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Mangalesh S, Toth CA. Preterm infant retinal OCT markers of perinatal health and retinopathy of prematurity. Front Pediatr 2023; 11:1238193. [PMID: 37808559 PMCID: PMC10551634 DOI: 10.3389/fped.2023.1238193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
The increasing survival of preterm infants has led to the importance of improving long-term outcomes associated with preterm birth. Antenatal and perinatal insults not only impact mortality, but also long-term disability. While in the intensive care nursery, preterm infants are also exposed to various stressors that lead to long-term cognitive deficits. It is therefore critical to identify early, low-stress, non-invasive biomarkers for preterm infant health. Optical coherence tomography (OCT) is a powerful imaging modality that has recently been adapted to the infant population and provides noninvasive, high-resolution, cross-sectional imaging of the infant eye at the bedside with low stress relative to conventional examination. In this review we delve into discussing the associations between preterm systemic health factors and OCT-based retinal findings and their potential contribution to the development of non-invasive biomarkers for infant health and for retinopathy of prematurity (ROP).
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Affiliation(s)
| | - Cynthia A. Toth
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States
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2
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Nuijts MA, Stegeman I, Porro GL, Bennebroek CAM, van Seeters T, Proudlock FA, Schouten-van Meeteren AYN, Imhof SM. Diagnostic accuracy of retinal optical coherence tomography in children with a newly diagnosed brain tumour. Acta Ophthalmol 2023; 101:658-669. [PMID: 36924320 DOI: 10.1111/aos.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/15/2023] [Accepted: 02/09/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To estimate the diagnostic accuracy of circumpapillary retinal nerve fibre layer (RNFL) thickness and macular ganglion cell layer-inner plexiform layer (GCL-IPL) thickness measurements to discriminate an abnormal visual function (i.e. abnormal age-based visual acuity and/or visual field defect) in children with a newly diagnosed brain tumour. METHODS This cross-sectional analysis of a prospective longitudinal nationwide cohort study was conducted at four hospitals in the Netherlands, including the national referral centre for paediatric oncology. Patients aged 0-18 years with a newly diagnosed brain tumour and reliable visual acuity and/or visual field examination and optical coherence tomography were included. Diagnostic accuracy was evaluated with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS Of 115 patients included in the study (67 [58.3%] male; median age 10.6 years [range, 0.2-17.8 years]), reliable RNFL thickness and GCL-IPL thickness measurements were available in 92 patients (80.0%) and 84 patients (73.0%), respectively. The sensitivity for detecting an abnormal visual function was 74.5% for average RNFL thickness and 41.7% for average GCL-IPL thickness at a specificity of 44.5% and 82.9%, respectively. The PPV and NPV were 33.0% and 82.6% for the average RNFL thickness and 57.1% and 82.2% for the average GCL-IPL thickness. CONCLUSION An abnormal visual function was discriminated correctly by using the average RNFL thickness in seven out of ten patients and by using the average GCL-IPL thickness in four out of ten patients. The relatively high NPVs signified that patients with normal average RNFL thickness and average GCL-IPL thickness measurements had a relative high certainty of a normal visual function.
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Affiliation(s)
- Myrthe A Nuijts
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology and Head & Neck Surgery University, University Medical Centre Utrecht, Utrecht, The Netherlands
- Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Giorgio L Porro
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Carlien A M Bennebroek
- Department of Ophthalmology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van Seeters
- Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | | | - Saskia M Imhof
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Shen LL, Mangalesh S, Michalak SM, McGeehan B, Sarin N, Finkle J, Winter KP, Tran-Viet D, Benner EJ, Vajzovic L, Freedman SF, Younge N, Cotten CM, El-Dairi M, Ying GS, Toth C. Associations between systemic health and retinal nerve fibre layer thickness in preterm infants at 36 weeks postmenstrual age. Br J Ophthalmol 2023; 107:242-247. [PMID: 34389548 PMCID: PMC8858642 DOI: 10.1136/bjophthalmol-2021-319254] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/30/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Neonatal insults from systemic diseases have been implicated in the pathway of impaired neurodevelopment in preterm infants. We aimed to investigate the associations between systemic health factors and retinal nerve fibre layer (RNFL) thickness in preterm infants. METHODS We prospectively enrolled infants and imaged both eyes at 36±1 weeks postmenstrual age (PMA) using a hand-held optical coherence tomography system at the bedside in the Duke intensive care nurseries. We evaluated associations between RNFL thickness and 29 systemic health factors using univariable and multivariable regression models. RESULTS 83 infants with RNFL thickness measures were included in this study. Based on the multivariable model, RNFL thickness was positively associated with infant weight at imaging and was negatively associated with sepsis/necrotising enterocolitis (NEC). RNFL thickness was 10.4 µm (95% CI -15.9 to -4.9) lower in infants with than without sepsis/NEC in the univariable analysis (p<0.001). This difference remained statistically significant after adjustment for confounding variables in various combinations (birth weight, birthweight percentile, gestational age, infant weight at imaging and growth velocity). A 250 g increase in infant weight at imaging was associated with a 3.1 µm (95% CI 2.1 to 4.2) increase in RNFL thickness in the univariable analysis (p<0.001). CONCLUSIONS Low infant weight and sepsis/NEC were independently associated with thinner RNFL in preterm infants at 36 weeks PMA. To our knowledge, this study is the first to suggest that sepsis/NEC may affect retinal neurodevelopment. Future longitudinal studies are needed to investigate this relationship further.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Shwetha Mangalesh
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Suzanne M Michalak
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brendan McGeehan
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neeru Sarin
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joanne Finkle
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katrina P Winter
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Du Tran-Viet
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eric J Benner
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Noelle Younge
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mays El-Dairi
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cynthia Toth
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
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Pavone R, Fonte C, Sardi I, Caputo R, Marziali E, Mazzeo F, Secci J, Bergamini A, De Masi S, Leo MC, Censullo ML, Bacci GM. Optical Coherence Tomography Significance in Managing Early Onset of Optic Pathway Gliomas in Children Younger than 5 Years of Age—A Retrospective Study. CHILDREN 2022; 9:children9091307. [PMID: 36138616 PMCID: PMC9497564 DOI: 10.3390/children9091307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022]
Abstract
We aimed to investigate the significance of optical coherence tomography (SD-OCT) in managing pediatric optic pathway gliomas (OPGs) in children younger than 5 years of age. A retrospective monocentric study was conducted. SD-OCT scans were obtained using the handheld iVue system to assess peripapillary retinal nerve fibre layer (pRNFL) thickness at three time points: baseline (OCT1), end of treatment (OCT2), and at last follow-up (OCT3). We compared the median value of pRNFL (and interquartile range—IQR) at different follow-up times and in different sub-groups (stable disease—SD, partial response—PR, and progression disease—PD). Thirteen children younger than 5 years of age were included. The Median follow-up time was 3.9 years (IQR 1.2). Six patients showed a pRNFL change of more than 10% during follow-up. Seven patients showed PD during follow-up. Median pRNFL at baseline was 81.5 µm (IQR 31.5); median pRNFL at the end of treatment was 73 µm (IQR 33); median pRNFL at last follow-up was 72 µm (IQR 38.5). The mean pRNFL at baseline was significantly lower than the mean normative values. Only subjects with PD showed pRNFL change close to statistical significance. This study confirms the role of SD-OCT in managing OPGs for therapeutic decisions and strategy planning of visual rehabilitation.
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Affiliation(s)
- Rossana Pavone
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital, 50134 Florence, Italy
| | - Carla Fonte
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital, 50134 Florence, Italy
| | - Iacopo Sardi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital, 50134 Florence, Italy
| | - Roberto Caputo
- Pediatric Ophthalmology Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50134 Florence, Italy
| | - Elisa Marziali
- Pediatric Ophthalmology Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50134 Florence, Italy
| | - Fabio Mazzeo
- Pediatric Ophthalmology Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50134 Florence, Italy
| | - Jacopo Secci
- Pediatric Ophthalmology Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50134 Florence, Italy
| | - Alessia Bergamini
- Pediatric Ophthalmology Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50134 Florence, Italy
| | | | - Maria Carmela Leo
- Clinical Research and Study Design Office, Meyer Children’s Hospital, 50134 Florence, Italy
| | - Maria Luigia Censullo
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children’s Hospital, 50134 Florence, Italy
| | - Giacomo Maria Bacci
- Pediatric Ophthalmology Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50134 Florence, Italy
- Correspondence: ; Tel.: +39-(0)555662526; Fax: +39-(0)555662400
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Lohkamp LN, Parkin P, Puran A, Bartels UK, Bouffet E, Tabori U, Rutka JT. Optic Pathway Glioma in Children with Neurofibromatosis Type 1: A Multidisciplinary Entity, Posing Dilemmas in Diagnosis and Management Multidisciplinary Management of Optic Pathway Glioma in Children with Neurofibromatosis Type 1. Front Surg 2022; 9:886697. [PMID: 35592129 PMCID: PMC9111519 DOI: 10.3389/fsurg.2022.886697] [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: 02/08/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Neurofibromatosis type 1 (NF1) has an incidence of 1 in 2,000 to 3,000 individuals and in 15% is associated with optic pathway glioma (OPG). Given the variability in clinical presentation and related morbidity, a multidisciplinary approach for diagnosis and management of children with NF1 and OPG is required, but often lacks coordination and regular information exchange. Herein we summarize our experience and describe the care pathways/network provided by a multidisciplinary team. The role of the distinct team members is elucidated as well as the care amendments made over time. Methods We performed a retrospective single-center observational study, including children treated at our institution between 1990 and 2021. Inclusion criteria were clinical diagnosis of NF1, radiographic and/or histopathological diagnosis of OPG and age below 18 years. Patients being treated elsewhere were excluded from the study. Data was abstracted from each child’s health record using a standardized data collection form. Characteristics of children with NF1 and OPG were described using means (SD) and percentages. Outcomes were determined using Kaplan-Meier estimates. Results From 1990 to 2021, 1,337 children were followed in our institution. Of those, 195 were diagnosed with OPG (14.6%), including 94 (48.21%) females and 101 (51.79%) males. Comprehensive data were available in 150 patients. The mean (SD) age at diagnosis was 5.31(4.08) years (range: 0.8–17.04 years). Sixty-two (41.3%) patients remained stable and did not undergo treatment, whereas 88 (58.7%) patients required at least one treatment. The mean (SD) duration of follow up was 8.14 (5.46) years (range: 0.1–25.9 years; median 6.8 years). Overall survival was of 23.6 years (±1.08), comprising 5 deaths. A dedicated NF clinic, including pediatricians and a nurse, provides regular follow up and plays a central role in the management of children with NF1, identifying those at risk of OPG, coordinating referrals to Neuroradiology and other specialists as indicated. All children are assessed annually by Ophthalmology. Comprehensive care was provided by a multidisciplinary team consisting of Dermatology, Genetics, Neuro-oncology, Neuroradiology, Neurosurgery, Ophthalmology and Pediatrics. Conclusions The care of children with NF1 and OPG is optimized with a multidisciplinary team approach, coordinated by a central specialty clinic.
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Affiliation(s)
- Laura-Nanna Lohkamp
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Correspondence: Laura-Nanna Lohkamp
| | - Patricia Parkin
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Allan Puran
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Katharina Bartels
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Thomas Rutka
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Papageorgiou E, Lazari K, Gottlob I. Hand-held optical coherence tomography: advancements in detection and assessment of optic nerve abnormalities and disease progression monitoring. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2060821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Eleni Papageorgiou
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece
| | - Katerina Lazari
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece
| | - Irene Gottlob
- Department of Neurology, Cooper Medical School of Rowan University and Cooper University Healthcare, Camden, New Jersey, USA
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, UK
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7
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Nuijts MA, Imhof SM, Veldhuis N, Dekkers CC, Schouten – van Meeteren AYN, Stegeman I. The diagnostic accuracy and prognostic value of OCT for the evaluation of the visual function in children with a brain tumour: A systematic review. PLoS One 2021; 16:e0261631. [PMID: 34941930 PMCID: PMC8699950 DOI: 10.1371/journal.pone.0261631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose To systematically review the evidence on the diagnostic accuracy and prognostic value of retinal optical coherence tomography (OCT) to detect visual acuity (VA) or visual field (VF) loss in children with a brain tumour. Methods PubMed, Embase and Cochrane Library databases were searched from inception to February 2021. We included studies evaluating retinal OCT and standard visual function parameters (VA and or VF) in children with a brain tumour. Two authors independently extracted data from each included study. They also assessed the methodological quality of the studies using the QUADAS-2 or QUIPS tool. The diagnostic accuracy of OCT was evaluated with receiver operating characteristic analysis, sensitivity, specificity, positive predictive value and negative predictive value. The prognostic value of OCT was evaluated with predictive measures (odds ratio). Results We included five diagnostic studies, with a total of 186 patients, all diagnosed with optic pathway glioma. No prognostic studies were eligible for inclusion. Included studies evaluated either retinal nerve fiber layer (RNFL) thickness or ganglion cell layer—inner plexiform layer (GCL-IPL) thickness. There was considerable heterogeneity between OCT devices, OCT protocols, visual function parameters and threshold values. Sensitivity and specificity for RNFL thickness measurement ranged from 60.0% to 100.0% and 76.6% to 100%, respectively. For GCL-IPL thickness measurement, area under the curve ranged from 0.91 to 0.98 for different diameters. Conclusion The literature regarding the diagnostic accuracy and prognostic value of OCT parameters in children with a brain tumour is scarce. Due to heterogeneity and a considerable risk of bias of included studies, we cannot draw solid conclusions regarding the accuracy of retinal OCT. Future research should investigate the potential of OCT as diagnostic and prognostic tool for the evaluation of the visual function and detection of visual impairment in children with any type of brain tumour.
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Affiliation(s)
- Myrthe A. Nuijts
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nienke Veldhuis
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Coco C. Dekkers
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | | | - Inge Stegeman
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology and Head & Neck Surgery University, University Medical Centre Utrecht, Utrecht, The Netherlands
- Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Ni S, Wei X, Ng R, Ostmo S, Chiang MF, Huang D, Jia Y, Campbell JP, Jian Y. High-speed and widefield handheld swept-source OCT angiography with a VCSEL light source. BIOMEDICAL OPTICS EXPRESS 2021; 12:3553-3570. [PMID: 34221678 PMCID: PMC8221946 DOI: 10.1364/boe.425411] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 05/18/2023]
Abstract
Optical coherence tomography (OCT) and OCT angiography (OCTA) enable noninvasive structural and angiographic imaging of the eye. Portable handheld OCT/OCTA systems are required for imaging patients in the supine position. Examples include infants in the neonatal intensive care unit (NICU) and operating room (OR). The speed of image acquisition plays a pivotal role in acquiring high-quality OCT/OCTA images, particularly with the handheld system, since both the operator hand tremor and subject motion can cause significant motion artifacts. In addition, having a large field of view and the ability of real-time data visualization are critical elements in rapid disease screening, reducing imaging time, and detecting peripheral retinal pathologies. The arrangement of optical components is less flexible in the handheld system due to the limitation of size and weight. In this paper, we introduce a 400-kHz, 55-degree field of view handheld OCT/OCTA system that has overcome many technical challenges as a portable OCT system as well as a high-speed OCTA system. We demonstrate imaging premature infants with retinopathy of prematurity (ROP) in the NICU, a patient with incontinentia pigmenti (IP), and a patient with X-linked retinoschisis (XLRS) in the OR using our handheld OCT system. Our design may have the potential for improving the diagnosis of retinal diseases and help provide a practical guideline for designing a flexible and portable OCT system.
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Affiliation(s)
- Shuibin Ni
- Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239, USA
| | - Xiang Wei
- Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ringo Ng
- Department of Engineering Science, Simon Fraser University, Burnaby, Canada
| | - Susan Ostmo
- Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239, USA
| | - Michael F. Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - David Huang
- Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - J. Peter Campbell
- Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239, USA
| | - Yifan Jian
- Casey Eye Institute, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
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de Paula A, Abdolrahimzadeh S, Fragiotta S, Di Pippo M, Scuderi G. Current concepts on ocular vascular abnormalities in the phakomatoses. Semin Ophthalmol 2021; 36:549-560. [PMID: 33755531 DOI: 10.1080/08820538.2021.1900284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurofibromatosis, Von Hippel Lindau disease, and tuberous sclerosis complex are classified under the term phakomatoses. They are characterized by ocular vascular abnormalities such as vascular tortuosity, corkscrew retinal vessel configuration, moyamoya-like aspect, microaneurysms, hemangioblastomas, and focal sheathing of retinal arteries, possibly due to abnormal formation, migration, and differentiation of neural crest cells. These alterations can be the first sign or the hallmark of disease and can be related to vasoproliferative tumors. PURPOSE Novel imaging technologies in ophthalmology, such as near-infrared reflectances and spectral domain optical coherence tomography, have improved our knowledge in the diagnosis of these pathologies. Previously undetected macular vascular alterations have been reported in phakomatoses using optical coherence tomography angiography. This review will summarize the ophthalmic vascular abnormalities and novel imaging methods in the phakomatoses. CONCLUSION Active research is being led into the ophthalmic management of these conditions and their complications, and owing to elevated vascular endothelial growth factor production from hemangioblastoma, hamartoma, and retinal vascular proliferative tumors, increasing interest in this line of therapy has been conducted although research is still ongoing in this area.
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Affiliation(s)
- Alessandro de Paula
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Solmaz Abdolrahimzadeh
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mariachiara Di Pippo
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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10
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Visual function tests including the role of optical coherence tomography in neurofibromatosis 1. Childs Nerv Syst 2020; 36:2363-2375. [PMID: 32749524 DOI: 10.1007/s00381-020-04706-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/25/2020] [Indexed: 10/23/2022]
Abstract
Optic pathway glioma (OPG) is a common and significant complication of neurofibromatosis 1 (NF-1) that might lead to vision loss. The main reason to treat OPG is to preserve vision. Tumor location along the visual pathway largely dictates the presenting signs and symptoms. Clinical ophthalmic evaluation is focused on optic nerve functions including evaluation of pupils' reaction to light, visual acuity, color vision, and visual field, as well as optic nerve appearance. An important relatively new ancillary test is optic coherence tomography (OCT) that measures the volume of retinal nerve fiber layer around the optic nerve and the ganglion cell layer-inner plexiform layer (GCL-IPL) of the macula, both proved to be strongly associated with losing vision in OPG. Accurate evaluation of vision functions plays a critical role in the decision of treatment. In this review, we describe the ophthalmological assessment including new biomarkers in clinical use. We also outline prognostic factors and current recommendations for surveillance and indications for treatment.
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11
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Nix JS, Blakeley J, Rodriguez FJ. An update on the central nervous system manifestations of neurofibromatosis type 1. Acta Neuropathol 2020; 139:625-641. [PMID: 30963251 DOI: 10.1007/s00401-019-02002-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023]
Abstract
Neurofibromatosis 1 (NF1) is an autosomal dominant genetic disorder that presents with variable phenotypes as a result of mutations in the neurofibromatosis type 1 (NF1) gene and subsequently, abnormal function of the protein product, neurofibromin. Patients with NF1 are at increased risk for central nervous system (CNS) manifestations including structural, functional, and neoplastic disease. The mechanisms underlying the varied manifestations of NF1 are incompletely understood, but the loss of functional neurofibromin, resulting in sustained activation of the oncoprotein RAS, is responsible for tumorigenesis throughout the body, including the CNS. Much of our understanding of NF1-related CNS manifestations is from a combination of data from animal models and natural history studies of people with NF1 and CNS disease. Data from animal models suggest the importance of both Nf1 mutations and somatic genetic alterations, such as Tp53 loss, for development of neoplasms, as well as the role of the timing of the acquisition of such alterations on the variability of CNS manifestations. A variety of non-neoplastic structural (macrocephaly, hydrocephalus, aqueductal stenosis, and vasculopathy) and functional (epilepsy, impaired cognition, attention deficits, and autism spectrum disorder) abnormalities occur with variable frequency in individuals with NF1. In addition, there is increasing evidence that similar appearing CNS neoplasms in people with and without the NF1 syndrome are due to distinct oncogenic pathways. Gliomas in people with NF1 show alterations in the RAS/MAPK pathway, generally in the absence of BRAF alterations (common to sporadic pilocytic astrocytomas) or IDH or histone H3 mutations (common to diffuse gliomas subsets). A subset of low-grade astrocytomas in these patients remain difficult to classify using standard criteria, and occasionally demonstrate morphologic features resembling subependymal giant cell astrocytomas that afflict patients with tuberous sclerosis complex ("SEGA-like astrocytomas"). There is also emerging evidence that NF1-associated high-grade astrocytomas have frequent co-existing alterations such as ATRX mutations and an alternative lengthening of telomeres (ALT) phenotype responsible for unique biologic properties. Ongoing efforts are seeking to improve diagnostic accuracy for CNS neoplasms in the setting of NF1 versus sporadic tumors. In addition, MEK inhibitors, which act on the RAS/MAPK pathway, continue to be studied as rational targets for the treatment of NF1-associated tumors, including CNS tumors.
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12
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Ji X, Wright T, VandenHoven C, MacKeen L, McFarlane M, Liu H, Dupuis A, Westall C. Reliability of Handheld Optical Coherence Tomography in Children Younger Than Three Years of Age Undergoing Vigabatrin Treatment for Childhood Epilepsy. Transl Vis Sci Technol 2020; 9:9. [PMID: 32704429 PMCID: PMC7347507 DOI: 10.1167/tvst.9.3.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Vigabatrin-associated retinal toxicity manifests as reduction in the clinical electroretinogram and retinal nerve fiber layer (RNFL) thinning. This observational investigation of RNFL thickness in young vigabatrin-treated children was to identify intravisit and intervisit reliabilities of peripapillary RNFL thickness measurements performed with Envisu (optical coherence tomography) OCT. Secondarily, a longitudinal assessment investigated the presence and extent of RNFL thinning. Methods We measured the handheld OCT in sedated children to evaluate the RNFL thickness using segmentation software. Intraclass correlation coefficient (ICC) statistics identified intravisit and intervisit reliabilities for RNFL thickness. Results Twenty-nine children (10.1 ± 6.0 months old) underwent handheld optical coherence tomography (OCT). Fourteen of these completed follow-up assessments. Intravisit reliability was good for the right eye (ICCs = 0.82-0.98) and the left eye (ICCs = 0.75-0.89) for each of the 4 retinal quadrants. Inter-visit ICCs for each of the 4 retinal quadrants were good (ICC = 0.82-0.98). There was no consistent change in RNFL thickness longitudinally. Conclusions In this pediatric cohort, RNFL thickness measures using handheld OCT provided good reliability within a single visit and between consecutive visits supporting its use as an adjunctive tool in the clinical setting. Further long-term follow-up is required to understand RNFL thickness changes in this specific population and its association with vigabatrin toxicity. Translational Relevance The findings of good reliability and clinical feasibility would provide an opportunity for the handheld OCT to monitor reliably for vigabatrin-associated retinal toxicity in children who often show noncompliance to traditional testing approaches.
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Affiliation(s)
- Xiang Ji
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Tom Wright
- Kensington Eye Institute, Toronto, ON, Canada
| | - Cynthia VandenHoven
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leslie MacKeen
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle McFarlane
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Henry Liu
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Annie Dupuis
- Clinical Research Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carol Westall
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Lobbous M, Bernstock JD, Coffee E, Friedman GK, Metrock LK, Chagoya G, Elsayed G, Nakano I, Hackney JR, Korf BR, Nabors LB. An Update on Neurofibromatosis Type 1-Associated Gliomas. Cancers (Basel) 2020; 12:E114. [PMID: 31906320 PMCID: PMC7017116 DOI: 10.3390/cancers12010114] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/26/2019] [Accepted: 12/29/2019] [Indexed: 12/22/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant tumor predisposition syndrome that affects children and adults. Individuals with NF1 are at high risk for central nervous system neoplasms including gliomas. The purpose of this review is to discuss the spectrum of intracranial gliomas arising in individuals with NF1 with a focus on recent preclinical and clinical data. In this review, possible mechanisms of gliomagenesis are discussed, including the contribution of different signaling pathways and tumor microenvironment. Furthermore, we discuss the recent notable advances in the developing therapeutic landscape for NF1-associated gliomas including clinical trials and collaborative efforts.
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Affiliation(s)
- Mina Lobbous
- Division of Neuro Oncology, Department of Neurology, University of Alabama at Birmingham, 510 20th Street South, Faculty Office Tower Suite 1020 Birmingham, Birmingham, AL 35294, USA; (E.C.)
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Elizabeth Coffee
- Division of Neuro Oncology, Department of Neurology, University of Alabama at Birmingham, 510 20th Street South, Faculty Office Tower Suite 1020 Birmingham, Birmingham, AL 35294, USA; (E.C.)
| | - Gregory K. Friedman
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (G.K.F.); (L.K.M.)
| | - Laura K. Metrock
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (G.K.F.); (L.K.M.)
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (G.C.); (G.E.); (I.N.)
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (G.C.); (G.E.); (I.N.)
| | - Ichiro Nakano
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (G.C.); (G.E.); (I.N.)
| | - James R. Hackney
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Bruce R. Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Louis B. Nabors
- Division of Neuro Oncology, Department of Neurology, University of Alabama at Birmingham, 510 20th Street South, Faculty Office Tower Suite 1020 Birmingham, Birmingham, AL 35294, USA; (E.C.)
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Nuijts MA, Degeling MH, Stegeman I, Schouten-van Meeteren AYN, Imhof SM. Visual impairment in children with a brain tumor: a prospective nationwide multicenter study using standard visual testing and optical coherence tomography (CCISS study). BMC Ophthalmol 2019; 19:220. [PMID: 31706271 PMCID: PMC6842490 DOI: 10.1186/s12886-019-1225-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/23/2019] [Indexed: 01/11/2023] Open
Abstract
Background Children with a brain tumor have a high risk of impaired vision. Up to now, visual acuity measurement, visual field testing and orthoptic testing are the most informative diagnostic investigations for the assessment of visual function. Evaluating vision in children can be challenging given the challenges in cooperation, concentration and age-dependent shifts in visual tests. Since visual loss due to a brain tumor can be progressive and irreversible, we must aim to detect visual impairment as early as possible. Several studies have shown that optical coherence tomography facilitates discovery of nerve fiber damage caused by optic nerve glioma. Consequently, early detection of potential ocular damage will effect treatment decisions and will provide timely referral to visual rehabilitation centers. Methods/design The CCISS study is a prospective, observational, multicenter cohort study in The Netherlands. Patients aged 0–18 years with a newly diagnosed brain tumor are invited for inclusion in this study. Follow-up visits are planned at 6, 12, 18 and 24 months. Primary endpoints are visual acuity, visual field and optical coherence tomography parameters (retinal nerve fiber layer thickness and ganglion cell layer – inner plexiform layer thickness). Secondary endpoints include the course of visual function (measured by visual acuity, visual field and optical coherence tomography at different follow-up visits), course of the disease and types of treatment. Discussion The CCISS study will heighten the awareness of visual impairment in different types of brain tumors in children. This study will show whether optical coherence tomography leads to earlier detection of visual impairment compared to standard ophthalmological testing (i.e. visual acuity, visual field testing) in children with a brain tumor. Furthermore, the systematic approach of ophthalmological follow-up in this study will give us insight in the longitudinal relation between the course of visual function, course of the disease and types of treatment in children with a brain tumor. Trial registration The CCISS study is prospectively registered in the Netherlands Trial Register (NTR) since April 2019. Identifier: NL7697.
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Affiliation(s)
- M A Nuijts
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Room E 03.136, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - M H Degeling
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Stegeman
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - S M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Liu X, Kale AU, Capewell N, Talbot N, Ahmed S, Keane PA, Mollan S, Belli A, Blanch RJ, Veenith T, Denniston AK. Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study. BMJ Open 2019; 9:e030882. [PMID: 31699727 PMCID: PMC6858135 DOI: 10.1136/bmjopen-2019-030882] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the feasibility of retinal imaging in critical care using a novel mobile optical coherence tomography (OCT) device. The Heidelberg SPECTRALIS FLEX module (Heidelberg Engineering, Heidelberg, Germany) is an OCT unit with a boom arm, enabling ocular OCT assessment in less mobile patients. DESIGN We undertook an evaluation of the feasibility of using the SPECTRALIS FLEX for undertaking ocular OCT images in unconscious and critically ill patients. SETTING This study was conducted in the critical care unit of a large tertiary referral unit in the United Kingdom. PARTICIPANTS 13 systemically unwell patients admitted to the critical care unit were purposively sampled to enable evaluation in patients with a range of clinical states. OUTCOME MEASURES The primary outcome was the feasibility of acquiring clinically interpretable OCT scans on a consecutive series of patients. The standardised scanning protocol included macula-focused OCT, OCT optic nerve head (ONH), OCT angiography (OCTA) of the macula and ONH OCTA. RESULTS OCT images from 13 patients were attempted. The success rates of each scan type are 84% for OCT macula, 76% for OCT ONH, 56% for OCTA macula and 36% for OCTA ONH. The overall mean success rate of scans per patient was 64% (95% CI 46% to 81%). Clinicians reported clinical value in 100% scans which were successfully obtained, including both ruling in and ruling out relevant ocular complications such as corneal thinning, macular oedema and optic disc swelling. The most common causes of failure to achieve clinically interpretable scans were inadequately sustained OCT alignment in delirious patients and a compromised ocular surface due to corneal exposure. CONCLUSIONS This prospective evaluation indicates the feasibility and potential clinical value of the SPECTRALIS FLEX OCT system on the critical care unit. Portable OCT systems have the potential to bring instrument-based ophthalmic assessment to critically ill patients, enabling detection and micron-level monitoring of ocular complications.
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Affiliation(s)
- Xiaoxuan Liu
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, United Kingdom
| | - Aditya Uday Kale
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicholas Capewell
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicholas Talbot
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sumiya Ahmed
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pearse A Keane
- Health Data Research UK, London, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Susan Mollan
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Rare Diseases, Institute of Translational Medicine, Birmingham, UK
| | - Antonio Belli
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
- Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard J Blanch
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Tonny Veenith
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alastair K Denniston
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Centre for Rare Diseases, Institute of Translational Medicine, Birmingham, UK
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Abstract
PURPOSE OF REVIEW To review the recent advances in understanding how primary brain tumors affect vision in children. RECENT FINDINGS Children with primary brain tumors may have vision loss due to involvement of their afferent visual pathways or from papilledema. These vision deficits may go unrecognized until later in life, years after treatment of the primary lesion. Strabismus and cranial nerve palsies may occur as a result of brain tumors. Ophthalmologists can monitor and treat young children at risk for vision loss from amblyopia as a result of effects from their underlying lesion. Advances in imaging techniques have made it possible to quantify damage to the visual pathways with objective tests. SUMMARY Systematic referrals for evaluation by an ophthalmologist should occur early in the course of treatment of primary brain tumors as these evaluations may improve visual outcomes and quality of life.
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18
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Zahavi A, Toledano H, Cohen R, Sella S, Luckman J, Michowiz S, Goldenberg-Cohen N. Use of Optical Coherence Tomography to Detect Retinal Nerve Fiber Loss in Children With Optic Pathway Glioma. Front Neurol 2018; 9:1102. [PMID: 30619059 PMCID: PMC6306407 DOI: 10.3389/fneur.2018.01102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Optic pathway glioma (OPG) presents in childhood and can cause significant morbidity and visual loss. Magnetic resonance imaging (MRI) is the current imaging modality of choice for evaluation of OPG progression, but it is a relatively limited resource often requiring sedation in the pediatric age group. Additionally, OPG progression on MRI does not always correlate with clinical progression. As a result, several other modalities for evaluating OPG are being investigated, including optical coherence tomography (OCT), a readily available imaging technique in ophthalmic practice. The purpose of the present study was to examine the association between retinal nerve fiber layer (RNFL) thickness measured using OCT and optic nerve function in children with OPG with and without neurofibromatosis-1 (NF-1). A retrospective chart review was conducted to identify children diagnosed with OPG from 2001 to 2015 at a tertiary pediatric medical center. The correlation between OCT measurements and clinical visual parameters was statistically analyzed. Included were 23 children with imaging-confirmed OPG and spectral domain OCT: 10 with NF-1 (mean age at diagnosis 5.8 years) and 13 without (mean age at diagnosis 5.9 years). The glioma involved the chiasma-hypothalamus in 19 patients, optic nerve in 11, and optic tract in 7; more than one anatomic site was affected in 15. Symptoms were reported in 2 patients with NF-1 and most patients without NF-1. Visual field defects included monocular, bitemporal, nasal, and homonymous hemianopia. Initial mean RNFL was 85.4 μm in the NF-1 group and 65 μm in the non-NF-1 group. Visual acuity deteriorated in 1/10 patients and 5/13 patients, respectively. Repeated OCT showed continued RNFL thinning in 3 patients (5 eyes) in the NF-1 group and in 8 patients (11 eyes) in the non-NF-1 group, often associated with a decrease in optic nerve function. In conclusion, visual function in children with OPG is correlated with repeated OCT measurements and weakly with neuroimaging. Children without NF-1 are usually symptomatic and have a worse clinical outcome. These findings may have important implications when considering initiating, continuing or stopping chemotherapy for OPG. The application of OCT in the assessment of OPG and the correlation of the findings to clinical progression can have a significant impact on OPG patient management.
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Affiliation(s)
- Alon Zahavi
- Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Helen Toledano
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Rony Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Sara Sella
- Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Judith Luckman
- Radiology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Shalom Michowiz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurosurgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Nitza Goldenberg-Cohen
- Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petah Tikva, Israel.,Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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19
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Detection and characterisation of visual field defects using Saccadic Vector Optokinetic Perimetry in children with brain tumours. Eye (Lond) 2018; 32:1563-1573. [PMID: 29880917 PMCID: PMC6169726 DOI: 10.1038/s41433-018-0135-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 02/24/2018] [Accepted: 05/09/2018] [Indexed: 01/09/2023] Open
Abstract
Purpose To determine the ability of Saccadic Vector Optokinetic Perimetry (SVOP) to detect and characterise visual field defects in children with brain tumours using eye-tracking technology, as current techniques for assessment of visual fields in young children can be subjective and lack useful detail. Methods Case-series study of children receiving treatment and follow-up for brain tumours at the Royal Hospital for Sick Children in Edinburgh from April 2008 to August 2013. Patients underwent SVOP testing and the results were compared with clinically expected visual field patterns determined by a consensus panel after review of clinical findings, neuroimaging, and where possible other forms of visual field assessment. Results Sixteen patients participated in this study (mean age of 7.2 years; range 2.9–15 years; 7 male, 9 female). Twelve children (75%) successfully performed SVOP testing. SVOP had a sensitivity of 100% and a specificity of 50% (positive predictive value of 80% and negative predictive value of 100%). In the true positive and true negative SVOP results, the characteristics of the SVOP plots showed agreement with the expected visual field. Six patients were able to perform both SVOP and Goldmann perimetry, these demonstrated similar visual fields in every case. Conclusion SVOP is a highly sensitive test that may prove to be extremely useful for assessing the visual field in young children with brain tumours, as it is able to characterise the central 30° of visual field in greater detail than previously possible with older techniques.
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Jones DTW, Kieran MW, Bouffet E, Alexandrescu S, Bandopadhayay P, Bornhorst M, Ellison D, Fangusaro J, Fisher MJ, Foreman N, Fouladi M, Hargrave D, Hawkins C, Jabado N, Massimino M, Mueller S, Perilongo G, Schouten van Meeteren AYN, Tabori U, Warren K, Waanders AJ, Walker D, Weiss W, Witt O, Wright K, Zhu Y, Bowers DC, Pfister SM, Packer RJ. Pediatric low-grade gliomas: next biologically driven steps. Neuro Oncol 2018; 20:160-173. [PMID: 29016845 PMCID: PMC5786244 DOI: 10.1093/neuonc/nox141] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Despite the fact that they are not typically life-threatening, low-grade gliomas (LGGs) remain a significant clinical challenge in pediatric neuro-oncology due to comorbidities associated with these tumors and/or their treatments, and their propensity to multiply recurs. LGGs, in total the most common brain tumors arising in childhood, can often become a chronic problem requiring decades of management. The Second International Consensus Conference on Pediatric Low-Grade Gliomas held in Padua, Italy in 2016 was convened in an attempt to advance the pace of translating biological discoveries on LGGs into meaningful clinical benefit. Topics discussed included: the implications of our growing biological understanding of the genomics underlying these tumors; the assessment of the model systems available; the implications of the molecular and histopathologic differences between adult and pediatric diffuse gliomas; and steps needed to expedite targeted therapy into late-stage clinical trials for newly diagnosed cases. Methods for the diagnostic assessment of alterations in the Ras/mitogen-activated protein kinase pathway, typical for these tumors, were also considered. While the overall tone was positive, with a consensus that progress is being and will continue to be made, the scale of the challenge presented by this complex group of tumors was also acknowledged. The conclusions and recommendations of the meeting panel are provided here as an outline of current thinking and a basis for further discussion.
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Affiliation(s)
- David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Hopp Children’s Cancer Center, Heidelberg, Germany
| | - Mark W Kieran
- Department of Medical Oncology, Brigham and Women’s Hospital, Harvard Medical School, and the Broad Institutem, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Eric Bouffet
- Paediatric Neuro-Oncology Program, Research Institute, The Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sanda Alexandrescu
- Department of Pathology, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Pratiti Bandopadhayay
- Department of Medical Oncology, Brigham and Women’s Hospital, Harvard Medical School, and the Broad Institutem, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Miriam Bornhorst
- Gilbert Family Neurofibromatosis Institute, Brain Tumor Institute, Children’s National Health System, Washington DC, USA
- Center for Cancer and Immunology Research, Children’s National Health System, Washington DC, USA
| | - David Ellison
- Department of Pathology and Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jason Fangusaro
- Ann and Robert H. Lurie Children’s Hospital of Chicago Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael J Fisher
- Department of Pediatric Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nicholas Foreman
- Children’s Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Maryam Fouladi
- Brain Tumor Center, Brain Tumor Translational Research and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Darren Hargrave
- Neuro-oncology and Experimental Therapeutics, Great Ormond Street Hospital for Children, London, UK
| | - Cynthia Hawkins
- Division of Pathology, The Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nada Jabado
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sabine Mueller
- Department of Neurology, Pediatrics, and Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Giorgio Perilongo
- Department of Woman’s and Child’s Health, University of Padua, Padua, Italy
| | | | - Uri Tabori
- Paediatric Neuro-Oncology Program, Research Institute, The Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Warren
- Department of Medical Oncology, Brigham and Women’s Hospital, Harvard Medical School, and the Broad Institutem, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- National Cancer Institute, Pediatric Oncology and Neuro-Oncology Branches, Bethesda, Maryland, USA
| | - Angela J Waanders
- Department of Pediatric Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David Walker
- Children’s Brain Tumor Research Centre, QMC University of Nottingham, Nottingham, UK
| | - William Weiss
- Department of Neurology, Pediatrics, and Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Olaf Witt
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Hopp Children’s Cancer Center, Heidelberg, Germany
| | | | - Yuan Zhu
- Gilbert Family Neurofibromatosis Institute, Brain Tumor Institute, Children’s National Health System, Washington DC, USA
| | - Daniel C Bowers
- Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas, USA
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Hopp Children’s Cancer Center, Heidelberg, Germany
| | - Roger J Packer
- Gilbert Family Neurofibromatosis Institute, Brain Tumor Institute, Children’s National Health System, Washington DC, USA
- Center for Neuroscience and Behavioral Medicine, Gilbert Family Neurofibromatosis Institute, Brain Tumor Institute, Children’s National Health System, Washington DC, USA
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Abstract
Central nervous tumors are the leading cause of death from cancer in the pediatric population. Advances in care for pediatric neuro-oncology patients have led to improved survival rates. As survivorship increases, care of the sequelae of the tumor and its treatment become more important for long-term quality of life. A significant portion of the brain is involved in vision. Pediatric brain tumors can distort, damage, and destroy portions of the brain involved in both the afferent and efferent vision pathways. This interruption of normal visual pathways can lead to permanent vision loss or other morbidities such as strabismus and nystagmus. This article reviews the presenting symptoms and signs of brain tumors in children and adolescents, as well as the effects of the tumor and its treatment on the afferent and efferent visual pathways. Strategies for monitoring during treatment, and management of sequelae are reviewed. Through systematic evaluation and monitoring of pediatric neuro-oncology patients, those at risk for vision loss or tumor progression can be identified.
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22
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Banc A, Stan C, Florian IS. Optical coherence tomography as a marker of vision in children with optic pathway gliomas. Childs Nerv Syst 2018; 34:51-60. [PMID: 28844094 DOI: 10.1007/s00381-017-3578-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 08/16/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Optic pathway gliomas (OPG) represent an important cause of visual loss in pediatric population. The indication of treatment is based on clinical or neuroimaging progression. Visual acuity loss is the most important symptom of disease progression, but children with OPG are frequently unable to complete the testing of visual function. Optical coherence tomography (OCT) was suggested as an objective tool for visual assessment. A literature review was performed in order to determine the role of retinal OCT as a surrogate marker of vision in children with OPG. METHODS The search was performed using PubMed, Embase, and Web of Science databases and was restricted to articles published in English between 2000 and 2016, with a minimum of ten participants enrolled. RESULTS Eleven studies met the eligibility criteria and were included in the present review. Both neurofibromatosis-1 associated and sporadic OPG were investigated. CONCLUSIONS Retinal OCT is a promising tool to be considered as a screening or follow-up test in children with OPG, and further multicenter research is encouraged.
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Affiliation(s)
- Ana Banc
- Department of Ophthalmology, Iuliu Hatieganu University of Medicine and Pharmacy, Clinicilor Street no 3-5, 400006, Cluj-Napoca, Romania.
| | - Cristina Stan
- Department of Ophthalmology, Iuliu Hatieganu University of Medicine and Pharmacy, Clinicilor Street no 3-5, 400006, Cluj-Napoca, Romania
- Ophthalmology Clinic, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Ioan Stefan Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Neurosurgery Clinic, Emergency County Hospital Cluj, Cluj-Napoca, Romania
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Sahinoglu-Keskek N, Altan-Yaycioglu R, Canan H, Coban-Karatas M, Erbay A, Yazıcı N, Alkan O. Measurements of Retinal Nerve Fiber Thickness and Ganglion Cell Complex in Neurofibromatosis Type 1, with and Without Optic Pathway Gliomas: A Case Series. Curr Eye Res 2017; 43:424-427. [PMID: 29185816 DOI: 10.1080/02713683.2017.1408130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to investigate differences in retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses in neurofibromatosis 1 (NF1) cases, with and without optic pathway gliomas (OPGs). MATERIALS AND METHODS In total, 33 eyes of 33 subjects were evaluated in this prospective observational case series. Twenty-one patients with a diagnosis of NF1 were enrolled. Patients with NF1 and OPGs were included in Group 1 (n = 9), and patients with NF1 without OPGs were included in Group 2 (n = 12). The control group (Group 3) was comprised of 12 age- and sex-matched subjects with no history of ophthalmic or systemic diseases. All of the subjects underwent complete ophthalmic examinations, including best-corrected visual acuity (BCVA), slit lamp microscopy, and indirect ophthalmoscopy. Additionally, optical coherence tomography (OCT) measurements were obtained. RESULTS There were no statistically significant between-group differences in age and sex (p = 0.227 and 0.986, respectively). The average RNFL thickness in Group 1 (NF1 patients with OPGs) was significantly lower than in Groups 2 and 3 (86.6 ± 22.5, 107.4 ± 6.65, and 108.4 ± 5.05 µm, respectively; p = 0.001). Furthermore, the average GCC thickness in Group 1 was significantly lower than in Groups 2 and 3 (78.6 ± 16.3, 94.8 ± 3.55, and 94.9 ± 3.82 µm, respectively; p < 0.001). CONCLUSIONS Both RNFL and GCC thicknesses were significantly lower in NF1 patients with OPGs. The use of OCT to quantify damage to the visual pathway may enable earlier detection of OPGs in NF1 patients.
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Affiliation(s)
- Nedime Sahinoglu-Keskek
- a Department of Ophthalmology, Faculty of Medicine , Baskent University, Adana Training and Research Center , Adana , Turkey
| | - Rana Altan-Yaycioglu
- a Department of Ophthalmology, Faculty of Medicine , Baskent University, Adana Training and Research Center , Adana , Turkey
| | - Handan Canan
- a Department of Ophthalmology, Faculty of Medicine , Baskent University, Adana Training and Research Center , Adana , Turkey
| | - Muge Coban-Karatas
- a Department of Ophthalmology, Faculty of Medicine , Baskent University, Adana Training and Research Center , Adana , Turkey
| | - Ayşe Erbay
- b Department of Pediatric Hematology and Oncology, Faculty of Medicine , Baskent University, Adana Training and Research Center , Adana , Turkey
| | - Nalan Yazıcı
- b Department of Pediatric Hematology and Oncology, Faculty of Medicine , Baskent University, Adana Training and Research Center , Adana , Turkey
| | - Ozlem Alkan
- c Department of Radiology, Faculty of Medicine , Baskent University, Adana Training and Research Center , Adana , Turkey
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Optic Pathway Gliomas in Neurofibromatosis Type 1: An Update: Surveillance, Treatment Indications, and Biomarkers of Vision. J Neuroophthalmol 2017; 37 Suppl 1:S23-S32. [PMID: 28806346 DOI: 10.1097/wno.0000000000000550] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Optic pathway gliomas (OPGs) occur in 15%-20% of children with neurofibromatosis type 1 (NF1), leading to visual deficits in fewer than half of these individuals. The goal of chemotherapy is to preserve vision, but vision loss in NF1-associated OPG can be unpredictable. Determining which child would benefit from chemotherapy and, equally important, which child is better observed without treatment can be difficult. Unfortunately, despite frequent imaging and ophthalmologic evaluations, some children experience progressive vision loss before treatment. Indications for chemotherapy usually are based on a comprehensive, quantitative assessment of vision, but reliable vision evaluation can be challenging in young children with NF1-OPG. The ability to identify and predict impending vision loss could potentially improve management decisions and visual outcomes. To address this challenge, ophthalmologic, electrophysiologic, and imaging biomarkers of vision in NF1-OPG have been proposed. We review current recommendations for the surveillance of children at risk for NF1-OPG, outline guidelines for initiating therapy, and describe the utility of proposed biomarkers for vision.
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Tsang DS, Murphy ES, Merchant TE. Radiation Therapy for Optic Pathway and Hypothalamic Low-Grade Gliomas in Children. Int J Radiat Oncol Biol Phys 2017; 99:642-651. [DOI: 10.1016/j.ijrobp.2017.07.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/12/2017] [Accepted: 07/18/2017] [Indexed: 01/10/2023]
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Siebelmann S, Bachmann B, Lappas A, Dietlein T, Steven P, Cursiefen C. [Intraoperative optical coherence tomography for examination of newborns and infants under general anesthesia]. Ophthalmologe 2017; 113:651-5. [PMID: 27324964 DOI: 10.1007/s00347-016-0299-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Examination of newborn and children under general anesthesia is essential to prevent amblyopia and blindness; however, the validity was often limited due to a lack of state of the art diagnostic tools in the intraoperative set-up, e. g. optical coherence tomography (OCT). Since OCT devices have been integrated into surgical microscopes, this technique is also available for examination with patients under general anesthesia. OBJECTIVE To give an overview about the possibilities of intraoperative OCT (iOCT) during examination of newborn and infant children under general anesthesia. MATERIAL AND METHODS Analysis of recent literature (PubMed) and initial experiences at the Center for Ophthalmology of the University Hospital of Cologne. RESULTS The use of iOCT enables real-time high-resolution imaging during examinations of children under general anesthesia. All relevant structures of the anterior eye segment (including cornea, lens, chamber angle and iris) can be visualized. Especially when the anterior chamber view is limited due to corneal opacifications, iOCT can deliver important information in addition to that obtained using a surgical microscope. This information is important for the further therapy of the patients. CONCLUSION Online iOCT is a useful extension of the normal surgical microscope, especially for examination of children under general anesthesia and limited view into the anterior chamber. In our experience it also makes sense to transfer this technique to anomalies of the posterior pole because high-resolution imaging of the macula and optic nerve head is possible.
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Affiliation(s)
- S Siebelmann
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland. .,Cluster of Excellence: Cellular Stress Responses in Aging-associated Diseases (CECAD), University of Cologne, Köln, Deutschland.
| | - B Bachmann
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - A Lappas
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - T Dietlein
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
| | - P Steven
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland.,Cluster of Excellence: Cellular Stress Responses in Aging-associated Diseases (CECAD), University of Cologne, Köln, Deutschland
| | - C Cursiefen
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland
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Abstract
Children with neurofibromatosis type 1 frequently manifest optic pathway gliomas-low-grade gliomas intrinsic to the visual pathway. This review describes the molecular and genetic mechanisms driving optic pathway gliomas as well as the clinical symptoms of this relatively common genetic condition. Recommendations for clinical management and descriptions of the newest imaging techniques are discussed.
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Affiliation(s)
| | - Robert A Avery
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Avery RA, Mansoor A, Idrees R, Trimboli-Heidler C, Ishikawa H, Packer RJ, Linguraru MG. Optic pathway glioma volume predicts retinal axon degeneration in neurofibromatosis type 1. Neurology 2016; 87:2403-2407. [PMID: 27815398 DOI: 10.1212/wnl.0000000000003402] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/19/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine whether tumor size is associated with retinal nerve fiber layer (RNFL) thickness, a measure of axonal degeneration and an established biomarker of visual impairment in children with optic pathway gliomas (OPGs) secondary to neurofibromatosis type 1 (NF1). METHODS Children with NF1-OPGs involving the optic nerve (extension into the chiasm and tracts permitted) who underwent both volumetric MRI analysis and optical coherence tomography (OCT) within 2 weeks of each other were included. Volumetric measurement of the entire anterior visual pathway (AVP; optic nerve, chiasm, and tract) was performed using high-resolution T1-weighted MRI. OCT measured the average RNFL thickness around the optic nerve. Linear regression models evaluated the relationship between RNFL thickness and AVP dimensions and volume. RESULTS Thirty-eight participants contributed 55 study eyes. The mean age was 5.78 years. Twenty-two participants (58%) were female. RNFL thickness had a significant negative relationship to total AVP volume and total brain volume (p < 0.05, all comparisons). For every 1 mL increase in AVP volume, RNFL thickness declined by approximately 5 microns. A greater AVP volume of OPGs involving the optic nerve and chiasm, but not the tracts, was independently associated with a lower RNFL thickness (p < 0.05). All participants with an optic chiasm volume >1.3 mL demonstrated axonal damage (i.e., RNFL thickness <80 microns). CONCLUSIONS Greater OPG and AVP volume predicts axonal degeneration, a biomarker of vision loss, in children with NF1-OPGs. MRI volumetric measures may help stratify the risk of visual loss from NF1-OPGs.
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Affiliation(s)
- Robert A Avery
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA.
| | - Awais Mansoor
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Rabia Idrees
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Carmelina Trimboli-Heidler
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Hiroshi Ishikawa
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Roger J Packer
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Marius George Linguraru
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
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Blakeley JO, Plotkin SR. Therapeutic advances for the tumors associated with neurofibromatosis type 1, type 2, and schwannomatosis. Neuro Oncol 2016; 18:624-38. [PMID: 26851632 PMCID: PMC4827037 DOI: 10.1093/neuonc/nov200] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/17/2015] [Indexed: 01/08/2023] Open
Abstract
Neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis (SWN) are tumor-suppressor syndromes. Each syndrome is an orphan disease; however, the tumors that arise within them represent the most common tumors of the nervous system worldwide. Systematic investigation of the pathways impacted by the loss of function of neurofibromin (encoded byNF1) and merlin (encoded byNF2) have led to therapeutic advances for patients with NF1 and NF2. In the syndrome of SWN, the genetic landscape is more complex, with 2 known causative genes (SMARCB1andLZTR1) accounting for up to 50% of familial SWN patients. The understanding of the molecular underpinnings of these syndromes is developing rapidly and offers more therapeutic options for the patients. In addition, common sporadic cancers harbor somatic alterations inNF1(ie, glioblastoma, breast cancer, melanoma),NF2(ie, meningioma, mesothelioma) andSMARCB1(ie, atypical teratoid/rhabdoid tumors) such that advances in management of syndromic tumors may benefit patients both with and without germline mutations. In this review, we discuss the clinical and genetic features of NF1, NF2 and SWN, the therapeutic advances for the tumors that arise within these syndromes and the interaction between these rare tumor syndromes and the common tumors that share these mutations.
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Affiliation(s)
- Jaishri O Blakeley
- Neurology, Neurosurgery and Oncology, Johns Hopkins University, Baltimore, MD (J.O.B.); Neurology, Harvard Medical School, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA (S.R.P.)
| | - Scott R Plotkin
- Neurology, Neurosurgery and Oncology, Johns Hopkins University, Baltimore, MD (J.O.B.); Neurology, Harvard Medical School, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA (S.R.P.)
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Thinner Retinal Nerve Fiber Layer in Very Preterm Versus Term Infants and Relationship to Brain Anatomy and Neurodevelopment. Am J Ophthalmol 2015; 160:1296-1308.e2. [PMID: 26386157 DOI: 10.1016/j.ajo.2015.09.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 01/02/2023]
Abstract
PURPOSE To assess retinal nerve fiber layer (RNFL) thickness at term-equivalent age in very preterm (<32 weeks gestational age) vs term-born infant cohorts, and compare very preterm infant RNFL thickness with brain anatomy and neurodevelopment. DESIGN Cohort study. METHODS RNFL was semi-automatically segmented (1 eye per infant) in 57 very preterm and 50 term infants with adequate images from bedside portable, handheld spectral-domain optical coherence tomography imaging at 37-42 weeks postmenstrual age. Mean RNFL thickness was calculated for the papillomacular bundle (-15 degrees to +15 degrees) and temporal quadrant (-45 degrees to +45 degrees) relative to the fovea-optic nerve axis. Brain magnetic resonance imaging (MRI) scans clinically obtained in 26 very preterm infants were scored for global structural abnormalities by an expert masked to data except for age. Cognitive, language, and motor skills were assessed in 33 of the very preterm infants at 18-24 months corrected age. RESULTS RNFL was thinner for very preterm vs term infants at the papillomacular bundle ([mean ± standard deviation] 61 ± 17 vs 72 ± 13 μm, P < .001) and temporal quadrant (72 ± 21 vs 82 ± 16 μm, P = .005). In very preterm infants, thinner papillomacular bundle RNFL correlated with higher global brain MRI lesion burden index (R(2) = 0.35, P = .001) and lower cognitive (R(2) = 0.18, P = .01) and motor (R(2) = 0.17, P = .02) scores. Relationships were similar for temporal quadrant. CONCLUSIONS Thinner RNFL in very preterm infants relative to term-born infants may relate to brain structure and neurodevelopment.
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Avery RA, Cnaan A, Schuman JS, Trimboli-Heidler C, Chen CL, Packer RJ, Ishikawa H. Longitudinal Change of Circumpapillary Retinal Nerve Fiber Layer Thickness in Children With Optic Pathway Gliomas. Am J Ophthalmol 2015; 160:944-952.e1. [PMID: 26231306 DOI: 10.1016/j.ajo.2015.07.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate longitudinal changes in circumpapillary retinal nerve fiber layer (RNFL) thickness, as measured by spectral-domain optical coherence tomography (SD OCT), in children with optic pathway gliomas. DESIGN Longitudinal cohort study. METHODS Global and quadrant-specific circumpapillary RNFL thickness measures were acquired using either a hand-held SD OCT during sedation or a table-top SD OCT in children old enough to cooperate. Vision loss was defined as either a 0.2 logMAR decline in visual acuity or progression of visual field. Percent change in circumpapillary RNFL thickness in eyes experiencing vision loss was compared to eyes with stable vision. RESULTS Fifty-five eyes completed 250 study visits. Ten eyes (18%) from 7 patients experienced a new episode of vision loss during the study and 45 eyes (82%) from 39 patients demonstrated stable vision across study visits. Percent decline of RNFL thickness between the baseline visit and first event of vision loss event was greatest in the superior (-14%) and inferior (-10%) quadrants as well as global average (-13%). Using a threshold of ≥10% decline in RNFL, the positive and negative predictive value for vision loss when 2 or more anatomic sectors were affected was 100% and 94%, respectively. CONCLUSIONS Children experiencing vision loss from their optic pathway gliomas frequently demonstrate a ≥10% decline of RNFL thickness in 1 or more anatomic sectors. Global average and the inferior quadrant demonstrated the best positive and negative predictive values. Circumpapillary RNFL is a surrogate marker of vision and could be helpful in making treatment decisions for children with optic pathway gliomas.
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Avery RA, Rajjoub RD, Trimboli-Heidler C, Waldman AT. Applications of optical coherence tomography in pediatric clinical neuroscience. Neuropediatrics 2015; 46:88-97. [PMID: 25803824 PMCID: PMC4436151 DOI: 10.1055/s-0035-1549098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For nearly two centuries, the ophthalmoscope has permitted examination of the retina and optic nerve-the only axons directly visualized by the physician. The retinal ganglion cells project their axons, which travel along the innermost retina to form the optic nerve, marking the beginning of the anterior visual pathway. Both the structure and function of the visual pathway are essential components of the neurologic examination as it can be involved in numerous acquired, congenital and genetic central nervous system conditions. The development of optical coherence tomography now permits the pediatric neuroscientist to visualize and quantify the optic nerve and retinal layers with unprecedented resolution. As optical coherence tomography becomes more accessible and integrated into research and clinical care, the pediatric neuroscientist may have the opportunity to utilize and/or interpret results from this device. This review describes the basic technical features of optical coherence tomography and highlights its potential clinical and research applications in pediatric clinical neuroscience including optic nerve swelling, optic neuritis, tumors of the visual pathway, vigabatrin toxicity, nystagmus, and neurodegenerative conditions.
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Affiliation(s)
- Robert A. Avery
- The Gilbert Family Neurofibromatosis Institute, Children’s National Health System, Washington, District of Columbia, United States,Department of Neurology, Children’s National Health System, Washington, District of Columbia, United States,Department of Ophthalmology, Children’s National Health System, Washington, District of Columbia, United States,Department of Pediatrics, Children’ s National Health System, Washington, District of Columbia, United States,Center for Neuroscience and Behavior, Children’s National Health System, Washington, District of Columbia, United States
| | - Raneem D. Rajjoub
- George Washington University School of Medicine, Washington, District of Columbia, United States
| | - Carmelina Trimboli-Heidler
- The Gilbert Family Neurofibromatosis Institute, Children’s National Health System, Washington, District of Columbia, United States
| | - Amy T. Waldman
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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Rothman AL, Sevilla MB, Freedman SF, Tong AY, Tai V, Tran-Viet D, Farsiu S, Toth CA, El-Dairi MA. Assessment of retinal nerve fiber layer thickness in healthy, full-term neonates. Am J Ophthalmol 2015; 159:803-11. [PMID: 25634528 DOI: 10.1016/j.ajo.2015.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To measure average retinal nerve fiber layer (RNFL) thicknesses in healthy, full-term neonates. DESIGN Descriptive research to develop normative data. METHODS Healthy infants born between 37 and 42 weeks postmenstrual age were imaged with hand-held spectral-domain optical coherence tomography. A custom script segmented the RNFL; the fovea and optic nerve center were manually selected. A second script measured the average RNFL thickness along the papillomacular bundle, defined as the arc from -15 degrees to +15 degrees on the axis from the optic nerve to fovea, with radii of 1.1, 1.3, 1.5, and 1.7 mm from the center of the optic disc. Shapiro-Wilk W tests assessed these measurements for normality to determine the age-appropriate radial distance for subsequent analyses. Average RNFL thicknesses for four temporal 45-degree sectors (superior temporal, temporal superior, temporal inferior, and inferior temporal) and the temporal quadrant were calculated and compared to demographic parameters for all infants. RESULTS Fifty full-term infants were adequately imaged for RNFL analysis. RNFL thicknesses at 1.5 mm radial distance from the optic nerve were the most normally distributed. While there was a trend toward greater mean superior temporal RNFL thickness for both black and Hispanic vs white infants (128 ± 27 μm, 124 ± 30 μm, and 100 ± 19 μm, respectively, P = .04 for both comparisons), there were no other significant differences noted in RNFL thicknesses by race, sex, gestational age, or birth weight. CONCLUSIONS We present RNFL thickness measurements for healthy, full-term infants that may serve as normative data for future analyses.
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Affiliation(s)
- Adam L Rothman
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Monica B Sevilla
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Amy Y Tong
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Vincent Tai
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Du Tran-Viet
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Sina Farsiu
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina; Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
| | - Mays A El-Dairi
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
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Brossier NM, Gutmann DH. Improving outcomes for neurofibromatosis 1-associated brain tumors. Expert Rev Anticancer Ther 2015; 15:415-23. [PMID: 25652347 DOI: 10.1586/14737140.2015.1009043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Children and adults with neurofibromatosis type 1 (NF1) are predisposed to developing CNS tumors, including optic pathway gliomas (OPGs), brainstem gliomas (BSGs) and high-grade gliomas. Although current first-line treatments for low-grade gliomas (OPGs and BSGs) may prevent further tumor growth, they rarely result in restoration of the associated visual or neurological deficits. The availability of accurate small-animal models of NF1-associated brain tumors has established tractable experimental platforms for the discovery and evaluation of promising therapeutic agents. On the basis of these preclinical studies, biologically targeted agents are now being evaluated in children with NF1-associated low-grade brain tumors. Collectively, these models have also begun to reveal potential neuroprotective and risk assessment strategies for this brain tumor-prone population.
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Affiliation(s)
- Nicole M Brossier
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
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Rajjoub RD, Trimboli-Heidler C, Packer RJ, Avery RA. Reproducibility of retinal nerve fiber layer thickness measures using eye tracking in children with nonglaucomatous optic neuropathy. Am J Ophthalmol 2015; 159:71-7.e1. [PMID: 25256068 DOI: 10.1016/j.ajo.2014.09.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/16/2014] [Accepted: 09/18/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine the intra- and intervisit reproducibility of circumpapillary retinal nerve fiber layer (RNFL) thickness measures using eye tracking-assisted spectral-domain optical coherence tomography (SD OCT) in children with nonglaucomatous optic neuropathy. DESIGN Prospective longitudinal study. METHODS Circumpapillary RNFL thickness measures were acquired with SD OCT using the eye-tracking feature at 2 separate study visits. Children with normal and abnormal vision (visual acuity ≥ 0.2 logMAR above normal and/or visual field loss) who demonstrated clinical and radiographic stability were enrolled. Intra- and intervisit reproducibility was calculated for the global average and 9 anatomic sectors by calculating the coefficient of variation and intraclass correlation coefficient. RESULTS Forty-two subjects (median age 8.6 years, range 3.9-18.2 years) met inclusion criteria and contributed 62 study eyes. Both the abnormal and normal vision cohort demonstrated the lowest intravisit coefficient of variation for the global RNFL thickness. Intervisit reproducibility remained good for those with normal and abnormal vision, although small but statistically significant increases in the coefficient of variation were observed for multiple anatomic sectors in both cohorts. The magnitude of visual acuity loss was significantly associated with the global (ß = 0.026, P < .01) and temporal sector coefficient of variation (ß = 0.099, P < .01). CONCLUSION SD OCT with eye tracking demonstrates highly reproducible RNFL thickness measures. Subjects with vision loss demonstrate greater intra- and intervisit variability than those with normal vision.
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Affiliation(s)
- Raneem D Rajjoub
- George Washington University School of Medicine, Children's National Health System, Washington, DC
| | | | - Roger J Packer
- The Gilbert Family Neurofibromatosis Institute, Children's National Health System, Washington, DC; Department of Pediatrics, Children's National Health System, Washington, DC; Center for Neuroscience and Behavior, Children's National Health System, Washington, DC; The Brain Tumor Institute, Children's National Health System, Washington, DC
| | - Robert A Avery
- The Gilbert Family Neurofibromatosis Institute, Children's National Health System, Washington, DC; Department of Ophthalmology, Children's National Health System, Washington, DC; Department of Pediatrics, Children's National Health System, Washington, DC; Center for Neuroscience and Behavior, Children's National Health System, Washington, DC.
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Kaul A, Toonen JA, Cimino PJ, Gianino SM, Gutmann DH. Akt- or MEK-mediated mTOR inhibition suppresses Nf1 optic glioma growth. Neuro Oncol 2014; 17:843-53. [PMID: 25534823 DOI: 10.1093/neuonc/nou329] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 11/08/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Children with neurofibromatosis type 1 (NF1) develop optic pathway gliomas, which result from impaired NF1 protein regulation of Ras activity. One obstacle to the implementation of biologically targeted therapies is an incomplete understanding of the individual contributions of the downstream Ras effectors (mitogen-activated protein kinase kinase [MEK], Akt) to optic glioma maintenance. This study was designed to address the importance of MEK and Akt signaling to Nf1 optic glioma growth. METHODS Primary neonatal mouse astrocyte cultures were employed to determine the consequence of phosphatidylinositol-3 kinase (PI3K)/Akt and MEK inhibition on Nf1-deficient astrocyte growth. Nf1 optic glioma-bearing mice were used to assess the effect of Akt and MEK inhibition on tumor volume, proliferation, and retinal ganglion cell dysfunction. RESULTS Both MEK and Akt were hyperactivated in Nf1-deficient astrocytes in vitro and in Nf1 murine optic gliomas in vivo. Pharmacologic PI3K or Akt inhibition reduced Nf1-deficient astrocyte proliferation to wild-type levels, while PI3K inhibition decreased Nf1 optic glioma volume and proliferation. Akt inhibition of Nf1-deficient astrocyte and optic glioma growth reflected Akt-dependent activation of mammalian target of rapamycin (mTOR). Sustained MEK pharmacologic blockade also attenuated Nf1-deficient astrocytes as well as Nf1 optic glioma volume and proliferation. Importantly, these MEK inhibitory effects resulted from p90RSK-mediated, Akt-independent mTOR activation. Finally, both PI3K and MEK inhibition reduced optic glioma-associated retinal ganglion cell loss and nerve fiber layer thinning. CONCLUSION These findings establish that the convergence of 2 distinct Ras effector pathways on mTOR signaling maintains Nf1 mouse optic glioma growth, supporting the evaluation of pharmacologic inhibitors that target mTOR function in future human NF1-optic pathway glioma clinical trials.
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Affiliation(s)
- Aparna Kaul
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (A.K., J.A.T., S.M.G., D.H.G.); Department of Pathology, Washington University School of Medicine, St. Louis, Missouri (P.J.C.)
| | - Joseph A Toonen
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (A.K., J.A.T., S.M.G., D.H.G.); Department of Pathology, Washington University School of Medicine, St. Louis, Missouri (P.J.C.)
| | - Patrick J Cimino
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (A.K., J.A.T., S.M.G., D.H.G.); Department of Pathology, Washington University School of Medicine, St. Louis, Missouri (P.J.C.)
| | - Scott M Gianino
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (A.K., J.A.T., S.M.G., D.H.G.); Department of Pathology, Washington University School of Medicine, St. Louis, Missouri (P.J.C.)
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (A.K., J.A.T., S.M.G., D.H.G.); Department of Pathology, Washington University School of Medicine, St. Louis, Missouri (P.J.C.)
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Drimtzias E, Simmons I. Ophthalmic manifestation and management of CNS tumors in paediatric population. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2015.987755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Intra- and inter-visit reproducibility of ganglion cell-inner plexiform layer measurements using handheld optical coherence tomography in children with optic pathway gliomas. Am J Ophthalmol 2014; 158:916-23. [PMID: 25068639 DOI: 10.1016/j.ajo.2014.07.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the intra- and inter-visit reproducibility of ganglion cell-inner plexiform layer thickness measures using handheld optical coherence tomography (OCT) in sedated children with optic pathway gliomas and/or neurofibromatosis type 1 (NF1). DESIGN Prospective longitudinal cohort study. METHODS Children with sporadic optic pathway gliomas and/or NF1 who had ≥2 volumes acquired over the macula using handheld OCT during sedation for clinically indicated magnetic resonance imaging were eligible for the intra-visit cohort. Children with repeat handheld OCT imaging within 6 months were eligible for the inter-visit cohort. Total retinal thickness and ganglion cell-inner plexiform layer thickness were measured using custom-designed automated segmentation software. Reproducibility was compared across average and anatomic quadrant by calculating the coefficient of variation (CV) and intraclass correlation coefficient (ICC). RESULTS Forty-two subjects (median age 5.4 years, range 0.8-12.7 years) contributed 45 eyes to the intra-visit cohort. Thirty-one subject eyes had normal vision and 14 had abnormal vision (decreased visual acuity and/or visual field). Average and quadrant ganglion cell-inner plexiform layer measures demonstrated CVs ≤4.5% with excellent ICCs (>0.935). The superior quadrant CV differed between subjects with (4.4%) and without (2.1%) vision loss (P < .05). Twenty-five subject eyes were eligible for the inter-visit cohort, demonstrating CVs from 1.6% to 5.2%. Inter-visit ICCs were excellent (0.955-0.995). DISCUSSION Handheld OCT imaging in sedated children with optic pathway gliomas produces highly reproducible measures of ganglion cell-inner plexiform layer thickness.
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Avery RA, Cnaan A, Schuman JS, Chen CL, Glaug NC, Packer RJ, Quinn GE, Ishikawa H. Reproducibility of circumpapillary retinal nerve fiber layer measurements using handheld optical coherence tomography in sedated children. Am J Ophthalmol 2014; 158:780-787.e1. [PMID: 24983792 DOI: 10.1016/j.ajo.2014.06.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the intra- and intervisit reproducibility of circumpapillary retinal nerve fiber layer (RNFL) measures using handheld optical coherence tomography (OCT) in sedated children. DESIGN Prospective cross-sectional and longitudinal study. METHODS Children undergoing sedation for a clinically indicated magnetic resonance imaging for an optic pathway glioma and/or neurofibromatosis type 1 (NF1) had multiple 6 × 6 mm volumes (isotropic 300 × 300 or nonisotropic 1000 × 100 samplings) acquired over the optic nerve. Children with 2 handheld OCT sessions within 6 months were included in the intervisit cohort. The intra- and intervisit coefficient of variation (CV) and intraclass correlation coefficient (ICC) were calculated for the average and anatomic quadrant circumpapillary RNFL thickness. RESULTS Fifty-nine subjects (mean age 5.1 years, range 0.8-13.0 years) comprised the intravisit cohort and 29 subjects (mean age 5.7 years, range 1.8-12.7 years) contributed to the intervisit cohort. Forty-nine subjects had an optic pathway glioma and 10 subjects had NF1 without an optic pathway glioma. The CV was comparable regardless of imaging with an isotropic and nonisotropic volume in both the intra- and intervisit cohorts. The average circumpapillary RNFL demonstrated the lowest CV and highest ICC compared to the quadrants. For the intervisit cohort, the average ICC was typically higher while the CV was typically lower, but not statistically different compared to the other quadrants. DISCUSSION Circumpapillary RNFL measures acquired with handheld OCT during sedation demonstrate good intra- and intervisit reproducibility. Handheld OCT has the potential to monitor progressive optic neuropathies in young children who have difficulty cooperating with traditional OCT devices.
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Kaul A, Toonen JA, Gianino SM, Gutmann DH. The impact of coexisting genetic mutations on murine optic glioma biology. Neuro Oncol 2014; 17:670-7. [PMID: 25246427 DOI: 10.1093/neuonc/nou287] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/26/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Children with the neurofibromatosis type 1 (NF1) tumor predisposition syndrome are prone to the development of optic pathway gliomas resulting from biallelic inactivation of the NF1 gene. Recent studies have revealed the presence of other molecular alterations in a small portion of these NF1-associated brain tumors. The purpose of this study was to leverage Nf1 genetically engineered mouse strains to define the functional significance of these changes to optic glioma biology. METHODS Nf1+/- mice were intercrossed with Nf1(flox/flox) mice, which were then crossed with Nf1(flox/flox); GFAP-Cre mice, to generate Nf1(flox/mut); GFAP-Cre (FMC) mice. These mice were additionally mated with conditional KIAA1549:BRAF knock-in or Pten(flox/wt) mice to generate Nf1(flox/mut); f-BRAF; GFAP-Cre (FMBC) mice or Nf1(flox/mut); Pten(flox/wt); GFAP-Cre (FMPC) mice, respectively. The resulting optic gliomas were analyzed for changes in tumor volume, proliferation, and retinal ganglion cell loss. RESULTS While KIAA1549:BRAF conferred no additional biological properties on Nf1 optic glioma, FMPC mice had larger optic gliomas with greater proliferative indices and microglial infiltration. In addition, all 3 Nf1 murine optic glioma strains exhibited reduced retinal ganglion cell survival and numbers; however, FMPC mice had greater retinal nerve fiber layer thinning near the optic head relative to FMC and FMBC mice. CONCLUSIONS Collectively, these experiments demonstrate genetic cooperativity between Nf1 loss and Pten heterozygosity relevant to optic glioma biology and further underscore the value of employing genetically engineered mouse strains to define the contribution of discovered molecular alterations to brain tumor pathogenesis.
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Affiliation(s)
- Aparna Kaul
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph A Toonen
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Scott M Gianino
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
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Gu S, Glaug N, Cnaan A, Packer RJ, Avery RA. Ganglion cell layer-inner plexiform layer thickness and vision loss in young children with optic pathway gliomas. Invest Ophthalmol Vis Sci 2014; 55:1402-8. [PMID: 24519429 DOI: 10.1167/iovs.13-13119] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine if measures of macular ganglion cell layer-inner plexiform layer (GCL-IPL) thickness can discriminate between children with and without vision loss (visual acuity or field) from their optic pathway glioma (OPG) using spectral-domain optical coherence tomography (SD-OCT). METHODS Children with OPGs (sporadic or secondary to neurofibromatosis type 1) enrolled in a prospective study of SD-OCT were included if they were cooperative for vision testing and macular SD-OCT images were acquired. Manual segmentation of the macular GCL-IPL and macular retinal nerve fiber layer (RNFL) was performed using elliptical annuli with diameters of 1.5, 3.0, and 4.5 mm. Logistic regression assessed the ability of GCL-IPL and RNFL thickness measures (micrometers) to differentiate between the normal and abnormal vision groups. RESULTS Forty-seven study eyes (normal vision = 31, abnormal vision = 16) from 26 children with OPGs were included. Median age was 5.3 years (range, 2.5-12.8). Thickness of all GCL-IPL and RNFL quadrants differed between the normal and abnormal vision groups (P < 0.01). All GCL-IPL measures demonstrated excellent discrimination between groups (area under the curve [AUC] > 0.90 for all diameters). Using the lower fifth percentile threshold, the number of abnormal GCL-IPL inner macula (3.0 mm) quadrants achieved the highest AUC (0.989) and was greater than the macula RNFL AUCs (P < 0.05). CONCLUSIONS Decreased GCL-IPL thickness (<fifth percentile) can discriminate between children with and without vision loss from their OPG. Ganglion cell layer-inner plexiform layer thickness could be used as a surrogate marker of vision in children with OPGs.
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Affiliation(s)
- Sherry Gu
- George Washington University School of Medicine, Washington, DC
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