The pupillary membrane in premature infants

Persistent anterior tunica vasculosa lentis in multisystemic smooth muscle dysfunction syndrome: A case report

RATIONALE

Multisystemic smooth muscle dysfunction syndrome (MSMDS) is a genetic disease that affects multiple organs. The report here concerns a patient with MSMDS, who is known so far as the youngest among all the reported patients. In addition to the typical manifestations, we observed previously unreported ocular abnormalities, including persistent anterior tunica vasculosa lentis (TVL) and early-onset retinal arteriolar tortuosity, by the fluorescein angiography (FA).

PATIENT CONCERNS

The patient was admitted to the neonatal intensive care unit immediately after birth for a diagnosis of urinary system dysplasia during fetal life. After a thorough examination, the patient was found with patent ductus arteriosus, pulmonary hypertension, cerebrovascular disease, hypotonic bladder, intestinal malrotation, and congenital mydriasis. The FA of the eyes undertaken in her 6-week demonstrated perfused vasculature in the persistent anterior TVL and prominent retinal arteriolar tortuosity. The whole exome sequencing revealed a de novo heterozygous ACTA2 gene missense mutation p.R179H.

DIAGNOSES

The patient was diagnosed with MSMDS.

INTERVENTIONS

Follow-up observation.

OUTCOMES

At the 3-month follow-up, no change of the ocular disease was observed.

LESSONS

The persistent anterior TVL in this case implies that ACTA2 p.R179H mutation affects not only the smooth muscle cells but also the pericytes, and further affects the TVL regression. The prominent retinal arteriolar tortuosity in this 6-week-old infant indicates that the retinal arteriolar tortuosity can present early in MSMDS.

Ultrastructure of the human posterior tunica vasculosa lentis during early gestation

In human embryos with a gestational age of from 7.6 to 14.0/15.0 weeks, the posterior tunica vasculosa lentis (TVL) was examined by both scanning and transmission electron microscopy. Even at the very early age of 7.6 weeks the tunica was found to be fully developed. It consisted of a radiating network of tortuous capillaries. Their walls were composed of a continuous layer of endothelial cells, surrounded by a basement membrane and a discontinuous sheath of pericytes. The thickness of the basement membrane increased with increasing gestational age. As opposed to previous studies, the endothelial cells exhibited transitory fenestrations. In the neighborhood of the posterior TVL macrophages were found.

Retinal photography in the newborn

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