A novel PAX6 variant as the cause of aniridia in a Chinese patient with SRRRD

BACKGROUND

The genotype characteristics and their associated clinical phenotypes in patients with aniridia were analyzed to explore pathogenic variants using whole-exome sequencing.

METHODS

One patient with aniridia was enrolled at the Beijing Tongren Hospital. Comprehensive ophthalmic and general examinations were performed on the patient. DNA was extracted from the patient, and whole-exome sequencing was performed to identify the causative variant. The pathogenicity of the variant was predicted using in silico analysis and evaluated according to American College of Medical Genetics and Genomics guidelines. Relationships between genetic variants and clinical features were analyzed.

RESULTS

In addition to the classical aniridia phenotype showing complete iris aplasia, foveal hypoplasia, and ectopic lentis, the patient also exhibited spontaneous reattachment rhegmatogenous retinal detachment (SRRRD). Whole-exome sequencing identified a novel heterozygous variant, exon8:c.640_646del:p.R214Pfs*28.

CONCLUSIONS

The present study broadens the range of genetic variants described in aniridia and presents an aniridia patient with SRRRD.

Spontaneous Resolution of a Rhegmatogenous Retinal Detachment

A retinal detachment is the term used to describe detachment of the neurosensory retina from the underlying membrane, the retinal pigment epithelium (RPE). Rhegmatogenous detachments are caused by a break in the retina through which fluid passes from the vitreous cavity into the subretinal space. The incidence of rhegmatogenous retinal detachment in the general population in Europe is 1 in 10 000 persons per year. Danger is the greatest in the age range from 55 to 70 years. Without treatment, blindness in the affected eye may occur. Individual risks depend on the presence or absence of specific factors including myopia, positive family anamnesis, retina rupture, trauma, ablation in the other eye, ablation in a vitreous body, retina high-risk peripheral de-generations and vitreoretinal degenerations. Majority of the untreated rhegmatogenous retina ablations progress to the subtotal or total retinal detachment and blindness. This paper describes a very rare case of the spontaneous complete reattachment of the sensory retina to the retinal pigment epithelium in a patient with the total rhegmatogenous retinal ablation in the right eye. The female patient, who was 52 years old, was examined by an Ophthalmologist after she had experienced a sudden loss of vision, 2 months before appointment. After a detailed ophthalmological examination, a total rhegmatogenous retinal ablation of the right eye was diagnosed. The best corrected visual acuity, evaluated on a Snellen chart, was 2/60. The patient was referred to a tertiary-level Institution since a surgical intervention of the ablation was needed. Due to technical inabilities in the above-mentioned Institution, the operation was not performed, and despite the recommendation to perform the intervention in another tertiary level Institution, the patient did not have ophthalmological examinations during the following three months. During the next visit, the Ophthalmologist determined that there was a spontaneous retinal fixation on the retinal pigment epithelium and a partial restoration of the visual function of the affected eye which was evaluated at 0.5.

Characteristics of spontaneous reattachment of rhegmatogenous retinal detachment: optical coherence tomography features and follow-up outcomes

PURPOSE

To investigate the clinical features of spontaneous reattachment of rhegmatogenous retinal detachment (SRRRD) with diffuse retinal pigmentary changes.

METHODS

This retrospective study included patients diagnosed with SRRRD. The diagnosis of SRRRD was made based on characteristic fundus findings, such as diffuse retinal pigmentary clumpings, retinal pigmentary atrophy, and convex lesion margins. The clinical features of SRRRD were also evaluated. In addition, optical coherence tomography (OCT) images and follow-up data were analyzed.

RESULTS

Twenty patients were included in the study. All the patients showed unilateral involvement. SRRRD predominantly involved the inferior or temporal retina (90.0%). On OCT, severe disruption of the outer retinal layers was noted in the region of SRRRD. A subretinal gliosis band was noted in 11 patients (55.0%), and an epiretinal membrane (ERM) was noted in nine patients (45.0%). In 18 patients, a mean follow-up of 24.9 ± 29.2 months was performed. During the follow-up period, no definite retinal changes were noted on fundus examination or OCT.

CONCLUSIONS

SRRRD usually involves the inferior or temporal retina. Although severe disruption of the retinal microstructure is noted in the involved region, the condition is likely to be stable. However, long-term follow-up is required to identify progression of the ERM.