourne, Melbourne, Australia
| | - Deborah J Colville
- Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia.,Department of Ophthalmology, Melbourne Health, Melbourne, Australia
| | - Phillip Harraka
- Department of Medicine (Northern), University of Melbourne, Melbourne, Australia
| | - Judith Anne Savige
- Department of Medicine (Northern), University of Melbourne, Melbourne, Australia
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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Fragiotta S, Fernández-Avellaneda P, Breazzano MP, Scuderi G. Clinical Manifestations of Cuticular Drusen: Current Perspectives. Clin Ophthalmol 2021; 15:3877-3887. [PMID: 34584401 PMCID: PMC8464647 DOI: 10.2147/opth.s272345] [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: 07/12/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
Cuticular drusen are part of the spectrum of age-related macular degeneration (AMD) with particular clinical and multimodal imaging characteristics. This drusen subpopulation shares several high-risk single nucleotide polymorphisms with AMD. Despite this feature, they can manifest at a relatively young age, presenting with a female preponderance. Multimodal imaging is essential for characterizing such lesions, using a combination of color fundus photographs, optical coherence tomography (OCT), fluorescein angiography (FA), and fundus autofluorescence (FAF). The classic starry-sky pattern visible on FA and the typical central hypoautofluorescent lesion with hyperautofluorescent rim on FAF is considered the result of a central retinal pigment epithelium (RPE) erosion from these triangular elevations of the RPE-basal lamina. This finding may also be responsible for the typical choroidal hypertransmission appreciated through OCT. The clinical course of cuticular drusen may be relatively benign at early stages, with small drusen presenting at a young age. However, the presence of clinical phenotypes characterized by diffuse involvement and/or accompanying large drusen in patients older than 60 years may confer a significant risk for either macular neovascularization or geographic atrophy.
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Affiliation(s)
- Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | | | - Mark P Breazzano
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, UA
| | - Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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de-Pablo-Gómez-de-Liaño L, Cañas Zamarra I, Fernández-Vigo JI, Fernández Vidal M, Navarro-Perea C, Cavero Escribano T. Retinal manifestations in patients with complement-mediated membranoproliferative glomerulonephritis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:95-99. [PMID: 30078750 DOI: 10.1016/j.oftal.2018.06.013] [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: 04/20/2018] [Revised: 06/16/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
Complement-mediated membranoproliferative glomerulonephritis is a rare progressive glomerular disease. In some patients it can be associated with retinal lesions. Therefore, the purpose of this study was to assess a case series with this diagnosis in our hospital. A cross-sectional study was conducted on 8 patients diagnosed with complement-mediated membranoproliferative glomerulonephritis. Funduscopy, optical coherence tomography (OCT) and Swept Source domain OCT angiography were performed. Only 1 of the 8 patients showed drusen-like deposits that were located under the retinal pigment epithelium in the OCT, with the presence of associated choroidal neovascularization being ruled out in OCT angiography. Therefore, membranoproliferative glomerulonephritis may produce retinal alterations with drusen or retinal pigment epithelium detachment, and requires an appropriate differential diagnosis to be made with age-related macular degeneration. The follow-up of these patients is important in order to detect vision-threatening complications.
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Affiliation(s)
| | - I Cañas Zamarra
- Departamento de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - M Fernández Vidal
- Departamento de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Navarro-Perea
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - T Cavero Escribano
- Departamento de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
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Kheir V, Dirani A, Halfon M, Venetz JP, Halabi G, Guex-Crosier Y. Multimodal imaging of retinal pigment epithelial detachments in patients with C3 glomerulopathy: case report and review of the literature. BMC Ophthalmol 2017; 17:207. [PMID: 29166869 PMCID: PMC5700542 DOI: 10.1186/s12886-017-0602-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/14/2017] [Indexed: 11/15/2022] Open
Abstract
Background To describe the optical coherence tomography angiograhy (OCTA) of drusenoid pigment epithelial detachments (PEDs) in a woman affected by Complement 3 (C3) glomerulopathy, which represents a spectrum of glomerular diseases characterized on fluorescent microscopy by C3 accumulation with absent, or scanty, immunoglobulin deposits. It is due to acquired or genetically defective alternative pathway control and is generally associated with drusen-like deposits in Bruch’s membrane, as well as choriocapillaris. These retinal lesions can be associated with choroidal neovascularization and central serous chorioretinopathy (CSCR). OCTA is useful to detect neovascularization without injecting a contrast product, particularly in these patients who may have renal insufficiency. Case presentation A 28-year-old woman affected by C3 glomerulpathy was diagnosed with asymptomatic multiple bilateral PEDs during a routine ophthalmologic consultation. To better characterize the lesions, multimodal imaging was performed and included: optic coherence tomography (OCT), en-face OCT, OCTA, fluorescence and indocyanine angiography. The OCTA clearly identified vascular network rarefaction with decreased choriocapillary vascularization. It confirmed that PEDs associated with C3 glomerulonephritis are not vascularized, but rather of serous type. Conclusions Patients affected by C3 glomerulopathy can develop neovascular membranes as retinal complications of pigment epithelial detachments. Optical coherence angiography may be indicated to identify this complication, without injecting any contrast product that could produce further kidney damage.
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Affiliation(s)
- Valeria Kheir
- Jules Gonin Eye Hospital, Department of Ophthalmology, University of Lausanne, Ave de France 15, 1000, Lausanne 2, Switzerland
| | - Ali Dirani
- Jules Gonin Eye Hospital, Department of Ophthalmology, University of Lausanne, Ave de France 15, 1000, Lausanne 2, Switzerland
| | - Matthieu Halfon
- Service de Néphrologie du CHUV, Université de Lausanne, Lausanne, Switzerland
| | - Jean-Pierre Venetz
- Centre hospitalier universitaire vaudois (CHUV), Centre de transplantation d'organes, Université de Lausanne, Lausanne, Switzerland
| | - Georges Halabi
- Service de Néphrologie du CHUV, Université de Lausanne, Lausanne, Switzerland
| | - Yan Guex-Crosier
- Jules Gonin Eye Hospital, Department of Ophthalmology, University of Lausanne, Ave de France 15, 1000, Lausanne 2, Switzerland.
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Mansour AM, Lima LH, Arevalo JF, Amaro MH, Lozano V, Ghannam AB, Chan EW. Retinal findings in membranoproliferative glomerulonephritis. Am J Ophthalmol Case Rep 2017; 7:83-90. [PMID: 29260086 PMCID: PMC5722170 DOI: 10.1016/j.ajoc.2017.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 04/10/2017] [Accepted: 06/20/2017] [Indexed: 02/05/2023] Open
Abstract
Purpose To assess the evolution of retinal findings in patients with membranoproliferative glomerulonephritis (MPGN) by funduscopy, intravenous fluorescein angiography and optical coherence tomography. Observations Three women and one man were followed for a period of 1.5–37 years. Four patients (8 eyes) had drusen detected at first fundus exam at age 24, 29, 50 and 55. Three patients (6 eyes) had diffuse thickening of Bruch's membrane, and two patients (3 eyes) had detachment of the retinal pigment epithelium with serous retinal detachment. Drusen tended to widen over a period of 10-year follow-up in one case. Conclusions and importance Drusen remain the ocular stigmata for MPGN occuring at an early age. The retinal disease is progressive with gradual thickening of Bruch's membrane and occurrence of retinal pigment epithelium detachment.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Luiz H Lima
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Miguel Hage Amaro
- Instituto de Olhos e Laser de Belém, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Virginia Lozano
- Department of Ophthalmology, Complejo Hospitalario Universitario de Canarias, Tenerife, Canary Islands, Spain
| | - Alaa Bou Ghannam
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Errol W Chan
- Department of Ophthalmology, McGill University, Montreal, Canada
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Høeg TB, Klein R, Moldow B, La Cour M, Klemp K, Erngaard D, Buch H, Ellervik C. THE ASSOCIATION BETWEEN CUTICULAR DRUSEN AND KIDNEY FUNCTION: A Population-Based Case-Control Study. Retina 2016; 36:896-900. [PMID: 27115854 DOI: 10.1097/iae.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the association between cuticular drusen (CD) and kidney function. DESIGN observational case-control study. METHODS SETTING Population-based. Patients or Study Population: 53 participants with (CD) and 53 age- and sex-matched controls, selected from the Danish Rural Eye Study. Cuticular drusen participants were diagnosed using fluorescein angiography and controls were excluded if the patients were suspected of having CD on fundus photography or did not have an available estimated glomerular filtration rate. MAIN OUTCOME MEASURES creatinine and estimated glomerular filtration rate. RESULTS The mean estimated glomerular filtration rate of those with CD was 73.3 mL·min·1.73 m (95% confidence interval [CI]: 70.0-76.6) and 73.4 mL·minute·1.73 m (95% CI: 69.5-77.3) in controls. The difference was not significant (P: 0.970). The mean creatinine among those with CD was 72.8 μmol/L (69.3-76.4) and 73.5 μmol/L (95% CI: 69.3-77.6) among controls. The difference was not significant (P = 0.820). CONCLUSION The authors did not find an association between a (CD) diagnosis and decreased kidney function at a population level.
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Affiliation(s)
- Tracy B Høeg
- *Department of Ophthalmology, Næstved Hospital, Næstved, Denmark;†The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark;‡Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin;§Department of Ophthalmology, Capital Region Eye Clinic, Glostrup, Denmark; and¶Department of General Population Study, Nykøbing-Falster Hospital, Nykøbing Falster, Denmark
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Boon CJ, van de Ven JP, Hoyng CB, den Hollander AI, Klevering BJ. Cuticular drusen: Stars in the sky. Prog Retin Eye Res 2013; 37:90-113. [DOI: 10.1016/j.preteyeres.2013.08.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/14/2013] [Accepted: 08/19/2013] [Indexed: 12/24/2022]
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The spectrum of phenotypes caused by variants in the CFH gene. Mol Immunol 2009; 46:1573-94. [PMID: 19297022 DOI: 10.1016/j.molimm.2009.02.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 02/09/2009] [Accepted: 02/11/2009] [Indexed: 12/24/2022]
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Shenoy R, McCilvenny S. Microperimetric evaluation of macula in retinopathy of membranoproliferative glomerulonephritis type II: a case report. Eur J Ophthalmol 2006; 16:634-6. [PMID: 16952110 DOI: 10.1177/112067210601600425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report on the microperimetric evaluation of the central visual field in a patient with retinopathy due to membranoproliferative glomerulonephritis. METHODS The central 20 degrees visual field was evaluated using fundus-related perimetry with (Nidek MP1) microperimeter in a patient with proven membranoproliferative glomerulonephritis type II, who had multiple drusen-like lesions involving the posterior pole of both eyes, with corresponding window defects on fundus fluorescein angiogram. RESULTS Static threshold perimetry of the central 20 degrees using a 10 dB threshold, Goldmann size II stimulus, with (Nidek-MP1) microperimeter showed reduction in retinal sensitivity in the parafoveal and in the temporal paramacular areas in both the eyes that had drusen-like lesions. CONCLUSIONS Early loss of function in retinopathy of membranoproliferative glomerulonephritis type II can probably be detected by fundus-related microperimetry.
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Affiliation(s)
- R Shenoy
- Department of Ophthalmology and Program for Ophthalmic Technicians, Sultan Qaboos University Hospital, PO Box 38, PC 123, Al Khoud, Muscat, Sultanate of Oman.
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Huang SJ, Costa DLL, Gross NE, Yannuzzi LA. Peripheral drusen in membranoproliferative glomerulonephritis type II. Retina 2003; 23:429-31. [PMID: 12824858 DOI: 10.1097/00006982-200306000-00036] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sheau Jiun Huang
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA
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Kim RY, Faktorovich EG, Kuo CY, Olson JL. Retinal function abnormalities in membranoproliferative glomerulonephritis type II. Am J Ophthalmol 1997; 123:619-28. [PMID: 9152067 DOI: 10.1016/s0002-9394(14)71074-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To characterize retinal electrophysiologic and psychophysical abnormalities associated with membranoproliferative glomerulonephritis type II. METHODS Three adults with membranoproliferative glomerulonephritis type II were studied. Retinal function was measured psychophysically (automated perimetry, Farnsworth D-15 color vision testing, and dark adaptometry) and electrophysiologically (full-field flash electroretinography and electro-oculography). RESULTS Two symptomatic individuals had prominent drusenlike deposits and retinal pigment epithelial disturbances, findings characteristic of membranoproliferative glomerulonephritis type II retinopathy. These individuals had mild visual field and color vision abnormalities, prolonged dark adaptation, and delayed electroretinographic dark-adapted dim and bright flash responses of normal amplitude. The electro-oculogram of the most severely affected individual was abnormal. The third individual who was asymptomatic had the mildest fundus abnormalities and exhibited normal psychophysical and electrophysiologic responses. CONCLUSIONS Membranoproliferative glomerulonephritis type II retinopathy may be associated with symptomatic and measurable psychophysical and electrophysiologic abnormalities of retinal function.
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Affiliation(s)
- R Y Kim
- Department of Ophthalmology, University of California, San Francisco 94143-0730, USA.
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Ulbig MR, Riordan-Eva P, Holz FG, Rees HC, Hamilton PA. Membranoproliferative glomerulonephritis type II associated with central serous retinopathy. Am J Ophthalmol 1993; 116:410-3. [PMID: 8213970 DOI: 10.1016/s0002-9394(14)71397-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Membranoproliferative glomerulonephritis type II is specifically associated with the presence of dense deposits in the basement membrane of Bruch's membrane, which result in lesions similar to basal laminar drusen, exudative drusen, and retinal pigment epithelial detachments. In advanced stages of this dense-deposit retinopathy, choroidal neovascularization may occur. We observed a 36-year-old patient with membranoproliferative glomerulonephritis type II who developed central serous retinopathy in the presence of specific dense-deposit-associated fundus lesions. The diffuse drusenlike dense deposits (at the level of Bruch's membrane) and associated retinal pigment epithelial detachments appear to contribute to the pathogenesis of central serous retinopathy. Thus changes in Bruch's membrane may be involved in the development of central serous retinopathy.
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Affiliation(s)
- M R Ulbig
- Retinal Diagnostic Department, Moorfields Eye Hospital, London, United Kingdom
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Abstract
Membranoproliferative glomerulonephritis is a renal disorder characterized by proliferation of cells and changes in the basement membrane of the glomerulus. The disease is divided into three subtypes: type I, characterized by the presence of subendothelial electrondense deposits; type II, characterized by deposition of electrondense material of unknown origin in the lamina densa of the glomerular basement membrane; and type III, characterized by lesions having both type I and type II qualities. Specific posterior segment changes have been reported with membranoproliferative glomerulonephritis type II. We examined three patients with membranoproliferative glomerulonephritis type II and two patients with type III disease. All three patients with type II disease had Bruch's membrane and retinal pigment epithelial changes, whereas both patients with type III disease had normal posterior segments.
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Affiliation(s)
- D D Kim
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee
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