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Gillingham MB, Choi D, Gregor A, Wongchaisuwat N, Black D, Scanga HL, Nischal KK, Sahel JA, Arnold G, Vockley J, Harding CO, Pennesi ME. Early diagnosis and treatment by newborn screening (NBS) or family history is associated with improved visual outcomes for long-chain 3-hydroxyacylCoA dehydrogenase deficiency (LCHADD) chorioretinopathy. J Inherit Metab Dis 2024. [PMID: 38623632 DOI: 10.1002/jimd.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024]
Abstract
Long chain 3-hydroxyacyl-CoA dehydrogenase (LCHADD) is the only fatty acid oxidation disorder to develop a progressive chorioretinopathy resulting in vision loss; newborn screening (NBS) for this disorder began in the United States around 2004. We compared visual outcomes among 40 participants with LCHADD or trifunctional protein deficiency diagnosed symptomatically to those who were diagnosed via NBS or a family history. Participants completed ophthalmologic testing including measures of visual acuity, electroretinograms (ERG), fundal imaging, contrast sensitivity, and visual fields. Records were reviewed to document medical and treatment history. Twelve participants presented symptomatically with hypoglycemia, failure to thrive, liver dysfunction, cardiac arrest, or rhabdomyolysis. Twenty eight were diagnosed by NBS or due to a family history of LCHADD. Participants diagnosed symptomatically were older but had similar percent males and genotypes as those diagnosed by NBS. Treatment consisted of fasting avoidance, dietary long-chain fat restriction, MCT, C7, and/or carnitine supplementation. Visual acuity, rod- and cone-driven amplitudes on ERG, contrast sensitivity scores, and visual fields were all significantly worse among participants diagnosed symptomatically compared to NBS. In mixed-effects models, both age and presentation (symptomatic vs. NBS) were significant independent factors associated with visual outcomes. This suggests that visual outcomes were improved by NBS, but there was still lower visual function with advancing age in both groups. Early diagnosis and treatment by NBS is associated with improved visual outcomes and retinal function compared to participants who presented symptomatically. Despite the impact of early intervention, chorioretinopathy was greater with advancing age, highlighting the need for novel treatments.
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Affiliation(s)
- Melanie B Gillingham
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon, USA
| | - Dongseok Choi
- OHSU-PSU School of Public Health, Biostatistics, Oregon Health & Science University, Portland, Oregon, USA
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Ashley Gregor
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon, USA
| | - Nida Wongchaisuwat
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Danielle Black
- Division of Genetic and Genomic Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hannah L Scanga
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ken K Nischal
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Georgianne Arnold
- Division of Genetic and Genomic Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jerry Vockley
- Division of Genetic and Genomic Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cary O Harding
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark E Pennesi
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
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Wongchaisuwat N, Gillingham MB, Yang P, Everett L, Gregor A, Harding CO, Sahel JA, Nischal KK, Scanga HL, Black D, Vockley J, Arnold G, Pennesi ME. A proposal for an updated staging system for LCHADD retinopathy. Ophthalmic Genet 2024; 45:140-146. [PMID: 38288966 PMCID: PMC11010772 DOI: 10.1080/13816810.2024.2303682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/05/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To develop an updated staging system for long-chain 3-hydroxyacyl coenzyme A dehydrogenase deficiency (LCHADD) chorioretinopathy based on contemporary multimodal imaging and electrophysiology. METHODS We evaluated forty cases of patients with genetically confirmed LCHADD or trifunctional protein deficiency (TFPD) enrolled in a prospective natural history study. Wide-field fundus photographs, fundus autofluorescence (FAF), optical coherence tomography (OCT), and full-field electroretinogram (ffERG) were reviewed and graded for severity. RESULTS Two independent experts first graded fundus photos and electrophysiology to classify the stage of chorioretinopathy based upon an existing published system. With newer imaging modalities and improved electrophysiology, many patients did not fit cleanly into a single traditional staging group. Therefore, we developed a novel staging system that better delineated the progression of LCHADD retinopathy. We maintained the four previous delineated stages but created substages A and B in stages 2 to 3 to achieve better differentiation. DISCUSSION Previous staging systems of LCHADD chorioretinopathy relied on only on the assessment of standard 30 to 45-degree fundus photographs, visual acuity, fluorescein angiography (FA), and ffERG. Advances in recordings of ffERG and multimodal imaging with wider fields of view, allow better assessment of retinal changes. Following these advanced assessments, seven patients did not fit neatly into the original classification system and were therefore recategorized under the new proposed system. CONCLUSION The new proposed staging system improves the classification of LCHADD chorioretinopathy, with the potential to lead to a deeper understanding of the disease's progression and serve as a more reliable reference point for future therapeutic research.
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Affiliation(s)
- Nida Wongchaisuwat
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Melanie B. Gillingham
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Paul Yang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
| | - Lesley Everett
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Ashley Gregor
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Cary O. Harding
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Jose Alain Sahel
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ken K. Nischal
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hannah L. Scanga
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Danielle Black
- Division of Genetic and Genomic Medicine, University of Pittsburgh Medical Center Children’s Hospital, Pittsburgh, Pennsylvania, USA
| | - Jerry Vockley
- Division of Genetic and Genomic Medicine, University of Pittsburgh Medical Center Children’s Hospital, Pittsburgh, Pennsylvania, USA
| | - Georgianne Arnold
- Division of Genetic and Genomic Medicine, University of Pittsburgh Medical Center Children’s Hospital, Pittsburgh, Pennsylvania, USA
| | - Mark E. Pennesi
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
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Weiss JS, Rapuano CJ, Seitz B, Busin M, Kivelä TT, Bouheraoua N, Bredrup C, Nischal KK, Chawla H, Borderie V, Kenyon KR, Kim EK, Møller HU, Munier FL, Berger T, Lisch W. IC3D Classification of Corneal Dystrophies-Edition 3. Cornea 2024; 43:466-527. [PMID: 38359414 PMCID: PMC10906208 DOI: 10.1097/ico.0000000000003420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/08/2023] [Accepted: 09/24/2023] [Indexed: 02/17/2024]
Abstract
PURPOSE The International Committee for the Classification of Corneal Dystrophies (IC3D) was created in 2005 to develop a new classification system integrating current information on phenotype, histopathology, and genetic analysis. This update is the third edition of the IC3D nomenclature. METHODS Peer-reviewed publications from 2014 to 2023 were evaluated. The new information was used to update the anatomic classification and each of the 22 standardized templates including the level of evidence for being a corneal dystrophy [from category 1 (most evidence) to category 4 (least evidence)]. RESULTS Epithelial recurrent erosion dystrophies now include epithelial recurrent erosion dystrophy, category 1 ( COL17A1 mutations, chromosome 10). Signs and symptoms are similar to Franceschetti corneal dystrophy, dystrophia Smolandiensis, and dystrophia Helsinglandica, category 4. Lisch epithelial corneal dystrophy, previously reported as X-linked, has been discovered to be autosomal dominant ( MCOLN1 mutations, chromosome 19). Classic lattice corneal dystrophy (LCD) results from TGFBI R124C mutation. The LCD variant group has over 80 dystrophies with non-R124C TGFBI mutations, amyloid deposition, and often similar phenotypes to classic LCD. We propose a new nomenclature for specific LCD pathogenic variants by appending the mutation using 1-letter amino acid abbreviations to LCD. Pre-Descemet corneal dystrophies include category 1, autosomal dominant, punctiform and polychromatic pre-Descemet corneal dystrophy (PPPCD) ( PRDX3 mutations, chromosome 10). Typically asymptomatic, it can be distinguished phenotypically from pre-Descemet corneal dystrophy, category 4. We include a corneal dystrophy management table. CONCLUSIONS The IC3D third edition provides a current summary of corneal dystrophy information. The article is available online at https://corneasociety.org/publications/ic3d .
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Affiliation(s)
- Jayne S Weiss
- Departments of Ophthalmology, Pathology and Pharmacology, Louisiana State University Eye Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Christopher J Rapuano
- Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Massimo Busin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy
| | - Tero T Kivelä
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nacim Bouheraoua
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital and Sorbonne Université, Paris, France
| | - Cecilie Bredrup
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus and Adult Motility, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Harshvardhan Chawla
- Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Vincent Borderie
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital and Sorbonne Université, Paris, France
| | - Kenneth R Kenyon
- Department of Ophthalmology, Tufts University School of Medicine and Harvard Medical School, Schepens Eye Research Institute and New England Eye Center, Boston, MA
| | - Eung Kweon Kim
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Saevit Eye Hospital, Goyang, Korea
| | - Hans Ulrik Møller
- Department of Pediatric Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Francis L Munier
- Retinoblastoma and Oculogenetic Units, Jules-Gonin Eye Hospital and Fondation Asile des Aveugle, University of Lausanne, Lausanne, Switzerland; and
| | - Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Walter Lisch
- Department of Ophthalmology, Johannes Gutenberg University Mainz, Mainz, Germany
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Franco E, Gagrani M, Scanga HL, Areaux RG, Chu CT, Nischal KK. Variable Phenotype of Congenital Corneal Opacities in Biallelic CYP1B1 Pathogenic Variants. Cornea 2024; 43:195-200. [PMID: 37788597 PMCID: PMC10840913 DOI: 10.1097/ico.0000000000003395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/19/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The aim of this study is to describe the variable phenotype of congenital corneal opacities occurring in patients with biallelic CYP1B1 pathogenic variants. METHODS A retrospective chart review was conducted to identify patients with congenital corneal opacities and CYP1B1 pathogenic variants seen at UPMC Children's Hospital of Pittsburgh. Ophthalmic examination, high-frequency ultrasound, anterior segment optical coherence tomography, histopathologic images, and details of genetic testing were reviewed. RESULTS Three children were identified. All presented with raised intraocular pressure. Two patients showed bilateral limbus-to-limbus avascular corneal opacification that did not resolve with intraocular pressure control; 1 showed unilateral avascular corneal opacity with a crescent of clear cornea, iridocorneal adhesions, iridolenticular adhesions, and classical features of congenital glaucoma in the fellow eye (enlarged corneal diameter, Haab striae, and clearing of the corneal clouding with appropriate intraocular pressure control). The first 2 patients were visually rehabilitated with penetrating keratoplasty. Histopathology revealed distinct features: a variably keratinized epithelium; a thick but discontinuous Bowman-like layer with areas of disruption and abnormal cellularity; Descemet membrane, when observed, showed reduced endothelial cells; and no pathological changes of Haab striae were identified. Two patients had compound heterozygous pathogenic variants in CYP1B1 causing premature stop codons, whereas 1 was homozygous for a pathogenic missense variant. CONCLUSIONS Congenital corneal opacities seen in biallelic CYP1B1 pathogenic variants have a variable phenotype. One is that commonly termed as Peters anomaly type 1 (with iridocorneal adhesions, with or without iridolenticular adhesions) and the other is a limbus-to-limbus opacity, termed CYP1B1 cytopathy. Clinicians should be aware of this phenotypic variability.
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Affiliation(s)
- Elena Franco
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Meghal Gagrani
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Hannah L Scanga
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Raymond G Areaux
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Charleen T Chu
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Grodecki BM, Potluri SC, Olsen K, Eldib A, Scanga HL, Pihlblad MS, Nischal KK. Calcified Sclero-Choroidal Choristomas in Mosaic RASopathies: A Description of a New Imaging Sign. Ophthalmol Retina 2024:S2468-6530(24)00048-4. [PMID: 38302056 DOI: 10.1016/j.oret.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE To evaluate the imaging and clinical features of unusual calcified lesions seen in the fundus of patients with mosaic RASopathy. DESIGN Single-center retrospective observational study. SUBJECTS Ten eyes with calcified fundus lesions in 7 patients with mosaic RASopathy. METHODS The lesions were evaluated with fundus photography, oral fundus fluorescein angiography, B-scan ultrasonography, magnetic resonance imaging (MRI), and computed tomography (CT) scan where available. MAIN OUTCOME MEASURES The imaging characteristics of calcified fundus lesions were assessed. RESULTS We found 7 patients with mosaic RASopathies, 5 men and 2 women (3 with linear sebaceous nevus syndrome, 3 with oculoectodermal syndrome, and 1 with encephalocraniocutaneous lipomatosis) with molecular confirmation in 5 cases, all 5 having KRAS-pathogenic variants. Calcified fundus lesions were identified in 10 eyes (bilateral in 3 patients), appearing as slightly elevated, creamy-yellow lesions around or adjacent to the optic nerve, extending supero-nasally; all but 2 of these lesions involved both the choroid and sclera, with 2 of them only involving the sclera at the time of examination. One case developed a choroidal neovascular membrane necessitating intravitreal bevacizumab injections. All 7 patients had B-scan ultrasonography, and the lesion appeared as a hyperechogenic area with an acoustic shadow posteriorly despite reduced gain. Five patients had MRI, and where fundus lesions were present, there was a focal defect in the sclero-choroidal layer. Four patients had a CT scan, and all 4 showed calcifications affecting both the posteromedial sclero-choroid and adjacent medial rectus muscle. Two of these patients had normal eye movements, 1 had a unilateral fixed adducted eye and a vestigial fibrous medial rectus muscle seen in imaging and intraoperatively, and the fourth had marked exotropia with a right gaze deficit affecting both eyes. CONCLUSIONS We propose that the lesions seen in this cohort are calcified sclero-choroidal choristomas and should be suspected in mosaic RASopathies when creamy-yellow lesions are seen in the fundus. If identified, the possibility of choroidal neovascularization should be considered during follow-up. In all cases where a CT scan was performed, a novel sign of sclero-muscular calcification involving the medial rectus muscle was seen. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Brian M Grodecki
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Saipriya C Potluri
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Karl Olsen
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Retina Vitreous Consultants, Pittsburgh, Pennsylvania
| | - Amgad Eldib
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Vision Institute, Pittsburgh, Pennsylvania
| | - Hannah L Scanga
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Vision Institute, Pittsburgh, Pennsylvania
| | - Matthew S Pihlblad
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Vision Institute, Pittsburgh, Pennsylvania
| | - Ken K Nischal
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Vision Institute, Pittsburgh, Pennsylvania.
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Wongchaisuwat N, Wang J, Yang P, Everett L, Gregor A, Sahel JA, Nischal KK, Pennesi ME, Gillingham MB, Jia Y. Optical coherence tomography angiography of choroidal neovascularization in long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD). Am J Ophthalmol Case Rep 2023; 32:101958. [PMID: 38161518 PMCID: PMC10757195 DOI: 10.1016/j.ajoc.2023.101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose To report the clinical utility of optical coherence tomography angiography (OCTA) for demonstrating choroidal neovascularization (CNV) associated with Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency (LCHADD) retinopathy. Methods Thirty-three participants with LCHADD (age 7-36 years; median 17) were imaged with OCTA and the Center for Ophthalmic Optics & Lasers Angiography Reading Toolkit (COOL-ART) software was implemented to process OCTA scans. Results Seven participants (21 %; age 17-36 years; median 25) with LCHADD retinopathy demonstrated evidence of CNV by retinal examination or presence of CNV within outer retinal tissue on OCTA scans covering 3 × 3 and/or 6 × 6-mm. These sub-clinical CNVs are adjacent to hyperpigmented areas in the posterior pole. CNV presented at stage 2 or later of LCHADD retinopathy prior to the disappearance of RPE pigment in the macula. Conclusion OCTA can be applied as a non-invasive method to evaluate the retinal and choroidal microvasculature. OCTA can reveal CNV in LCHADD even when the clinical exam is inconclusive. These data suggest that the incidence of CNV is greater than expected and can occur even in the early stages of LCHADD retinopathy.
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Affiliation(s)
- Nida Wongchaisuwat
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jie Wang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - Paul Yang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - Lesley Everett
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Ashley Gregor
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Jose Alain Sahel
- Vision Institute, University of Pittsburgh Medical Center and School of Medicine, Pennsylvania, USA
| | - Ken K. Nischal
- Vision Institute, University of Pittsburgh Medical Center and School of Medicine, Pennsylvania, USA
- UPMC Children's Hospital, Pennsylvania, USA
| | - Mark E. Pennesi
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Melanie B. Gillingham
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Yali Jia
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
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Gagrani M, Conner EA, Scanga H, Hiasat JG, Tripi KS, Pihlblad MS, Jhanji V, Nischal KK. Thygeson's superficial punctate keratitis in children. Eye (Lond) 2023; 37:3455-3460. [PMID: 37085721 PMCID: PMC10630495 DOI: 10.1038/s41433-023-02533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/07/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE To describe the first paediatric case series of Thygesons' superficial punctate keratitis (TSPK) with management outcomes. METHODS A retrospective chart review was done for all children either diagnosed at initial presentation or referred with TSPK from 01/2012 to 08/2021 at a tertiary children's hospital. Records were assessed for signs, symptoms, diagnosis, steroid and cyclosporine 0.05% use. The main outcome measures were visual acuity, treatment response and total steroid exposure. RESULTS Fifteen children (7 females), mean age at presentation 8 ± 4 years were included. All had bilateral disease and a BCVA of >20/40 in the better eye. All patients received topical fluorometholone 0.1%, (FML) initially. 80% had a good response to FML. Corneal scraping was done to exclude infectious causes in four cases due to poor initial response or clinical suspicion. All 4 needed EUA for scraping and anterior segment OCT, after which 2 had molecularly confirmed TGFBI-related stromal dystrophy. For the rest, slow steroid taper was done every 4-6 weeks and recurrences were treated by increasing steroid frequency. Cyclosporine 0.05% was started in nine patients (69%), 8 ± 6 months after initial presentation. The decrease in total steroid exposure per week after starting cyclosporine was statistically significant (p < 0.05). CONCLUSION Children with TSPK respond quickly to steroids, however, recurrences are common, necessitating a slow taper. Non-response to steroid needs careful reconsideration of the diagnosis and may necessitate the use of an EUA. Using cyclosporine 0.05% reduces the total steroid exposure in TSPK.
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Affiliation(s)
- Meghal Gagrani
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth A Conner
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hannah Scanga
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamila G Hiasat
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly Schooping Tripi
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Matthew S Pihlblad
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vishal Jhanji
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Ramappa M, Nischal KK. Advancing therapies for anterior segment developmental anomalies. Taiwan J Ophthalmol 2023; 13:403-404. [PMID: 38249506 PMCID: PMC10798393 DOI: 10.4103/tjo.tjo-d-23-00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 01/23/2024] Open
Affiliation(s)
- Muralidhar Ramappa
- Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, Telangana, India
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Jasti V Ramanamma Children’s Eye Care Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ken K Nischal
- UPMC Eye Center, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Conner EA, Eldib A, Hiasat JG, Pihlblad MS, Errera MH, Chhablani PP, Gagrani M, Luchansky C, Keim E, Liasis A, Nischal KK. Pediatric oral fluorescein angiography: a retrospective review from a single institution. J AAPOS 2023; 27:191.e1-191.e6. [PMID: 37507064 DOI: 10.1016/j.jaapos.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE To describe our experience with locally developed evidence-based guidelines for oral fluorescein angiography (FA) for retinal imaging in children. METHODS The medical records of consecutive pediatric patients (≤18 years of age) at University of Pittsburgh Medical Center Children's Hospital Eye Center who underwent oral FA between November 1, 2018, and April 1, 2022, were reviewed retrospectively. Adherence to or deviation from the guidelines was noted at the time of testing. RESULTS A total of 55 patients aged 3-18 with 79 examinations were included. No patient was excluded from the retrospective case review because of lack of recorded data. The main indications for oral FA included uveitis, retinal vasculopathy, disk pathology, and retinal lesions. Three children had transient side effects, and 1 had delayed urticaria 4 hours after examination. No child had anaphylaxis. One patient had suboptimal imaging due to nonadherence to the guidelines-recommended fasting protocol. All other examinations (78/79), where guidelines were followed, provided images adequate for clinical decision making. CONCLUSIONS Based on our experience, we recommend that oral FA be considered, especially in children where intravenous access is less well tolerated while awake. Informed consent that includes the possibility of delayed side effects is advisable.
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Affiliation(s)
- Elizabeth A Conner
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Amgad Eldib
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Jamila G Hiasat
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Matthew S Pihlblad
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Marie-Helene Errera
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Preeti Patil Chhablani
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Meghal Gagrani
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Craig Luchansky
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Erin Keim
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Alki Liasis
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania
| | - Ken K Nischal
- University of Pittsburgh Medical Center (UPMC) Eye Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC Division of Pediatric Ophthalmology Strabismus and Adult Motility, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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Daruich A, Duncan M, Robert MP, Lagali N, Semina EV, Aberdam D, Ferrari S, Romano V, des Roziers CB, Benkortebi R, De Vergnes N, Polak M, Chiambaretta F, Nischal KK, Behar-Cohen F, Valleix S, Bremond-Gignac D. Congenital aniridia beyond black eyes: From phenotype and novel genetic mechanisms to innovative therapeutic approaches. Prog Retin Eye Res 2023; 95:101133. [PMID: 36280537 PMCID: PMC11062406 DOI: 10.1016/j.preteyeres.2022.101133] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
Congenital PAX6-aniridia, initially characterized by the absence of the iris, has progressively been shown to be associated with other developmental ocular abnormalities and systemic features making congenital aniridia a complex syndromic disorder rather than a simple isolated disease of the iris. Moreover, foveal hypoplasia is now recognized as a more frequent feature than complete iris hypoplasia and a major visual prognosis determinant, reversing the classical clinical picture of this disease. Conversely, iris malformation is also a feature of various anterior segment dysgenesis disorders caused by PAX6-related developmental genes, adding a level of genetic complexity for accurate molecular diagnosis of aniridia. Therefore, the clinical recognition and differential genetic diagnosis of PAX6-related aniridia has been revealed to be much more challenging than initially thought, and still remains under-investigated. Here, we update specific clinical features of aniridia, with emphasis on their genotype correlations, as well as provide new knowledge regarding the PAX6 gene and its mutational spectrum, and highlight the beneficial utility of clinically implementing targeted Next-Generation Sequencing combined with Whole-Genome Sequencing to increase the genetic diagnostic yield of aniridia. We also present new molecular mechanisms underlying aniridia and aniridia-like phenotypes. Finally, we discuss the appropriate medical and surgical management of aniridic eyes, as well as innovative therapeutic options. Altogether, these combined clinical-genetic approaches will help to accelerate time to diagnosis, provide better determination of the disease prognosis and management, and confirm eligibility for future clinical trials or genetic-specific therapies.
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Affiliation(s)
- Alejandra Daruich
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, Paris, France; INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France
| | - Melinda Duncan
- Department of Biological Sciences, University of Delaware, Newark, DE, USA
| | - Matthieu P Robert
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, Paris, France; Borelli Centre, UMR 9010, CNRS-SSA-ENS Paris Saclay-Paris Cité University, Paris, France
| | - Neil Lagali
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, 581 83, Linköping, Sweden; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Elena V Semina
- Department of Pediatrics, Children's Research Institute at the Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI, 53226, USA
| | - Daniel Aberdam
- INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France
| | - Stefano Ferrari
- Fondazione Banca degli Occhi del Veneto, Via Paccagnella 11, Venice, Italy
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiolological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Italy
| | - Cyril Burin des Roziers
- INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France; Service de Médecine Génomique des Maladies de Système et d'Organe, APHP. Centre Université de Paris, Fédération de Génétique et de Médecine Génomique Hôpital Cochin, 27 rue du Fbg St-Jacques, 75679, Paris Cedex 14, France
| | - Rabia Benkortebi
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, Paris, France
| | - Nathalie De Vergnes
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, Paris, France
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology, Hôpital Universitaire Necker Enfants Malades, AP-HP, Paris Cité University, INSERM U1016, Institut IMAGINE, France
| | | | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA; UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francine Behar-Cohen
- INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France
| | - Sophie Valleix
- INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France; Service de Médecine Génomique des Maladies de Système et d'Organe, APHP. Centre Université de Paris, Fédération de Génétique et de Médecine Génomique Hôpital Cochin, 27 rue du Fbg St-Jacques, 75679, Paris Cedex 14, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris Cité University, Paris, France; INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Sorbonne Paris Cité University, Centre de Recherche des Cordeliers, Paris, France.
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11
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Franco E, Gagrani M, Lalgudi VG, Shah PR, Lenhart P, Bhola R, Nischal KK. Technique for the Management of Extensive Ocular Surface Lipodermoid Involving the Cornea of Children. Cornea 2023; 42:770-775. [PMID: 36735292 PMCID: PMC10164034 DOI: 10.1097/ico.0000000000003245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Ocular surface lipodermoids with corneal involvement may require surgical intervention; if deep, ocular surface reconstruction with lamellar corneal tissue or amniotic membrane may be needed. We describe a staged technique using autologous ipsilateral simple limbal epithelial transplantation. METHODS After verifying sparing of Descemet membrane, the conjunctival portion of the lipodermoid was debulked in the first stage. Six weeks later, the corneal portion was excised, followed by autologous ipsilateral simple limbal epithelial transplantation to promote rapid reepithelialization of the residual stromal bed. Temporary tarsorrhaphy was used for patient comfort and to expedite ocular surface healing. RESULTS Three eyes of 3 children with grade III large ocular surface lipodermoids that encroached the visual axis and hindered proper eyelid closure underwent surgery without complications. In all cases, the visual axis was cleared and eyelid closure was improved. At the last follow-up (mean 35.7 months, median 36.0 months), the bed of the original dermoid showed minimal haze in 1 case, while 2 eyes developed small pseudopterygium; best spectacle-corrected visual acuity improved from 20/200 to 20/70 in the first case, from fix and follow to 20/50 in the second case, and remained fix and follow in the last case, but this child had congenital hydrocephalus with severe developmental delay. CONCLUSIONS This surgical technique is a promising option for children with grade III large ocular surface lipodermoids given its effectiveness in clearing the visual axis and in improving eyelid closure. Moreover, it does not require lamellar corneal transplantation or intervention to the fellow eye.
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Affiliation(s)
- Elena Franco
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Meghal Gagrani
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Vaitheeswaran G. Lalgudi
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Department of Cornea and Refractive surgery, University of Ottawa Eye Institute - The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Parth R. Shah
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Department of Ophthalmology, Sydney Children’s Hospital, Sydney, Australia
| | - Phoebe Lenhart
- Section of Pediatric Ophthalmology, Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Road, NE, Suite 5400, Atlanta, GA, 30322, USA
| | - Rahul Bhola
- Division of Ophthalmology, CHOC Children’s Hospital, Orange, California
| | - Ken K. Nischal
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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12
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Franco E, Scanga HL, Nischal KK. Corneal Plana-Like Phenotype With Peripheral Scleralization Associated With a Pathogenic Variant of PITX2 : A Case Report. Cornea 2023; 42:639-640. [PMID: 36727872 PMCID: PMC10081730 DOI: 10.1097/ico.0000000000003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/02/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to report a case of corneal plana-like phenotype with bilateral peripheral scleralization associated with a PITX2 pathogenic variant. METHODS Clinical findings were obtained by ophthalmologic examination. Molecular diagnosis was performed by whole-exome sequencing in the patient and his parents. RESULTS A 12-month-old male patient present with bilateral peripheral corneal scleralization, corneal plana-like phenotype, and iris hypoplasia. The genetic analysis revealed a de novo PITX2 pathogenic variant (c.323G>A, p.R108H). CONCLUSIONS PITX2 c.323G>A (p.R108H) can be associated with a unique corneal plana-like phenotype with peripheral scleralization, and thus, PITX2 should be targeted in genetic testing of this specific phenotype.
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Affiliation(s)
- Elena Franco
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Hannah L Scanga
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Ken K Nischal
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA; and
- University of Pittsburgh School of Medicine, Pittsburgh, PA
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13
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Flitcroft I, Ainsworth J, Chia A, Cotter S, Harb E, Jin ZB, Klaver CCW, Moore AT, Nischal KK, Ohno-Matsui K, Paysse EA, Repka MX, Smirnova IY, Snead M, Verhoeven VJM, Verkicharla PK. IMI-Management and Investigation of High Myopia in Infants and Young Children. Invest Ophthalmol Vis Sci 2023; 64:3. [PMID: 37126360 PMCID: PMC10153576 DOI: 10.1167/iovs.64.6.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the epidemiology, etiology, clinical assessment, investigation, management, and visual consequences of high myopia (≤-6 diopters [D]) in infants and young children. Findings High myopia is rare in pre-school children with a prevalence less than 1%. The etiology of myopia in such children is different than in older children, with a high rate of secondary myopia associated with prematurity or genetic causes. The priority following the diagnosis of high myopia in childhood is to determine whether there is an associated medical diagnosis that may be of greater overall importance to the health of the child through a clinical evaluation that targets the commonest features associated with syndromic forms of myopia. Biometric evaluation (including axial length and corneal curvature) is important to distinguishing axial myopia from refractive myopia associated with abnormal development of the anterior segment. Additional investigation includes ocular imaging, electrophysiological tests, genetic testing, and involvement of pediatricians and clinical geneticists is often warranted. Following investigation, optical correction is essential, but this may be more challenging and complex than in older children. Application of myopia control interventions in this group of children requires a case-by-case approach due to the lack of evidence of efficacy and clinical heterogeneity of high myopia in young children. Conclusions High myopia in infants and young children is a rare condition with a different pattern of etiology to that seen in older children. The clinical management of such children, in terms of investigation, optical correction, and use of myopia control treatments, is a complex and often multidisciplinary process.
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Affiliation(s)
- Ian Flitcroft
- Children's Health Ireland (CHI) at Temple Street, Dublin, Ireland
- Centre for Eye Research Ireland, Technological University of Dublin, Dublin, Ireland
| | - John Ainsworth
- Birmingham Children's Hospital, Steelhouse Lane Birmingham, United Kingdom
| | | | - Susan Cotter
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, United States
| | - Elise Harb
- Wertheim School Optometry and Vision Science, Berkeley, California, United States
- University of California - San Francisco, School of Medicine, San Francisco, California, United States
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Anthony T Moore
- University of California - San Francisco, School of Medicine, San Francisco, California, United States
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Evelyn A Paysse
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Michael X Repka
- Wilmer Eye Institute, The John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | | | - Martin Snead
- Department of Vitreoretinal Research, John van Geest Centre for Brain Repair, University of Cambridge, United Kingdom
| | - Virginie J M Verhoeven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
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Franco E, Scanga HL, Jacob S, Chu CT, Nischal KK. Congenital corneal staphyloma in 8q21.11 microdeletion syndrome. Ophthalmic Genet 2023; 44:147-151. [PMID: 36341706 DOI: 10.1080/13816810.2022.2127152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although 8q21.11 microdeletion syndrome (8q21.11 DS) has been reported in association with congenital corneal opacities, reports of the clinicopathological features and management are scarce. METHODS We reviewed medical records including ophthalmic evaluations, imaging, operative reports, and pathology reports of two unrelated patients referred to the Ophthalmology Clinic of UPMC Children's Hospital of Pittsburgh with a cytogenetic diagnosis of 8q21.11 DS. RESULTS Ophthalmological evaluation of both children revealed bilateral enlarged, staphylomatous, and cloudy corneas with neovascularization. These findings were consistent with the diagnosis of congenital corneal staphyloma (CCS). In one patient, anterior segment optical coherence tomography and high-frequency ultrasound revealed materials consistent with lens remnants embedded in the cornea; this was confirmed by histopathology. In the second patient, lens was found to be adherent to the cornea during surgery. One eye underwent enucleation for corneal perforation secondary to elevated intraocular pressure. In the other eyes, treatment consisted of penetrating keratoplasty combined with vitrectomy. Ahmed tube was subsequently placed to control intraocular pressure. CONCLUSION 8q21.11 microdeletion syndrome can be associated with bilateral CCS, likely related to a combination of anterior segment developmental anomalies and elevated intraocular pressure. Tectonic penetrating keratoplasty is necessary to prevent corneal perforation, together with a strict control of the intraocular pressure.
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Affiliation(s)
- Elena Franco
- Division of Pediatric Ophthalmology, Strabismus, andAdult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Hannah L Scanga
- Division of Pediatric Ophthalmology, Strabismus, andAdult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Charleen T Chu
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus, andAdult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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15
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Melachuri S, Dansingani KK, Wesalo J, Paez-Escamilla M, Gagrani M, Atta S, Indermill C, Sahel JA, Nischal KK, Chhablani J, Errera MH. OCT Angiography in Noninfectious Uveitis: A Description of Five Cases and Clinical Applications. Diagnostics (Basel) 2023; 13:diagnostics13071296. [PMID: 37046514 PMCID: PMC10092962 DOI: 10.3390/diagnostics13071296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Background: Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality used to analyze the retinochoroidal vasculature and detect vascular flow. The resulting images can be segmented to view each vascular plexus individually. While fluorescein angiography is still the gold standard for the diagnosis of posterior uveitis, it has limitations, and can be replaced by OCTA in some cases. Methods: This case series describes five patients with posterior noninfectious uveitis and their description by OCTA. Results: Cases included lupus retinopathy (n = 1) for which OCTA showed ischemic maculopathy as areas of flow deficit at the superficial and deep capillary plexus; choroidal granulomas (n = 1) with a non-detectable flow signal in the choroid; active punctate inner choroiditis and multifocal choroiditis (n = 1) with OCTA that showed active inflammatory chorioretinal lesions as non-detectable flow signals in choriocapillaris and choroid; dense type 2 inflammatory secondary neovascularization (n = 1) associated with active choroiditis; and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) (n = 1) without flow abnormalities at the superficial and deep retinal plexuses but non-detectable flow at the levels of the choriocapillaris and choroid. Conclusions: Ophthalmologists can use OCTA to identify inflammatory changes in retinal and choroidal vasculature, aiding in the diagnosis, management, and monitoring of posterior uveitis.
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16
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Mataftsi A, Seliniotaki AK, Moutzouri S, Prousali E, Darusman KR, Adio AO, Haidich AB, Nischal KK. Digital eye strain in young screen users: A systematic review. Prev Med 2023; 170:107493. [PMID: 36977430 DOI: 10.1016/j.ypmed.2023.107493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023]
Abstract
Digital eye strain (DES) or computer vision syndrome (CVS) is a phenomenon linked to ever increasing digital screen use globally, affecting a large number of individuals. Recognizing causative and alleviating factors of DES may help establish appropriate policies. We aimed to review factors that aggravate or alleviate DES symptoms in young, i.e. pre-presbyopic (<40 years old), digital device users. We searched PubMed, Scopus, EMBASE, Cochrane, Trip Database, and grey literature up to 1st July 2021. Among a plethora of studies with heterogeneous diagnostic criteria for DES, we only included those using a validated questionnaire for the diagnosis and evaluating associated factors in young subjects. Relevant data were extracted, risk of bias assessment of the included studies and GRADE evaluation of each outcome were performed. Ten studies were included (five interventional, five observational) involving 2365 participants. Evidence coming from studies with moderate risk of bias suggested that blue-blocking filters do not appear to prevent DES (2 studies, 130 participants), while use of screens for >4-5 h/day (2 studies, 461 participants) and poor ergonomic parameters during screen use (1 study, 200 participants) are associated with higher DES symptoms'score. GRADE evaluation for the outcomes of blue-blocking filters and duration of screen use showed low to moderate quality of evidence. It appears advisable to optimize ergonomic parameters and restrict screen use duration, for minimizing DES symptoms. Health professionals and policy makers may consider recommending such practices for digital screen users at work or leisure. There is no evidence for use of blue-blocking filters.
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Affiliation(s)
- Asimina Mataftsi
- 2(nd) Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Aikaterini K Seliniotaki
- 2(nd) Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Moutzouri
- 2(nd) Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Prousali
- 2(nd) Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kianti R Darusman
- Department of Ophthalmology, Eka Hospital, South Tangerang, Indonesia
| | - Adedayo O Adio
- Department of Pediatric Ophthalmology, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA; UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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17
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Liasis A, Franco E, Eldib A, Handley S, Scanga HL, Nischal KK. The influence of congenital corneal opacity on ERGs obtained using an abbreviated protocol. Ophthalmic Genet 2023; 44:6-10. [PMID: 36541570 DOI: 10.1080/13816810.2022.2149817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Visual electrophysiology may be used to assess visual potential in infants with congenital corneal opacities (CCO). It is essential to recognize confounding effects from these opacities on the flash electroretinogram (ERG). METHODS ERGs were recorded in awake children employing skin electrodes placed at the lower eyelid crease, both referred to a midfrontal electrode (Fz). A hand-held stimulator was used to present a mixed rod-cone and a dim white stimulus. Recordings were carried out before and after penetrating keratoplasty (PK), when performed. RESULTS Five infants under the age of 12 months with visually significant CCO were evaluated. In all cases, initial ERGs employing the mixed rod-cone stimulus showed well-defined a-wave with reduced amplitude b-wave. Reduction of stimulus intensity resulted in an increase in the b-wave and normalization of the b:a ratio from 1.1 (range 0.7 to 1.3) to 2.8 (range 1.5 to 4.3). In three cases who underwent PK, the postoperative ERGs recorded with a mixed rod-cone stimulus were normal in waveform shape with a mean b:a ratio of 2.0 (range 1.7 to 3.0). CONCLUSION Selective reduction of the scotopic bright flash ERG b-wave is typically caused by retinal dysfunction that is post-phototransduction or inner retinal. In infants with CCO, scotopic ERGs to bright flashes can show a reduced b:a ratio that improves or normalizes either after PK or stimulus intensity reduction. The study highlights that media opacity can contribute to the generation of an ERG with reduced b-wave in the absence of inner retinal dysfunction.
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Affiliation(s)
- Alkiviades Liasis
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Italy
| | - Elena Franco
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Amgad Eldib
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Italy
| | - Sian Handley
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hannah L Scanga
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ken K Nischal
- Division of Paediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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18
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Franco E, Scanga HL, Nischal KK. Variable phenotype of secondary congenital corneal opacities associated with microphthalmia with linear skin defects syndrome. Am J Med Genet A 2023; 191:586-591. [PMID: 36369709 DOI: 10.1002/ajmg.a.63043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/15/2022]
Abstract
To describe the anterior segment (AS) findings in patients with microphthalmia with linear skin defects syndrome (MLS), also known as microphthalmia, dermal aplasia, and sclerocornea (MIDAS). A retrospective chart review was conducted to identify patients with a diagnosis of MLS syndrome seen at UPMC Children's Hospital of Pittsburgh. Ophthalmic examination, high-frequency ultrasound, AS optical coherence tomography, and molecular testing were reviewed. Five female patients (10 eyes) were identified. One eye was anophthalmic, one was in a status post penetrating keratoplasty, and eight eyes presented with congenital corneal opacity (CCO). Of these, one showed a normal lens and a very small faint CCO; five showed congenital aphakia and characteristic silvery appearance of the cornea with vascularization; and two showed irido-corneal adhesions in association with normal or abnormal lens and localized avascular CCO. Genetic testing was performed and revealed involvement of HCCS in four patients. In MLS patients, kerato-irido-lenticular dysgenesis can be associated with secondary CCO. It is important to distinguish these CCO from sclerocornea, in order to refine the appropriate management and counseling the parents about the prognosis.
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Affiliation(s)
- Elena Franco
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy
| | - Hannah L Scanga
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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19
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Nanda KD, Nischal KK. The Effect of Refractive Amblyopia on the Frisby Stereotest. J Binocul Vis Ocul Motil 2023; 73:7-10. [PMID: 35984966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To identify the expected degree of stereoacuity measured by the Frisby Stereotest, in various degrees of unilateral refractive amblyopia. METHODS A prospective investigation of 22 patients, with a clinical diagnosis of unilateral refractive amblyopia. All patients were aged 4-12 years and seen between February and November 2021.All patients were recruited to the study at their first return visit with new glasses as prescribed by our physicians, following a cycloplegic refraction. All patients had a full orthoptic examination including the near Frisby Stereotest, visual acuity assessment, an induced tropia test (ITT) using a 20 base-in prism. A fixation preference qualified as amblyopia for the purpose of this study. All tests performed are part of our routine examination. RESULTS Regression analysis was performed on the data to identify a correlation between variables. We compared the Frisby scores with the maximum visual acuity difference between the eyes, the amblyopic visual acuity, the non-amblyopic visual acuity, and the spherical equivalent of the patients' refractions.Analysis revealed a strong relationship between both the visual acuity difference and the Frisby score (r = 0.64, R2 = 0.41), and the amblyopic visual acuity and Frisby score (r = 0.73, R2 = 0.53). There was no relationship between the anisometropia based on spherical equivalent refractions (r = 0.03, R2 = 0.0007). CONCLUSIONS Given the moderate-to-strong correlation noted between visual acuity and stereoacuity, we suggest that the Frisby Stereotest can be utilized to imply possible refractive amblyopia and allow earlier intervention which may lead to more successful outcomes.
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Affiliation(s)
- Kaajal D Nanda
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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20
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Ramappa M, Chaurasia S, Mohamed A, Ramya Achanta DS, Mandal AK, Edward DP, Gokhale N, Swarup R, Nischal KK. Selective Endothelialectomy in Peters Anomaly: A Novel Surgical Technique and Its Clinical Outcomes in Children. Cornea 2022; 41:1477-1486. [PMID: 36198649 PMCID: PMC9640272 DOI: 10.1097/ico.0000000000003134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study describes the surgical outcomes of selective endothelialectomy in Peters anomaly (SEPA), a relatively new technique to manage Peters anomaly (PA). METHODS This study included 34 eyes of 28 children who had a visually significant posterior corneal defect due to PA and underwent SEPA between 2012 and 2019. A selective endothelialectomy from the posterior corneal defect was performed while preserving Descemet membrane. The primary outcome measure was the resolution of corneal opacification. The secondary outcome measures were functional vision, complications, and risk factors for failure. RESULTS At a mean postoperative follow-up of 0.96 ± 0.20 years, 29 eyes (85.3%) maintained a successful outcome. Mean preoperative and postoperative best-corrected visual acuities were 2.55 ± 0.13 and 1.78 ± 0.13 ( P < 0.0001), respectively. Ambulatory functional visual improvement was seen in 97%, and 23% attained vision ranging between 20/190 and 20/50. Corneal opacification failed to clear in 5 eyes (15%). Risk factors associated with surgical failure were female sex ( P = 0.006), disease severity ( P < 0.0001), glaucoma ( P = 0.001), and additional interventions after SEPA ( P = 0.002). In multivariate analysis, only disease severity (ie, a type 2 PA) was a significant risk factor for the failure of SEPA. There were no sight-threatening complications. CONCLUSIONS SEPA is a safe and effective technique in select cases of posterior corneal defect due to PA. SEPA could be a potential surgical alternative to pediatric keratoplasty or optical iridectomy in children with central corneal opacification smaller than 7 mm due to PA.
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Affiliation(s)
- Muralidhar Ramappa
- Institute for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | - Sunita Chaurasia
- Institute for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Institute for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Divya Sree Ramya Achanta
- Institute for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | | | - Deepak Paul Edward
- Department of Ophthalmology and Visual Sciences and Pathology, University of Illinois College of Medicine, Chicago, IL
| | | | | | - Ken K. Nischal
- UPMC Eye Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; and
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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21
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Liasis A, Paez-Escamilla M, Gruszewski J, Singh AD, Nischal KK. Melphalan toxicity following treatment of retinoblastoma identified by pattern electroretinogram. Ophthalmic Genet 2022:1-4. [DOI: 10.1080/13816810.2022.2116652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alkiviades Liasis
- Department of Pediatric Ophthalmology and Strabismus and Adult Motilty, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Manuel Paez-Escamilla
- Department of Pediatric Ophthalmology and Strabismus and Adult Motilty, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Jessi Gruszewski
- Department of Pediatric Ophthalmology and Strabismus and Adult Motilty, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Arun D. Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ken K. Nischal
- Department of Pediatric Ophthalmology and Strabismus and Adult Motilty, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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22
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Jimenez J, Resnick JL, Chaudhry AB, Gertsman I, Nischal KK, DiLeo MV. Ocular biodistribution of cysteamine delivered by a sustained release microsphere/thermoresponsive gel eyedrop. Int J Pharm 2022; 624:121992. [PMID: 35809831 DOI: 10.1016/j.ijpharm.2022.121992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022]
Abstract
The objective of the investigation was to determine the ocular biodistribution of cysteamine, a reducing agent used for treatment of cystine crystals in cystinosis, following topical administration of a sustained release formulation and traditional eyedrop formulation. To the right eye only, rabbits received a 50 µL drop of 0.44% cysteamine eyedrops at one drop per waking hour for 2, 6, 12, and 24 h. A second group received one 100 µL drop of a sustained release formulation containing encapsulated cysteamine microspheres suspended in a thermoresponsive gel. Upon serial sacrifice, ocular tissues from both eyes and plasma were obtained and quantified for cysteamine using LC-MS/MS. Cysteamine was detected in the cornea, aqueous humor and vitreous humor. Systemic plasma concentrations of cysteamine from treatment groups were below the limit of detection. As expected, 0.44% cysteamine eyedrops when administered hourly maintained drug concentrations within the cornea at a magnitude 5 times higher than a single dose of the sustained release formulation over 12 h. The sustained release formulation maintained cysteamine presentation across 12 h from a single drop. These studies demonstrate distribution of cysteamine to the eye following topical administration, including high drug uptake to the cornea and low systemic distribution.
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Affiliation(s)
- Jorge Jimenez
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Jayde L Resnick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ahmad B Chaudhry
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | | | - Ken K Nischal
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Morgan V DiLeo
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, PA 15261, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA; McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15219, USA.
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23
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Scanga HL, Nischal KK. ADAMTSL4-related ectopia lentis: A case of pseudodominance with an asymptomatic parent. Am J Med Genet A 2022; 188:1853-1857. [PMID: 35218299 DOI: 10.1002/ajmg.a.62698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/15/2021] [Accepted: 01/24/2022] [Indexed: 01/06/2023]
Abstract
Pathogenic variants of ADAMTSL4 are associated with autosomal recessive ectopia lentis et pupillae and isolated ectopia lentis, often presenting congenitally or in childhood. We describe a pedigree of a 4-year-old female child with bilateral ectopia lentis and her asymptomatic 35-year-old father with mild anterior segment findings. Molecular evaluation revealed compound heterozygosity for ADAMTSL4 pathogenic variants in the proband and homozygosity for an ADAMTSL4 pathogenic founder mutation in her father. The results of genetic testing revealed a pseudodominant inheritance pattern in the family. This case expands variability of ADAMTSL4-related ectopia lentis through the first description of an asymptomatic adult in the 4th decade and highlights importance of clinical and molecular evaluations of family members when investigating genetic disorders.
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Affiliation(s)
- Hannah L Scanga
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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24
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Ernst J, Medsinge A, Scanga HL, Hiasat J, Moore W, Ali A, Levin AV, Stahl ED, Nischal KK. Congenital primary aphakia. J AAPOS 2022; 26:4.e1-4.e5. [PMID: 35051625 DOI: 10.1016/j.jaapos.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/29/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the natural history, management, and visual outcome in children with congenital primary aphakia (CPA). METHODS This is a multicenter retrospective consecutive case series from five academic centers in England and North America. RESULTS A total of 27 eyes of 14 patients were included (male:female, 1.7:1). Thirteen patients had bilateral CPA, and 1 patient had unilateral CPA. Mean age at diagnosis was 18 months (median, 21; range, 0.5-144). Of 11 patients who underwent genetic testing, 9 had FOXE3 pathogenic variants. In all patients, visual acuity at presentation was not better than fixing and following light. Typical findings included silvery appearance of the cornea with vascularization (96%), glaucoma (81%), iridocorneal adhesions (74%), optic nerve coloboma (55%), abnormal vitreous (33%), retinal detachment (30%), and aniridia with hypoplasia of ciliary body (19%). Surgical interventions in select patients included penetrating keratoplasty (PKP), glaucoma drainage device implantation, and cyclophotocoagulation (CPC). CONCLUSIONS Eyes with corneal ectasia and a silvery appearance of the cornea with vascularization should alert the physician to the possibility of CPA. Glaucoma causes globe enlargement and may increase the risk of corneal perforation, but glaucoma is often refractory to medical treatment, and the threshold for surgical treatment should be low. PKP outcomes are very poor.
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Affiliation(s)
- Julia Ernst
- Department of Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Anagha Medsinge
- Kittner Eye Center, University of North Carolina, Chapel Hill
| | - Hannah L Scanga
- Department of Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Jamila Hiasat
- Department of Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - William Moore
- Pediatric Ophthalmology Services, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alex V Levin
- Pediatric Ophthalmology and Ocular Genetics, Flaum Eye Institute, Pediatric Genetics, Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Erin D Stahl
- Pediatric Ophthalmology, Children's Mercy Hospital, Kansas City, Missouri
| | - Ken K Nischal
- Department of Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
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25
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Abstract
PURPOSE Peters-plus syndrome is a rare, autosomal recessive congenital disorder of glycosylation caused by mutations in the gene B3GLCT. A detailed description of the ocular findings is currently lacking in the scientific literature. We report a case series of Peters-plus syndrome with deep ocular phenotyping using anterior segment optical coherence tomography and ultrasound biomicroscopy. Where available, we describe the histology of host corneal buttons. METHODS A retrospective chart review of patients with Peters-plus syndrome was conducted under the care of the senior author between January 2000 and June 2019. Demographic and clinical data including ocular and systemic features, ophthalmic imaging, and molecular diagnostic reports were collected. RESULTS Four cases of Peters-plus syndrome were identified. Three patients were male and 1 was female. Five of the 8 eyes had an avascular paracentral ring opacity with relative central clearing. The paracentral opacity is due to iridocorneal adhesion and the relative central clearing associated with posterior stromal thinning. One eye had persistent fetal vasculature and microphthalmia, which has not previously been reported. One eye from each of 2 patients had a significantly different phenotype with a large vascularized central corneal opacity. CONCLUSIONS The most common ocular phenotype seen in Peters-plus syndrome is an avascular paracentral ring opacity with relative central clearing. A different phenotype with a large vascularized corneal opacity may also be observed.
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Affiliation(s)
- Parth R Shah
- UPMC Eye Center, Pittsburgh, PA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Bharesh Chauhan
- UPMC Eye Center, Pittsburgh, PA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Charleen T Chu
- Division of Neuropathology, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA; and
| | - Julia Kofler
- Division of Neuropathology, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA; and
| | - Ken K Nischal
- UPMC Eye Center, Pittsburgh, PA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- School of Medicine, University of Pittsburgh, PA
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26
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Paez-Escamilla M, Scanga HL, Liasis A, Nischal KK. Macular atrophy in JAG1-related Alagille syndrome: a case series. Ophthalmic Genet 2021; 43:230-234. [PMID: 34886763 DOI: 10.1080/13816810.2021.2004432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND : Alagille syndrome (AS) is a multisystem disorder associated with a range of ocular anomalies affecting the anterior and posterior segments. While chorioretinal abnormalities have been reported in Alagille Syndrome, identification of macular dystrophy and detailed clinical and electrophysiologic descriptions are scarce. MATERIALS AND METHODS : A retrospective review was conducted to identify patients with a diagnosis of AS and retinal disease who were evaluated in the Division of Pediatric Ophthalmology, Strabismus, and Adult Motility at UPMC Children's Hospital of Pittsburgh. Criteria of AS included biopsy-proven bile duct hypoplasia, presence of major clinical features of AS, and molecular confirmation of the JAG1 gene. RESULTS : This cohort included three patients, two females and one male, diagnosed with JAG1-Alagille syndrome. The diagnosis was made before 2 years of life in all patients. The mean follow-up period in our center was 8 years. All patients were found to have retinal pigmentary changes, macular atrophy, choroidal thinning, optic disc anomalies, and progressive decrease in vision. Marked retinal and macular dysfunction were found in electrophysiological studies. CONCLUSIONS : Three patients with molecularly confirmed Alagille syndrome demonstrated unusual retinal and macular findings, with two showing progressive vision loss. Due to the rarity of retinal findings in AS and the observed progression of disease in our patients, clinical genetic testing for retinal dystrophies could be completed in two cases. These investigations failed to reveal a separate molecular cause for the observed retinal dystrophy, helping to confirm the association with JAG1-related AS.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hannah L Scanga
- Division of Pediatric Ophthalmology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alkiviades Liasis
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ken K Nischal
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Division of Pediatric Ophthalmology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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27
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Eldib AA, Patil P, Nischal KK, Mitchell ER, Hiasat JG, Pihlblad MS. Safety of apraclonidine eye drops in diagnosis of Horner syndrome in an outpatient pediatric ophthalmology clinic. J AAPOS 2021; 25:336.e1-336.e4. [PMID: 34737082 PMCID: PMC8792311 DOI: 10.1016/j.jaapos.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the efficacy and systemic side effects of apraclonidine drops 0.5% in children clinically suspected of having Horner syndrome. METHODS The medical records of patients with clinically suspected Horner syndrome who underwent testing with apraclonidine 0.5% eyedrops were reviewed retrospectively. The following data were retrieved from the record: allergic reactions, somnolence, shallow respiration, pallor, or excessive fussiness noted by the examiner or parents. RESULTS A total of 46 patients presenting with anisocoria and tested with apraclonidine 0.5% were included. Of these, 15 had a positive result, with reversal of anisocoria. The mean age of patients was 3.2 years (median, 0.91; mode, 0.25 years). Twenty-four patients were ≤1 year of age; 19 were ≤6 months. No systemic side effects were noted during the examination or reported by parents in any patients. CONCLUSIONS The use of topical apraclonidine eyedrops has been described as an effective test for Horner syndrome. However, concerns have been raised regarding the potential systemic side effects in children, especially those under the age of 6 months. In our cohort, no systemic side effects were reported, including in those under 6 months of age.
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Affiliation(s)
- Amgad A Eldib
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Preeti Patil
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ellen R Mitchell
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jamila G Hiasat
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew S Pihlblad
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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28
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Nanda KD, Liasis A, Walters B, Nischal KK. Does the Aphakic Eye Contribute to the Visual Field with Both Eyes Open? Ophthalmology 2021; 129:231-233. [PMID: 34506848 DOI: 10.1016/j.ophtha.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kaajal D Nanda
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alki Liasis
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bronwen Walters
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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Kapoor S, Scanga HL, Reyes-Múgica M, Nischal KK. Somatic KRAS mutation affecting codon 146 in linear sebaceous nevus syndrome. Am J Med Genet A 2021; 185:3825-3830. [PMID: 34254724 DOI: 10.1002/ajmg.a.62422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/04/2021] [Accepted: 06/11/2021] [Indexed: 01/04/2023]
Abstract
Linear Sebaceous Nevus Syndrome is a rare disorder that presents with nevus sebaceus in association with corneal dermoids, colobomas, choroidal osteomas, and arachnoid cysts. It is thought to represent a mosaic RASopathy. These are disorders characterized by postzygotic somatic mutation in genes involved in RAS/MAPK signaling pathway. In this report we describe two patients with linear sebaceous nevus syndrome found to have mutations in codon 146 of KRAS with evidence of mosaicism. This specific mutation has previously been reported in Oculoectodermal Syndrome and Encephalocraniocutaneous Lipomatosis, two other mosaic RASopathies with predominantly cerebrooculocutaneous manifestations. These findings suggest that, while initially classified as different syndromes, these disorders should be evaluated and managed as a spectrum of related disorders.
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Affiliation(s)
- Saloni Kapoor
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hannah L Scanga
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Scanga HL, Liasis A, Pihlblad MS, Nischal KK. NYX-related Congenital Stationary Night Blindness in Two Siblings due to Probable Maternal Germline Mosaicism. Ophthalmic Genet 2021; 42:588-592. [PMID: 34165036 DOI: 10.1080/13816810.2021.1941129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Congenital Stationary Night Blindness (CSNB) is a clinically and genetically heterogenous inherited retinal disorder associated with nystagmus, myopia, strabismus, defective dark adaptation, and decreased vision. Pathogenic variants in at least 17 genes have been associated with CSNB, where a hemizygous variant of NYX causing an X-linked form of the disorder is among the commonest causes.Materials and Methods: A retrospective chart review of a single pedigree was performed. Three pediatric patients underwent ophthalmic examinations, visual electrophysiology, and ocular imaging. Molecular genetic testing for CSNB was pursued where clinically indicated.Results: Two male siblings demonstrated clinical and electroretinographic evidence of complete CSNB. Genetic testing identified a NYX pathogenic, in-frame deletion in both children. Targeted variant analysis of the mother failed to identify the variant in two independent samples, most consistent with mosaicism.Conclusions: Clinical and molecular analyses within the described family demonstrate the possibility of maternal mosaicism in NYX-related CSNB. The importance of cascade molecular testing is highlighted. The prospect of somatic or germline mosaicism in NYX-related CSNB informs genetic counseling, genetic testing decisions, and risk assessment in affected families.
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Affiliation(s)
- H L Scanga
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - A Liasis
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsbrugh, USA
| | - M S Pihlblad
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsbrugh, USA
| | - K K Nischal
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsbrugh, USA
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Gonzalez-Gonzalez LA, Scanga H, Traboulsi E, Nischal KK. Novel clinical presentation of a CRX rod-cone dystrophy. BMJ Case Rep 2021; 14:e233711. [PMID: 33910785 PMCID: PMC8094365 DOI: 10.1136/bcr-2019-233711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/04/2022] Open
Abstract
We describe a novel clinical presentation of a CRX rod-cone dystrophy in a single family. Two boys ages 6 and 12 years presented with clinical and optical coherence tomography features suggestive of X-linked retinoschisis, but with optic nerve swelling without increased intracranial pressure. One patient had an electronegative electroretinogram (ERG) and the other had rod-cone dysfunction. Neither had retinoschisin (RS1) gene mutations. Biological mother and sister presented with retinal pigment epithelium (RPE) changes and abnormal cone-rod ERG responses. On further testing, next generation sequencing with array comparative genomic hybridisation showed a deletion in exon 4 of the CRX gene. Cystoid maculopathy in young male children can be difficult to distinguish from RS1-associated schisis. Phenotypic variants within a family must prompt a thorough retinal dystrophy evaluation even with electronegative ERG in the presenting child. This novel phenotype for CRX presents with optic nerve swelling and cystoid maculopathy in men, and RPE changes in women.
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Affiliation(s)
- Luis Alonso Gonzalez-Gonzalez
- Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Hannah Scanga
- Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | | | - Ken K Nischal
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Ernst J, Eldib A, Scanga HL, Nischal KK. Keratoconus in a child with partial trisomy 13. Ophthalmic Genet 2021; 42:360-363. [PMID: 33858272 DOI: 10.1080/13816810.2021.1897849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Clinical studies suggest the importance of genetic components in the etiology of keratoconus. However, the contributing genes and variants remain elusive. We present a case of bilateral keratoconus in a child with partial trisomy 13, with a trisomic region spanning loci that have been associated with keratoconus.Materials and Methods: This is a single, retrospective case report of a child with a molecular diagnosis of partial trisomy 13, who was diagnosed with bilateral keratoconus for which at the age of 11 years, she underwent successive epithelium-off corneal cross-linking (CXL) procedures in both eyes, followed by temporary central tarsorrhaphy under general anesthesia.Results: Patient's molecular diagnosis was 70 Megabase trisomic region 13q14.11q34. Pre CXL pachymetry was 426 μm and 496 μm, maximum K values were 52.28 D and 55.45 D in right and left eyes, respectively; at last follow up (12 months post-op) these were 494 μm and 509 μm for pachymetry and maximum K values 50.50 D and 52.43 D in the right and left eyes, respectively. No signs of progression were detected.Conclusion: To the best of our knowledge, this is the first case report to document bilateral keratoconus in a child with partial trisomy 13, in whom successful epithelium-off CXL was achieved with general anesthesia. We emphasize the importance of screening, early diagnosis, and therapy of this treatable but rare cause of decreased vision in partial trisomy 13 patients.
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Affiliation(s)
- Julia Ernst
- UPMC Eye Center, Pittsburgh, Pennsylvania, USA.,UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Medical University of Warsaw, Warsaw, Poland
| | - Amgad Eldib
- UPMC Eye Center, Pittsburgh, Pennsylvania, USA.,UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hannah L Scanga
- UPMC Eye Center, Pittsburgh, Pennsylvania, USA.,UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ken K Nischal
- UPMC Eye Center, Pittsburgh, Pennsylvania, USA.,UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Nischal KK. Introduction. Dev Ophthalmol 2021; 61:VI-VIII. [PMID: 33588409 DOI: 10.1159/000511814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
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Ernst J, Hiasat J, Alabek ML, Scanga HL, Motley W, Nischal KK. Expansion of the ophthalmic phenotype of SPINT2-related syndromic congenital sodium diarrhea. Am J Med Genet A 2021; 185:1270-1274. [PMID: 33547739 DOI: 10.1002/ajmg.a.62094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/08/2022]
Abstract
A 5-year-old girl presented with treatment-refractory dry eye and recurrent episodes of eye pain. She had been previously diagnosed with syndromic congenital sodium diarrhea (SCSD) caused by a pathogenic variant in SPINT2. Her local pediatric ophthalmologist had made the diagnosis of severe dry eye with corneal erosions, based on which, we arranged an eye exam under anesthesia (EUA) and punctal plug placement. Anterior segment optical coherence tomography (OCT) and corneal photographs were taken during the procedure. There are reports describing similar ophthalmic findings in this syndrome. However, to the best of our knowledge, this is the first case report to document OCT imaging and corneal photographs in a patient with SCSD, which we feel expands the ophthalmic phenotype of this rare genetic disorder.
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Affiliation(s)
- Julia Ernst
- Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,The Division of Pediatric Ophthalmology, Strabismus and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Medical University of Warsaw, Warsaw, Poland
| | - Jamila Hiasat
- Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,The Division of Pediatric Ophthalmology, Strabismus and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michelle L Alabek
- Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,The Division of Pediatric Ophthalmology, Strabismus and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hannah L Scanga
- Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,The Division of Pediatric Ophthalmology, Strabismus and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Motley
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Ken K Nischal
- Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,The Division of Pediatric Ophthalmology, Strabismus and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Jimenez J, Washington MA, Resnick JL, Nischal KK, Fedorchak MV. A sustained release cysteamine microsphere/thermoresponsive gel eyedrop for corneal cystinosis improves drug stability. Drug Deliv Transl Res 2021; 11:2224-2238. [PMID: 33543397 DOI: 10.1007/s13346-020-00890-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
Cystinosis is a rare, metabolic, recessive genetic disease in which the intralysosomal accumulation of cystine leads to system wide organ and tissue damage. In the eye, cystine accumulates in the cornea as corneal cystine crystals and severely impacts vision. Corneal cystine crystals are treated with cysteamine eyedrops when administrated 6 to 12 times day and used within 1 week. The strict dosing regimen and poor stability are inconvenient and add to the burden of therapy. To reduce the dosing frequency and improve the stability, we present reformulation of cysteamine into a novel controlled release eyedrop. In this work, we characterize and evaluate a topical drug delivery system comprised of encapsulated cysteamine in polymer microspheres with a thermoresponsive gel carrier. Spray-dried encapsulation of cysteamine was performed. In vitro cysteamine release, stability, and ocular irritation and corneal permeation were evaluated. The data suggest that encapsulated cysteamine improves the stability to 7 weeks when compared with 1-week aqueous cysteamine eyedrops. Release studies from one drop of our system show that cysteamine release was present for 24 h and above the minimum cysteamine eyedrop amount (6 drops). Cysteamine from our system also resulted in negligible irritation and enhanced permeation when compared with traditional cysteamine eyedrops. In vivo studies were implemented to support ease of administration, tolerability, and retention for 24 h. These studies suggest that our controlled release delivery system may provide stable cysteamine from a safe, once daily gel eyedrop.
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Affiliation(s)
- Jorge Jimenez
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Michael A Washington
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Jayde L Resnick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Ken K Nischal
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224, USA
| | - Morgan V Fedorchak
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA. .,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA. .,Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA. .,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, 15213, USA. .,McGowan Institute for Regenerative Medicine, Pittsburgh, PA, 15219, USA.
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36
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Chauhan BK, Medsinge A, Scanga HL, Chu CT, Nischal KK. Transcriptome from opaque cornea of Fanconi anemia patient uncovers fibrosis and two connected players. Mol Genet Metab Rep 2021; 26:100712. [PMID: 33552906 PMCID: PMC7846932 DOI: 10.1016/j.ymgmr.2021.100712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022] Open
Abstract
Congenital corneal opacities (CCO) are a group of blinding corneal disorders, where the underlying molecular mechanisms are poorly understood. Phenotyping through specialized imaging and histopathology analysis, together with assessment of key transcriptomic changes (including glycosaminoglycan metabolic enzymes) in cornea(s) with CCO from a case of Fanconi anemia is the approach taken in this study to identify causal mechanisms. Based on our findings, we propose a novel mechanism and two key players contributing to CCO.
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Affiliation(s)
- Bharesh K Chauhan
- UPMC Eye Center, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Anagha Medsinge
- UPMC Eye Center, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Hannah L Scanga
- UPMC Eye Center, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Charleen T Chu
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ken K Nischal
- UPMC Eye Center, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Abstract
Concussion is a worldwide health concern among children and adolescents. Over the decades concussion has been gradually better recognized as an entity that accounts for a significant disability post head trauma in patients. Patients present with cognitive, somatic and oculo-vestibular symptoms that can be incapacitating. Most concussion symptoms are transient and resolve within 1-2 weeks but can persist for years. Concussion pathophysiology is complex and may not be fully understood but it involves numerous mechanisms including cellular metabolic derangements, cerebral blood inflow, and axonal disruption. With no associated objective biomarkers or visible pathologic brain changes, diagnosis of concussion can be challenging. Many organizations and collaborative groups have suggested numerous definitions and diagnostic criteria for concussion in an attempt to improve the evidence-based clinical assessments and therapies for concussion. Proper assessment and evaluation is crucial starting from counseling of the patient, gradual return to cognitive and physical activity in an individualized treatment plan to ensure a timely return to daily activities and full sport participation. This report provides a grasp over the current state of sport-related concussion knowledge, diagnosis, and clinical evaluation in children and adolescent, with a focus on the ocular symptoms and signs.
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Affiliation(s)
- Jamila G Hiasat
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
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Ernst J, Alabek ML, Eldib A, Madan-Khetarpal S, Sebastian J, Bhatia A, Liasis A, Nischal KK. Ocular findings of albinism in DYRK1A-related intellectual disability syndrome. Ophthalmic Genet 2020; 41:650-655. [PMID: 32838606 DOI: 10.1080/13816810.2020.1814349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/10/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pathogenic variants in DYRK1A are associated with DYRK1A-related intellectual disability syndrome (DIDS). Common features of this diagnosis include microcephaly, intellectual disability, speech impairment, and distinct facial features. Reported ocular features include deep-set eyes, myopia, and strabismus. We present a case of DYRK1A-related intellectual disability syndrome with ocular findings of albinism and explore the possible pathogenesis of this previously unreported manifestation. MATERIALS AND METHODS This is a single, retrospective case report of a child with DIDS who underwent an ophthalmic exam including detailed visual electrophysiology. Results: A 21-month-old female with microcephaly, failure to thrive, language delay, cleft palate, and cardiac defects had an ophthalmic exam showing myopia, strabismus, a hypopigmented fundus and crossed asymmetry on visual evoked potential (VEP), consistent with ocular findings of albinism. Whole exome sequencing identified a pathogenic DYRK1A variant; no albinism gene variants were reported. Her constellation of features is consistent with a diagnosis of DYRK1A-related intellectual disability syndrome; however, ocular features of albinism have not previously been reported in this condition. CONCLUSIONS This is, to the best of our knowledge, the first report of ocular findings of albinism in a case of DYRK1A-related intellectual disability syndrome. We propose that ocular albinism is a novel ocular phenotype of DYRK1A-related disease. Ophthalmic exams in patients with this diagnosis should include thorough evaluation for ocular albinism, including VEPs.
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Affiliation(s)
- Julia Ernst
- UPMC Eye Center , Pittsburgh, PA, USA
- Ophthalmology Departement, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, USA
- Medical University of Warsaw , Warsaw, Poland
| | - Michelle L Alabek
- UPMC Eye Center , Pittsburgh, PA, USA
- Ophthalmology Departement, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, USA
| | - Amgad Eldib
- UPMC Eye Center , Pittsburgh, PA, USA
- Ophthalmology Departement, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, USA
| | - Suneeta Madan-Khetarpal
- Ophthalmology Departement, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, USA
- School of Medicine, University of Pittsburgh , Pittsburgh, PA, USA
| | - Jessica Sebastian
- Ophthalmology Departement, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, USA
| | - Aashim Bhatia
- Ophthalmology Departement, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, USA
- School of Medicine, University of Pittsburgh , Pittsburgh, PA, USA
- UPMC Radiology Department at Children's Hospital of Pittsburgh , Pittsburgh, PA, USA
| | - Alkiviades Liasis
- UPMC Eye Center , Pittsburgh, PA, USA
- Ophthalmology Departement, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, USA
| | - Ken K Nischal
- UPMC Eye Center , Pittsburgh, PA, USA
- Ophthalmology Departement, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, USA
- School of Medicine, University of Pittsburgh , Pittsburgh, PA, USA
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Sharma N, Agarwal R, Jhanji V, Bhaskar S, Kamalakkannan P, Nischal KK. Lamellar keratoplasty in children. Surv Ophthalmol 2020; 65:675-690. [DOI: 10.1016/j.survophthal.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023]
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Yeh RY, Nischal KK, LeDuc P, Cagan J. Written in Blood: Applying Shape Grammars to Retinal Vasculatures. Transl Vis Sci Technol 2020; 9:36. [PMID: 32908799 PMCID: PMC7453052 DOI: 10.1167/tvst.9.9.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/09/2020] [Indexed: 01/15/2023] Open
Abstract
Purpose Blood vessel networks within the retina are crucial for maintaining tissue perfusion and therefore good vision. Their complexity and unique patterns often require a steep learning curve for humans to identify trends and changes in the shape and topology of the networks, even though there exists much information important to identifying disease within them. Methods Through image processing, the vasculature is isolated from other features of the fundus images, forcing the viewer to focus on the complex vascular feature. This article explores an approach using a grammar based on shape to describe retinal vasculature and to generate realistic and increasingly unrealistic artificial vascular networks that are then reviewed by ophthalmologists via digital survey. The ophthalmologists are asked whether these artificial vascular networks appeared realistic or unrealistic. Results With only three rules (initiate, branch, and curve), the grammar accomplishes these goals. Networks are generated by adding noise to rule parameters present in existing networks. Via the survey of synthetic networks generated with different noise parameters, a correlation between noise in the branch rule and realistic association is revealed. Conclusions By creating a language to describe retinal vasculature, this article allows for the potential of new insight into such an important but less understood feature of the retina, which in the future may play a role in diagnosing or helping to predict types of ocular disease. Translational Relevance Applying shape grammar to describe retinal vasculature permits new understanding, which in turn provides the potential for new diagnostic tools.
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Affiliation(s)
- Ryan Y Yeh
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus and Adult Motility, University of Pittsburgh Medical Center Children's Hospital, Pittsburgh, PA, USA
| | - Philip LeDuc
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Jonathan Cagan
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
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Williams AM, Kalra G, Commiskey PW, Bowers EMR, Rudolph BR, Pitcher MD, Dansingani KK, Jhanji V, Nischal KK, Sahel JA, Waxman EL, Fu R. Ophthalmology Practice During the Coronavirus Disease 2019 Pandemic: The University of Pittsburgh Experience in Promoting Clinic Safety and Embracing Video Visits. Ophthalmol Ther 2020; 9:1-9. [PMID: 32377502 PMCID: PMC7201393 DOI: 10.1007/s40123-020-00255-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 pandemic has led to widespread change as public health strategies for containment have emphasized social distancing and remaining at home. These policies have led to downscaled clinic volumes, cancellation of elective procedures, enhanced personal protective strategies in the clinic, and adoption of telemedicine encounters. We describe the evidence-based practical approach taken in our ophthalmology department to continue delivering eye care during the pandemic by rescheduling visits, enhancing clinic safety, and adopting virtual video encounters.
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Affiliation(s)
- Andrew M. Williams
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Gagan Kalra
- Government Medical College and Hospital, Chandigarh, India
| | - Patrick W. Commiskey
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Eve M. R. Bowers
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Brian R. Rudolph
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Mary D. Pitcher
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Kunal K. Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Ken K. Nischal
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Evan L. Waxman
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Roxana Fu
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
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Tibrewal S, Subhedar K, Sen P, Mohan A, Singh S, Shah C, Nischal KK, Ganesh S. Clinical spectrum of non-syndromic microphthalmos, anophthalmos and coloboma in the paediatric population: a multicentric study from North India. Br J Ophthalmol 2020; 105:897-903. [PMID: 32829301 DOI: 10.1136/bjophthalmol-2020-316910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 11/04/2022]
Abstract
AIMS To describe the clinical features, visual acuity and causes of ocular morbidity in children (0-18 years) with microphthalmos, anophthalmos, and coloboma (MAC) from North India. METHODS A retrospective study conducted between October 2017 and September 2018 in three tertiary eye institutes, part of the Bodhya Eye Consortium with consensus led common pro formas. Children with complete clinical data and without syndromic/systemic involvement were included. The clinical phenotype was divided into isolated ocular coloboma (CB), coloboma with microcornea (CBMC), colobomatous microphthalmos (CBMO), non-colobomatous microphthalmos (MO) and anophthalmos (AO). RESULTS A total of 532 children with MAC were examined. Seventeen records were excluded due to incomplete data (0.2%). 515 children (845 eyes) were included: 54.4% males and 45.6% females. MAC was unilateral in 36% and bilateral in 64%. CB, CBMC, CBMO, MO and AO were seen in 26.4%, 31%, 22%, 8% and 12.5% of eyes, respectively. Nystagmus was found in 40%, strabismus in 23%, cataract in 18.7% and retinal detachment in 15%. Best-corrected visual acuity (BCVA) of <3/60 was seen in 62.4% eyes. Blindness (BCVA <3/60 in better eye) was seen in 42.8% of bilateral patients. Those with microcornea or microphthalmos with coloboma had worse BCVA (p<0.001). There were regional differences in the type of MAC phenotype presenting to the three institutes. CONCLUSION The MAC group of disorders cause significant ocular morbidity. The presence of microcornea or microphthalmos with coloboma predicts worse BCVA. The variation of the MAC phenotype with the district of origin of the patient raises questions of aetiology and is subject to further studies.
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Kapoor S, Eldib A, Hiasat J, Scanga H, Tomasello J, Alabek M, Ament K, Arner D, Benson A, Berret K, Blaha B, Brinza M, Caterino R, Chauhan B, Churchfield W, Fulwylie C, Gruszewski J, Hrinak D, Johnston L, Meyer C, Nanda K, Newton T, Pomycala B, Runkel L, Sanchez K, Skellett S, Steigerwald J, Mitchell E, Pihlblad M, Luchansky C, Keim E, Yu J, Quinn P, Mittal A, Pitetti R, Patil-Chhablani P, Liasis A, Nischal KK. Developing a pediatric ophthalmology telemedicine program in the COVID-19 crisis. J AAPOS 2020; 24:204-208.e2. [PMID: 32890736 PMCID: PMC7467070 DOI: 10.1016/j.jaapos.2020.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To describe our methodology for implementing synchronous telemedicine during the 2019 novel coronavirus (COVID-19) pandemic. METHODS A retrospective review of outpatient records at a single children's hospital from March 21 to April 10, 2020, was carried out to determine the outcome of already-scheduled face-to-face outpatient appointments. The week leading up to the March 21, all appointments in the study period were categorized as follows: (1) requiring an in-person visit, (2) face-to-face visit that could be postponed, and (3) consultation required but could be virtual. Teams of administrators, schedulers, and ophthalmic technicians used defined scripts and standardized emails to communicate results of categorization to patients. Flowcharts were devised to schedule and implement telemedicine visits. Informational videos were made accessible on social media to prepare patients for the telemedicine experience. Simultaneously our children's hospital launched a pediatric on-demand e-consult service, the data analytics of which could be used to determine how many visits were eye related. RESULTS A total of 237 virtual ophthalmology consult visits were offered during the study period: 212 were scheduled, and 206 were completed, of which 43 were with new patients and 163 with returning patients. Following the initial virtual visit, another was required on average in 4 weeks by 21 patients; in-person follow-up was required for 170 patients on average 4.6 months after the initial virtual visit. None needed review within 72 hours. The pediatric on-demand service completed 290 visits, of which 25 had eye complaints. CONCLUSIONS With proper materials, technology, and staffing, a telemedicine strategy based on three patient categories can be rapidly implemented to provide continued patient care during pandemic conditions. In our study cohort, the scheduled clinic e-visits had a low no-show rate (3%), and 8% of the on-demand virtual access for pediatric care was eye related.
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Affiliation(s)
- Saloni Kapoor
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amgad Eldib
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jamila Hiasat
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hannah Scanga
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Michelle Alabek
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kellie Ament
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Debbi Arner
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ashley Benson
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristine Berret
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bianca Blaha
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melissa Brinza
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roxanne Caterino
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Baresh Chauhan
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Jessi Gruszewski
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Denise Hrinak
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lori Johnston
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cheryl Meyer
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaajal Nanda
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Teresa Newton
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Becci Pomycala
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lauren Runkel
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Sarah Skellett
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jess Steigerwald
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ellen Mitchell
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew Pihlblad
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Craig Luchansky
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erin Keim
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jenny Yu
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick Quinn
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anshul Mittal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raymond Pitetti
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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Affiliation(s)
- Saloni Kapoor
- Department of Ophthalmology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alkiviades Liasis
- Department of Ophthalmology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ken K Nischal
- Department of Ophthalmology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Williams AM, Shepler AM, Chu CT, Nischal KK. Sympathetic ophthalmia presenting 5 days after penetrating injury. Am J Ophthalmol Case Rep 2020; 19:100816. [PMID: 32695926 PMCID: PMC7363657 DOI: 10.1016/j.ajoc.2020.100816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To describe a rare case of early sympathetic ophthalmia that presented 5 days after penetrating injury. Observations A 13-year-old boy presented with a penetrating left globe injury from a BB metallic projectile that was emergently repaired. Five days later, routine dilated exam of the right eye revealed interval development of vitritis over the posterior pole. Optical coherence tomography revealed fine, vitreous hyper-reflective material. Intravenous and topical steroid therapy was started, and the patient underwent prompt enucleation of the traumatized eye. Histopathologic examination of the globe demonstrated lymphocytic choroiditis and macrophage infiltration, consistent with prior reports of early sympathetic ophthalmia. The sympathizing eye maintained 20/20 acuity and never caused visual complaints. Conclusions and importance This is the earliest reported case of sympathetic ophthalmia, to our knowledge, and it presented without visual symptoms only five days after penetrating trauma. This case suggests that routine examination should start before the typical 14 days associated with development of sympathetic ophthalmia.
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Affiliation(s)
- Andrew M Williams
- Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, USA
| | - Anne M Shepler
- Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street Pittsburgh, Pennsylvania, USA
| | - Charleen T Chu
- Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, USA.,Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street Pittsburgh, Pennsylvania, USA
| | - Ken K Nischal
- Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, USA.,UPMC Eye Center, UPMC Children's Hospital of Pittsburgh, 4401, Penn Avenue, Pittsburgh, PA, USA
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Scanga HL, Nischal KK. Reply. J AAPOS 2020; 24:60-61. [PMID: 32001368 DOI: 10.1016/j.jaapos.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Hannah L Scanga
- UPMC Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh, School of Medicine
| | - Ken K Nischal
- UPMC Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh, School of Medicine
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To LK, Shah PR, Scanga HL, Franks AL, Cladis FP, Nischal KK. Personalized pediatric ophthalmology: a case report. J AAPOS 2019; 23:234-236. [PMID: 31129100 DOI: 10.1016/j.jaapos.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022]
Abstract
The availability of genetic sequencing has given physicians a new tool for diagnosis and treatment of disease, and "personalized medicine" has become an increasingly common term in general but not in pediatric ophthalmology. We present a case of a toddler who developed ataxia, opsoclonus, myoclonus, and developmental regression following anesthesia for a common otolaryngology procedure. The child was found to have a variant in the MT-ND6 gene (m.14484T>C), most commonly associated with Leber hereditary optic neuropathy, despite a phenotype more closely resembling Leigh syndrome. The incongruence of phenotype and genotype prompted whole exome sequencing, which identified an unexpected intronic missense mutation in RB1 (1960+5G>A), with a 90% penetrance for retinoblastoma. Limited evaluation of the posterior pole in clinic did not identify any lesions, and the risks and benefits of examination under anesthesia were discussed among neurology, ophthalmology, and anesthesiology. We report the outcome of these discussions. The value and risks of personalized medicine are discussed.
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Affiliation(s)
- Lillian K To
- UPMC Eye Center, UPMC Children's Hospital of Pittsburgh, and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Parth R Shah
- UPMC Eye Center, UPMC Children's Hospital of Pittsburgh, and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hannah L Scanga
- UPMC Eye Center, UPMC Children's Hospital of Pittsburgh, and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alexis L Franks
- Department of Pediatrics, Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Franklyn P Cladis
- Department of Anesthesiology, UPMC Children's Hospital of Pittsburgh, and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ken K Nischal
- UPMC Eye Center, UPMC Children's Hospital of Pittsburgh, and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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Davis AA, Zuccoli G, Haredy MM, Losee J, Pollack IF, Madan-Khetarpal S, Goldstein JA, Nischal KK. RASopathy in Patients With Isolated Sagittal Synostosis. Glob Pediatr Health 2019; 6:2333794X19846774. [PMID: 31192281 PMCID: PMC6540476 DOI: 10.1177/2333794x19846774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/24/2019] [Accepted: 03/29/2019] [Indexed: 11/17/2022] Open
Abstract
RASopathy is caused by dysfunction in the MAPK pathway, and include syndromes like Noonan syndrome (NS), NS with multiple lentigines (formerly known as Leopard syndrome), cardiofaciocutaneous (CFC), Legius syndrome, capillary malformation–arteriovenous malformation, neurofibromatosis type 1, and Costello syndrome. When counted together, RASopathies affect 1/1000 live births, and are characterized by cardiovascular manifestations, short stature, developmental delay, renal, urogenital, skin/skeletal abnormalities, and dysmorphic appearance. NS—one of the most common RASopathies—occurs in 1/1000 to 1/2500 live births. On the other hand, the frequency of CFC is unknown, but it is one of the rarest RASopathies, with estimates of only a few hundred cases worldwide. However, its phenotype overlaps with that of NS. In this case series, we describe 5 patients with a clinical and genetic diagnosis of RASopathy—either NS or CFC—all of whom were also diagnosed with isolated sagittal synostosis (ISS). Medical records from ophthalmology, cardiology, plastic surgery, medical genetics, cleft craniofacial, and neurosurgery were used to determine patient history. In our cohort, late presentation of ISS was the predominant form of ISS presentation. We hope this report further characterizes the burgeoning relationship between RASopathy and ISS. Furthermore, these findings support including sagittal synostosis among the presenting features in the clinical phenotype of RASopathies. Ethical approval was obtained from the university’s institutional review board.
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Affiliation(s)
- Amani Ali Davis
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Giulio Zuccoli
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | - Joseph Losee
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Ian F Pollack
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | | | - Ken K Nischal
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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Ganesh A, Edmond J, Forbes B, Katowitz WR, Nischal KK, Miller M, Levin AV. An update of ophthalmic management in craniosynostosis. J AAPOS 2019; 23:66-76. [PMID: 30928366 DOI: 10.1016/j.jaapos.2018.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/26/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
Abstract
Craniosynostosis has a varied clinical spectrum, ranging from isolated single suture involvement to multisutural fusions. Syndromic and nonsyndromic patients require orchestrated and multidisciplinary care from birth to adulthood. Advances in our understanding of craniosynostosis over the last quarter-century have resulted in more systematic management of the problems associated with the syndromic and nonsyndromic forms of this condition. This review provides an update on the genetic basis of, management of strabismus and oculoplastic manifestations in, and visual surveillance of patients with craniosynostosis.
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Affiliation(s)
- Anuradha Ganesh
- Department of Ophthalmology, Sultan Qaboos University Hospital, Sultanate of Oman
| | - Jane Edmond
- Departments of Ophthalmology and Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Brian Forbes
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - William R Katowitz
- Oculoplastic and Orbital Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ken K Nischal
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | | | - Alex V Levin
- Wills Eye Institute, Philadelphia, Pennsylvania.
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