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Astafurov KV, Barkmeier AJ. Angiographic dark choroid in systemic non-hereditary amyloidosis. Am J Ophthalmol Case Rep 2022; 25:101334. [PMID: 35198799 PMCID: PMC8851078 DOI: 10.1016/j.ajoc.2022.101334] [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: 02/08/2021] [Revised: 09/16/2021] [Accepted: 01/20/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe a novel finding of angiographic dark choroid in a patient with systemic non-hereditary amyloidosis. Observation A 43-year old female with systemic light-chain amyloidosis associated with advanced kidney disease presented with metamorphopsia and blurry vision in both eyes of 1 year duration. Examination revealed subretinal yellowish deposits in the central macula and mid-periphery with patchy RPE mottling bilaterally. OCT demonstrated thickened choroid with a widened hyporeflective sub-Bruch's choriocapillaris band. FAF showed hypoautofluorescence of the central maculae with hyperautofluorescence flecks perifoveally. Fluorescein angiography demonstrated normal vascular filling without leakage and peripheral microaneurysms. The FA also revealed a strikingly diminished diffuse lack of choroidal fluorescence throughout all angiographic phases in both eyes which has not been previously described in this condition. Conclusionsand Importance This case demonstrates that patients with systemic amyloidosis may exhibit attenuation of choroidal signal (“dark choroid”) on fluorescein angiography, possibly due to accumulation of amyloid material in the sub-RPE space.
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Choi KJ, Son KY, Kang SW, Kim D, Choi JO, Kim HJ, Kim JS, Jeon ES, Kim AY, Kang MC, Kim SJ. OCULAR MANIFESTATIONS OF ASP38ALA AND THR59LYS FAMILIAL TRANSTHYRETIN AMYLOIDOSIS. Retina 2022; 42:396-403. [PMID: 34483316 DOI: 10.1097/iae.0000000000003296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the ophthalmic manifestations of familial transthyretin amyloidosis (FTA) mutations, including Asp38Ala and Thr59Lys, which have not been previously reported to have ocular involvement. METHODS This is an observational case series of prospectively collected data of 16 patients with FTA who were taking tafamidis for mild peripheral neuropathy and underwent a comprehensive ophthalmic examination at a single tertiary center, between January 2013 and March 2020. The ocular involvement of each FTA mutation type and the specific manifestations were the main outcome measures. RESULTS Six of 16 patients with FTA manifested ocular involvement. Ocular involvement was noted in two of three patients with Glu89Lys mutations having retinal deposits, retinal hemorrhages, and corneal opacity. Three of nine patients with Asp38Ala mutations and one of two patients with Thr59Lys mutations showed ocular involvement that had not been previously described. The ophthalmic findings included glaucoma, anterior lens capsule opacity, vitreous opacity, and retinal deposits. The decrease in vascular flow due to perivascular cuffing of the amyloid deposits was detected by optical coherence tomography angiography. CONCLUSION The current study newly described that two transthyretin mutation types of FTA, Asp38Ala and Thr59Lys, may manifest with ocular findings such as anterior lens capsule opacity and retinal deposits.
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Affiliation(s)
- Kyung Jun Choi
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
| | - Ki Young Son
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jin Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jung Sun Kim
- Department of Pathology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea; and
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - A Young Kim
- Department of Ophthalmology, Ewha Womans University Medical Center, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Min Chae Kang
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University Seoul, Republic of Korea
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Mano F, Dispenzieri A, Kusaka S, Pavesio C, Khalid H, Keane PA, Pulido JS. ASSOCIATION BETWEEN CHOROIDAL CHARACTERISTICS AND SYSTEMIC SEVERITY IN AMYLOIDOSIS. Retina 2021; 41:1037-1046. [PMID: 32826787 DOI: 10.1097/iae.0000000000002961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed to describe the choroidal features of ocular amyloidosis using multimodal imaging, to correlate these findings with systemic involvement, and to propose a choroidal grading system. METHODS Eleven patients with systemic amyloidosis were reviewed retrospectively. Each case was assigned a grade according to the severity of choroidal findings as determined by both enhanced depth imaging optical coherence tomography and indocyanine green angiography. The severity of systemic amyloidosis was then correlated with the choroidal involvement. RESULTS On indocyanine green angiography, all patients exhibited hyperfluorescent spots in the late stage and were classified according to preexisting criteria. On enhanced depth imaging optical coherence tomography, hyperreflective foci were seen in the choriocapillaris and Sattler's layer in Grade 1, partial loss of Sattler's layer was additionally seen in Grade 2, and a dense hyperreflective Haller's layer was seen in Grade 3. Choroidal grading scores were significantly correlated with the systemic severity score (P = 0.0014, Pearson's correlation coefficient; ρ = 0.83). CONCLUSION With ocular amyloidosis, evaluation of choroidal characteristics using multimodal imaging may serve as a biomarker for systemic involvement.
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Affiliation(s)
- Fukutaro Mano
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
- Department of Ophthalmology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | | | - Shunji Kusaka
- Department of Ophthalmology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hagar Khalid
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota; and
- Department of Ophthalmology, Wills Eye Hospital, Jefferson Kimmel Medical School, Philadelphia, Pennsylvania
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Nagura K, Inoue T, Ching J, Sato A, Kitahata S, Maruyama-Inoue M, Takeuchi M, Kadonosono K. Long-term follow-up of a case of amyloidosis-associated chorioretinopathy. Am J Ophthalmol Case Rep 2020; 19:100846. [PMID: 32885095 PMCID: PMC7453112 DOI: 10.1016/j.ajoc.2020.100846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/15/2020] [Accepted: 07/26/2020] [Indexed: 10/26/2022] Open
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Augstburger E, Sahel JA, Audo I. Progressive chorioretinal involvement in a patient with light-chain (AL) amyloidosis: a case report. BMC Ophthalmol 2020; 20:59. [PMID: 32085748 PMCID: PMC7035659 DOI: 10.1186/s12886-020-01341-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/12/2020] [Indexed: 12/19/2022] Open
Abstract
Background To report an unusual case of light-chain (AL) amyloidosis with progressive bilateral chorioretinal abnormalities documented with short-wavelength autofluorescence, SD-OCT, fluorescein and indocyanine green angiography. Case presentation Case report of a forty-three-year-old male patient with kappa AL amyloidosis. The patient presented with rapidly progressing pigmented and hyperautofluorescent drusenoid deposits in both eyes, associated with central serous retinal detachments, a pachychoroid and choriocapillaris enlargement. The general assessment revealed a renal failure symptomatic of a nephrotic syndrome, associated with proteinuria composed mainly of free kappa light chains. A kidney biopsy confirmed the diagnosis of kappa AL amyloidosis. Chemotherapy was quickly started. During remission, the extension of drusenoid deposits on the fundus was stopped and a disappearance of the subretinal fluid on SD-OCT was observed. Conclusions AL amyloidosis is an insidious and potentially fatal condition. This case is one of the first to document the rapid progression of fundus alterations and their stabilization after disease remission. Identifying these specific fundus abnormalities is essential to avoid diagnosis wandering and therapeutic delay.
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Affiliation(s)
- Edouard Augstburger
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Centre de Maladies Rares "dystrophies rétiniennes d'origine génétique", DHU Sight Restore INSERM-DHOS CIC 1423, 28, rue de Charenton, 75012, Paris, France.
| | - José-Alain Sahel
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Centre de Maladies Rares "dystrophies rétiniennes d'origine génétique", DHU Sight Restore INSERM-DHOS CIC 1423, 28, rue de Charenton, 75012, Paris, France.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France.,Department of Ophthalmology, The University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Isabelle Audo
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Centre de Maladies Rares "dystrophies rétiniennes d'origine génétique", DHU Sight Restore INSERM-DHOS CIC 1423, 28, rue de Charenton, 75012, Paris, France.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France
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Tei M, Maruko I, Uchimura E, Iida T. Retinal and choroidal circulation determined by optical coherence tomography angiography in patient with amyloidosis. BMJ Case Rep 2019; 12:12/2/bcr-2018-228479. [PMID: 30796071 PMCID: PMC6388794 DOI: 10.1136/bcr-2018-228479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A 43-year-old woman who was diagnosed with the cryopyrine-associated periodic syndrome (CAPS) with severe renal failure and heart failure due to amyloid accumulation was examined by swept source optical cohernce tomography (OCT) (SS-OCT; DRI-OCT, Topcon, Tokyo, Japan) and optical coherence tomography angiography (OCTA) (RTVue XR Avanti, Optovue, Fremont, CA). Her best-corrected visual acuity was 20/40 OD and 20/25 OS. A hyporeflective band of about 100 µm thickness was seen just inferior to the retinal pigment epithelium in the cross-sectional SS-OCT images, but the deeper choroidal structures were clearly visible. In the OCTA images, the density of the retinal capillaries in the superficial and deep capillary plexus slabs were reduced, and no signals of the choroidal capillary slab was detected after removing the projection artefacts. The accumulation of amyloid can cause a reduction of both the retinal and choroidal capillary circulations although the circulation in the larger vessels are preserved.
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Affiliation(s)
- Masami Tei
- Ophthalmology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Ichiro Maruko
- Ophthalmology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Eiko Uchimura
- Ophthalmology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomohiro Iida
- Ophthalmology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Roybal CN, Sanfilippo CJ, Nazari H, Law JC, Bhaleeya S, Chui Ming GC, Rao NA, Kiss S, Agarwal A, Sadda S, Sarraf D. MULTIMODAL IMAGING OF THE RETINA AND CHOROID IN SYSTEMIC AMYLOIDOSIS. Retin Cases Brief Rep 2015; 9:339-346. [PMID: 26421891 DOI: 10.1097/icb.0000000000000215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To present the multimodal imaging findings of four patients with systemic amyloidosis, renal failure, and chorioretinopathy. METHODS Retrospective analysis of four patients presenting to four institutions with evidence of amyloid induced chorioretinopathy. Fundus photography, autofluorescence, and spectral domain optical coherence tomography findings were studied and are presented. RESULTS Four patients with biopsy-proven systemic amyloidosis demonstrated progressive chorioretinal degeneration with color fundus photography and autofluorescent imaging. With spectral domain optical coherence tomography analysis, amyloidosis-induced chorioretinopathy was characterized by a widened choriocapillaris band, choroidal infiltration, diffuse photoreceptor dysfunction, and thinning of the outer nuclear layer. CONCLUSION Multimodal imaging including spectral domain optical coherence tomography analysis in eyes of patients with systemic amyloidosis shows deposition in the choroid. The deposition may cause a secondary toxic and or barrier effect resulting in diffuse retinal pigment epithelium and photoreceptor dysfunction.
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Affiliation(s)
- C Nathaniel Roybal
- *Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa; †Retinal Disorders and Ophthalmic Genetics Division, David Geffen School of Medicine, Stein Eye Institute, University of California, Los Angeles, California; ‡University of Southern California Eye Institute, Los Angeles, California; §Department of Ophthalmology, Vanderbilt Eye Institute, Nashville, Tennessee; ¶Medical Retina Service, Singapore National Eye Centre, Singapore; **Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York; ††Doheny Eye Institute, Los Angeles, California; ‡‡Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California; and §§Department of Ophthalmology, University of South Florida, Tampa, Florida
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Indocyanine green angiography findings in patients with nonfamilial amyloidosis. J Ophthalmic Inflamm Infect 2012; 2:199-203. [PMID: 22622522 PMCID: PMC3500987 DOI: 10.1007/s12348-012-0085-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 05/09/2012] [Indexed: 11/04/2022] Open
Abstract
Purpose The purpose of this study is to assess indocyanine green angiographic findings in patients with nonfamilial amyloidosis. Methods The method used was a prospective study including seven patients (14 eyes) with nonfamilial amyloidosis. All patients underwent detailed ophthalmic clinical examination, fundus photography, and indocyanine green angiography (ICGA). Fluorescein angiography (FA) was performed in four patients. Results Of the seven patients, four (57.1 %) were male. Mean age was 49.5 years. Six patients had renal amyloidosis and one patient had systemic amyloidosis. Mean best-corrected visual acuity was 20/25. Fundus and FA findings included cotton-wool spots (28.5 %), retinal hemorrhages (14.3 %), retinal pigment epithelial changes (21.4 %), serous retinal detachment (7.1 %), optic disk edema or staining (7.1 %), area of peripheral retinal capillary non-perfusion (7.1 %), disseminated peripheral punctiform hyperfluorescence (21.4 %), and subretinal pooling (7.1 %). Fundus examination results were unremarkable in eight eyes (57.1 %). ICGA showed abnormal findings in all eyes. These included diffuse or focal/multifocal choroidal vascular staining appearing at the late phase and prevailing in peripheral fundus (100 %), hyperfluorescent fleecy lesions appearing at the late phase and also prevailing in peripheral fundus (28.5 %), hypofluoresent areas of variable sizes (85.7 %), and pinpoints (71.4 %). Conclusions Our results show that a subclinical, fairly typical choroidal involvement, detectable only by ICGA, is common in patients with nonfamilial amyloidosis. ICGA may be useful in better understanding the pathogenesis of amyloidosis choroidopathy and in establishing a diagnosis of amyloidosis in atypical or incomplete clinical presentations.
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Altiparmak UE, Koklu B, Unlu N, Yagci R, Bayrak R, Gul Yilmaz Cinar F, Duman S. Macular involvement in secondary systemic amyloidosis. Eur J Ophthalmol 2008; 18:459-61. [PMID: 18465734 DOI: 10.1177/112067210801800325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE A patient with subretinal and preretinal hemorrhage after secondary systemic amyloidosis due to familial Mediterranean fever is presented. METHODS Case presentation. RESULTS A 30-year-old woman with secondary systemic amyloidosis secondary to familial Mediterranean fever presented with painless visual loss in the right eye. The examination demonstrated multiple subretinal and preretinal hemorrhages, massive deposits which may represent amyloid material at the left macular region. After 6 months, the hemorrhages disappeared, but deposits persisted. CONCLUSIONS The macular deposition and hemorrhage is an uncommon manifestation of secondary systemic amyloidosis secondary to familial Mediterranean fever. Further evidence is necessary to understand the nature of these deposits and their relevance to secondary systemic amyloidosis and/or familial Mediterranean fever.
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Affiliation(s)
- U E Altiparmak
- Department of Ophthalmology, Ankara Training and Research Hospital, Ankara - Turkey.
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