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Petersen SD, Belmouhand M, Hertz JM, Fagerberg C, Brasch-Andersen C, Grauslund J, Munier FL, Larsen M. Frail inner limiting membrane maculopathy suggested to describe a new retinal Alport-like condition with two variants in three generations of females. Ophthalmic Genet 2024:1-8. [PMID: 38197426 DOI: 10.1080/13816810.2023.2294844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 12/09/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND We report a three-generation family with isolated Alport-like retinal abnormalities in the absence of lenticonus, hearing loss, kidney disease, and detectable molecular genetic defects in known Alport-related genes. METHODS Clinical examination includes ocular biomicroscopy, fundus photography, optical coherence tomography, dipstick urinalysis, serum creatinine assessment, and molecular genetic analysis. RESULTS The proband, her mother, and her maternal grandmother had normal best-corrected visual acuity and normal visual fields in both eyes. The macula presented a petaloid stair-case profile with scarce vessels in both eyes of the proband and a flat temporal macula lacking a foveal avascular zone in her mother and her grandmother. No family member had renal symptoms, unexplained subnormal hearing, or lenticonus. Sequencing and MLPA found no defect in COL4A3, COL4A4, and COL4A5. Common SNPs around the genes ± 1Mb showed no segregation. Furthermore, none of the variants shared between the affected individuals in genes from a gene panel of genes relevant for ophthalmopathy nor whole exome- and genome sequencing explained the phenotype. CONCLUSION A new condition with two retinal Alport-like phenotypes was found. No abnormalities of the kidneys and lens were found, neither abnormalities of the type IV collagen genes related to Alport syndrome. Homology with retinal abnormalities seen in patients after surgical removal of the inner limiting membrane of the retina suggests that this is where the defect is located. We therefore suggest that the new retinal phenotypes and similar phenotypes can be described with the new definition "frail inner limiting membrane maculopathy."
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Affiliation(s)
- Sekita Dalsgård Petersen
- Faculty of Health and Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Mohamed Belmouhand
- Faculty of Health and Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Jens Michael Hertz
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Christina Fagerberg
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Charlotte Brasch-Andersen
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Vestfold University Trust, Tønsberg, Norway
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Michael Larsen
- Faculty of Health and Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
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Sanjuán P, Samaan M, Nadal J. AUTOLOGOUS RETINA TRANSPLANTATION FOR TREATMENT OF REFRACTORY DOUBLE FULL-THICKNESS MACULAR HOLE IN ALPORT SYNDROME. Retin Cases Brief Rep 2023; 17:89-92. [PMID: 33939398 DOI: 10.1097/icb.0000000000001122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To report the structural and functional outcomes of autologous neurosensory retinal transplantation for closure of refractory double full-thickness macular hole in a patient diagnosed with Alport syndrome. METHODS Patient with previous pars plana vitrectomy and a failed macular hole surgery (internal limiting membrane removal) underwent pars plana vitrectomy and autologous neurosensory retinal flap transplantation with silicone oil tamponade. Follow-up was performed after one year. The anatomic outcomes were evaluated mainly by fundus examination, optical coherence tomography (OCT), and microperimetry (MAIA). The functional changes were evaluated comparing best-corrected visual acuities preoperative and 1 year after surgery. RESULTS A 35-year-old man with progressive visual loss of two years of evolution presented a double full-thickness macular hole in the left eye. After retinal flap transplantation, the macular hole appeared successfully closed during the entire follow-up. Integration of both retinal flaps into the surrounding retina and regeneration of the external retinal layers were observed in optical coherence tomography. Best-corrected visual acuities improved from 20/200 preoperatively to 20/80 one-year postoperatively. CONCLUSION Pars plana vitrectomy combined with autologous neurosensory retinal flap transplantation is an effective option to achieve the anatomic closure of recurrent double full-thickness macular hole and significant visual recovery in Alport syndrome.
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Affiliation(s)
- Pablo Sanjuán
- Department of Ophthalmology, Centro de Oftalmología Barraquer, Barcelona, Spain ; and
- Instituto Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Muhsen Samaan
- Department of Ophthalmology, Centro de Oftalmología Barraquer, Barcelona, Spain ; and
- Instituto Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeroni Nadal
- Department of Ophthalmology, Centro de Oftalmología Barraquer, Barcelona, Spain ; and
- Instituto Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
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Zhu RL, Zhao L, Gu XP, Zhang YD, Wang F, Zhang YQ, Yang L. Temporal retinal thinning might be an early diagnostic indicator in male pediatric X-linked Alport syndrome. Int J Ophthalmol 2022; 15:1142-1148. [PMID: 35919312 DOI: 10.18240/ijo.2022.07.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/18/2022] [Indexed: 12/13/2022] Open
Abstract
AIM To evaluate temporal retinal thinning changes in retinal layers using spectral-domain optical coherence tomography (SD-OCT) in pediatric X-linked Alport syndrome (XLAS) patients. METHODS A retrospective case-control study. SD-OCT scans of pediatric patients diagnosed with XLAS and age- and sex-matched healthy control participants were reviewed. Automated segmentation of SD-OCT scans was induced to analyze the retinal thickness (RT) of different layers. The temporal thinning index (TTI) was calculated for each layer and compared between the patients and the control group. RESULTS Forty-three pediatric XLAS patients and 60 healthy controls were included. Temporal retinal thinning was present in 33 patients (76.74%), while 28 patients (65.11%) had severe pathological temporal retinal thinning and 5 patients (11.63%) had moderate thinning. The temporal inner sector RT (P<0.0001), the temporal outer sector RT (P<0.0001), and the nasal outer sector RT (P=0.0211) were significantly thinner in the XLAS male patients. The TTI of the total retina was significantly higher in the XLAS group than in the control group (P<0.0001). The TTI of the inner retina layers (P<0.0001), ganglion cell layer (P<0.0001), inner plexiform layer (P<0.0001), inner nuclear layer (P<0.0001), and outer nuclear layer (P<0.0001) were significantly higher in the XLAS group. The central RT of the XLAS group was significantly thinner than that of the control group (P<0.0001). CONCLUSION Temporal retinal thinning appears early in XLAS patients, especially in male patients. The thinning is mainly caused by structural abnormalities of the inner retina. This suggests that temporal retinal thinning could be helpful for the early diagnosis and follow-up of XLAS with noninvasive SD-OCT examination.
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Affiliation(s)
- Rui-Lin Zhu
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China
| | - Liang Zhao
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China
| | - Xiao-Peng Gu
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China
| | - Ya-Di Zhang
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China
| | - Fang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Yan-Qin Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, China
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Chaudhry SG, Liew G, Fung AT. Missing Internal Limiting Membrane during Macular Hole Repair in Alport Syndrome. Case Rep Ophthalmol 2021; 12:320-323. [PMID: 34054478 PMCID: PMC8136316 DOI: 10.1159/000513420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/27/2020] [Indexed: 11/19/2022] Open
Abstract
The aim of this manuscript is to describe a novel retinal finding of Alport syndrome during surgical management of an associated macular hole. A retrospective chart review of a 65-year-old man with a diagnosis of Alport syndrome confirmed by renal biopsy was found to have an associated full-thickness macular hole. Pars-plana vitrectomy surgery with internal limiting membrane (ILM) peeling was attempted, but intraoperatively the ILM was found to be absent at the macula. Alport syndrome may be associated with the absence of the ILM. This can complicate attempts at macular hole repair.
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Affiliation(s)
| | - Gerald Liew
- Westmead Hospital, Sydney, New South Wales, Australia.,Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute of Medical Research, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Adrian T Fung
- Westmead Hospital, Sydney, New South Wales, Australia.,Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute of Medical Research, Westmead, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Rodríguez-Gil R, Gil-Hernández MA, Afonso-Rodríguez A. [Macular hole and Alport's syndrome]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2012; 87:220-224. [PMID: 22732121 DOI: 10.1016/j.oftal.2011.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 10/07/2011] [Accepted: 10/20/2011] [Indexed: 06/01/2023]
Abstract
CASE REPORT We present the clinical cases of two male patients of 38 and 39 years, diagnosed with Alport's syndrome, who suffered a bilateral macular hole and a giant unilateral macular hole with retinal thinning in the other eye, respectively. DISCUSSION Alport's syndrome is a genetic disorder characterised by mutation of genes encoding type IV collagen, the main component of the internal limiting membrane, a structure identified in basal membrane of the retinal pigment epithelium-Brüch's membrane complex. This alteration can influence the predisposition to macular holes.
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Affiliation(s)
- R Rodríguez-Gil
- Servicio de Oftalmología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España.
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