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Saatci AO, Ataş F, Çetin GO, Kayabaşı M. Diagnostic and Management Strategies of Bietti Crystalline Dystrophy: Current Perspectives. Clin Ophthalmol 2023; 17:953-967. [PMID: 36998515 PMCID: PMC10046287 DOI: 10.2147/opth.s388292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
Bietti crystalline dystrophy (BCD) is a rare, genetically determined chorioretinal dystrophy presenting with intraretinal crystalline deposits and varying degrees of progressive chorioretinal atrophy commencing at the posterior pole. In some cases, there can be concomitant corneal crystals noted first in the superior or inferior limbus. CYP4V2 gene, a member of the cytochrome P450 family is responsible for the disease and more than 100 mutations have been defined thus far. However, a genotype-phenotype correlation has not been established yet. Visual impairment commonly occurs between the second and third decades of life. By the fifth or sixth decade of life, vision loss can become so severe that the patient may potentially become legally blind. Multitudes of multimodal imaging modalities can be utilized to demonstrate the clinical features, course, and complications of the disease. This present review aims to reiterate the clinical features of BCD, update the clinical perspectives with the help of multimodal imaging techniques, and overview its genetic background with future therapeutic approaches.
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Affiliation(s)
- Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Ferdane Ataş
- Department of Ophthalmology, Çerkezköy State Hospital, Tekirdağ, Turkey
| | - Gökhan Ozan Çetin
- Department of Medical Genetics, Pamukkale University, Denizli, Turkey
| | - Mustafa Kayabaşı
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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Jia R, Meng X, Chen S, Zhang F, Du J, Liu X, Yang L. AAV-mediated gene-replacement therapy restores viability of BCD patient iPSC derived RPE cells and vision of Cyp4v3 knockout mice. Hum Mol Genet 2023; 32:122-138. [PMID: 35925866 DOI: 10.1093/hmg/ddac181] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/17/2022] [Accepted: 07/31/2022] [Indexed: 01/25/2023] Open
Abstract
Bietti crystalline corneoretinal dystrophy (BCD) is an autosomal recessive retinal degenerative disease characterized by yellow-white crystal deposits in the posterior pole, degeneration of the retinal pigment epithelium (RPE), and sclerosis of the choroid. Mutations in the cytochrome P450 4V2 gene (CYP4V2) cause BCD, which is associated with lipid metabolic disruption. The use of gene-replacement therapy in BCD has been hampered by the lack of disease models. To advance CYP4V2 gene-replacement therapy, we generated BCD patient-specific induced pluripotent stem cell (iPSC)-RPE cells and Cyp4v3 knockout (KO) mice as disease models and AAV2/8-CAG-CYP4V2 as treatment vectors. We demonstrated that after adeno-associated virus (AAV)-mediated CYP4V2 gene-replacement therapy BCD-iPSC-RPE cells presented restored cell survival and reduced lipid droplets accumulation; restoration of vision in Cyp4v3 KO mice was revealed by elevated electroretinogram amplitude and ameliorated RPE degeneration. These results suggest that AAV-mediated gene-replacement therapy in BCD patients is a promising strategy.
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Affiliation(s)
- Ruixuan Jia
- Key Laboratory of Vision Loss and Restoration, Department of Ophthalmology, Ministry of Education, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xiang Meng
- Key Laboratory of Vision Loss and Restoration, Department of Ophthalmology, Ministry of Education, Peking University Third Hospital, Beijing, People's Republic of China
| | - Shaohong Chen
- Beijing Chinagene Corporation Ltd, Beijing, People's Republic of China
| | - Fan Zhang
- Beijing Chinagene Corporation Ltd, Beijing, People's Republic of China
| | - Juan Du
- Key Laboratory of Vision Loss and Restoration, Department of Ophthalmology, Ministry of Education, Peking University Third Hospital, Beijing, People's Republic of China.,Department of Anatomy, Histology, and Embryology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, and State Key Laboratory of Natural and Biomimetic Drugs, Peking University Health Science Center, Beijing, People's Republic of China
| | - Xiaozhen Liu
- Key Laboratory of Vision Loss and Restoration, Department of Ophthalmology, Ministry of Education, Peking University Third Hospital, Beijing, People's Republic of China
| | - Liping Yang
- Key Laboratory of Vision Loss and Restoration, Department of Ophthalmology, Ministry of Education, Peking University Third Hospital, Beijing, People's Republic of China
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Liu Z, Ayton LN, O'Hare F, Arslan J, Hu ML, Noar AP, Wang JH, Hickey DG, McGuinness MB, Vincent AL, Chen FK, Edwards TL. Intereye Symmetry in Bietti Crystalline Dystrophy. Am J Ophthalmol 2022; 235:313-325. [PMID: 34283985 DOI: 10.1016/j.ajo.2021.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/07/2021] [Accepted: 07/09/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate anatomic and functional intereye symmetry among individuals with Bietti crystalline dystrophy (BCD) using clinical and multimodal imaging methods, with a focus on the number, area, and distribution of the characteristic retinal crystalline deposits. DESIGN Observational case series with prospective and retrospective data. METHODS Setting: Multicenter. STUDY POPULATION Thirteen Australian and New Zealand participants (26 eyes) with confirmed biallelic CYP4V2 mutations and a characteristic BCD fundus appearance. Procedures and main outcome measures: Crystals visible on color fundus photography were manually counted. Crystals were superimposed on aligned multimodal fundus images. Spearman's correlation coefficients (ρ), intraclass correlation coefficients (ICCs), and Bland-Altman plots were used to quantify symmetry between eyes. MAIN OUTCOME MEASURES Fundus crystal area and count, and absent-autofluorescence (absent-AF) area. RESULTS Median participant age was 48 years (interquartile range: 40-60 years). Intereye symmetry was high for fundus crystal area (ρ = 1.00, 95% confidence interval [CI]: 1.00-1.00; ICC = 0.97, 95% CI: 0.88-0.99), fundus crystal count (ρ = 0.98, 95% CI: 0.92-1.00; ICC = 0.97, 95% CI: 0.89-0.99), and absent-AF area (ρ = 0.88, 95% CI: 0.53-0.98; ICC = 0.98, 95% CI: 0.90-0.99). Average foveal volume, foveal crystal count and area, average and central foveal thickness, best corrected visual acuity, and average macular and central foveal sensitivity were not highly correlated between eyes. CONCLUSIONS This study demonstrated strong intereye symmetry measured by fundus crystal area, fundus crystal number, and absent-AF area. This may influence the choice of outcome measures for future therapeutic trials for BCD and provides valuable clinical information for ophthalmologists involved in the care and counseling of patients with BCD.
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贾 睿, 姜 尚, 赵 琳, 杨 丽. [Generation and characterization of Cyp4v3 gene knockout mice]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:1099-1106. [PMID: 34916689 PMCID: PMC8695138 DOI: 10.19723/j.issn.1671-167x.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Bietti crystalline dystrophy (BCD) is a rare degenerative eye disease caused by mutations in the CYP4V2 gene, and Cyp4v3 is the murine ortholog to CYP4V2. To better understand the molecular pathogenesis of this disease and to explore the potential treatment we have established a Cyp4v3 knock-out mouse model. METHODS Cyp4v3-/- mice were generated by clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 in embryonic stem cells of C57BL/6J mice. Ocular morphologic characteristics were evaluated via fundus imaging, histologic analysis of rods and cones via immunofluorescence, and phalloidin stain to observe retinal pigment epithelium (RPE) in whole-mounts, electroretinogram (ERG) was also conducted to examine the retinal function. RESULTS The characteristic features of BCD recurred in the Cyp4v3-/- mice, including retinal crystalline deposits, atrophy and degeneration of RPE cells, and ERG amplitude decline of dark and light adapted a- and b- wave; however, the immunofluorescence stain of rod and cone cells did not show obvious differences when compared with the wild type (WT) mice. In the early stage of the disease, no crystal-like deposits were found in the fundus, ERG detection of the retinal function did not find a significant decline, and the morphological structure and quantity of the neural retina and RPE did not change significantly. Crystalline deposits occurred and converged when the Cyp4v3-/- mice at the end of 6 months, and the deposits disappeared when the Cyp4v3-/- mice at the end of 12 months. The ERG amplitude started to decline when the Cyp4v3-/- mice at the end of 6 months and deteriorated at the end of 12 months. The RPE cells of the 12-month old Cyp4v3-/- mice showed irregular shape by phalloidin staining of F-actin. The Cyp4v3-/- mice behaved normally and were viable and fertile when maintained under specific pathogen-free (SPF) housing conditions. CONCLUSION Just like BCD patients, the disease progress of Cyp4v3-/- mouse is correlated with the age, which provides a good model for pathogenesis and gene therapy study in the future. The atrophy and degeneration of RPE take the lead in progressing of the disease, but the mechanism is not clear yet.
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Affiliation(s)
- 睿璇 贾
- />北京大学第三医院眼科,眼部神经损伤的重建保护与康复北京市重点实验室,北京 100191Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - 尚伟 姜
- />北京大学第三医院眼科,眼部神经损伤的重建保护与康复北京市重点实验室,北京 100191Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - 琳 赵
- />北京大学第三医院眼科,眼部神经损伤的重建保护与康复北京市重点实验室,北京 100191Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - 丽萍 杨
- />北京大学第三医院眼科,眼部神经损伤的重建保护与康复北京市重点实验室,北京 100191Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
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A case of Bietti crystalline dystrophy with clinical, electrophysiological, and imaging findings. North Clin Istanb 2021; 8:521-524. [PMID: 34909593 PMCID: PMC8630728 DOI: 10.14744/nci.2019.78989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/13/2019] [Indexed: 11/22/2022] Open
Abstract
In this study, ophthalmologic examination findings, fundus fluorescein angiography, optic coherence tomography (OCT), visual field testing, electrophysiological, and systemic laboratory findings of a 43-year-old female patient who presented with blurry vision and who had retinal and corneal deposits were examined. Our patients’ best-corrected visual acuity was 0.9 bilaterally. Her anterior segments and intraocular pressures were bilaterally normal. Fundus examination revealed bilateral glistening yellowish intraretinal crystalline deposits in the posterior pole and midperipheral retina. The electroretinographic examination revealed a decrease in scotopic and photopic a and b wave amplitudes. Corneal and intraretinal glistening crystalloid deposits were observed in the OCT. Our patient and her husband were relatives. Her sister’s, brother’s, and children’s OCT also revealed bilateral corneal and intraretinal crystalloid deposits. We diagnosed this case as Bietti’s crystalline dystrophy which is a rare disease with genetic inheritance that must be considered in the differential diagnosis in countries in which consanguineous marriage is often.
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Abdolrahimzadeh S, Ciancimino C, Grassi F, Sordi E, Fragiotta S, Scuderi G. Near-Infrared Reflectance Imaging in Retinal Diseases Affecting Young Patients. J Ophthalmol 2021; 2021:5581851. [PMID: 34373789 PMCID: PMC8349282 DOI: 10.1155/2021/5581851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Near-infrared reflectance (NIR) is a noninvasive, contactless, and rapid in vivo imaging technique for visualizing subretinal alterations in the photoreceptor layer, retinal pigment epithelium, and choroid. The present report describes the application of this imaging method in retinal and choroidal pathologies affecting young patients where scarce cooperation, poor fixation, and intense glare sensation can result in a challenging clinical examination. A literature search of the MEDLINE database was performed using the terms "near-infrared reflectance" and "spectral-domain optical coherence tomography." Articles were selected if they described the diagnostic use of NIR in children or young adults. Of 700 publications, 42 manuscripts published between 2005 and 2020 were inherent to children or young adults and were considered in this narrative literature review. The first disease category is the phakomatoses where NIR is essential in visualizing choroidal alterations recognized as cardinal biomarkers in neurofibromatosis type 1, microvascular retinal alterations, and retinal astrocytic hamartomas. Another diagnostic application is the accurate visualization of crystals of various nature, including the glistening crystals that characterize Bietti crystalline dystrophy. Acute macular neuropathy and paracentral acute middle maculopathy represent a further disease category with young adulthood onset where NIR is not only diagnostic but also essential to monitor disease progression. A further interesting clinical application is to facilitate the detection of laser-induced maculopathy where funduscopic examination can be normal or subnormal. In conclusion, NIR imaging has a noninterchangeable role in diagnosing certain retinal diseases, especially in children and young adults where there is scarce collaboration and a lack of evident clinical findings. Moreover, this technique can reveal unique retinal and choroidal biomarkers highly specific to rare conditions.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Chiara Ciancimino
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Flaminia Grassi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Edoardo Sordi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
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da Palma MM, Motta FL, Salles MV, Texeira CHM, Gomes AV, Casaroli-Marano R, Sallum JMF. Expanding the Phenotypic and Genotypic Spectrum of Bietti Crystalline Dystrophy. Genes (Basel) 2021; 12:genes12050713. [PMID: 34068831 PMCID: PMC8151499 DOI: 10.3390/genes12050713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022] Open
Abstract
The rare form of retinal dystrophy, Bietti crystalline dystrophy, is associated with variations in CYP4V2, a member of the cytochrome P450 family. This study reports patients affected by typical and atypical Bietti crystalline dystrophy, expanding the spectrum of this disease. This is an observational case series of patients with a clinical and molecular diagnosis of Bietti crystalline dystrophy that underwent multimodal imaging. Four unrelated patients are described with two known variants, c.802-8_810del17insGC and c.518T > G (p.Leu173Trp), and one novel missense variant, c.1169G > T (p.Arg390Leu). The patient with the novel homozygous variant had the most severe phenotype resulting in macular hole formation and retinal detachment in both eyes. To the best of our knowledge, there is no association of these features with Bietti crystalline dystrophy. Patient 1 was the youngest patient and had the mildest phenotype with crystals in the retina without chorioretinal atrophy and visual complaints. Patients 2 and 3 presented with fewer crystals and chorioretinal atrophy. These three patients presented a classic phenotype. The fourth patient presented with an atypical and severe phenotype. This study reveals a new genotype and new phenotype associated with this disorder.
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Affiliation(s)
- Mariana Matioli da Palma
- Department of Ophthalmology, Federal University of São Paulo—UNIFESP, São Paulo, SP 04023-062, Brazil; (M.M.d.P.); (F.L.M.); (M.V.S.); (C.H.M.T.); (R.C.-M.)
- Instituto de Genética Ocular, São Paulo, SP 04552-050, Brazil
- Instituto Suel Abujamra, São Paulo, SP 01525-001, Brazil;
- Department of Surgery & Hospital Cínic de Barcelona, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Fabiana Louise Motta
- Department of Ophthalmology, Federal University of São Paulo—UNIFESP, São Paulo, SP 04023-062, Brazil; (M.M.d.P.); (F.L.M.); (M.V.S.); (C.H.M.T.); (R.C.-M.)
- Instituto de Genética Ocular, São Paulo, SP 04552-050, Brazil
| | - Mariana Vallim Salles
- Department of Ophthalmology, Federal University of São Paulo—UNIFESP, São Paulo, SP 04023-062, Brazil; (M.M.d.P.); (F.L.M.); (M.V.S.); (C.H.M.T.); (R.C.-M.)
- Instituto de Genética Ocular, São Paulo, SP 04552-050, Brazil
| | - Caio Henrique Marques Texeira
- Department of Ophthalmology, Federal University of São Paulo—UNIFESP, São Paulo, SP 04023-062, Brazil; (M.M.d.P.); (F.L.M.); (M.V.S.); (C.H.M.T.); (R.C.-M.)
- Instituto de Genética Ocular, São Paulo, SP 04552-050, Brazil
| | - André V. Gomes
- Instituto Suel Abujamra, São Paulo, SP 01525-001, Brazil;
| | - Ricardo Casaroli-Marano
- Department of Ophthalmology, Federal University of São Paulo—UNIFESP, São Paulo, SP 04023-062, Brazil; (M.M.d.P.); (F.L.M.); (M.V.S.); (C.H.M.T.); (R.C.-M.)
- Department of Surgery & Hospital Cínic de Barcelona, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Juliana Maria Ferraz Sallum
- Department of Ophthalmology, Federal University of São Paulo—UNIFESP, São Paulo, SP 04023-062, Brazil; (M.M.d.P.); (F.L.M.); (M.V.S.); (C.H.M.T.); (R.C.-M.)
- Instituto de Genética Ocular, São Paulo, SP 04552-050, Brazil
- Correspondence: ; Tel.: +55-11-9-9974-6530
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Oh JK, Lima de Carvalho JR, Nuzbrokh Y, Ryu J, Chemudupati T, Mahajan VB, Sparrow JR, Tsang SH. Retinal Manifestations of Mitochondrial Oxidative Phosphorylation Disorders. Invest Ophthalmol Vis Sci 2021; 61:12. [PMID: 33049060 PMCID: PMC7571321 DOI: 10.1167/iovs.61.12.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose The purpose of this paper was to discuss manifestations of primary mitochondrial dysfunctions and whether the retinal pigment epithelium or the photoreceptors are preferentially affected. Methods A retrospective analysis was performed of patients with clinically and laboratory confirmed diagnoses of maternally inherited diabetes and deafness (MIDD) or Kearns–Sayre syndrome (KSS). Patients underwent full ophthalmic examination, full-field electroretinogram, and multimodal imaging studies, including short-wavelength autofluorescence, spectral domain-optical coherence tomography, and color fundus photography. Results A total of five patients with MIDD and four patients with KSS were evaluated at two tertiary referral centers. Mean age at initial evaluation was 50.3 years old. Nascent outer retinal tubulations corresponding with faint foci of autofluorescence were observed in two patients with MIDD. Characteristic features of this cohort included a foveal sparing phenotype observed in 13 of 18 eyes (72%), global absence of intraretinal pigment migration, and preserved retinal function on full-field electroretinogram testing in 12 of 16 eyes (75%). One patient diagnosed with MIDD presented with an unusual pattern of atrophy surrounding the parapapillary region and one patient with KSS presented with an atypical choroideremia-like phenotype. Conclusions MIDD and KSS are phenotypically heterogeneous disorders. Several features of disease suggest that primary mitochondrial dysfunction may first affect the retinal pigment epithelium followed by secondary photoreceptor loss. Similarities between primary mitochondrial degenerations and retinal disorders, such as age-related macular degeneration may suggest a primary role of mitochondria in the pathogenesis of these oligogenic disorders.
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Affiliation(s)
- Jin Kyun Oh
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States.,State University of New York at Downstate Medical Center, Brooklyn, New York, United States
| | - Jose Ronaldo Lima de Carvalho
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States.,Department of Ophthalmology, Empresa Brasileira de Servicos Hospitalares (EBSERH) - Hospital das Clinicas de Pernambuco (HCPE), Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil.,Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Yan Nuzbrokh
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States.,Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
| | - Joseph Ryu
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
| | - Teja Chemudupati
- Molecular Surgery Laboratory, Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Vinit B Mahajan
- Molecular Surgery Laboratory, Byers Eye Institute, Stanford University, Palo Alto, California, United States.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States
| | - Janet R Sparrow
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology and Columbia Stem Cell Initiative (CSCI), Columbia University Irving Medical Center, New York, New York, United States
| | - Stephen H Tsang
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology and Columbia Stem Cell Initiative (CSCI), Columbia University Irving Medical Center, New York, New York, United States
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TOPICAL DORZOLAMIDE FOR CYSTOID MACULAR EDEMA IN BIETTI CRYSTALLINE RETINAL DYSTROPHY. Retin Cases Brief Rep 2021; 15:306-309. [PMID: 30028788 DOI: 10.1097/icb.0000000000000792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report a case of Bietti crystalline retinal dystrophy with cystoid macular edema (CME) that was successfully treated with topical carbonic anhydrase inhibitor. METHODS A 35-year-old otherwise healthy woman, with a known case of Bietti crystalline retinal dystrophy, presented with progressive visual impairment in her right eye for 3 months. The best-corrected visual acuity was 20/50 in the right eye and 20/25 in the left eye. On the basis of the multimodal imaging findings, the patient was diagnosed with Bietti crystalline retinal dystrophy with unilateral CME. Carbonic anhydrase inhibitor therapy twice a day was initiated. RESULTS Three months later, visual acuity improved to 20/25 in the right eye, and CME had resolved based on spectral domain ocular coherence tomography findings, although the CME reoccurred after discontinuation of the drug. Three months after resuming the therapy, the best-corrected visual acuity improved back to 20/25. CONCLUSION Cystoid macular edema is one of the main causes of central visual worsening in patients with Bietti crystalline retinal dystrophy. This complication may be resolved with topical carbonic anhydrase inhibitor, resulting in improved anatomical and visual outcomes.
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Ameri H, Su E, Dowd-Schoeman TJ. Autofluorescence of choroidal vessels in Bietti's crystalline dystrophy. BMJ Open Ophthalmol 2020; 5:e000592. [PMID: 33178891 PMCID: PMC7594368 DOI: 10.1136/bmjophth-2020-000592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 11/08/2022] Open
Abstract
Objective To describe the pattern of fundus autofluorescence (FAF) in Bietti’s crystalline dystrophy (BCD). Methods and analysis From the National Institutes of Health EyeGene database of 2769 patients with known pathogenic mutations, 5 patients with BCD-causing CYP4V2 mutations who had FAF images were selected. Demographic and genetic information and imaging files were obtained. From the FAF imaging files, unique autofluorescence (AF) patterns and correlation with retinal structures were assessed by three investigators for clinical significance. Results Five patients (four males, one female; mean age 56 years, range 42–76 years) were included, all with different CYP4V2 mutations. All patients displayed varying degrees of hypo-AF in the posterior pole. In four out of five patients, there was a relative hyper-AF of choroidal vessels within the hypo-AF area; this feature was limited to sclerotic vessels only. A transitional zone of speckled AF was visible around the hypo-AF area. This zone corresponded to the area containing retinal crystals on colour fundus photography; however, retinal crystals did not demonstrate hyper or hypo-AF. Conclusions This study presents a previously unreported characteristic finding in patients with BCD with CYP4V2 mutations. AF of choroidal vessels may aid in differentiating BCD from other retinal dystrophies.
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Affiliation(s)
- Hossein Ameri
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Erin Su
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tyler J Dowd-Schoeman
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Zhang Z, Yan B, Gao F, Li Q, Meng X, Chen P, Zhou L, Deng W, Li C, Xu W, Han S, Feng H, Li Y, Chen J, Yin Z, Liao C, Tse HF, Xu A, Lian Q. PSCs Reveal PUFA-Provoked Mitochondrial Stress as a Central Node Potentiating RPE Degeneration in Bietti's Crystalline Dystrophy. Mol Ther 2020; 28:2642-2661. [PMID: 32755565 PMCID: PMC7704739 DOI: 10.1016/j.ymthe.2020.07.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/25/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022] Open
Abstract
Bietti’s crystalline dystrophy (BCD) is an incurable retinal disorder caused by the polypeptide 2 of cytochrome P450 family 4 subfamily V (CYP4V2) mutations. Patients with BCD present degeneration of retinal pigmented epithelial (RPE) cells and consequent blindness. The lack of appropriate disease models and patients’ RPE cells limits our understanding of the pathological mechanism of RPE degeneration. In this study, using CYP4V2 mutant pluripotent stem cells as disease models, we demonstrated that RPE cells with CYP4V2 mutations presented a disrupted fatty acid homeostasis, which were characterized with excessive accumulation of poly-unsaturated fatty acid (PUFA), including arachidonic acid (AA) and eicosapentaenoic acid (EPA). The PUFA overload increased mitochondrial reactive oxygen species, impaired mitochondrial respiratory functions, and triggered mitochondrial stress-activated p53-independent apoptosis in CYP4V2 mutant RPE cells. Restoration of the mutant CYP4V2 using adeno-associated virus 2 (AAV2) can effectively reduce PUFA deposition, alleviate mitochondria oxidative stresses, and rescue RPE cell death in BCD RPE cells. Taken together, our results highlight a role of PUFA-induced mitochondrial damage as a central node to potentiate RPE degeneration in BCD patients. AAV2-mediated gene therapy may represent a feasible strategy for the treatment of BCD.
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Affiliation(s)
- Zhao Zhang
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Prenatal Diagnostic Centre and Cord Blood Bank, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Bin Yan
- Department of Computer Science, The University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China; Intervention and Cell Therapy Center, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Fei Gao
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Qing Li
- Ophthalmology, Grantham Hospital, Hospital Authority, Hong Kong SAR, China
| | - Xiaohong Meng
- Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China
| | - Peikai Chen
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Lei Zhou
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Wen Deng
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Cheng Li
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Weiyi Xu
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Shuo Han
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hong Feng
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yaping Li
- Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, China
| | - Junhui Chen
- Intervention and Cell Therapy Center, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Zhengqin Yin
- Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China
| | - Can Liao
- Prenatal Diagnostic Centre and Cord Blood Bank, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Hung-Fat Tse
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Aimin Xu
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR, China.
| | - Qizhou Lian
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Prenatal Diagnostic Centre and Cord Blood Bank, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China; State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR, China.
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12
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Surve A, Balaji A, Azad SV, Kumar V, Vohra R, Venkatesh P. Role of red free imaging, retinal reflectance and fundus autofluorescence in Bietti crystalline dystrophy: case report. THERAPEUTIC ADVANCES IN RARE DISEASE 2020; 1:2633004020958013. [PMID: 37180496 PMCID: PMC10032466 DOI: 10.1177/2633004020958013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/27/2020] [Indexed: 05/16/2023]
Abstract
Bietti crystalline dystrophy (BCD), a rare autosomal recessive hereditary disorder, is identified by its clinical features. It is characterised by crystalline deposits and hence called crystalline retinopathy. The retinopathy progresses with age, showing a decrease in the number of crystalline deposits and increase in the area of chorioretinal degeneration, which spreads in a centrifugal pattern. Thus, BCD can be confused with other disorders with crystalline-like deposits and chorioretinal degenerations. The red-free and near-infrared reflectance allows prominent visualisation of crystalline deposits that may be missed. The non-inferiority of red-free imaging and its wider availability could allow its use as a screening tool. The enhanced depth imaging optical coherence tomography shows crystalline deposits throughout the retina and outer retinal tubulation. Thus, multimodality imaging can act as an adjunct in diagnosis, monitoring and follow up in these cases, acting not only as a teaching tool but also giving an insight into the underlying pathophysiology of the disorder. Plain language summary Use of imaging in diagnosis of Bietti crystalline dystrophy Bietti crystalline dystrophy is a rare familial disorder but is not shown in all family members and may skip generations, as it has an autosomal recessive pattern of inheritance. It shows refractile yellow-white crystalline deposits and degenerative changes in the retina. These crystalline deposits disappear with age while degenerative changes increase and spread from centre to the periphery. This may cause difficulty in early detection, and confusion with similar degenerative diseases of the retina. The use of various imaging modalities can help in diagnosis and follow up of these cases. These modalities also provide understanding of the basic disease process.
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Affiliation(s)
- Abhidnya Surve
- Vitreoretinal, trauma and uvea services, Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
| | - Akshaya Balaji
- Dr. Rajendra Prasad Centre for Ophthalmic
Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi,
India
| | - Shorya Vardhan Azad
- Assistant Professor, Vitreo-retina, Trauma &
Uvea Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India
Institute of Medical Sciences, Ansari nagar, New Delhi 110029, India
| | - Vinod Kumar
- Vitreoretinal, trauma and uvea services, Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajpal Vohra
- Vitreoretinal, trauma and uvea services, Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
| | - Pradeep Venkatesh
- Vitreoretinal, trauma and uvea services, Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
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13
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Song WK, Clouston P, MacLaren RE. Presence of corneal crystals confirms an unusual presentation of Bietti's retinal dystrophy. Ophthalmic Genet 2019; 40:461-465. [PMID: 31638456 DOI: 10.1080/13816810.2019.1678176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Bietti crystalline corneoretinal dystrophy (BCD) (OMIM 210370) is a rare autosomal recessive retinal dystrophy typically characterized by multiple intraretinal crystals over the posterior pole of the retina. Degeneration of the retina and sclerosis of the choroidal vessels results in progressive night blindness and central visual field loss.Methods: Detailed ophthalmic and genetic testing of the patient and his father were performed.Results: We report on a 41-year-old male patient with advanced chorioretinal dystrophy at the posterior pole extending into the peripheral retina. His sister and his father were similarly affected with nyctalopia and decreased visual acuity, although his father had a milder phenotype of a typical macular dystrophy. On close slit-lamp examination, however, both patient and his father had multiple yellow-white crystals in the peripheral cornea. Corneal findings and consanguinity of the patient's parents lead to suspicion of BCD. Molecular genetic results of the patient and his father showed homozygous for CYP4V2, c. 197T>G p.(Met66Arg) confirming the diagnosis of BCD.Conclusions: The patient's pedigree shows pseudodominant inheritance due to consanguineous parents. However, careful examination of the corneal findings strengthened the clinical suspicion of BCD, facilitating the molecular genetic confirmation of this autosomal recessive disease.
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Affiliation(s)
- Won Kyung Song
- Nuffield Laboratory of Ophthalmology, University of Oxford & Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Penny Clouston
- Oxford Medical Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, University of Oxford & Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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14
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Kobat SG, Gul FC, Yusufoglu E. Bietti crystalline dystrophy and choroidal neovascularization in childhood. Int J Ophthalmol 2019; 12:1514-1516. [PMID: 31544053 DOI: 10.18240/ijo.2019.09.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/25/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sabiha Gungor Kobat
- Department of Ophthalmology, Elazig Health Sciences University, Elazig 23000, Turkey
| | - Fatih Cem Gul
- Department of Ophthalmology, Elazig Health Sciences University, Elazig 23000, Turkey
| | - Elif Yusufoglu
- Department of Ophthalmology, Elazig Health Sciences University, Elazig 23000, Turkey
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15
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Abstract
PURPOSE To describe an unusual manifestation of hyperreflective deposits in the subretinal space in a group of patients with clinically and genetically confirmed Stargardt disease. METHODS Retrospective review of color fundus, autofluorescence, infrared reflectance, red-free images, and spectral domain optical coherence tomography in 296 clinically diagnosed and genetically confirmed (2 expected disease-causing mutations in ABCA4) patients with Stargardt disease. Full-field electroretinogram (ffERG), medical history, and genotype data (in silico predictions) were further analyzed from the selected cohort. RESULTS Eight of 296 patients (2.7%) were found to exhibit small crystalline deposits that were detectable on certain imaging modalities, such as color, infrared reflectance and red-free images, but not autofluorescence. The deposits were most prevalent in the superior region of the macula, and spectral domain optical coherence tomography revealed their presence in the subretinal space. All patients presented with these findings at a notably advanced disease stage with abnormal ffERG and a high proportion of highly deleterious ABCA4 alleles. CONCLUSION Hyperreflective subretinal deposits may be a manifestation of advanced ABCA4 disease, particularly in regions susceptible to disease-related changes, such as lipofuscin accumulation.
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16
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García-García GP, Martínez-Rubio M, Moya-Moya MA, Pérez-Santonja JJ, Escribano J. Current perspectives in Bietti crystalline dystrophy. Clin Ophthalmol 2019; 13:1379-1399. [PMID: 31440027 PMCID: PMC6679682 DOI: 10.2147/opth.s185744] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/08/2019] [Indexed: 01/17/2023] Open
Abstract
Bietti crystalline dystrophy (BCD) is a rare-inherited disease caused by mutations in the CYP4V2 gene and characterized by the presence of multiple shimmering yellow-white deposits in the posterior pole of the retina in association with atrophy of the retinal pigment epithelium (RPE) and chorioretinal atrophy. The additional presence of glittering dots located at the corneal limbus is also a frequent finding. The CYP4V2 protein belongs to the cytochrome P450 subfamily 4 and is mainly expressed in the retina and the RPE and less expressed in the cornea. The disease has its metabolic origin in the diminished transformation of fatty acid substrates into n-3 polyunsaturated fatty acids due to a dysregulation of the lipid metabolism. In this review, we provide updated insights on clinical and molecular characteristics of BCD including underlying mechanisms of BCD, genetic diagnosis, progress in the identification of causative genetic and epigenetic factors, available techniques of exploration and development of novel therapies. This information will help clinicians to improve accuracy of BCD diagnosis, providing the patient reliable information regarding prognosis and clinical prediction of the disease course.
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Affiliation(s)
- G P García-García
- Department of Ophthalmology, General University Hospital of Alicante, Alicante 03010, Spain
| | - M Martínez-Rubio
- Department of Ophthalmology, General University Hospital of Alicante, Alicante 03010, Spain
| | - M A Moya-Moya
- Department of Ophthalmology, General University Hospital of Alicante, Alicante 03010, Spain
| | - J J Pérez-Santonja
- Department of Ophthalmology, General University Hospital of Alicante, Alicante 03010, Spain
| | - J Escribano
- Cooperative Research Network on Ophthalmology (OftaRed), Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain.,Laboratory of Human Molecular Genetics, Medicine Faculty/Research Institute on Neurological Disabilities (IDINE), University of Castilla La-Mancha, Albacete 02006, Spain
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17
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Darki F, Fekri S, Farhangmehr S, Ahmadieh H, Dehghan MH, Elahi E. CYP4V2 mutation screening in an Iranian Bietti crystalline dystrophy pedigree and evidence for clustering of CYP4V2 mutations. J Curr Ophthalmol 2019; 31:172-179. [PMID: 31317096 PMCID: PMC6611930 DOI: 10.1016/j.joco.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/26/2018] [Accepted: 01/16/2019] [Indexed: 10/31/2022] Open
Abstract
Purpose To report the genetic analysis of an Iranian Bietti crystalline dystrophy (BCD)-affected family, and to review previously reported mutations in the gene and assess the distribution of affected amino acids in the encoded protein. Methods The eleven exons of CYP4V2 were sequenced in the DNA of the proband of the Iranian BCD family. The putative disease-causing variation was screened in all affected and non-affected members. BCD causing CYP4V2 mutations previously reported in the literature were compiled, and positions of amino acids affected by nonsense and missense mutations were mapped onto the primary structure of the CYP4V2 protein. Results C.1219G > T in CYP4V2 that causes p.Glu407* was identified as cause of BCD in the Iranian family. The mutation segregated with disease status. Clinical presentations were similar among affected members, except that one patient presented with retinal macular hole. Twelve nonsense and 47 missense mutations in CYP4V2 were compiled. Inspection of distribution of amino acids affected by the mutations suggested non-random distribution and clustering of affected amino acids in nine regions of the protein, including regions that contain the heme binding site, the metal binding site, and a region between these binding sites. The most C-terminus proximal nonsense mutation affected position 482. Conclusions This study presents results of the genetic analysis of an Iranian BCD family. Protein regions affected by mutations within the nine mutation clusters include regions well conserved among orthologous proteins and human CYP4 proteins, some of which are associated with known functions. The findings may serve to identify reasonable candidate gene region targets for gene editing therapy approaches.
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Affiliation(s)
- Faezeh Darki
- School of Biology, University College of Science, University of Tehran, Tehran, Iran
| | - Sahba Fekri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Farhangmehr
- School of Biology, University College of Science, University of Tehran, Tehran, Iran.,Department of Molecular Genetics, University of Toronto, Toronto, CA, USA
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Dehghan
- Department of Ophthalmology, Labbafinejad Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Elahi
- School of Biology, University College of Science, University of Tehran, Tehran, Iran
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18
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Kovach JL, Isildak H, Sarraf D. Crystalline retinopathy: Unifying pathogenic pathways of disease. Surv Ophthalmol 2019; 64:1-29. [DOI: 10.1016/j.survophthal.2018.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 01/02/2023]
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19
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Borrelli E, Sarraf D, Freund KB, Sadda SR. OCT angiography and evaluation of the choroid and choroidal vascular disorders. Prog Retin Eye Res 2018; 67:30-55. [DOI: 10.1016/j.preteyeres.2018.07.002] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 12/31/2022]
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20
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García-García GP, Martínez-Rubio M, Moya-Moya MA, Pérez-Santonja JJ, Escribano J. Identification of novel CYP4V2 genotypes associated with Bietti crystalline dystrophy and atypical anterior segment phenotypes in Spanish patients. Acta Ophthalmol 2018; 96:e865-e873. [PMID: 29691984 DOI: 10.1111/aos.13768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/01/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify the spectrum of disease-causing CYP4V2 variants in Spanish patients with clinically diagnosed Bietti crystalline dystrophy (BCD) over an 8-year period and to analyse the phenotype-genotype correlation of the identified variants. METHODS Four unrelated Spanish probands with a clinical diagnosis of BCD were recruited. Ophthalmological examination included visual acuity (VA), slit lamp examination, in vivo corneal confocal microscopy, funduscopy and fluoresceinic angiography. Genomic DNA was obtained from blood samples, and the exons and flanking intron sequences of the CYP4V2 gene were screened by Sanger sequencing. Family members of the patients with mutations in CYP4V2 gene were subsequently studied. RESULTS Clinical examination revealed retinal and corneal patterns compatible with BCD in all the participants. We identified a total of six CYP4V2 variants among the four carriers. As far as we know, the variant p.(Trp244Cysfs*33) has not previously been reported. This variant along with p.(Ala204Thr) and p.(Arg443Trp) were combined in three novel pathogenic phenotypes that share the presence of bilateral limbic glistening deposits, severe retinal damage and visual impairment and a fast rate of progression of the disease. CONCLUSION To the best of our knowledge, this study represents the largest effort to determine the genetic alterations underlying BCD in Spain to date. Our results show that analysis of CYP4V2 variants is required for a reliable diagnosis of BCD. We report a high prevalence of anterior segment changes in this Spanish BCD cohort, which we consider representative of the Spanish patients.
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Affiliation(s)
| | | | | | | | - Julio Escribano
- Laboratory of Human Molecular Genetics; School of Medicine/Research Institute of Neurological Disabilities (IDINE); University of Castilla La-Mancha; Albacete Spain
- Cooperative Research Network on Visual and Life Quality; Instituto de Salud Carlos III; Madrid Spain
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21
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Kasaee A, Rafizadeh SM, Ghadimi H, Shahraki K, Asadi Amoli F, Jamshidian-Tehrani M. A Rare Case of Congenital Orbital Cystic Neuroblastoma in an Infant. Ocul Oncol Pathol 2018; 5:167-170. [PMID: 31049322 DOI: 10.1159/000490476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Neuroblastoma, a relatively common tumor in infants, is rarely present at birth. A solid mass is the typical appearance of this neoplasm, while cystic formation is uncommon. Congenital cystic neuroblastoma is extremely rare and no previous report exists of its occurrence in the orbit. A newborn girl was referred with an extremely large mass on the right side of her face on the third day of her life. Prenatal ultrasonography had revealed a large mass (80 × 80 mm) in the frontal area. MRI revealed a heterogeneous mass composed of cystic and solid, contrast-enhancing components. Excisional biopsy was successfully performed and histopathologic diagnosis of neuroblastoma was confirmed. Systemic workup was negative for involvement of other organs and levels of catecholamine metabolites of serum and urine (homovanillic acid and vanillylmandelic acid) were normal. Postoperative course was uneventful with complete healing of the anophthalmic socket and normal physical and mental growth and development of the infant. To our knowledge, this is the first report of congenital cystic neuroblastoma primarily arising in the orbit.
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Affiliation(s)
- Abolfazl Kasaee
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Ghadimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kianoosh Shahraki
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Asadi Amoli
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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22
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Abstract
Bietti’s crystalline dystrophy (BCD) is an autosomal recessive, progressive chorioretinal degenerative disease. Retinal pigment epithelium (RPE) cells are impaired in patients with BCD, but the underlying mechanisms of RPE cell damage have not yet been determined because cells from lesions cannot be readily acquired from patients with BCD. In the present study, we successfully generated a human in vitro model of BCD, BCD patient-specific iPSC-RPE cells, and demonstrated that the accumulation of free cholesterol caused RPE cell damage and subsequent cell death via the induction of lysosomal dysfunction and impairment of autophagy flux in BCD-affected cells. We believe these findings provide evidence of the possible therapeutic efficacy of reducing intracellular free cholesterol in BCD. Bietti’s crystalline dystrophy (BCD) is an intractable and progressive chorioretinal degenerative disease caused by mutations in the CYP4V2 gene, resulting in blindness in most patients. Although we and others have shown that retinal pigment epithelium (RPE) cells are primarily impaired in patients with BCD, the underlying mechanisms of RPE cell damage are still unclear because we lack access to appropriate disease models and to lesion-affected cells from patients with BCD. Here, we generated human RPE cells from induced pluripotent stem cells (iPSCs) derived from patients with BCD carrying a CYP4V2 mutation and successfully established an in vitro model of BCD, i.e., BCD patient-specific iPSC-RPE cells. In this model, RPE cells showed degenerative changes of vacuolated cytoplasm similar to those in postmortem specimens from patients with BCD. BCD iPSC-RPE cells exhibited lysosomal dysfunction and impairment of autophagy flux, followed by cell death. Lipidomic analyses revealed the accumulation of glucosylceramide and free cholesterol in BCD-affected cells. Notably, we found that reducing free cholesterol by cyclodextrins or δ-tocopherol in RPE cells rescued BCD phenotypes, whereas glucosylceramide reduction did not affect the BCD phenotype. Our data provide evidence that reducing intracellular free cholesterol may have therapeutic efficacy in patients with BCD.
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23
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Alkatan HM, AlObaidan OS, Kfoury H, Al-Faky YH. Orbital immature teratoma: A rare entity with diagnostic challenges. Saudi J Ophthalmol 2018; 32:75-78. [PMID: 29755277 PMCID: PMC5944002 DOI: 10.1016/j.sjopt.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 11/05/2022] Open
Abstract
Childhood orbital teratomas are congenital lesions that presents most often at birth with progressive, severe unilateral proptosis. Due to the rarity of such tumors, the diagnosis is often missed with delay in the patient's management. We are presenting a unique case of an immature right orbital teratoma with extensive growth in a full-term newly born baby boy. In this case report, we provide description of the clinical findings, initial misdiagnosis and the eventual management with review of similar reported cases.
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Affiliation(s)
- Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia
| | | | - Hala Kfoury
- Department of Pathology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University-Medical City, Riyadh, Saudi Arabia
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24
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Miyata M, Oishi A, Hasegawa T, Ishihara K, Oishi M, Ogino K, Sugahara M, Hirashima T, Hata M, Yoshikawa M, Tsujikawa A. Choriocapillaris flow deficit in Bietti crystalline dystrophy detected using optical coherence tomography angiography. Br J Ophthalmol 2017; 102:1208-1212. [DOI: 10.1136/bjophthalmol-2017-311313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/27/2017] [Accepted: 11/21/2017] [Indexed: 11/04/2022]
Abstract
Background/AimsThis study aimed to evaluate blood flow in the choriocapillaris in patients with Bietti crystalline dystrophy (BCD) with CYP4V2 mutations using optical coherence tomography angiography (OCTA), and to explore the parameters associated with visual function.MethodsThis prospective case-series study included 13 eyes of 13 consecutive patients with BCD with CYP4V2 mutations and 20 healthy eyes. Using OCTA, we obtained en face images of blood flow in the choriocapillaris. The residual choriocapillaris area on en face images in a 10°×10° macular cube was manually measured and graded according to whether the choriocapillaris remained at the subfovea. We also investigated factors associated with visual acuity (VA) and the mean deviation (MD) value using a Humphrey field analyser with a 10–2 Swedish Interactive Threshold Algorithm standard program among OCTA-derived parameters.ResultsChoriocapillaris blood flow deficit was observed in 12 eyes (92%), whereas this was observed in none of healthy eyes. The adjusted residual choriocapillaris area was 2.47±1.79 mm2. The presence of the choriocapillaris at the subfovea was significantly correlated with VA and the MD value (P=0.006, r=0.71; P=0.04, r=−0.59, respectively).ConclusionsUsing OCTA, choriocapillaris blood flow deficit could be observed in most patients with BCD with CYP4V2 mutations. The presence of the choriocapillaris at the subfovea was significantly correlated with visual function in these patients. Analysis of choriocapillaris blood flow using OCTA allows non-invasive assessment of the patient’s state.
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25
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Akıncıoğlu D, Yolcu Ü, İlhan A, Gündoğan FÇ. Objective Determination of Retinal Function in Bietti Crystalline Retinopathy. Turk J Ophthalmol 2016; 46:144-147. [PMID: 27800277 PMCID: PMC5076297 DOI: 10.4274/tjo.02693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/26/2014] [Indexed: 12/01/2022] Open
Abstract
A 44-year-old female patient without any known systemic or ocular disease presented with progressive visual loss and night vision disturbance. Visual acuity was 0.6 in the right eye and 0.2 in the left eye. Tiny, yellow crystalline deposits were seen on fundus examination. In addition, areas of retinal pigment epithelium and choriocapillaris atrophy were detected. Rod and cone responses were depressed in full-field flash electroretinogram. Multifocal electroretinogram testing showed severe foveal function disturbance with less severe but still depressed responses toward the periphery. Multiple hyperreflective lesions were detected in the retina in optical coherence tomography. We aimed to present the role of ocular electrophysiology by comparing the patient’s signs and symptoms with her ocular electrophysiological test results.
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Affiliation(s)
- Dorukcan Akıncıoğlu
- Gülhane Military Medical Academy, Department of Ophthalmology, Ankara, Turkey
| | - Ümit Yolcu
- Siirt Military Hospital, Ophthalmology Clinic, Siirt, Turkey
| | - Abdullah İlhan
- Erzurum Military Hospital, Ophthalmology Clinic, Erzurum, Turkey
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Abstract
Bietti crystalline dystrophy (BCD) is an inherited retinal degenerative disease characterized by crystalline deposits in the retina, followed by progressive atrophy of the retinal pigment epithelium (RPE), choriocapillaris, and photoreceptors. CYP4V2 has been identified as the causative gene for BCD. The CYP4V2 gene belongs to the cytochrome P450 superfamily and encodes for fatty acid ω-hydroxylase of both saturated and unsaturated fatty acids. The CYP4V2 protein is localized most abundantly within the endoplasmic reticulum in the RPE and is postulated to play a role in the physiological lipid recycling system between the RPE and photoreceptors to maintain visual function. Electroretinographic assessments have revealed progressive dysfunction of rod and cone photoreceptors in patients with BCD. Several genotypes have been associated with more severe phenotypes based on clinical and electrophysiological findings. With the advent of multimodal imaging with spectral domain optical coherence tomography, fundus autofluorescence, and adaptive optics scanning laser ophthalmoscopy, more precise delineation of BCD severity and progression is now possible, allowing for the potential future development of targets for gene therapy.
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Affiliation(s)
- Danny S C Ng
- From the *Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; and †2010 Retina and Macula Centre, Kowloon, Hong Kong
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Fuerst NM, Serrano L, Han G, Morgan JIW, Maguire AM, Leroy BP, Kim BJ, Aleman TS. Detailed functional and structural phenotype of Bietti crystalline dystrophy associated with mutations in CYP4V2 complicated by choroidal neovascularization. Ophthalmic Genet 2016; 37:445-452. [PMID: 27028354 DOI: 10.3109/13816810.2015.1126616] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe in detail the phenotype of a patient with Bietti crystalline dystrophy (BCD) complicated by choroidal neovascularization (CNV) and the response to intravitreal Bevacizumab (Avastin®; Genentech/Roche). METHODS A 34-year-old woman with BCD and mutations in CYP4V2 (c.802-8_806del13/p.H331P:c992A>C) underwent a complete ophthalmic examination, full-field flash electroretinography (ERG), kinetic and two-color dark-adapted perimetry, and dark-adaptometry. Imaging was performed with spectral domain optical coherence tomography (SD-OCT), near infrared (NIR) and short wavelength (SW) fundus autofluorescence (FAF), and fluorescein angiography (FA). RESULTS Best-corrected visual acuity (BCVA) was 20/20 and 20/60 for the right and left eye, respectively. There were corneal paralimbal crystal-like deposits. Kinetic fields were normal in the peripheral extent. Retinal crystals were most obvious on NIR-reflectance and corresponded with hyperreflectivities within the RPE on SD-OCT. There was parafoveal/perifoveal hypofluorescence on SW-FAF and NIR-FAF. Rod > cone sensitivity loss surrounded fixation and extended to ~10° of eccentricity corresponding to regions of photoreceptor outer segment-retinal pigmented epithelium (RPE) interdigitation abnormalities. The outer nuclear layer was normal in thickness. Recovery of sensitivity following a ~76% rhodopsin bleach was normal. ERGs were normal. A subretinal hemorrhage in the left eye co-localized with elevation of the RPE on SD-OCT and leakage on FA, suggestive of CNV. Three monthly intravitreal injections of Bevacizumab led to restoration of BCVA to baseline (20/25). CONCLUSION crystals in BCD were predominantly located within the RPE. Photoreceptor outer segment and apical RPE abnormalities underlie the relatively extensive retinal dysfunction observed in relatively early-stage BCD. Intravitreal Bevacizumab was effective in treating CNV in this setting.
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Affiliation(s)
- Nicole M Fuerst
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Leona Serrano
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Grace Han
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Jessica I W Morgan
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Albert M Maguire
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA.,b Division of Ophthalmology, Children's Hospital of Philadelphia, and Department of Ophthalmology , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Bart P Leroy
- b Division of Ophthalmology, Children's Hospital of Philadelphia, and Department of Ophthalmology , University of Pennsylvania , Philadelphia , Pennsylvania , USA.,c Center for Cellular & Molecular Therapeutics, Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA.,d Department of Ophthalmology and the Center for Medical Genetics, Ghent University and Ghent University Hospital , Ghent , Belgium
| | - Benjamin J Kim
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Tomas S Aleman
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA.,b Division of Ophthalmology, Children's Hospital of Philadelphia, and Department of Ophthalmology , University of Pennsylvania , Philadelphia , Pennsylvania , USA
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Yin X, Yang L, Chen N, Cui H, Zhao L, Feng L, Li A, Zhang H, Ma Z, Li G. Identification of CYP4V2 mutation in 36 Chinese families with Bietti crystalline corneoretinal dystrophy. Exp Eye Res 2016; 146:154-162. [PMID: 26971461 DOI: 10.1016/j.exer.2016.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 01/20/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
Abstract
Bietti crystalline corneoretinal dystrophy (BCD) is an inherited eye disease that is most common in the Chinese. It is caused by a mutation in the CYP4V2 gene. In this study, 43 Chinese BCD families were recruited; most patients manifested the characteristic phenotype of BCD, with 2 families initially misdiagnosed with retinitis pigmentosa. Five patients in our cohort presented with BCD and choroidal neovascularization (CNV), and 1 patient presented with typical BCD and abnormality in the terminals of both fingers and toes. A total of 17 pathogenic mutations involving 68 alleles were identified from 36 families using targeted exon sequencing and Sanger sequencing; we achieved a diagnostic rate of approximately 84%. Fifteen families were found to carry homozygous mutations, 17 families carried compound heterozygous mutations, and 4 families carried a single heterozygous mutation. Of the mutations identified, four variants c.802-8_810del17bpinsGC, c.802-8_810del17bpinsGT, c.992A > C (p.H331P), and c.1091-2A > G accounted for 71% of the mutations identified in CYP4V2. These mutations were hotspots in Chinese populations for BCD. Five among them were novel and predicted to be disease-causing, including c.65T > A (p.L22H), c.681_4delTGAG (p.S227Rfs*1), c.802-8_810del17bpinsGT, c.965_7delAAG (p.321delE), and c.994G > A (p.D332N). No apparent correlation between genotype and phenotype was identified. Our findings broaden the spectrum of CYP4V2 mutations that cause BCD and the phenotypic spectrum of the disease in Chinese families. These results will be useful for the genetic diagnosis of BCD, genetic consultation, and gene therapy in the future.
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Affiliation(s)
- Xiaobei Yin
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, PR China
| | - Liping Yang
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, PR China
| | - Ningning Chen
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, PR China
| | - Hui Cui
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, PR China
| | - Lin Zhao
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, PR China
| | - Lina Feng
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, PR China
| | - Aijun Li
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, PR China
| | - Huirong Zhang
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, PR China
| | - Zhizhong Ma
- Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, PR China
| | - Genlin Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, PR China.
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Şahin M, Yıldırım A, Türkcü FM, Yüksel H, Şahin A. Bietti Crystalline Retinal Dystrophy: A Case Report. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2016. [DOI: 10.5799/jcei.328695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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UTILIZATION OF FUNDUS AUTOFLUORESCENCE, SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY, AND ENHANCED DEPTH IMAGING IN THE CHARACTERIZATION OF BIETTI CRYSTALLINE DYSTROPHY IN DIFFERENT STAGES. Retina 2015; 35:2074-84. [DOI: 10.1097/iae.0000000000000592] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Onion Sign in Neovascular Age-Related Macular Degeneration Represents Cholesterol Crystals. Ophthalmology 2015; 122:2316-26. [PMID: 26298717 DOI: 10.1016/j.ophtha.2015.07.008] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To investigate the frequency, natural evolution, and histologic correlates of layered, hyperreflective, subretinal pigment epithelium (sub-RPE) lines, known as the onion sign, in neovascular age-related macular degeneration (AMD). DESIGN Retrospective observational cohort study and experimental laboratory study. PARTICIPANTS Two hundred thirty eyes of 150 consecutive patients with neovascular AMD and 40 human donor eyes with histopathologic diagnosis of neovascular AMD. METHODS Spectral-domain optical coherence tomography (SD OCT), near-infrared reflectance (NIR), color fundus images, and medical charts were reviewed. Donor eyes underwent multimodal ex vivo imaging, including SD OCT, before processing for high-resolution histologic analysis. MAIN OUTCOME MEASURES Presence of layered, hyperreflective sub-RPE lines, qualitative analysis of their change in appearance over time with SD OCT, histologic correlates of these lines, and associated findings within surrounding tissues. RESULTS Sixteen of 230 eyes of patients (7.0%) and 2 of 40 donor eyes (5.0%) with neovascular AMD had layered, hyperreflective sub-RPE lines on SD OCT imaging. These appeared as refractile, yellow-gray exudates on color imaging and as hyperreflective lesions on NIR. In all 16 patient eyes, the onion sign persisted in follow-up for up to 5 years, with fluctuations in the abundance of lines and association with intraretinal hyperreflective foci. Patients with the onion sign disproportionately were taking cholesterol-lowering medications (P=0.025). Histologic analysis of 2 donor eyes revealed that the hyperreflective lines correlated with clefts created by extraction of cholesterol crystals during tissue processing. The fluid surrounding the crystals contained lipid, yet was distinct from oily drusen. Intraretinal hyperreflective foci correlated with intraretinal RPE and lipid-filled cells of probable monocytic origin. CONCLUSIONS Persistent and dynamic, the onion sign represents sub-RPE cholesterol crystal precipitation in an aqueous environment. The frequency of the onion sign in neovascular AMD in a referral practice and a pathology archive is 5% to 7%. Associations include use of cholesterol-lowering medication and intraretinal hyperreflective foci attributable to RPE cells and lipid-filled cells of monocyte origin.
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Ilhan A, Yolcu U. Re: Halford et al.: Detailed phenotypic and genotypic characterization of Bietti crystalline dystrophy (Ophthalmology 2014;121:1174-84). Ophthalmology 2015; 122:e22. [PMID: 25797086 DOI: 10.1016/j.ophtha.2014.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Abdullah Ilhan
- Erzurum Military Hospital, Department of Ophthalmology, Erzurum, Turkey.
| | - Umit Yolcu
- Sarikamis Military Hospital, Department of Ophthalmology, Kars, Turkey
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Abstract
OBJECTIVE Bietti crystalline dystrophy is a rare form of tapetoretinal degeneration associated with retinal crystalline deposits. However, Bietti crystalline dystrophy is extremely unusually associated with macular hole formation. A 32-year-old man with Bietti crystalline dystrophy and bilateral macular holes is described. DESIGN Case report and literature review. RESULTS Clinical and angiographic features, optical coherence tomography results, electroretinographic findings, and visual evoked potentials are reported. CONCLUSION Bietti crystalline dystrophy can occur with bilateral macular holes, but the cause is unclear.
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Astuti GDN, Sun V, Bauwens M, Zobor D, Leroy BP, Omar A, Jurklies B, Lopez I, Ren H, Yazar V, Hamel C, Kellner U, Wissinger B, Kohl S, De Baere E, Collin RWJ, Koenekoop RK. Novel insights into the molecular pathogenesis of CYP4V2-associated Bietti's retinal dystrophy. Mol Genet Genomic Med 2014; 3:14-29. [PMID: 25629076 PMCID: PMC4299712 DOI: 10.1002/mgg3.109] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/09/2022] Open
Abstract
Bietti's crystalline dystrophy (BCD) is a rare, autosomal recessive retinal degenerative disease associated with mutations in CYP4V2. In this study, we describe the genetic and clinical findings in 19 unrelated BCD patients recruited from five international retinal dystrophy clinics. Patients underwent ophthalmic examinations and were screened for CYP4V2 mutations by Sanger sequencing and quantitative polymerase chain reaction (qPCR) copy number variation screening. Eight CYP4V2 mutations were found in 10/19 patients, including three patients in whom only monoallelic mutations were detected. Four novel mutations were identified: c.604G>A; p.(Glu202Lys), c.242C>G; p.(Thr81Arg), c.604+4A>G; p.(?), and c.1249dup; p.(Thr417Asnfs*2). In addition, we identified a heterozygous paternally inherited genomic deletion of at least 3.8 Mb, encompassing the complete CYP4V2 gene and several other genes, which is novel. Clinically, patients demonstrated phenotypic variability, predominantly showing choroidal sclerosis, attenuated vessels, and crystalline deposits of varying degrees of severity. To our knowledge, our study reports the first heterozygous CYP4V2 deletion and hence a novel mutational mechanism underlying BCD. Our results emphasize the importance of copy number screening in BCD. Finally, the identification of CYP4V2-negative patients with indistinguishable phenotypes from CYP4V2-positive patients might suggest the presence of mutations outside the coding regions of CYP4V2, or locus heterogeneity, which is unreported so far.
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Affiliation(s)
- Galuh D N Astuti
- Department of Human Genetics, Radboud University Medical Centre Nijmegen, The Netherlands ; Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre Nijmegen, The Netherlands ; Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University Semarang, Indonesia
| | - Vincent Sun
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada
| | - Miriam Bauwens
- Center for Medical Genetics, Ghent University Hospital Ghent, Belgium
| | - Ditta Zobor
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen Tübingen, Germany
| | - Bart P Leroy
- Center for Medical Genetics, Ghent University Hospital Ghent, Belgium ; Department of Ophthalmology, Ghent University Hospital Ghent, Belgium
| | - Amer Omar
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada ; Moorfields Eye Hospital London, United Kingdom
| | | | - Irma Lopez
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada
| | - Huanan Ren
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada
| | - Volkan Yazar
- Department of Human Genetics, Radboud University Medical Centre Nijmegen, The Netherlands
| | - Christian Hamel
- Institute of Neurosciences of Montpellier, Hôpital Saint Eloi Montpellier, France
| | - Ulrich Kellner
- Rare Retinal Disease Center, AugenZentrum Siegburg, MVZ ADTC Siegburg GmbH Siegburg, Germany
| | - Bernd Wissinger
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen Tübingen, Germany
| | - Susanne Kohl
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen Tübingen, Germany
| | - Elfride De Baere
- Center for Medical Genetics, Ghent University Hospital Ghent, Belgium
| | - Rob W J Collin
- Department of Human Genetics, Radboud University Medical Centre Nijmegen, The Netherlands ; Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre Nijmegen, The Netherlands
| | - Robert K Koenekoop
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada
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High-Resolution Imaging of Patients with Bietti Crystalline Dystrophy with CYP4V2 Mutation. J Ophthalmol 2014; 2014:283603. [PMID: 25276414 PMCID: PMC4167809 DOI: 10.1155/2014/283603] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/02/2014] [Accepted: 08/03/2014] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to determine the retinal morphology of eyes with Bietti crystalline dystrophy (BCD) associated with a CYP4V2 mutation using high-resolution imaging techniques. Three subjects with BCD underwent detailed ophthalmic examinations. High-resolution fundus images were obtained with an adaptive optics (AO) fundus camera. A common homozygous mutation was detected in the three patients. Funduscopic examination of the three patients revealed the presence of crystalline deposits in the retina, and all of the crystalline deposits were also detected in the infrared (IR) images. The crystals observed in the IR images were seen as bright reflective plaques located on the RPE layer in the SD-OCT images. The clusters of hyperreflective signals in the AO images corresponded to the crystals in the IR images. High-magnification AO images revealed that the clusters of hyperreflective signals consisted of circular spots that are similar to the signals of cone photoreceptors. Most of these circular spots were detected in healthy areas in the FAF images. There is a possibility that circular spots observed by AO are residual cone photoreceptors located over the crystals.
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Nakano M, Lockhart CM, Kelly EJ, Rettie AE. Ocular cytochrome P450s and transporters: roles in disease and endobiotic and xenobiotic disposition. Drug Metab Rev 2014; 46:247-60. [PMID: 24856391 PMCID: PMC4676416 DOI: 10.3109/03602532.2014.921190] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drug metabolism and transport processes in the liver, intestine and kidney that affect the pharmacokinetics and pharmacodynamics of therapeutic agents have been studied extensively. In contrast, comparatively little research has been conducted on these topics as they pertain to the eye. Recently, however, catalytic functions of ocular cytochrome P450 enzymes have gained increasing attention, in large part due to the roles of CYP1B1 and CYP4V2 variants in primary congenital glaucoma and Bietti's corneoretinal crystalline dystrophy, respectively. In this review, we discuss challenges to ophthalmic drug delivery, including Phase I drug metabolism and transport in the eye, and the role of three specific P450s, CYP4B1, CYP1B1 and CYP4V2 in ocular inflammation and genetically determined ocular disease.
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Affiliation(s)
- Mariko Nakano
- Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Catherine M. Lockhart
- Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Edward J. Kelly
- Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Allan E. Rettie
- Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, WA, USA
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Halford S, Liew G, Mackay DS, Sergouniotis PI, Holt R, Broadgate S, Volpi EV, Ocaka L, Robson AG, Holder GE, Moore AT, Michaelides M, Webster AR. Detailed Phenotypic and Genotypic Characterization of Bietti Crystalline Dystrophy. Ophthalmology 2014; 121:1174-84. [DOI: 10.1016/j.ophtha.2013.11.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022] Open
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Molecular analysis and phenotypic study in 14 Chinese families with Bietti crystalline dystrophy. PLoS One 2014; 9:e94960. [PMID: 24739949 PMCID: PMC3989252 DOI: 10.1371/journal.pone.0094960] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/21/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the clinical features and cytochrome P450 family 4 subfamily V polypeptide 2 (CYP4V2) gene mutations in 14 Chinese families with Bietti crystalline dystrophy (BCD). Methods Seventeen patients from 14 unrelated Chinese families with BCD were recruited for complete clinical ophthalmic examination and genetic study. The 11 exons of CYP4V2 were amplified from genomic DNA of all patients and their family members by polymerase chain reaction (PCR) and then sequenced. Exons of TIMP3 were also sequenced in BCD patient associated with choroidal neovascularization (CNV). One hundred and seventy unrelated healthy Chinese subjects were screened for mutations in CYP4V2. Results All 17 patients with BCD had mutations in CYP4V2; one of these mutations was novel (c.219T>A, p.F73L) and four other mutations had been reported. The p.F73L mutation was a commonly detected mutation in our study (seven out of 34 alleles), either in the homozygous state or in the heterozygous state. Among the patients, considerable phenotypic variability was detected, both within and between families. Screening of TIMP3 did not find any mutation in the BCD patient associated with CNV. Conclusion The novel CYP4V2 c.219T>A (p.F73L) mutation may be another recurrent mutation in Chinese patients with BCD. Our study expands the mutation spectrum of CYP4V2 and characterizes novel genotype–phenotype associations in Chinese patients with BCD.
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Broadhead GK, Chang AA. Acetazolamide for cystoid macular oedema in Bietti crystalline retinal dystrophy. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:189-91. [PMID: 24688265 PMCID: PMC3958638 DOI: 10.3341/kjo.2014.28.2.189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/05/2014] [Indexed: 11/23/2022] Open
Abstract
Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.
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Affiliation(s)
- Geoffrey K Broadhead
- Sydney Institute of Vision Science, Sydney, Australia. ; Sydney Retina Clinic & Day Surgery, Sydney, Australia. ; Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Andrew A Chang
- Sydney Institute of Vision Science, Sydney, Australia. ; Sydney Retina Clinic & Day Surgery, Sydney, Australia. ; Save Sight Institute, The University of Sydney, Sydney, Australia
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Genotype-phenotype analysis of Bietti crystalline dystrophy in a family with the CYP4V2 Ile111Thr mutation. Cornea 2014; 32:1002-8. [PMID: 23538635 DOI: 10.1097/ico.0b013e31828a27bc] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purposes of this study were to evaluate the genotypic and phenotypic correlations of Bietti crystalline dystrophy and to investigate the utility of in vivo corneal confocal microscopy in diagnosing this disorder. METHODS A Spanish woman (proband) with a clinical diagnosis of Bietti crystalline dystrophy and 7 members of her family were recruited prospectively for complete clinical ophthalmic examination and genetic study. The medical records of an additional family member were reviewed retrospectively. Genomic DNA was obtained from blood samples, and 11 exons of the CYP4V2 gene were screened for mutations by polymerase chain reaction DNA sequencing. RESULTS Clinical examination revealed an atypical pattern of corneal dystrophy with central and paracentral distribution not only in the proband but also in 2 elderly heterozygous carriers. Corneal deposits were observed by slit-lamp examination and in vivo corneal confocal microscopy. Genetic analysis revealed the homozygous CYP4V2 Ile111Thr mutation in the proband and identified 5 heterozygous carriers. CONCLUSIONS The authors identified a case of Bietti crystalline dystrophy with central and paracentral keratopathy and the molecular analysis of the causative gene in a Spanish family. Data suggest a dose-dependent phenotype ranging from subclinical corneal changes in subjects carrying 1 mutant Ile111Thr CYP4V2 allele to the complete manifestation of the disease in homozygous subjects. In vivo corneal confocal microscopy is a useful technique in the diagnosis of this disorder.
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41
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Song Y, Mo G, Yin G. A novel mutation in the CYP4V2 gene in a Chinese patient with Bietti's crystalline dystrophy. Int Ophthalmol 2012; 33:269-76. [PMID: 23242590 DOI: 10.1007/s10792-012-9686-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 11/24/2012] [Indexed: 11/25/2022]
Abstract
Bietti crystalline corneoretinal dystrophy (BCD, MIM 210370) is a type of hereditary retinal disorder which commonly occurs in China. It is known that mutations in the CYP4V2 gene result in BCD. The purpose of this study was to investigate the case of a Chinese family and characterize the polymorphisms of the CYP4V2 gene. A 29-year-old male (the son of a Chinese family) with typical clinical symptoms of BCD and his family were recruited into this study. Ophthalmologic examination, including best-corrected visual acuity, slit-lamp, and fundus examination with dilated pupils, was conducted to determine the clinical characteristics of the whole family. The entire coding region and adjacent intronic sequences of 11 coding regions of the CYP4V2 gene of the whole family were then amplified by polymerase chain reaction and sequenced. Our results show that the son had typical clinical features of BCD. His bilateral decimal visual acuity was 0.06 (left eye) and 0.01 (right eye). Bilateral crystal-like deposits were found in the posterior pole of his fundus, and differing extent of atrophy of the retinal pigment epithelium, and carpet-like retinal degeneration along with numerous tiny glittering crystals were also clearly observed. However, such characteristics were not found on the fundus of his parents' eyes. Five mutations within the CYP4V2 gene (c.64C>G, c.775C>A, c.810T>G, c.1091-2A>G, and c.1399T>C) were identified in the son. Among the five mutations, four had previously been reported and the c.1399T>C was discovered for the first time. This novel mutation causes an amino acid substitution (C467R) in the CYP4V2 protein, but it was not detected in the parents. As there is no apparent relationship in genotype-phenotype correlation between the CYP4V2 gene and the occurrence of BCD, this novel mutation may be a possible cause that could induce the clinical phenotype of BCD.
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Affiliation(s)
- Yanping Song
- Department of Ophthalmology, Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430070, China
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Nachiappan K, Krishnan T, Madhavan J. Ranibizumab for choroidal neovascular membrane in a rare case of Bietti's crystalline dystrophy: a case report. Indian J Ophthalmol 2012; 60:207-9. [PMID: 22569382 PMCID: PMC3361816 DOI: 10.4103/0301-4738.95873] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a rare case of Bietti's crystalline dystrophy presenting with choroidal neovascular membrane (CNVM) which was treated with three injections of intravitreal ranibizumab. The CNVM underwent scarring after the injections with stabilization of visual acuity at a follow-up period of 12 months suggesting that intravitreal ranibizumab may have a role in the management of CNVM in these rare cases.
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Toto L, Carpineto P, Parodi MB, Di Antonio L, Mastropasqua A, Mastropasqua L. Spectral domain optical coherence tomography and in vivo confocal microscopy imaging of a case of Bietti's crystalline dystrophy. Clin Exp Optom 2012; 96:39-45. [PMID: 22908902 DOI: 10.1111/j.1444-0938.2012.00784.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 05/08/2012] [Accepted: 05/17/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The aim was to describe the morphology and localisation of crystals in a case of Bietti's crystalline corneo-retinal dystrophy (BCD) by means of spectral domain optical coherence tomography (SD-OCT) and in vivo confocal microscopy (IVCM). METHODS Clinical examination, SD-OCT and IVCM evaluation of a 35-year-old woman with BCD. RESULTS Optical coherence tomography examination of the macular region revealed multiple crystals in the retinal pigment epithelium (RPE)-choriocapillaris, some crystals within the full thickness of the neurosensory retina and less numerous crystals in the choroid. Crystals were present peripherally in areas of retinal atrophy, predominantly in the choroid and to a lesser extent in the RPE-choriocapillaris and the neuroepithelium. In vivo confocal microscopy showed multiple crystals of varying morphology in the peripheral and paralimbal cornea, mainly located in the anterior stroma over 360°. CONCLUSIONS SD-OCT provided greater precision in the localisation of crystals, found mainly in the choroid and RPE-choriocapillaris rather than the neuroepithelium. In vivo confocal microscopy revealed a higher number of crystals compared to those visible using conventional slitlamp biomicroscopy and showed a different crystal morphology.
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Affiliation(s)
- Lisa Toto
- Department of Medicine and Science of Ageing, Eye Clinic, University G. D'Annunzio, Chieti-Pescara, Italy.
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Nakano M, Kelly EJ, Wiek C, Hanenberg H, Rettie AE. CYP4V2 in Bietti's crystalline dystrophy: ocular localization, metabolism of ω-3-polyunsaturated fatty acids, and functional deficit of the p.H331P variant. Mol Pharmacol 2012; 82:679-86. [PMID: 22772592 DOI: 10.1124/mol.112.080085] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Bietti's crystalline corneoretinal dystrophy (BCD) is a recessive degenerative eye disease caused by germline mutations in the CYP4V2 gene. More than 80% of mutant alleles consist of three mutations, that is, two splice-site alterations and one missense mutation, c.992C>A, which translates to p.H331P. In the present study, we analyzed the expression of CYP4 family members in human tissues and conducted functional studies with the wild-type and p.H331P enzymes, to elucidate the link between CYP4V2 activity and BCD. Expression analysis of 17 CYP1 to CYP4 genes showed CYP4V2 to be a major cytochrome P450 in ARPE-19 cells (a human cell line spontaneously generated from normal human retinal pigmented epithelium) and the only detectable CYP4 transcript. Immunohistochemical analyses demonstrated that CYP4V2 protein was present in epithelial cells of the retina and cornea and the enzyme was localized to endoplasmic reticulum. Recombinant reconstituted CYP4V2 protein metabolized eicosapentaenoic acid and docosahexaenoic acid (an important constituent of the retina) to their respective ω-hydroxylated products at rates similar to those observed with purified CYP4F2, which is an established hepatic polyunsaturated fatty acid (PUFA) hydroxylase. The disease-associated p.H331P variant was undetectable in Western blot analyses of HepG2 cells stably transduced with lentiviral expression vectors. Finally, overexpression of functional CYP4V2 in HepG2 cells altered lipid homeostasis. We demonstrated that CYP4V2 protein is expressed at high levels in ocular target tissues of BCD, that the enzyme is metabolically active toward PUFAs, and that the functional deficit among patients with BCD who carry the H331P variant is most likely a consequence of the instability of the mutant protein.
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Affiliation(s)
- Mariko Nakano
- Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Washington, USA
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Parravano M, Sciamanna M, Giorno P, Boninfante A, Varano M. Bietti crystalline dystrophy: a morpho-functional evaluation. Doc Ophthalmol 2011; 124:73-7. [PMID: 22205354 DOI: 10.1007/s10633-011-9309-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/20/2011] [Indexed: 11/28/2022]
Abstract
We report the clinical findings and macular function of a patient with Bietti crystalline dystrophy. A 39-year-old woman reported visual loss in both eyes and nyctalopia. A complete ophthalmological evaluation, retromode imaging, SD-OCT acquisition, MP1 microperimetry, and multifocal electroretinogram (mfERG) were performed. Microcrystalline deposits in the cornea and the retina with retinal pigment epithelial atrophy were observed. Retromode imaging revealed visualization of normal large choroidal vessels, cystoid macular edema, and small defined glistening lesions. SD-OCT showed changes in the outer retina with numerous microcrystalline deposits. Microperimetry showed an absolute scotoma involving the perimacular area but sparing of the fovea. In both eyes, mfERG analysis suggests a dysfunction of pre-ganglionic retinal elements detectable in the 20 central retinal degrees. The genetic characterization showed an homozygous mutation c.772C > T[p.Leu258Phe] in exon 6. Retromode imaging and SD-OCT were useful tools to determine the extent and the localization of the crystals. Microperimetry should allow evaluation of the progression of the macular changes.
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Yokoi Y, Sato K, Aoyagi H, Takahashi Y, Yamagami M, Nakazawa M. A Novel Compound Heterozygous Mutation in the CYP4V2 Gene in a Japanese Patient with Bietti's Crystalline Corneoretinal Dystrophy. Case Rep Ophthalmol 2011; 2:296-301. [PMID: 22087103 PMCID: PMC3214674 DOI: 10.1159/000331885] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose: To describe the clinical and genetic characteristics of a Japanese family in which one member exhibited Bietti's crystalline corneoretinal dystrophy (BCD). Methods: Using direct sequencing, mutation screening was performed in the CYP4V2 gene of both the patient with BCD and her daughter. Ophthalmic examinations were performed to determine the clinical features of both subjects. Results: The 64-year-old female patient had a bilateral visual acuity of 0.4. Slit lamp examination revealed bilateral crystalline-like deposits at the superior limbus of the cornea. Fundus examination revealed there was chorioretinal atrophy along with numerous glistening yellowish-white crystalline deposits that were scattered throughout the posterior pole and the mid-peripheral retina. Standard flash electroretinography showed an extinguished electroretinogram and Goldmann kinetic perimetry detected a relative scotoma. Genetic analysis revealed that the patient had a heterozygous mutation in the CYP4V2 gene (IVS6-8delTCATACAGGTCATCGCG/GC), which is the most commonly found mutation in Japanese patients with BCD. Furthermore, the patient was also shown to have a novel heterozygous point mutation in exon 9 of the CYP4V2 gene (c.1168C>T). In contrast, her daughter exhibited no clinical findings for BCD even though she carried the same heterozygous mutation in the CYP4V2 gene (c.1168C>T). Conclusion: A novel compound heterozygous mutation was found in the CYP4V2 gene of a patient with BCD. This previously unreported c.1168C>T mutation causes a missense mutation (p.R390C) in the CYP4V2 protein.
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Affiliation(s)
- Yumiko Yokoi
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Liu DN, Liu Y, Meng XH, Yin ZQ. The characterization of functional disturbances in Chinese patients with Bietti's crystalline dystrophy at different fundus stages. Graefes Arch Clin Exp Ophthalmol 2011; 250:191-200. [PMID: 21892605 DOI: 10.1007/s00417-011-1809-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/07/2011] [Accepted: 08/15/2011] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to characterize the functional and clinical disturbances and screen the optimal functional tests in assessing Bietti's crystalline dystrophy (BCD) patients by a cross-sectional method. METHODS The clinical characteristics of BCD were studied in 15 Chinese patients using fundoscopy, fundus fluorescein angiography (FFA), and autofluorescence (AF). The functional features were evaluated by full-field electroretinography (fERG), 85º and 30º perimetry, multifocal ERG (mERG), and chromatic pupillometry. RESULTS The 15 patients were separated into three clinical stages according to their fundus features. fERG- and mERG- showed reduced reponses in the early stages. Substages could be further defined according to the fERG results in the intermediate stages. Reduced pupillary light reflex (PLR) activities with blue-and white-light stumili existed in all patients. The most reduced PLR activities were elicited in the advanced stage of patients who had other nonresponsive functional tests. CONCLUSIONS This study identified the most sensitive functional methods for assessing BCD patients, and the significance of PLR in the advanced stages. In addition, the defined-substages can help us understand the disease more clearly.
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Affiliation(s)
- Dan Ning Liu
- Southwest Hospital, Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China
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Kelly EJ, Nakano M, Rohatgi P, Yarov-Yarovoy V, Rettie AE. Finding homes for orphan cytochrome P450s: CYP4V2 and CYP4F22 in disease states. Mol Interv 2011; 11:124-32. [PMID: 21540472 DOI: 10.1124/mi.11.2.10] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The cytochrome P450 (CYP) 4 family of enzymes contains several recently identified membersthat are referred to as “orphan P450s” because their endogenous substrates are unknown.Human CYP4V2 and CYP4F22 are two such orphan P450s that are strongly linked to ocular andskin disease, respectively. Genetic analyses have identified a wide spectrum of mutations in the CYP4V2gene from patients suffering from Bietti’s crystalline corneoretinal dystrophy, and mutations in theCYP4F22 gene have been linked to lamellar ichthyosis. The strong gene–disease associations provideunique opportunities for elucidating the substrate specificity of these orphan P450s and unraveling thebiochemical pathways that may be impacted in patients with CYP4V2 and CYP4F22 functional deficits.
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Affiliation(s)
- Edward J Kelly
- Department of Pharmaceutics, University of Washington, Seattle, WA 98195, USA.
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Xiao X, Mai G, Li S, Guo X, Zhang Q. Identification of CYP4V2 mutation in 21 families and overview of mutation spectrum in Bietti crystalline corneoretinal dystrophy. Biochem Biophys Res Commun 2011; 409:181-6. [DOI: 10.1016/j.bbrc.2011.04.112] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 04/23/2011] [Indexed: 10/18/2022]
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Abstract
PURPOSE The aim was to investigate multifocal electroretinogram (mfERG) findings in Bietti's crystalline dystrophy (BCD) using a retrospective, non-interventional, consecutive case series. METHODS Five patients, two women and three men (mean age 31.8 years), clinically diagnosed with BCD underwent full-field electroretinogram (ffERG) and mfERG using Burian Allen bipolar contact lens electrode on the VERIS Science 5.2.1X system. The ffERG and mfERG parameters of patients with Bietti's crystalline dystrophy were compared with age-matched normal subjects. The N1, P1 amplitudes and implicit times of the mfERG for the six concentric rings were analysed. RESULTS The ffERG showed significant decreases in the amplitude of the scotopic and photopic responses in all patients; however, implicit times were only mildly prolonged. Rod response implicit times appeared to be more affected than the cone responses. The N1 and P1 amplitudes of mfERG showed a significant decrease in all rings in all patients. N1 implicit times were significantly delayed in rings 3, 4 and 5. The P1 implicit time was significantly delayed in all rings except 1 and 6. CONCLUSION The mfERG in Bietti's crystalline dystrophy can provide insight into the functional retina and objectively help to quantify the extent of retinal damage.
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Affiliation(s)
- Parveen Sen
- Bhagwan Mahavir Vitreo-Retinal Services Medical Research Foundation, Sankara, Nethralaya, Chennai, India.
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