Clinical spectrum of eye malformations in four patients with Mowat-Wilson syndrome

Mowat-Wilson syndrome (MWS) is a rare genetic syndrome characterized by a specific facial gestalt, intellectual deficiency, Hirschsprung disease and multiple congenital anomalies. Heterozygous mutations or deletions in the zinc finger E-box-binding homeobox2 gene (ZEB2) cause MWS. ZEB2 encodes for Smad-interacting protein 1, a transcriptional co-repressor involved in TGF-beta and BMP pathways and is strongly expressed in early stages of development in mice. Eye abnormalities have rarely been described in patients with this syndrome. Herein, we describe four patients (two males and two females; mean age 7 years) with MWS and eye malformations. Ocular anomalies included, iris/retinal colobomas, atrophy or absence of the optic nerve, hyphema, and deep refraction troubles, sometimes with severe visual consequences. All eye malformations were asymmetric and often unilateral and all eye segments were affected, similarly to the nine MWS cases with ophthalmological malformations previously reported (iris/chorioretinal/optic disc coloboma, optic nerve atrophy, retinal epithelium atrophy, cataract, and korectopia). In human embryo, ZEB2 is expressed in lens and neural retina. Using the present report and data from the literature, we set out to determine whether or not the presence of eye manifestations could be due to specific type or location of mutations. We concluded that the presence of eye malformations, although a rare feature in MWS, should be considered as a part of the clinical spectrum of the condition.

Persistance de liquide sous-rétinien maculaire après traitement d’un décollement de rétine rhegmatogène par cryothérapie-indentation

We report the case of a phakic patient with late visual recovery after successful surgery of macula-off retinal detachment, using the scleral buckling procedure. Visual acuity remained low because of the persistence of subfoveal fluid despite the reattachment of peripheral retina. The amount of subfoveal fluid decreased slowly and final visual acuity finally recovered. We used optical coherence tomography (OCT) to quantify the remaining subfoveal fluid. Persistence of submacular fluid can explain late visual recovery after surgical treatment of retinal detachment.

Trefoil factor family 1, MUC5AC and human leucocyte antigen-DR expression by conjunctival cells in patients with glaucoma treated with chronic drugs: could these markers predict the success of glaucoma surgery?

AIMS

To evaluate conjunctival expression of trefoil factor family (TFF)1, MUC5AC and human leucocyte antigen (HLA)-DR in patients with glaucoma treated with topical drugs, and to determine whether these parameters can predict the outcome of glaucoma surgery.

METHODS

77 conjunctival impression cytology specimens were collected from 77 patients with glaucoma (66 receiving drops with preservative and 11 treated with preservative-free drops) and 43 controls. TFF1, MUC5AC and HLA-DR expression was analysed using flow cytometry. Trabeculectomy was performed in 56 patients; success was defined as an intraocular pressure (IOP) < or =15 mm Hg without any IOP-lowering drug at 6 months.

RESULTS

The expression of TFF1, MUC5AC and HLA-DR was significantly higher in patients than in controls (p = 0.01, 0.05 and 0.004, respectively). A higher expression of MUC5AC was found in patients treated with preserved drops than in those receiving unpreserved drops (p = 0.04). A higher MUC5AC expression and a lower HLA-DR expression was observed in successful glaucoma surgeries than in failures.

CONCLUSIONS

TFF1 and MUC5AC secretions are probably a response to mild ocular surface changes caused by long-term use of topical treatment. Their increased expression could be a predicting factor of further successful glaucoma surgery.

Étude des atteintes de la surface oculaire chez les patients diabétiques

INTRODUCTION

Diabetes mellitus leads to microvascular complications and altered basement membranes, which are partly responsible for ocular complications. Corneal nerve impairment is involved in ocular surface disease as well. We examined the possible relation between ocular surface signs and retinal or neuronal degenerative complications due to diabetes.

PATIENTS AND METHODS

Diabetics and control subjects were compared for corneal sensitivity and tear function parameters such as the Schirmer test, tear film break-up time (BUT), and fluorescein and lissamine green stainings. The relation of the duration of the disease, the stage of retinopathy, metabolic control (HbA1c), and diabetic peripheral neuropathy with ocular surface disorders were noted.

RESULTS

Twelve healthy patients were compared to 48 diabetics. The Schirmer test value, BUT, and fluorescein and lissamine green impregnations were significantly modified in diabetics compared to controls (p<0.0001), with no relation to the duration of the disease or metabolic control. The mean corneal sensitivity was significantly lower in diabetic patients (p<0.01), diabetics with peripheral neuropathy (p=0.00008), and diabetics with preproliferative retinopathy (p=0.0003). Tear function parameters were more frequently altered in patients presenting preproliferative retinopathy and peripheral neuropathy (p<0.001).

CONCLUSIONS

Diabetes can lead to ocular surface impairments with qualitative and quantitative tear disorders, all of which seem to evolve in close relation with retinopathy and peripheral neuropathy. These lacrymal and corneoconjunctival abnormalities, even if not currently mentioned by diabetic patients, can result in severe neurotrophic complications.