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Structural Features of Patients with Drusen-like Deposits and Systemic Lupus Erythematosus. J Clin Med 2022; 11:jcm11206012. [PMID: 36294333 PMCID: PMC9605325 DOI: 10.3390/jcm11206012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/06/2022] [Accepted: 10/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The relevance of drusen-like deposits (DLD) in patients with systemic lupus erythematosus (SLE) is to a large extent uncertain. Their genesis is proposed to be correlated to immune-complex and complement depositions in the framework of SLE. The intention of this study was to determine potential morphological differences in the choroid and retina as well as potential microvascular changes comparing two cohorts of SLE patients divergent in the presence or absence of DLD using multimodal imaging. Methods: Both eyes of 16 SLE patients with DLD were compared to an age- and sex-matched control-group consisting of 16 SLE patients without detectable DLD. Both cohorts were treated with hydroxychloroquine (HCQ) and did not differ in the treatment duration or dosage. Using spectral-domain optical coherence tomography (SD-OCT) choroidal volume measures, choroidal vascularity indices (CVI) and retinal layer segmentation was performed and compared. In addition, by the exploitation of optical coherence tomography angiography vascular density, perfusion density of superficial and deep retinal capillary plexuses and the choriocapillaris were analyzed. For the choroidal OCT-scans, a subset of 51 healthy individuals served as a reference-group. Results: CVI measures revealed a significant reduction in eyes with DLD compared to healthy controls (0.56 (0.54−0.59) versus 0.58 (0.57−0.59) (p = 0.018) and 0.56 (0.54−0.58) versus 0.58 (0.57−0.60) (p < 0.001)). The photoreceptor cell layer presented significant thinning in both eyes of subjects with DLD compared to control subjects without DLD (68.8 ± 7.7 µm vs. 77.1 ± 7.3 µm for right eyes, p = 0.008, and 66.5 ± 10.5 µm vs. 76.1 ± 6.3 µm for left eyes, p = 0.011). OCTA scans revealed no significant changes, yet there could be observed numerically lower values in the capillary plexuses of the retina in eyes with DLD than in eyes without DLD. Conclusions: Our results illustrated significant alterations in the choroidal and retinal analyzes, suggesting a correlation between DLD and the progression of inflammatory processes in the course of SLE leading to retinal degeneration. For this reason, DLD could serve as a biomarker for a more active state of disease.
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Terao R, Matsuda A, Ogawa A, Shimizu K, Azuma K, Inoue T, Obata R. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY STUDY OF CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH EARLY-ONSET DRUSEN. Retin Cases Brief Rep 2021; 15:581-587. [PMID: 30664081 DOI: 10.1097/icb.0000000000000856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report three middle-aged cases with choroidal neovascularization (CNV) associated with early-onset drusen documented with optical coherence tomography angiography (OCTA). METHODS Three patients with bilateral early-onset drusen were referred to our hospital. Fundus examination, fluorescein angiography, indocyanine green angiography, OCTA, and other multimodal imaging were performed. RESULTS Case 1 involved a 47-year-old woman who presented with sudden unilateral anorthopia. She had no previous systemic pathologies. Funduscopic examination and fluorescein angiography revealed bilateral large colloid drusen accompanied by unilateral mild subretinal hemorrhage. Indocyanine green angiography revealed CNV, although it was unclear in fluorescein angiography. Optical coherence tomography angiography also showed interconnecting CNV beneath the retinal pigment epithelium. Case 2 involved a 40-year-old woman with membranoproliferative glomerulonephritis Type 3 who presented with unilateral anorthopia. On fluorescein angiography, cuticular drusen secondary to membranoproliferative glomerulonephritis were seen in both eyes. An interconnecting vascular network was revealed with OCTA and indocyanine green angiography indicating Type 1 CNV in the affected eye. Case 3 involved a 47-year-old man without any medical or family history. Predominant large colloid drusen associated with cuticular drusen were seen in both eyes. Unilateral mild serosanguinous changes were accompanied in the macula, where Type 1 CNV was detected with OCTA. CONCLUSION All our cases with early-onset drusen showed Type 1 CNV that was detected by indocyanine green angiography or OCTA. Optical coherence tomography angiography has a potential to help noninvasively diagnose CNV in the cases of EOD.
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Affiliation(s)
- Ryo Terao
- Department of Ophthalmology, Graduate School of Medicine, Tokyo University, Tokyo, Japan ; and
| | - Aya Matsuda
- Department of Ophthalmology, Toranomon Hospital, Tokyo, Japan
| | - Asako Ogawa
- Department of Ophthalmology, Graduate School of Medicine, Tokyo University, Tokyo, Japan ; and
| | - Kimiko Shimizu
- Department of Ophthalmology, Graduate School of Medicine, Tokyo University, Tokyo, Japan ; and
| | - Keiko Azuma
- Department of Ophthalmology, Graduate School of Medicine, Tokyo University, Tokyo, Japan ; and
| | - Tatsuya Inoue
- Department of Ophthalmology, Graduate School of Medicine, Tokyo University, Tokyo, Japan ; and
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine, Tokyo University, Tokyo, Japan ; and
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Awan MA, Grierson DJ, Walker S. Bilateral macular sub‐retinal fluid and retinal pigment epithelial detachment associated with type 2 membrano‐proliferative glomerulonephritis. Clin Exp Optom 2021; 91:476-9. [DOI: 10.1111/j.1444-0938.2008.00268.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Muhammad Amer Awan
- Hairmyres Hospital, Glasgow, United Kingdom
- Gartnavel General Hospital, Glasgow, United Kingdom
E‐mail:
| | | | - S Walker
- Gartnavel General Hospital, Glasgow, United Kingdom
E‐mail:
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Song D, Mohammed I, Bhuyan R, Miwa T, Williams AL, Gullipalli D, Sato S, Song Y, Dunaief JL, Song WC. Retinal Basal Laminar Deposits in Complement fH/fP Mouse Model of Dense Deposit Disease. Invest Ophthalmol Vis Sci 2019; 59:3405-3415. [PMID: 30025090 PMCID: PMC6040236 DOI: 10.1167/iovs.18-24133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose Dense deposit disease (DDD) is caused by dysregulation of the alternative pathway of the complement cascade and characterized by electron-dense deposits in the kidney glomerular basement membrane (GBM) and drusen in Bruch's membrane (BrM). Complement factor H (fH) and factor properdin (fP) regulate complement activation; fH inhibits alternative pathway (AP) activation, whereas fP promotes it. We report pathologic changes in eyes of an fH and fP double-mutant mouse, which we previously showed have dense deposits in the GBM and early mortality from nephropathy. Methods fHm/m, fP−/−, and fHm/m/fP−/− mice were generated on a C57BL/6–129J background. Fundus imaging at 8 weeks of age was followed by analysis via light and electron microscopy. Retinal function was assessed by electroretinography (ERG). Complement levels and localization were tested by immunohistochemistry and ELISA. Retinas of fHm/m/fP−/− mice treated with intraperitoneal injections of an anti-C5 antibody were compared to those of age- and genotype-matched mice injected with an isotype control antibody. Results fHm/m/fP−/− mice suffered early-onset retinal hypopigmented spots detected using in vivo retinal photography, and histologic examination showed basal laminar deposits (BLamD), degeneration of the photoreceptors, and RPE vacuolization. ERG showed diminished retinal function. The anti-C5 antibody was retina-protective. Conclusions This unique mouse represents a new model of complement-mediated rapid-onset DDD, and could be useful in exploring the pathologic changes associated with BLamD in age-related macular degeneration.
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Affiliation(s)
- Delu Song
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Imran Mohammed
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Rupak Bhuyan
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Takashi Miwa
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Allison Lesher Williams
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Damodar Gullipalli
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Sayaka Sato
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ying Song
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joshua L Dunaief
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Wen-Chao Song
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Takei M, Obana A, Inomata T, Tanaka T, Shiang T, Bae Y, Takemura T, Murakami A. Fundus changes in type III membranoproliferative glomerulonephritis: a case report. BMC Ophthalmol 2018; 18:72. [PMID: 29510686 PMCID: PMC5840715 DOI: 10.1186/s12886-018-0738-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/02/2018] [Indexed: 11/15/2022] Open
Abstract
Background Membranoproliferative glomerulonephritis (MPGN) is characterized by mesangial cell proliferation and is classified into types I, II and III based on structural changes in the glomerular capillary walls. The drusen-like deposits of MPGN type II have been studied, but the fundus changes in MPGN type III have yet to be clarified. We report a case of MPGN type III with multiple deposits in the retinal pigment epithelium (RPE). Case presentation A 40-year-old Japanese woman with MPGN type III developed numerous yellow-white patches in the central macula of both eyes. Optical coherence tomography (OCT) showed deposits between the RPE and Bruch’s membrane. Fluorescein angiography showed choroidal neovascularization (CNV) and OCT confirmed it as type 1 (sub RPE) CNV with fibrin tissue and subretinal fluid in the right eye. After 12 months, the CNV and subretinal fluid resolved spontaneously but the RPE deposits remained in both eyes. Her final visual acuity was 20/20 in the right eye and 20/16 in the left eye. Conclusion We report a case of MPGN type III with multiple deposits in the RPE and CNV, suggesting that various fundus changes occur in MPGN type III and careful fundus follow-up is necessary to prevent vision loss.
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Affiliation(s)
- Masato Takei
- Department of Ophthalmology, Japan Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, Japan.,Department of Ophthalmology, Juntendo University Faculty of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Akira Obana
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, Japan
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Faculty of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Strategic Operation Management and Improvement, Juntendo University Faculty of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Takao Tanaka
- Ebisu Eye Clinic, 1-1-2, Ebisunishi, Shibuya-ku, Tokyo, Japan
| | - Tina Shiang
- Orange Park Medical Center, Jacksonville, FL, USA
| | - Yuan Bae
- Department of Pathology, Japan Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, Japan
| | - Tamiko Takemura
- Department of Pathology, Japan Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Faculty of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Mansour AM, Lima LH, Arevalo JF, Amaro MH, Lozano V, Ghannam AB, Chan EW. Retinal findings in membranoproliferative glomerulonephritis. Am J Ophthalmol Case Rep 2017; 7:83-90. [PMID: 29260086 PMCID: PMC5722170 DOI: 10.1016/j.ajoc.2017.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 04/10/2017] [Accepted: 06/20/2017] [Indexed: 02/05/2023] Open
Abstract
Purpose To assess the evolution of retinal findings in patients with membranoproliferative glomerulonephritis (MPGN) by funduscopy, intravenous fluorescein angiography and optical coherence tomography. Observations Three women and one man were followed for a period of 1.5–37 years. Four patients (8 eyes) had drusen detected at first fundus exam at age 24, 29, 50 and 55. Three patients (6 eyes) had diffuse thickening of Bruch's membrane, and two patients (3 eyes) had detachment of the retinal pigment epithelium with serous retinal detachment. Drusen tended to widen over a period of 10-year follow-up in one case. Conclusions and importance Drusen remain the ocular stigmata for MPGN occuring at an early age. The retinal disease is progressive with gradual thickening of Bruch's membrane and occurrence of retinal pigment epithelium detachment.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Luiz H Lima
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Miguel Hage Amaro
- Instituto de Olhos e Laser de Belém, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Virginia Lozano
- Department of Ophthalmology, Complejo Hospitalario Universitario de Canarias, Tenerife, Canary Islands, Spain
| | - Alaa Bou Ghannam
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Errol W Chan
- Department of Ophthalmology, McGill University, Montreal, Canada
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Invernizzi A, dell'Arti L, Leone G, Galimberti D, Garoli E, Moroni G, Santaniello A, Agarwal A, Viola F. Drusen-like Deposits in Young Adults Diagnosed With Systemic Lupus Erythematosus. Am J Ophthalmol 2017; 175:68-76. [PMID: 27939560 DOI: 10.1016/j.ajo.2016.11.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the prevalence of drusen-like deposits (DLDs) and choroidal changes in patients with systemic lupus erythematosus (SLE), with or without glomerulonephritis; and to correlate ocular findings with systemic features. DESIGN Case-control study. METHODS Sixty patients with SLE (age, 18-55 years; 30 with and 30 without SLE-related glomerulonephritis) and 60 age- and sex-matched healthy controls were enrolled. All patients underwent noninvasive multimodal imaging that included fundus photography, near-infrared reflectance, blue autofluorescence, blue reflectance, and spectral-domain optical coherence tomography (SDOCT). Images were analyzed for the prevalence of DLDs. Distribution, size, and number of DLDs were measured. Correlations between ocular findings and systemic features were analyzed. Subfoveal choroidal thickness (SCT) was measured using the SDOCT. RESULTS Drusen-like deposits were detected in 40% of SLE subjects and 3.33% of controls (P < .0001). Compared with other techniques, SDOCT detected the largest number of affected subjects. In eyes with DLDs, small, medium, and large lesions were found in 75%, 50%, and 42% of cases, respectively. Drusen-like deposits were located in the nasal, temporal, inferior, superior, and central regions of the posterior pole in 83%, 75%, 67%, 54%, and 25% of eyes, respectively. The prevalence of DLDs in patients with SLE was similar regardless of renal involvement, but patients with glomerulonephritis had more DLDs per eye, larger deposits, and DLDs in >3 quadrants (P < .001, P = .03, P = .009, respectively). Subfoveal choroidal thickness was greater in patients with SLE (P = .002). CONCLUSIONS Drusen-like deposits in patients with SLE were independent of renal disease and were best detected with SDOCT. Lupus-related glomerulonephritis was associated with more fundus abnormalities and a screening SDOCT should be considered in all patients with SLE. Drusen-like deposits in the absence of glomerulonephritis may support the recent proposal that complement alteration is the primary cause of these lesions.
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Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy; Ophthalmological Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy.
| | - Laura dell'Arti
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaia Leone
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Galimberti
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Garoli
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriella Moroni
- Nephrology Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Santaniello
- Immunological Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| | - Aniruddha Agarwal
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Francesco Viola
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
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Dalvin LA, Fervenza FC, Sethi S, Pulido JS. Manifestations of Complement-Mediated and Immune Complex-Mediated Membranoproliferative Glomerulonephritis: A Comparative Consecutive Series. Ophthalmology 2016; 123:1588-94. [PMID: 26996341 DOI: 10.1016/j.ophtha.2016.02.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/26/2016] [Accepted: 02/06/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Membranoproliferative glomerulonephritis (MPGN) recently was reclassified to reflect the underlying cause as a complement-mediated and immune complex-mediated disease. This classification is based on renal biopsy immunofluorescence examination, making the former electron-microscopy classification obsolete. In this report, we describe related eye findings in patients with MPGN based on the new classification. DESIGN Retrospective case series. PARTICIPANTS All Mayo Clinic Rochester patients with pathology-confirmed complement- and immune complex-mediated MPGN who had available ophthalmology records from 1997 through 2014 were included in this study. METHODS The medical and pathologic records of patients with MPGN and eye examination results were reviewed from years 1997 through 2014. MAIN OUTCOME MEASURES The number of patients and the number of eyes with MPGN-related pathologic features were examined. Visual acuity also was considered. RESULTS There were 23 patients with complement-mediated MPGN and available eye examination results. Of these, 9 patients (39%) and 17 eyes (37%) had retinal pathologic features that likely were related to the same underlying pathophysiologic process as their renal disease. Five patients (22%) and 6 eyes (13%) had significant vision loss. There were 23 patients with immune complex-mediated MPGN and available eye examination results. Only 2 (9%) of these patients (4 eyes) had retinal pathologic features that potentially could be related to the same underlying pathophysiologic process as their renal disease, and neither had vision loss. CONCLUSIONS Retinal abnormalities are more prominent among patients with complement-mediated MPGN when compared with patients with immune complex-mediated MPGN. It is critical for ophthalmologists to recognize the updated MPGN classification system, and all patients with complement-mediated MPGN require screening eye examinations.
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Affiliation(s)
- Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Fernando C Fervenza
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Sethi
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota.
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Savige J, Amos L, Ierino F, Mack HG, Symons RCA, Hughes P, Nicholls K, Colville D. Retinal disease in the C3 glomerulopathies and the risk of impaired vision. Ophthalmic Genet 2016; 37:369-376. [PMID: 26915021 DOI: 10.3109/13816810.2015.1101777] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Dense deposit disease and atypical hemolytic uremic syndrome are often caused by Complement Factor H (CFH) mutations. This study describes the retinal abnormalities in dense deposit disease and, for the first time, atypical haemolytic uremic syndrome. It also reviews our understanding of drusen pathogenesis and their relevance for glomerular disease. METHODS Six individuals with dense deposit disease and one with atypical haemolytic uremic syndrome were studied from 2 to 40 years after presentation. Five had renal transplants. All four who had genetic testing had CFH mutations. Individuals underwent ophthalmological review and retinal photography, and in some cases, optical coherence tomography, and further tests of retinal function. RESULTS All subjects with dense deposit disease had impaired night vision and retinal drusen or whitish-yellow deposits. Retinal atrophy, pigmentation, and hemorrhage were common. In late disease, peripheral vision was restricted, central vision was distorted, and there were scotoma from sub-retinal choroidal neovascular membranes and atypical serous retinopathy. Drusen were present but less prominent in the young person with atypical uremic syndrome due to a heterozygous CFH mutation. CONCLUSIONS Drusen are common in forms of C3 glomerulopathy caused by compound heterozygous or heterozygous CFH mutations. They are useful diagnostically but also impair vision. Drusen have an identical composition to glomerular deposits. They are also identical to the drusen of age-related macular degeneration, and may respond to the same treatments. Individuals with a C3 glomerulopathy should be assessed ophthalmologically at diagnosis, and monitored regularly for vision-threatening complications.
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Affiliation(s)
- J Savige
- a University of Melbourne Department of Medicine , Melbourne Health and Northern Health, Royal Melbourne Hospital , Parkville , Victoria , Australia.,b Department of Nephrology , Royal Melbourne Hospital , Parkville , Victoria , Australia
| | - L Amos
- a University of Melbourne Department of Medicine , Melbourne Health and Northern Health, Royal Melbourne Hospital , Parkville , Victoria , Australia
| | - Frank Ierino
- c Department of Nephrology , Austin Health , Heidelberg , Victoria , Australia
| | - H G Mack
- d University of Melbourne Department of Ophthalmology , Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - R C Andrew Symons
- e Department of Ophthalmology , Royal Melbourne Hospital , Parkville Victoria , Australia.,f University of Melbourne Department of Surgery , Royal Melbourne Hospital , Parkville Victoria , Australia
| | - P Hughes
- b Department of Nephrology , Royal Melbourne Hospital , Parkville , Victoria , Australia
| | - K Nicholls
- b Department of Nephrology , Royal Melbourne Hospital , Parkville , Victoria , Australia
| | - D Colville
- a University of Melbourne Department of Medicine , Melbourne Health and Northern Health, Royal Melbourne Hospital , Parkville , Victoria , Australia
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10
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The spectrum of phenotypes caused by variants in the CFH gene. Mol Immunol 2009; 46:1573-94. [PMID: 19297022 DOI: 10.1016/j.molimm.2009.02.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 02/09/2009] [Accepted: 02/11/2009] [Indexed: 12/24/2022]
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12
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Tabandeh H, Dubovy S, Green WR. Bilateral midperipheral large drusen and retinal pigment epithelial detachments associated with multifocal areas of choroidal neovascularization: a histopathologic study. Retina 2007; 26:1063-9. [PMID: 17151495 DOI: 10.1097/01.iae.0000254892.55895.2f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The ocular histopathologic features of a patient with bilateral multiple midperipheral areas of choroidal vascularization, large drusen, and detachments of the retinal pigment epithelium (RPE) are presented. METHODS The eyes were obtained at autopsy and fixed in 4% buffered formaldehyde. Serial sections through the macula area and inferior segments were prepared. Light as well as electron microscopy was performed. RESULTS Microscopic examination disclosed numerous large drusen measuring up to 200 micro m in height and 280 micro m in diameter and areas of serous RPE detachments in the midperiphery of both eyes. Some of the large drusen had choroidal vascularization. Areas of sub-RPE neovascularization that measured up to 6.5 mm in diameter were present in the midperiphery of both eyes. The choroidal origin for neovascularization was evident in 10 areas. A 1-mm area of hemorrhagic detachment of the RPE contiguous with choroidal neovascularization (CNV) was present in the immediate postequatorial area temporally in the left eye. No drusen, basal deposit, or CNV was present in the macular area. CONCLUSION Multifocal midperipheral RPE detachments and CNV can occur in the absence of significant age-related macular disease.
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Affiliation(s)
- Homayoun Tabandeh
- Eye Pathology Laboratory, Wilmer Eye Institute and Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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13
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Rattner A, Nathans J. Macular degeneration: recent advances and therapeutic opportunities. Nat Rev Neurosci 2006; 7:860-72. [PMID: 17033682 DOI: 10.1038/nrn2007] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The central retina mediates high acuity vision, and its progressive dysfunction due to macular degeneration is the leading cause of visual disability among adults in industrialized societies. Here, we summarize recent progress in understanding the pathophysiology of macular degeneration and the implications of this new knowledge for treatment and prevention. The past decade has witnessed remarkable advances in this field, including the development of new, non-invasive retinal imaging technologies, the development of animal models for macular disease, and the isolation of many of the genes responsible for both early- and late-onset macular diseases. These advances have set the stage for the development of effective mechanism-based therapies.
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Affiliation(s)
- Amir Rattner
- Department of Molecular Biology and Genetics, Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Abstract
AIMS The aims of this study were to: Investigate retinal changes associated with type 2 membranoproliferative glomerulonephritis (type 2 MPGN). Assess whether there was a relationship between the severity of the kidney disease and ophthalmoscopically visible fundal changes. Find out if renal transplantation was linked with visual deterioration. Decide if patients with type 2 MPGN need to be referred for ophthalmological assessment. METHODS The patients were identified from pathology department records as having renal biopsy proven type 2 MPGN from January 1981 to October 2003. Patients were invited to attend for ophthalmic assessment. RESULTS A total of 26 biopsy proven cases of type 2 MPGN were identified. One patient lost vision from a possible occult choroidal neovascular membrane. The extent of ocular involvement did not consistently appear to be related to the severity of the renal involvement, although there was a relationship between the presence of ocular lesions and the duration of the disease. The longer the disease was present the more likely the patients were to have ophthalmoscopically visible fundal changes. Renal transplantation did not appear to have a detrimental effect on vision with the possible exception of one patient. CONCLUSION Referral of type 2 MPGN patients by the renal physician for an initial ophthalmological assessment may be beneficial so that symptoms of choroidal neovascularization can be explained and patients advised to seek urgent help if distortion of central vision occurs. Renal transplantation does not appear to be a risk factor for the development of choroidal neovascular membranes.
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Affiliation(s)
- C E McAvoy
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
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15
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Ryan SJ, Hinton DR, Murata T. Choroidal Neovascularization. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Narendran N, Guymer RH, Cain M, Baird PN. Identification of a mutation in the PKD2 gene in a family with age-related macular degeneration. Am J Med Genet A 2005; 127A:208-10. [PMID: 15108213 DOI: 10.1002/ajmg.a.20673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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17
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Ambati J, Anand A, Fernandez S, Sakurai E, Lynn BC, Kuziel WA, Rollins BJ, Ambati BK. An animal model of age-related macular degeneration in senescent Ccl-2- or Ccr-2-deficient mice. Nat Med 2003; 9:1390-7. [PMID: 14566334 DOI: 10.1038/nm950] [Citation(s) in RCA: 438] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2003] [Accepted: 09/23/2003] [Indexed: 12/19/2022]
Abstract
The study and treatment of age-related macular degeneration (AMD), a leading cause of blindness, has been hampered by a lack of animal models. Here we report that mice deficient either in monocyte chemoattractant protein-1 (Ccl-2; also known as MCP-1) or its cognate C-C chemokine receptor-2 (Ccr-2) develop cardinal features of AMD, including accumulation of lipofuscin in and drusen beneath the retinal pigmented epithelium (RPE), photoreceptor atrophy and choroidal neovascularization (CNV). Complement and IgG deposition in RPE and choroid accompanies senescence in this model, as in human AMD. RPE or choroidal endothelial production of Ccl-2 induced by complement C5a and IgG may mediate choroidal macrophage infiltration into aged wild-type choroids. Wild-type choroidal macrophages degrade C5 and IgG in eye sections of Ccl2(-/-) or Ccr2(-/-) mice. Impaired macrophage recruitment may allow accumulation of C5a and IgG, which induces vascular endothelial growth factor (VEGF) production by RPE, possibly mediating development of CNV. These models implicate macrophage dysfunction in AMD pathogenesis and may be useful as a platform for validating therapies.
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Affiliation(s)
- Jayakrishna Ambati
- Department of Ophthalmology, University of Kentucky, 740 South Limestone Street, Lexington, Kentucky 40536-0284, USA.
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Colville D, Guymer R, Sinclair RA, Savige J. Visual impairment caused by retinal abnormalities in mesangiocapillary (membranoproliferative) glomerulonephritis type II ("dense deposit disease"). Am J Kidney Dis 2003; 42:E2-5. [PMID: 12900843 DOI: 10.1016/s0272-6386(03)00665-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with mesangiocapillary glomerulonephritis (MCGN) type II usually present by early adulthood with hematuria, proteinuria, and renal impairment, and these features often are accompanied by a partial lipodystrophy and an autoantibody for the alternative complement pathway convertase (C3NeF). The diagnosis of MCGN type II depends on the demonstration of "dense deposits" in the glomerular basement membrane (GBM). Most patients also have multiple subretinal white spots or drusen that are histopathologically identical with the GBM deposits and evident ophthalmoscopically by the time renal failure develops. Initially visual acuity and visual fields are preserved, but fluorescein angiography and specialized tests of retinal function, such as dark adaptation, electroretinography, and electrooculography, may be abnormal and will worsen progressively. Over the next 20 years, vision often deteriorates because of retinal atrophy, and sometimes because of subretinal neovascular membranes, macular detachment, and central serous retinopathy. The authors describe a patient with MCGN type II who presented with renal failure and impaired vision at the age of 59. He already had widespread retinal atrophy, and subsequently a subretinal membrane developed. The drusen seen in MCGN type II, like the partial lipodystrophy, are a helpful clinical pointer to the diagnosis of this condition. All patients with MCGN type II should be warned of the risk of retinal complications and reviewed by an ophthalmologist at presentation and regularly after about 10 years to minimize the loss of visual acuity from complications of the retinopathy.
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Affiliation(s)
- Deb Colville
- Centre for Eye Research, University Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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Mullins RF, Aptsiauri N, Hageman GS. Structure and composition of drusen associated with glomerulonephritis: implications for the role of complement activation in drusen biogenesis. Eye (Lond) 2001; 15:390-5. [PMID: 11450763 DOI: 10.1038/eye.2001.142] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The ocular fundi of many patients with membranoproliferative glomerulonephritis type II (MPGN-II) are characterised by the presence of deposits within Bruch's membrane that resemble drusen, hallmark lesions associated with age-related macular degeneration (AMD). Glomerulonephritis (GN)-associated drusen appear at a younger age, however, than do drusen in individuals with AMD. In light of recent evidence that immune-mediated events participate in drusen biogenesis and AMD, we examined the structure and composition of drusen in eyes obtained from human donors with two distinct glomerulopathies, both of which involve complement deposition within glomeruli. These features were compared with those of drusen from patients with clinically documented AMD. METHODS Eyes obtained from two human human donors diagnosed with membranous and post-streptococcal GN, respectively, were analysed histochemically, immunohistochemically and ultrastructurally. RESULTS Subretinal pigment epithelial (RPE) deposits in both types of GN are numerous and indistinguishable, both structurally and compositionally, from drusen in donors with AMD. GN-associated drusen exhibit sudanophilia, bind filipin, and react with antibodies directed against vitronectin, complement C5 and C5b-9 complexes, TIMP-3 and amyloid P component. Drusen from the membranous GN donor, but not the post-streptococcal GN donor, reacted with peanut agglutinin and antibodies directed against MHC class II antigens and IgG. The ultrastructural characteristics of these deposits were also identical with those of AMD-associated drusen. CONCLUSIONS The composition and structure of ocular drusen associated with membranous and post-streptococcal/segmental GN are generally similar to those of drusen in individuals with AMD. In view of the recent data supporting the involvement of complement activation in drusen biogenesis and the pathobiology of AMD, further studies of the biological relationships between AMD and diseases associated with complement activation are warranted.
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Affiliation(s)
- R F Mullins
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City 52240, USA
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20
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Mullins RF, Russell SR, Anderson DH, Hageman GS. Drusen associated with aging and age‐related macular degeneration contain proteins common to extracellular deposits associated with atherosclerosis, elastosis, amyloidosis, and dense deposit disease. FASEB J 2000. [DOI: 10.1096/fasebj.14.7.835] [Citation(s) in RCA: 610] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Robert F. Mullins
- Department of Ophthalmology and Visual Sciences, The University of IowaThe University of Iowa Center for Macular DegenerationIowa City Iowa 52242 USA
| | - Stephen R. Russell
- Department of Ophthalmology and Visual Sciences, The University of IowaThe University of Iowa Center for Macular DegenerationIowa City Iowa 52242 USA
| | - Don H. Anderson
- Center for the Study of Macular DegenerationNeuroscience Research Institute, University of CaliforniaSanta Barbara California 93106 USA
| | - Gregory S. Hageman
- Department of Ophthalmology and Visual Sciences, The University of IowaThe University of Iowa Center for Macular DegenerationIowa City Iowa 52242 USA
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Kim RY, Faktorovich EG, Kuo CY, Olson JL. Retinal function abnormalities in membranoproliferative glomerulonephritis type II. Am J Ophthalmol 1997; 123:619-28. [PMID: 9152067 DOI: 10.1016/s0002-9394(14)71074-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To characterize retinal electrophysiologic and psychophysical abnormalities associated with membranoproliferative glomerulonephritis type II. METHODS Three adults with membranoproliferative glomerulonephritis type II were studied. Retinal function was measured psychophysically (automated perimetry, Farnsworth D-15 color vision testing, and dark adaptometry) and electrophysiologically (full-field flash electroretinography and electro-oculography). RESULTS Two symptomatic individuals had prominent drusenlike deposits and retinal pigment epithelial disturbances, findings characteristic of membranoproliferative glomerulonephritis type II retinopathy. These individuals had mild visual field and color vision abnormalities, prolonged dark adaptation, and delayed electroretinographic dark-adapted dim and bright flash responses of normal amplitude. The electro-oculogram of the most severely affected individual was abnormal. The third individual who was asymptomatic had the mildest fundus abnormalities and exhibited normal psychophysical and electrophysiologic responses. CONCLUSIONS Membranoproliferative glomerulonephritis type II retinopathy may be associated with symptomatic and measurable psychophysical and electrophysiologic abnormalities of retinal function.
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Affiliation(s)
- R Y Kim
- Department of Ophthalmology, University of California, San Francisco 94143-0730, USA.
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Abstract
Membranoproliferative glomerulonephritis is a renal disorder characterized by proliferation of cells and changes in the basement membrane of the glomerulus. The disease is divided into three subtypes: type I, characterized by the presence of subendothelial electrondense deposits; type II, characterized by deposition of electrondense material of unknown origin in the lamina densa of the glomerular basement membrane; and type III, characterized by lesions having both type I and type II qualities. Specific posterior segment changes have been reported with membranoproliferative glomerulonephritis type II. We examined three patients with membranoproliferative glomerulonephritis type II and two patients with type III disease. All three patients with type II disease had Bruch's membrane and retinal pigment epithelial changes, whereas both patients with type III disease had normal posterior segments.
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Affiliation(s)
- D D Kim
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee
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Leys A, Vanrenterghem Y, Van Damme B, Snyers B, Pirson Y, Leys M. Fundus changes in membranoproliferative glomerulonephritis type II. A fluorescein angiographic study of 23 patients. Graefes Arch Clin Exp Ophthalmol 1991; 229:406-10. [PMID: 1937071 DOI: 10.1007/bf00166300] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A total of 23 patients aged between 11 and 64 years who had biopsy-proven membranoproliferative glomerulonephritis type II (dense deposit disease) were studied using fluorescein angiography of the retina. With the exception of two adolescents, all patients exhibited small subretinal nodules that were similar to basal laminar drusen. Subjects with a long history of renal disease displayed more numerous and larger nodules as well as atrophic changes. Four subjects presented with subretinal neovascular membranes.
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Affiliation(s)
- A Leys
- Department of Ophthalmology, K.U. Leuven, Belgium
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Leys A, Proesmans W, Van Damme-Lombaerts R, Van Damme B. Specific eye fundus lesions in type II membranoproliferative glomerulonephritis. Pediatr Nephrol 1991; 5:189-92. [PMID: 2031833 DOI: 10.1007/bf01095950] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In three adolescents, suffering from membrano-proliferative glomerulonephritis type II, ophthalmoscopy and fluorescein angiography revealed retinal pigment epithelium lesions, referred to as basal laminar drusen. The patient with the longest renal history had the most pronounced fundus changes. These lesions, earlier described in adult patients, are believed to be specific for this particular form of chronic glomerulonephritis.
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Affiliation(s)
- A Leys
- Department of Ophthalmology, University Hospital, Gasthuisberg, Leuven, Belgium
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