Epidemiology of Angioid Streaks and Pseudoxanthoma Elasticum (2011-2020): A Nationwide Population-based Cohort Study

ABCC6 gene mutational spectrum and ocular features in Mexican patients with pseudoxanthoma elasticum-related angioid streaks

OBJECTIVE

Angioid streaks (AS) are uncommon retinal lesions associated with significant risk of vision loss due to choroidal neovascularization. About half of AS cases have a concurrent disease, most commonly pseudoxanthoma elasticum (PXE), a recessively inherited disorder that affects the skin, the eye, and vascular system and caused by biallelic mutations in the ABCC6 gene. In this work, we describe the ocular phenotype and the ABCC6 mutational profile in a cohort of 17 AS Mexican patients.

METHODS

17 unrelated AS probands, with or without concurrent dermatologic features were studied. ABCC6 mutational analysis was performed employing next-generation sequencing (NGS) gene panel or exome sequencing.

RESULTS

Biallelic pathogenic variants in ABCC6 were demonstrated in 10 out of 17 (~60%) AS patients confirming a PXE diagnosis. In 4 individuals, only heterozygous ABCC6 variants were recognized while in 3 cases no mutations in AS-related genes were identified. A total of 7 previously unpublished ABCC6 disease-causing variants were identified in our cohort, including 5 missense, 1 frameshift, and 1 intragenic deletion.

CONCLUSION

In most subjects from our cohort, AS were due to genetically confirmed PXE, as previously observed in other ethnic groups. We expanded the ABCC6-related mutational spectrum by recognizing 7 previously unpublished pathogenic variants.

Atypical angioid streaks in a patient with a monoallelic ABCC6 mutation

BACKGROUND

Pseudoxanthoma elasticum (PXE) is characterized by aberrant calcification of elastic tissues throughout the body causing varying degrees of skin, cardiac, and ocular disease. Although PXE is classically regarded as an autosomal recessive disease, recent reports have demonstrated a haploinsufficiency phenotype, in which carriers of monoallelic ATP-binding cassette transporter (ABCC6) gene mutations demonstrate mild manifestations of PXE. In this case report, we describe a patient with a monoallelic ABCC6 mutation and atypical angioid streaks.

MATERIALS AND METHODS

Case report.

OBSERVATIONS

A 31-year-old male with a history of paroxysmal tachycardia and right ventricular enlargement presented to the Eye Emergency Department complaining of bilateral eye pain with occasional flashes and bitemporal headaches. Family history was notable for unspecified heart disease in his father but no ocular disease. Best-corrected visual acuity was 20/20 in both eyes. Posterior segment examination demonstrated linear hypopigmented lesions radiating from the superior arcades of both eyes. Fundus autofluorescence of the lesions demonstrated speckled hypo- and hyperautofluorescence and fluorescein angiography revealed window defects consistent with atypical angioid streaks. Genetic testing was positive for a heterozygous c.2889C>A (p.Cys963*) mutation in the ABCC6 gene.

CONCLUSIONS AND IMPORTANCE

The current case demonstrates the potential for PXE carriers to display both systemic and ophthalmic manifestations of the disease. Individuals with known or suspected monoallelic ABCC6 mutations may benefit from genetic counseling and regular examination.

Association of Smoking and Alcohol with Abdominal Aortic Calcification in the General Middle-Aged and Elderly Populations

Background

Research results on the association between alcohol consumption and abdominal aortic calcification (AAC) has yielded inconsistent results. There is a paucity of evidence on the association of smoking and alcohol consumption with AAC in the general middle-aged and elderly population, including age subgroups. This study utilizes nationwide survey data to explore these associations.

Methods

Data from middle-aged and elderly National Health and Nutrition Examination Survey (NHANES) 2013-2014 participants receiving dual X-ray absorptiometry were analyzed. AAC severity was assessed using a scoring system with a maximum value of 24. Presence of AAC was defined as an AAC score >0, and severe AAC as an AAC score ≥6. Binary logistic regression was employed for analyzing the association of smoking and alcohol consumption-related indices with the presence of AAC, while cumulative odds logistic regression explored their associations with severe AAC.

Results

Data of 3135 participants were analyzed. Investigation in the entire population found that smoking history was linked to both AAC and severe AAC. In contrast, alcohol consumption history was not linked to AAC or severe AAC. After adjusting for confounders, the findings confirmed a significant association of smoking history with AAC and severe AAC. No significant associations were found for current alcohol consumption with either AAC or severe AAC. Compared with never smokers, former smokers and current smokers experienced increased AAC risk. Former smokers had a significantly lower AAC risk compared to current smokers. Compared with never alcohol consumers, neither former nor current alcohol consumers experienced a different AAC risk. No difference in AAC risk was found between former and current alcohol consumers. Individuals consuming more than 2 drinks of alcohol per day suffered from a significant increase in risk of AAC. Subgroup analyses found elderly ever and current smokers suffered from a significantly elevated AAC risk, as did middle-aged ever smokers. Elderly ever and current alcohol consumers also experienced increased risk of AAC.

Conclusions

Smoking history is significantly associated with both AAC and severe AAC. The cardiovascular benefits associated with smoking cessation primarily manifest as reduction in risk of AAC presence rather than severe AAC. Elderly smokers are exposed to a greater risk of AAC. In contrast, alcohol consumption shows no association with severe AAC. Alcohol consumption is not associated with AAC except in heavy drinking and elderly subpopulations.

Choroidal neovascularization secondary to angioid streaks in a patient with pseudoxanthoma elasticum: case report

Objective

Present the diagnosis and therapeutic approach in a patient with pseudoxanthoma elasticum and ocular involvement.

Case report

A 46-year-old patient presented for progressive loss of vision and metamorphopsias in the left eye. The ophthalmological examination showed angioid streaks and secondary choroidal neovascularization. The dermatologist performed an incisional biopsy of a skin area in the right axilla that showed white-yellow, discrete streaks. Histopathological examination confirmed the diagnosis of pseudoxanthoma elasticum. It was decided to start intravitreal injections with aflibercept. Three injections were made in the left eye with subsequent visual acuity improvement.

Discussion

Angioid streaks are a rare retinal condition, and pseudoxanthoma elasticum is the most common association. Other systemic conditions are Ehlers-Danlos syndrome, Paget's disease, and hemoglobinopathies. Definite diagnosis requires skin lesions or calcified elastic fibers on pathological examination and angioid streaks of the retina. Choroidal neovascularization is a frequent complication and leads to vision loss. Intravitreal inhibitors of vascular endothelial growth factor are currently the first line of treatment.

Conclusions

Pseudoxanthoma elasticum has numerous systemic manifestations and requires a multidisciplinary team to be monitored and treated.

Annual trends of ophthalmic surgeries in Japan's super-aged society, 2014-2020: a national claims database study

This study aimed to analyze the trends and factors influencing the number of ophthalmic surgeries in Japan using the open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan published by the Ministry of Health, Labour and Welfare. We calculated the number of cataract, glaucoma, and vitreoretinal surgeries, categorized by sex, age, and surgical type, for the fiscal years (FY) 2014 to 2020. The number of cataract surgeries remained stable at approximately 1.45 million cases from FY 2014 to 2018, increased to nearly 1.6 million cases in FY 2019, and decreased to 1.45 million cases in FY 2020. Among glaucoma surgeries, surgical treatments were increased 1.8 times over 7 years, from 33,000 to 60,000 cases. Laser treatment remained steady at around 55,000 cases from FY 2014 to 2017 and then increased to approximately 60,000 cases. The number of vitreoretinal surgeries was increased 1.2 times from FY 2014 to 2019, from 120,000 to 140,000, and decreased to 130,000 by FY 2020. Trends in ophthalmic surgeries over the past 7 years may be influenced by population aging, minimally invasive surgery, and the coronavirus disease pandemic. These findings have implications on surgical decision-making and resource allocation.