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Chen Y, Chen J, Wang H, Yu Y, Wang W, Liu W, Yu S, Gong Y, Jia H, Li T, Sun X. Prevalence and optical coherence tomography analyses of outer retinal tubulations in Chinese population with inherited retinal diseases. Eye (Lond) 2024; 38:328-334. [PMID: 37553355 PMCID: PMC10810923 DOI: 10.1038/s41433-023-02686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND To investigate the prevalence of outer retinal tubulation (ORT) and its correlations with optical coherence tomography (OCT) parameters in Chinese population with inherited retinal diseases (IRDs). METHODS This retrospective study enrolled consecutive patients identified with IRDs and referred for genetic testing between February 2016 and April 2021. Clinical characteristics from medical records and features of cross-sectional B-scans were reviewed and analysed. The associations of patient-specific and ocular features with the presence of ORT were evaluated using univariate and multivariate analyses. RESULTS Two hundred and three patients (401 eyes) with a mean age of 49.7 ± 16.7 years were enrolled. ORT was observed in 41 eyes (10.2%), including 26 of 28 eyes (92.9%) with Bietti crystalline corneoretinal dystrophy (BCD), 14 of 338 eyes (4.1%) with retinitis pigmentosa (RP), and 1 of 26 eyes (3.8%) in eyes with cone-rod dystrophy. Eyes with ORT showed significantly worse visual acuity than those without ORT (P = 0.002). Multivariate analysis indicated that the presence of ORT was positively correlated with choroidal atrophy and inner nuclear layer (INL) cysts (P < 0.01). ORTs were detected more frequently in eyes with BCD than RP (P = 0.024), most of which located exclusively within the extrafoveal area. Large choroidal vessels were detected underneath the corresponding ORTs in both patients with BCD and RP. CONCLUSIONS The prevalence of ORT varies among different IRDs phenotypes, with the highest prevalence in BCD. The presence of choroidal atrophy and INL cysts may be associated with an increased risk of ORT formation in patients with IRD.
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Affiliation(s)
- Yuhong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Jieqiong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Hong Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Yang Yu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqiu Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Wenjia Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Suqin Yu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Yuanyuan Gong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Huixun Jia
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Tong Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China.
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China.
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China.
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.
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Haraguchi Y, Chiang TK, Yu M. Application of Electrophysiology in Non-Macular Inherited Retinal Dystrophies. J Clin Med 2023; 12:6953. [PMID: 37959417 PMCID: PMC10649281 DOI: 10.3390/jcm12216953] [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: 07/23/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
Inherited retinal dystrophies encompass a diverse group of disorders affecting the structure and function of the retina, leading to progressive visual impairment and, in severe cases, blindness. Electrophysiology testing has emerged as a valuable tool in assessing and diagnosing those conditions, offering insights into the function of different parts of the visual pathway from retina to visual cortex and aiding in disease classification. This review provides an overview of the application of electrophysiology testing in the non-macular inherited retinal dystrophies focusing on both common and rare variants, including retinitis pigmentosa, progressive cone and cone-rod dystrophy, bradyopsia, Bietti crystalline dystrophy, late-onset retinal degeneration, and fundus albipunctatus. The different applications and limitations of electrophysiology techniques, including multifocal electroretinogram (mfERG), full-field ERG (ffERG), electrooculogram (EOG), pattern electroretinogram (PERG), and visual evoked potential (VEP), in the diagnosis and management of these distinctive phenotypes are discussed. The potential for electrophysiology testing to allow for further understanding of these diseases and the possibility of using these tests for early detection, prognosis prediction, and therapeutic monitoring in the future is reviewed.
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Affiliation(s)
| | | | - Minzhong Yu
- Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, OH 44106, USA
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3
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Saatci AO, Ataş F, Çetin GO, Kayabaşı M. Diagnostic and Management Strategies of Bietti Crystalline Dystrophy: Current Perspectives. Clin Ophthalmol 2023; 17:953-967. [PMID: 36998515 PMCID: PMC10046287 DOI: 10.2147/opth.s388292] [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: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
Bietti crystalline dystrophy (BCD) is a rare, genetically determined chorioretinal dystrophy presenting with intraretinal crystalline deposits and varying degrees of progressive chorioretinal atrophy commencing at the posterior pole. In some cases, there can be concomitant corneal crystals noted first in the superior or inferior limbus. CYP4V2 gene, a member of the cytochrome P450 family is responsible for the disease and more than 100 mutations have been defined thus far. However, a genotype-phenotype correlation has not been established yet. Visual impairment commonly occurs between the second and third decades of life. By the fifth or sixth decade of life, vision loss can become so severe that the patient may potentially become legally blind. Multitudes of multimodal imaging modalities can be utilized to demonstrate the clinical features, course, and complications of the disease. This present review aims to reiterate the clinical features of BCD, update the clinical perspectives with the help of multimodal imaging techniques, and overview its genetic background with future therapeutic approaches.
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Affiliation(s)
- Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
- Correspondence: Ali Osman Saatci, Department of Ophthalmology, Dokuz Eylul University, Mustafa Kemal Sahil Bulvari, No: 73 A Blok, Daire 9, Narlidere, Izmir, Turkey, Tel +90 5327437071, Email
| | - Ferdane Ataş
- Department of Ophthalmology, Çerkezköy State Hospital, Tekirdağ, Turkey
| | - Gökhan Ozan Çetin
- Department of Medical Genetics, Pamukkale University, Denizli, Turkey
| | - Mustafa Kayabaşı
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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4
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Jenny LA, Liu PK, Kolesnikova M, Duong J, Kim AH, Levi SR, Greenstein VC, Tsang SH. Foveolar thickness as potential standardized structural outcome measurement in studies of Bietti crystalline dystrophy. Sci Rep 2022; 12:14706. [PMID: 36038562 PMCID: PMC9424222 DOI: 10.1038/s41598-022-16563-y] [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: 02/01/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Bietti crystalline dystrophy (BCD) is an ultra-rare orphan disorder that can lead to blindness. Because of the variable rates of progression of the disease, it is necessary to identify suitable outcome measurements for tracking progression in BCD. A retrospective analysis of patients with a clinical and genetic diagnosis of BCD was conducted. Four measurements of spectral domain-optical coherence tomography were compared to patients’ best corrected visual acuity. We observed that patients with higher measurements of foveolar thickness, choroidal thickness in the foveolar region, ellipsoid zone band length and the outer nuclear layer + area, had on average better visual acuity. Future studies are needed to validate the structural–functional correlations we observed in BCD and to propose a sensitive and clinically meaningful outcome measurement for tracking this rare, variable disease.
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Affiliation(s)
- Laura A Jenny
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, USA.,Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Pei-Kang Liu
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Masha Kolesnikova
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, USA.,Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Jimmy Duong
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, USA
| | - Angela H Kim
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, USA.,Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Sarah R Levi
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, USA.,Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, USA
| | | | - Stephen H Tsang
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, USA. .,Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, USA. .,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA. .,Institute of Human Nutrition, Columbia University, New York, NY, USA. .,Columbia University Stem Cell Initiative, New York, NY, USA.
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5
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Ratra D, Chattree S, Raviselvan M, Pradhan A, Giridhar S. Structural and functional phenotypic features and molecular analysis of Indian patients with Bietti crystalline dystrophy. Indian J Ophthalmol 2022; 70:2526-2532. [PMID: 35791149 PMCID: PMC9426155 DOI: 10.4103/ijo.ijo_2146_21] [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] [Indexed: 12/02/2022] Open
Abstract
Purpose: Bietti crystalline dystrophy (BCD) is a rare retinal dystrophy, uncommon in Indians. This study describes the various phenotypic features seen in the Indian population. Methods: In this retrospective, descriptive case series, records of patients with either clinical or molecular diagnosis of BCD from 2009 to 2020 were perused. Phenotypic and genotype information was collected and analyzed. Results: This study included 58 patients of BCD (31 males) aged 21–79 years (mean: 47 ± 14 years). The age at onset ranged from 7 to 41 years (mean: 28.8 ± 5.1 years). Vision ranged from 20/20 to counting fingers. There were 18 (31%) patients with stage 1 with crystals and mild retinochoroidal atrophy, 22 (38%) with stage 2 with atrophy extending beyond arcades, and 18 (31%) with absent crystals and extensive atrophy of stage 3. Choroidal neovascular membrane was seen in four patients. The optical coherence tomography showed retinochoroidal thinning (84.6%), outer retinal tubulations (71.8%), and paradoxical foveal thickening with interlaminar bridges (7.7%). Electrophysiology and visual fields showed reduced responses in advanced retinochoroidal changes. Molecular confirmation was available in five patients; five mutations were seen in the CYP4V2. Conclusion: A wide variation is seen in the phenotypic picture of BCD. A molecular diagnosis is helpful in differentiating from other retinal dystrophies. The OCT shows the peculiar feature of the interlaminar bridge in early cases with photoreceptor loss. Further investigations into this OCT feature may provide insights into the pathogenesis of BCD. A genotype–phenotype correlation could not be done.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Surabhi Chattree
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Munispriyan Raviselvan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Arkaprava Pradhan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sneha Giridhar
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Multimodal Imaging Observation in Different Progressive Types of Bietti Crystalline Dystrophy. J Ophthalmol 2022; 2022:7426052. [PMID: 35655804 PMCID: PMC9155937 DOI: 10.1155/2022/7426052] [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: 02/02/2022] [Accepted: 04/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of the study is to observe the difference in progression between type 1 and type 2 Bietti crystalline dystrophy (BCD) using multimodal imaging. Methods A retrospective clinical study was performed with six BCD patients who underwent multimodal imaging twice in Hebei Provincial Eye Hospital from October 2015 to December 2020. Multimodal imaging includes color fundus photography, fundus autofluorescence (AF), infrared autofluorescence (IRAF), fundus fluorescein angiography (FFA), and spectral domain optical coherence tomography (SD-OCT). The fundus lesion progression difference was observed in 3 patients with type 1 BCD and 3 patients with type 2 BCD. Results In type 1 BCD, the range of hypoautofluorescence (hypo-AF), hypoinfrared autofluorescence (hypo-IRAF), and hypofluorescence in the posterior pole was enlarged, and FFA showed that the lesions in the posterior pole and periphery extended to the middle periphery. SD-OCT revealed retinal and choroidal thinning, progressive loss of the outer nuclear layer and ellipsoid zone, and reduction of the choroid macrovascular diameter. In type 2 BCD, the range of hypo-AF was enlarged, but there was no significant change in the macula area. The uniform hypo-IRAF in the posterior pole showed no significant change. FFA showed no significant change with the progression of the disease in the macula area and the hypofluorescence around it expanded. SD-OCT revealed no obvious change in the macula area. Conclusions The retinal choroid atrophy in the macula area of type 1 BCD continued to worsen, and the choroid great vessels became narrower. The macular lesions of type 2 BCD can remain unchanged for a long time.
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7
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Gao P, Jia D, Li P, Huang Y, Hu H, Sun K, Lv Y, Chen X, Han Y, Zhang Z, Ren X, Wang Q, Liu F, Tang Z, Liu M. Accumulation of Lipid Droplets in a Novel Bietti Crystalline Dystrophy Zebrafish Model With Impaired PPARα Pathway. Invest Ophthalmol Vis Sci 2022; 63:32. [PMID: 35616930 PMCID: PMC9150832 DOI: 10.1167/iovs.63.5.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Bietti crystalline dystrophy (BCD) is a progressive retinal degenerative disease primarily characterized by numerous crystal-like deposits and degeneration of retinal pigment epithelium (RPE) and photoreceptor cells. CYP4V2 (cytochrome P450 family 4 subfamily V member 2) is currently the only disease-causing gene for BCD. We aimed to generate a zebrafish model to explore the functional role of CYP4V2 in the development of BCD and identify potential therapeutic targets for future studies. Methods The cyp4v7 and cyp4v8 (homologous genes of CYP4V2) knockout zebrafish lines were generated by CRISPR/Cas9 technology. The morphology of photoreceptor and RPE cells and the accumulation of lipid droplets in RPE cells were investigated at a series of different developmental stages through histological analysis, immunofluorescence, and lipid staining. Transcriptome analysis was performed to investigate the changes in gene expression of RPE cells during the progression of BCD. Results Progressive retinal degeneration including RPE atrophy and photoreceptor loss was observed in the mutant zebrafish as early as seven months after fertilization. We also observed the excessive accumulation of lipid droplets in RPE cells from three months after fertilization, which preceded the retinal degeneration by several months. Transcriptome analysis suggested that multiple metabolism pathways, especially the lipid metabolism pathways, were significantly changed in RPE cells. The down-regulation of the peroxisome proliferator-activated receptor α (PPARα) pathway was further confirmed in the mutant zebrafish and CYP4V2-knockdown human RPE-1 cells. Conclusions Our work established an animal model that recapitulates the symptoms of BCD patients and revealed that abnormal lipid metabolism in RPE cells, probably caused by dysregulation of the PPARα pathway, might be the main and direct consequence of CYP4V2 deficiency. These findings will deepen our understanding of the pathogenesis of BCD and provide potential therapeutic approaches.
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Affiliation(s)
- Pan Gao
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Danna Jia
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Pei Li
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yuwen Huang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Hualei Hu
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Kui Sun
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yuexia Lv
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xiang Chen
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yunqiao Han
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zuxiao Zhang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xiang Ren
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Qing Wang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Fei Liu
- State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, The Innovative Academy of Seed Design, Hubei Hongshan Laboratory, Chinese Academy of Sciences, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhaohui Tang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Mugen Liu
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
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Liu Z, Ayton LN, O'Hare F, Arslan J, Hu ML, Noar AP, Wang JH, Hickey DG, McGuinness MB, Vincent AL, Chen FK, Edwards TL. Intereye Symmetry in Bietti Crystalline Dystrophy. Am J Ophthalmol 2022; 235:313-325. [PMID: 34283985 DOI: 10.1016/j.ajo.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/07/2021] [Accepted: 07/09/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate anatomic and functional intereye symmetry among individuals with Bietti crystalline dystrophy (BCD) using clinical and multimodal imaging methods, with a focus on the number, area, and distribution of the characteristic retinal crystalline deposits. DESIGN Observational case series with prospective and retrospective data. METHODS Setting: Multicenter. STUDY POPULATION Thirteen Australian and New Zealand participants (26 eyes) with confirmed biallelic CYP4V2 mutations and a characteristic BCD fundus appearance. Procedures and main outcome measures: Crystals visible on color fundus photography were manually counted. Crystals were superimposed on aligned multimodal fundus images. Spearman's correlation coefficients (ρ), intraclass correlation coefficients (ICCs), and Bland-Altman plots were used to quantify symmetry between eyes. MAIN OUTCOME MEASURES Fundus crystal area and count, and absent-autofluorescence (absent-AF) area. RESULTS Median participant age was 48 years (interquartile range: 40-60 years). Intereye symmetry was high for fundus crystal area (ρ = 1.00, 95% confidence interval [CI]: 1.00-1.00; ICC = 0.97, 95% CI: 0.88-0.99), fundus crystal count (ρ = 0.98, 95% CI: 0.92-1.00; ICC = 0.97, 95% CI: 0.89-0.99), and absent-AF area (ρ = 0.88, 95% CI: 0.53-0.98; ICC = 0.98, 95% CI: 0.90-0.99). Average foveal volume, foveal crystal count and area, average and central foveal thickness, best corrected visual acuity, and average macular and central foveal sensitivity were not highly correlated between eyes. CONCLUSIONS This study demonstrated strong intereye symmetry measured by fundus crystal area, fundus crystal number, and absent-AF area. This may influence the choice of outcome measures for future therapeutic trials for BCD and provides valuable clinical information for ophthalmologists involved in the care and counseling of patients with BCD.
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Louati Y, Vaclavik V, Moulin A, Schorderet D, Munier FL, Viet Tran H. Crystals deposits in the anterior and posterior lens cortex in Bietti corneo-retinal dystrophy. Ophthalmic Genet 2021; 42:773-779. [PMID: 34310258 DOI: 10.1080/13816810.2021.1952620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Whereas crystals deposit in the retina, the cornea and limbus in Bietty corneo-retinal dystrophy (BCD) is now well established and documented, only two published cases report their findings in the lens and no cases deep in the lens cortex. MATERIAL AND METHODS Four consecutive adult patients from three different unrelated families presenting lens crystals associated with advanced genetically confirmed BCD were enrolled with advanced disease and long follow up (>12 years). Demographics, visual acuity, slit lamp biomicroscopy, lens and posterior pole photography, optical coherence tomography (OCT), autofluorescence, and screening for CYP4V2 type of mutation were performed. The setting was Jules Gonin Eye Hospital, Switzerland, between 1.1 2013 and 1.11. 2019. RESULTS All patients were European women. The ages ranged from 40 to 81 years. Best Snellen visual acuity ranged from light perception to 1.0. All patients presented with limbus and retinal crystals deposit that disappeared over time and the development of severe chorioretinal atrophy. With long-term follow up, multiple crystal-like deposits appeared in the anterior, posterior lens capsule and cortex. All patients, but one, had homozygous or compound heterozygous mutations in CYP4V2 gene. CONCLUSIONS To the best of our knowledge, there are no published cases of crystal deposits in the cortex of the lens of patients diagnosed with BCD associated with CYP4V2 gene mutation. This could be a feature of advanced BCD, and their presence in the lens cortex questions the hypothesis of floating deposits from posterior pole although their exact etiology remains to be determined.
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Affiliation(s)
- Youssr Louati
- Oculogenetic Unit, Jules-Gonin University Eye Hospital, Lausanne, Switzerland
| | - Veronika Vaclavik
- Oculogenetic Unit, Jules-Gonin University Eye Hospital, Lausanne, Switzerland
| | - Alexandre Moulin
- Oculogenetic Unit, Jules-Gonin University Eye Hospital, Lausanne, Switzerland
| | | | - Francis L Munier
- Oculogenetic Unit, Jules-Gonin University Eye Hospital, Lausanne, Switzerland
| | - Hoai Viet Tran
- Oculogenetic Unit, Jules-Gonin University Eye Hospital, Lausanne, Switzerland
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10
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Wang W, Chen W, Bai X, Chen L. Multimodal imaging features and genetic findings in Bietti crystalline dystrophy. BMC Ophthalmol 2020; 20:331. [PMID: 32799831 PMCID: PMC7429681 DOI: 10.1186/s12886-020-01545-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bietti crystalline dystrophy (BCD) is a distinct entity of retinitis pigmentosa with a wide range of genotypic and phenotypic variabilities. The goal of the present study was to investigate the morphological, functional and genetic features of BCD. Methods A full series of multimodal imaging was performed in four Chinese patients with BCD, including fundus photography, fundus autofluorescence, fundus fluorescein angiography (FFA), indocyanine green (ICG) angiography, optical coherence tomography (OCT) and microperimetry. Electrophysiological tests including full-field electroretinography (ERG) and multifocal ERG were employed. CYP4V2 gene sequencing was performed. Results Intraretinal crystalline deposits were observed in fundus photographs in all patients. The crystals were better appreciated in infrared images. Autofluorescence imaging demonstrated multifocal patchy hypofluorescence, suggesting massive RPE atrophy. FFA and ICG angiography further confirmed atrophy of the RPE and the underlying choroidal vessels. OCT revealed disruption of the photoreceptors, RPE and the choroid. Outer retinal tubulations (ORTs) confining to the outer nuclear layer were detected in three out of four patients. Full-field ERG showed markedly diminished responses. Multifocal ERG displayed reduced central and peripheral responses in a patient with normal vision. Gene sequencing identified two deletion mutations in CYP4V2, c.802_807del and c.810delT. BCD complicated by choroidal neovascularization (CNV) was diagnosed in one patient, and intravitreal anti-vascular endothelial growth factor (VEGF) injection was given with favorable response. Conclusions Multimodal imaging features and electrophysiological findings of BCD patients were comprehensively discussed. A novel deletion mutation, c.802_807del, in the CYP4V2 gene was reported. ORTs are important changes in the outer retina of BCD patients, further investigation of this structure may provide insights into pathology of BCD. Intravitreal anti-VEGF therapy was effective for treatment of BCD complicated by CNV.
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Affiliation(s)
- Wei Wang
- Department of Ophthalmology and Vision Science, the Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.,Key Laboratory of Myopia of State Health Ministry (Fudan University) and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wei Chen
- Department of Ophthalmology and Vision Science, the Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.,Key Laboratory of Myopia of State Health Ministry (Fudan University) and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
| | - Xinyue Bai
- Department of Ophthalmology and Vision Science, the Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.,Key Laboratory of Myopia of State Health Ministry (Fudan University) and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
| | - Ling Chen
- Department of Ophthalmology and Vision Science, the Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China. .,Key Laboratory of Myopia of State Health Ministry (Fudan University) and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
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11
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Zhang Z, Yan B, Gao F, Li Q, Meng X, Chen P, Zhou L, Deng W, Li C, Xu W, Han S, Feng H, Li Y, Chen J, Yin Z, Liao C, Tse HF, Xu A, Lian Q. PSCs Reveal PUFA-Provoked Mitochondrial Stress as a Central Node Potentiating RPE Degeneration in Bietti's Crystalline Dystrophy. Mol Ther 2020; 28:2642-2661. [PMID: 32755565 PMCID: PMC7704739 DOI: 10.1016/j.ymthe.2020.07.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/25/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022] Open
Abstract
Bietti’s crystalline dystrophy (BCD) is an incurable retinal disorder caused by the polypeptide 2 of cytochrome P450 family 4 subfamily V (CYP4V2) mutations. Patients with BCD present degeneration of retinal pigmented epithelial (RPE) cells and consequent blindness. The lack of appropriate disease models and patients’ RPE cells limits our understanding of the pathological mechanism of RPE degeneration. In this study, using CYP4V2 mutant pluripotent stem cells as disease models, we demonstrated that RPE cells with CYP4V2 mutations presented a disrupted fatty acid homeostasis, which were characterized with excessive accumulation of poly-unsaturated fatty acid (PUFA), including arachidonic acid (AA) and eicosapentaenoic acid (EPA). The PUFA overload increased mitochondrial reactive oxygen species, impaired mitochondrial respiratory functions, and triggered mitochondrial stress-activated p53-independent apoptosis in CYP4V2 mutant RPE cells. Restoration of the mutant CYP4V2 using adeno-associated virus 2 (AAV2) can effectively reduce PUFA deposition, alleviate mitochondria oxidative stresses, and rescue RPE cell death in BCD RPE cells. Taken together, our results highlight a role of PUFA-induced mitochondrial damage as a central node to potentiate RPE degeneration in BCD patients. AAV2-mediated gene therapy may represent a feasible strategy for the treatment of BCD.
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Affiliation(s)
- Zhao Zhang
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Prenatal Diagnostic Centre and Cord Blood Bank, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Bin Yan
- Department of Computer Science, The University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China; Intervention and Cell Therapy Center, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Fei Gao
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Qing Li
- Ophthalmology, Grantham Hospital, Hospital Authority, Hong Kong SAR, China
| | - Xiaohong Meng
- Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China
| | - Peikai Chen
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Lei Zhou
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Wen Deng
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Cheng Li
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Weiyi Xu
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Shuo Han
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hong Feng
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yaping Li
- Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, China
| | - Junhui Chen
- Intervention and Cell Therapy Center, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Zhengqin Yin
- Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China
| | - Can Liao
- Prenatal Diagnostic Centre and Cord Blood Bank, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Hung-Fat Tse
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Aimin Xu
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR, China.
| | - Qizhou Lian
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Prenatal Diagnostic Centre and Cord Blood Bank, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China; State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR, China.
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12
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Tiryaki Demir S, Keles Yesiltas S, Kacar H, Akbas EB, Guven D. Optical coherence tomography and optical coherence tomography angiography imaging in Bietti crystalline dystrophy. Ophthalmic Genet 2020; 41:194-197. [PMID: 32281452 DOI: 10.1080/13816810.2020.1750036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Bietti crystalline dystrophy (BCD) is a rare autosomal recessive disorder due to genetic defect in the CYP4V2 gene. BCD is a disease characterized by shiny yellow crystalline deposits in the retina with progressive atrophy of the retinal pigment epithelium and choriocapillaris. Our aim is to present ocular imaging findings of a patient with BCD.Materials and Metods: A 38-year-old female patient with BCD was evaluated and the findings of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) were examined.Results: OCT imaging revealed multiple outer retinal tubulations (ORTs) with a few hyperreflective crystalline deposits. OCTA imaging showed that the vessel density of superficial anddeep capillary plexus and choriocapillaris blood flow were significantly decreased. ORTs were composedof multiple microtubules as finger-like protrusions that joined the macrotubules.Conclusion: In BCD, crystallinedeposits, ORTs and retinal vascular morphology can be shown in detail using OCT and OCTA.
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Affiliation(s)
- Semra Tiryaki Demir
- Department of Ophthalmology, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sümeyra Keles Yesiltas
- Department of Ophthalmology, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hakan Kacar
- Department of Ophthalmology, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Emine Betül Akbas
- Department of Ophthalmology, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Dilek Guven
- Department of Ophthalmology, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey
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13
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Surve A, Balaji A, Azad SV, Kumar V, Vohra R, Venkatesh P. Role of red free imaging, retinal reflectance and fundus autofluorescence in Bietti crystalline dystrophy: case report. THERAPEUTIC ADVANCES IN RARE DISEASE 2020; 1:2633004020958013. [PMID: 37180496 PMCID: PMC10032466 DOI: 10.1177/2633004020958013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/27/2020] [Indexed: 05/16/2023]
Abstract
Bietti crystalline dystrophy (BCD), a rare autosomal recessive hereditary disorder, is identified by its clinical features. It is characterised by crystalline deposits and hence called crystalline retinopathy. The retinopathy progresses with age, showing a decrease in the number of crystalline deposits and increase in the area of chorioretinal degeneration, which spreads in a centrifugal pattern. Thus, BCD can be confused with other disorders with crystalline-like deposits and chorioretinal degenerations. The red-free and near-infrared reflectance allows prominent visualisation of crystalline deposits that may be missed. The non-inferiority of red-free imaging and its wider availability could allow its use as a screening tool. The enhanced depth imaging optical coherence tomography shows crystalline deposits throughout the retina and outer retinal tubulation. Thus, multimodality imaging can act as an adjunct in diagnosis, monitoring and follow up in these cases, acting not only as a teaching tool but also giving an insight into the underlying pathophysiology of the disorder. Plain language summary Use of imaging in diagnosis of Bietti crystalline dystrophy Bietti crystalline dystrophy is a rare familial disorder but is not shown in all family members and may skip generations, as it has an autosomal recessive pattern of inheritance. It shows refractile yellow-white crystalline deposits and degenerative changes in the retina. These crystalline deposits disappear with age while degenerative changes increase and spread from centre to the periphery. This may cause difficulty in early detection, and confusion with similar degenerative diseases of the retina. The use of various imaging modalities can help in diagnosis and follow up of these cases. These modalities also provide understanding of the basic disease process.
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Affiliation(s)
- Abhidnya Surve
- Vitreoretinal, trauma and uvea services, Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
| | - Akshaya Balaji
- Dr. Rajendra Prasad Centre for Ophthalmic
Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi,
India
| | - Shorya Vardhan Azad
- Assistant Professor, Vitreo-retina, Trauma &
Uvea Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India
Institute of Medical Sciences, Ansari nagar, New Delhi 110029, India
| | - Vinod Kumar
- Vitreoretinal, trauma and uvea services, Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajpal Vohra
- Vitreoretinal, trauma and uvea services, Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
| | - Pradeep Venkatesh
- Vitreoretinal, trauma and uvea services, Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi, India
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14
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García-García GP, Martínez-Rubio M, Moya-Moya MA, Pérez-Santonja JJ, Escribano J. Current perspectives in Bietti crystalline dystrophy. Clin Ophthalmol 2019; 13:1379-1399. [PMID: 31440027 PMCID: PMC6679682 DOI: 10.2147/opth.s185744] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/08/2019] [Indexed: 01/17/2023] Open
Abstract
Bietti crystalline dystrophy (BCD) is a rare-inherited disease caused by mutations in the CYP4V2 gene and characterized by the presence of multiple shimmering yellow-white deposits in the posterior pole of the retina in association with atrophy of the retinal pigment epithelium (RPE) and chorioretinal atrophy. The additional presence of glittering dots located at the corneal limbus is also a frequent finding. The CYP4V2 protein belongs to the cytochrome P450 subfamily 4 and is mainly expressed in the retina and the RPE and less expressed in the cornea. The disease has its metabolic origin in the diminished transformation of fatty acid substrates into n-3 polyunsaturated fatty acids due to a dysregulation of the lipid metabolism. In this review, we provide updated insights on clinical and molecular characteristics of BCD including underlying mechanisms of BCD, genetic diagnosis, progress in the identification of causative genetic and epigenetic factors, available techniques of exploration and development of novel therapies. This information will help clinicians to improve accuracy of BCD diagnosis, providing the patient reliable information regarding prognosis and clinical prediction of the disease course.
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Affiliation(s)
- G P García-García
- Department of Ophthalmology, General University Hospital of Alicante, Alicante 03010, Spain
| | - M Martínez-Rubio
- Department of Ophthalmology, General University Hospital of Alicante, Alicante 03010, Spain
| | - M A Moya-Moya
- Department of Ophthalmology, General University Hospital of Alicante, Alicante 03010, Spain
| | - J J Pérez-Santonja
- Department of Ophthalmology, General University Hospital of Alicante, Alicante 03010, Spain
| | - J Escribano
- Cooperative Research Network on Ophthalmology (OftaRed), Visual and Life Quality, Instituto de Salud Carlos III, Madrid, Spain.,Laboratory of Human Molecular Genetics, Medicine Faculty/Research Institute on Neurological Disabilities (IDINE), University of Castilla La-Mancha, Albacete 02006, Spain
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15
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Huang XL, Song YP, Ding Q, Chen X, Hong L. Evaluation of outer retinal tubulations in diabetic macular edema underwent anti-VEGF treatment. Int J Ophthalmol 2019; 12:442-450. [PMID: 30918814 DOI: 10.18240/ijo.2019.03.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 01/02/2019] [Indexed: 12/22/2022] Open
Abstract
AIM To investigate the incidence and subsequent changes of outer retinal tubulations (ORTs) in diabetic macular edema (DME) underwent anti-vascular endothelial growth factor (VEGF) therapy, and to assess the possibility of ORT as a biomarker of DME severity or response to anti-VEGF therapy. METHODS This retrospective and descriptive study included a total of 228 patients (435 eyes) with DME and treated with intravitreal anti-VEGF agents between March 2016 and January 2018. Patients were divided into 2 groups according to the presence of ORTs. High-resolution spectral-domain optical coherence tomography (SD-OCT) images acquired by vertical and horizontal scans and over consecutive visits were analyzed. The evolution of ORT over time, type of fluid and subfoveal photoreceptor integrity on OCT imaging was also assessed. RESULTS ORTs were identified in 108 eyes of 435 eyes with an overall incidence rate of 24.83% at baseline. ORTs were prone to locate adjacent to the lesions of exudation and/or cystoid edema and possibly situated in outer nuclear layer (ONL), outer plexiform layer (OPL) and/or inner nuclear layer (INL) in eyes with DME. The formation process of ORT led to focal downward displacement of OPL and INL toward RPE near the lesion. During the follow up, 45 eyes had steady ORTs and 63 eyes had dynamic variants in ORTs, including disappearance, reappearance, collapse, diminution, and enlargement. There were higher proportion of closed ORTs and fewer proportion of forming ORTs in eyes with steady ORTs, which showed a statistically significance when compared with eyes with variant ORTs (P=0.006, P=0.017, respectively). The eyes without ORTs had significantly better final best corrected visual acuity (BCVA) and more BCVA change than those eyes with ORTs in DME patients after anti-VEGF therapy (P=0.023, P=0.009, respectively). The disruption of subfoveal photoreceptor integrity in eyes with ORTs was more serious than that in eyes without ORTs (P=0.013). The proportion of stable vision in eyes with ORTs was significantly higher than that in eyes without ORTs, showing statistical significance (P=0.016). ORTs were associated with worse visual prognosis due to damage of the subfoveal photoreceptor integrity. CONCLUSION ORTs have a high incidence and changes over time in DME with anti-VEGF treatment and may be located at various retinal layers. Persistent ORT can be as a negative biomarker of outcome of DME.
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Affiliation(s)
- Xiao-Li Huang
- Department of Ophthalmology, Wuhan School of Clinical Medicine, Southern Medical University (Wuhan General Hospital of Guangzhou Military Region), Wuhan 430060, Hubei Province, China
| | - Yan-Ping Song
- Department of Ophthalmology, Wuhan School of Clinical Medicine, Southern Medical University (Wuhan General Hospital of Guangzhou Military Region), Wuhan 430060, Hubei Province, China
| | - Qin Ding
- Department of Ophthalmology, Wuhan School of Clinical Medicine, Southern Medical University (Wuhan General Hospital of Guangzhou Military Region), Wuhan 430060, Hubei Province, China
| | - Xiao Chen
- Department of Ophthalmology, Wuhan School of Clinical Medicine, Southern Medical University (Wuhan General Hospital of Guangzhou Military Region), Wuhan 430060, Hubei Province, China
| | - Ling Hong
- Department of Ophthalmology, Wuhan School of Clinical Medicine, Southern Medical University (Wuhan General Hospital of Guangzhou Military Region), Wuhan 430060, Hubei Province, China
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16
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Kovach JL, Isildak H, Sarraf D. Crystalline retinopathy: Unifying pathogenic pathways of disease. Surv Ophthalmol 2019; 64:1-29. [DOI: 10.1016/j.survophthal.2018.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 01/02/2023]
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17
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Jauregui R, Cho GY, Takahashi VKL, Takiuti JT, Bassuk AG, Mahajan VB, Tsang SH. Caring for Hereditary Childhood Retinal Blindness. Asia Pac J Ophthalmol (Phila) 2018; 7:183-191. [PMID: 29536675 DOI: 10.22608/apo.201851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Inherited retinal diseases (IRDs) are a major cause of incurable familial blindness in the Western world. In the pediatric population, IRDs are a major contributor to the 19 million children worldwide with visual impairment. Unfortunately, the road to the correct diagnosis is often complicated in the pediatric population, as typical diagnostic tools such as fundus examination, electrodiagnostic studies, and other imaging modalities may be difficult to perform in the pediatric patient. In this review, we describe the most significant IRDs with onset during the pediatric years (ie, before the age of 18). We describe the pathogenesis, clinical presentation, and potential treatment of these diseases. In addition, we advocate the use of a pedigree (family medical history), electroretinography, and genetic testing as the 3 most crucial tools for the correct diagnosis of IRDs in the pediatric population.
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Affiliation(s)
- Ruben Jauregui
- Department of Ophthalmology, Columbia University, New York, NY
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University Medical Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Galaxy Y Cho
- Department of Ophthalmology, Columbia University, New York, NY
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University Medical Center, New York, NY
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT
| | - Vitor K L Takahashi
- Department of Ophthalmology, Columbia University, New York, NY
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University Medical Center, New York, NY
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Julia T Takiuti
- Department of Ophthalmology, Columbia University, New York, NY
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University Medical Center, New York, NY
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Vinit B Mahajan
- Byers Eye Institute, Omics Laboratory, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA
- Palo Alto Veterans Administration, Palo Alto, CA
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, NY
- Department of Pathology & Cell Biology, Stem Cell Initiative (CSCI), Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY
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18
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Oishi A, Oishi M, Miyata M, Hirashima T, Hasegawa T, Numa S, Tsujikawa A. Multimodal Imaging for Differential Diagnosis of Bietti Crystalline Dystrophy. Ophthalmol Retina 2018; 2:1071-1077. [PMID: 31047497 DOI: 10.1016/j.oret.2018.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/16/2018] [Accepted: 02/28/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the diagnostic usefulness of multimodal imaging in patients with Bietti crystalline dystrophy (BCD). DESIGN Retrospective cross-sectional study. PARTICIPANTS Patients with chorioretinal dystrophy accompanied by crystalline-like deposits. The right eyes of the patients were analyzed. METHODS Fundus photograph, near-infrared reflectance (NIR), fundus autofluorescence (FAF), and OCT images were evaluated. Presence of hyperreflectivity on NIR, well-demarcated areas of decreased FAF, hyperreflective material at or on the retinal pigment epithelium-Bruch's membrane complex, and outer retinal tubulation were graded for each patient. All exons and franking introns of CYP4V2 were screened using Sanger sequencing. MAIN OUTCOME MEASURES Sensitivity and specificity of the findings to discriminate patients with and without CYP4V2 mutation. RESULTS In total, 33 patients were included in the study. Sanger sequencing revealed homozygous or compound heterozygous CYP4V2 mutations in 20 patients and heterozygous mutations in 2 patients. Among the investigated factors, hyperreflective appearance on NIR imaging yielded 100% sensitivity and 100% specificity in this cohort. The presence of outer retinal tubulation also was sensitive (95%), but specificity was moderate (45%). The revised diagnoses of patients without CYP4V2 mutations included retinitis pigmentosa, late-onset macular dystrophy, and central areolar choroidal dystrophy. CONCLUSIONS Multimodal imaging, especially NIR imaging, is useful to differentiate BCD patients with CYP4V2 mutations from patients with other chorioretinal dystrophies accompanied by crystalline-like retinal deposits.
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Affiliation(s)
- Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Maho Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takako Hirashima
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoko Hasegawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shogo Numa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Abeshi A, Bruson A, Beccari T, Dundar M, Ziccardi L, Bertelli M. Genetic testing for Bietti crystalline dystrophy. EUROBIOTECH JOURNAL 2017. [DOI: 10.24190/issn2564-615x/2017/s1.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
We studied the scientific literature and disease guidelines in order to summarize the clinical utility of the genetic test for Bietti crystalline dystrophy (BCD). The disease has autosomal recessive inheritance, a prevalence of 1 per 67 000, and is caused by mutations in the CYP4V2 gene. Clinical diagnosis is based on clinical findings, ophthalmological examination, electroretinography and optical coherence tomography. The genetic test is useful for confirming diagnosis, and for differential diagnosis, couple risk assessment and access to clinical trials.
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Affiliation(s)
- Andi Abeshi
- MAGI Balkans, Tirana , Albania
- MAGI’S Lab, Rovereto , Italy
| | | | - Tommaso Beccari
- Department of Pharmaceutical Sciences, University of Perugia, Perugia , Italy
| | - Munis Dundar
- Department of Medical Genetics, Erciyes University Medical School, Kayseri , Turkey
| | - Lucia Ziccardi
- Neurophthalmology Unit, “G.B. Bietti” Foundation IRCCS, Rome , Italy
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20
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Abstract
Bietti crystalline dystrophy (BCD) is an inherited retinal degenerative disease characterized by crystalline deposits in the retina, followed by progressive atrophy of the retinal pigment epithelium (RPE), choriocapillaris, and photoreceptors. CYP4V2 has been identified as the causative gene for BCD. The CYP4V2 gene belongs to the cytochrome P450 superfamily and encodes for fatty acid ω-hydroxylase of both saturated and unsaturated fatty acids. The CYP4V2 protein is localized most abundantly within the endoplasmic reticulum in the RPE and is postulated to play a role in the physiological lipid recycling system between the RPE and photoreceptors to maintain visual function. Electroretinographic assessments have revealed progressive dysfunction of rod and cone photoreceptors in patients with BCD. Several genotypes have been associated with more severe phenotypes based on clinical and electrophysiological findings. With the advent of multimodal imaging with spectral domain optical coherence tomography, fundus autofluorescence, and adaptive optics scanning laser ophthalmoscopy, more precise delineation of BCD severity and progression is now possible, allowing for the potential future development of targets for gene therapy.
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Affiliation(s)
- Danny S C Ng
- From the *Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; and †2010 Retina and Macula Centre, Kowloon, Hong Kong
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21
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Fuerst NM, Serrano L, Han G, Morgan JIW, Maguire AM, Leroy BP, Kim BJ, Aleman TS. Detailed functional and structural phenotype of Bietti crystalline dystrophy associated with mutations in CYP4V2 complicated by choroidal neovascularization. Ophthalmic Genet 2016; 37:445-452. [PMID: 27028354 DOI: 10.3109/13816810.2015.1126616] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe in detail the phenotype of a patient with Bietti crystalline dystrophy (BCD) complicated by choroidal neovascularization (CNV) and the response to intravitreal Bevacizumab (Avastin®; Genentech/Roche). METHODS A 34-year-old woman with BCD and mutations in CYP4V2 (c.802-8_806del13/p.H331P:c992A>C) underwent a complete ophthalmic examination, full-field flash electroretinography (ERG), kinetic and two-color dark-adapted perimetry, and dark-adaptometry. Imaging was performed with spectral domain optical coherence tomography (SD-OCT), near infrared (NIR) and short wavelength (SW) fundus autofluorescence (FAF), and fluorescein angiography (FA). RESULTS Best-corrected visual acuity (BCVA) was 20/20 and 20/60 for the right and left eye, respectively. There were corneal paralimbal crystal-like deposits. Kinetic fields were normal in the peripheral extent. Retinal crystals were most obvious on NIR-reflectance and corresponded with hyperreflectivities within the RPE on SD-OCT. There was parafoveal/perifoveal hypofluorescence on SW-FAF and NIR-FAF. Rod > cone sensitivity loss surrounded fixation and extended to ~10° of eccentricity corresponding to regions of photoreceptor outer segment-retinal pigmented epithelium (RPE) interdigitation abnormalities. The outer nuclear layer was normal in thickness. Recovery of sensitivity following a ~76% rhodopsin bleach was normal. ERGs were normal. A subretinal hemorrhage in the left eye co-localized with elevation of the RPE on SD-OCT and leakage on FA, suggestive of CNV. Three monthly intravitreal injections of Bevacizumab led to restoration of BCVA to baseline (20/25). CONCLUSION crystals in BCD were predominantly located within the RPE. Photoreceptor outer segment and apical RPE abnormalities underlie the relatively extensive retinal dysfunction observed in relatively early-stage BCD. Intravitreal Bevacizumab was effective in treating CNV in this setting.
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Affiliation(s)
- Nicole M Fuerst
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Leona Serrano
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Grace Han
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Jessica I W Morgan
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Albert M Maguire
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA.,b Division of Ophthalmology, Children's Hospital of Philadelphia, and Department of Ophthalmology , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Bart P Leroy
- b Division of Ophthalmology, Children's Hospital of Philadelphia, and Department of Ophthalmology , University of Pennsylvania , Philadelphia , Pennsylvania , USA.,c Center for Cellular & Molecular Therapeutics, Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA.,d Department of Ophthalmology and the Center for Medical Genetics, Ghent University and Ghent University Hospital , Ghent , Belgium
| | - Benjamin J Kim
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Tomas S Aleman
- a Scheie Eye Institute and Perelman Center for Advanced Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA.,b Division of Ophthalmology, Children's Hospital of Philadelphia, and Department of Ophthalmology , University of Pennsylvania , Philadelphia , Pennsylvania , USA
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22
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Giachetti Filho RG, Zacharias LC, Monteiro TV, Preti RC, Pimentel SG. Prevalence of outer retinal tubulation in eyes with choroidal neovascularization. Int J Retina Vitreous 2016; 2:6. [PMID: 27847624 PMCID: PMC5088468 DOI: 10.1186/s40942-016-0029-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/10/2015] [Indexed: 12/22/2022] Open
Abstract
Background Outer retinal tubulations (ORTs) are branching tubular structures located in the outer nuclear layer of the retina. The goal of this study is to determine the prevalence of ORTs observed in eyes with choroidal neovascularization (CNV) undergoing treatment with anti-angiogenic intravitreous injection (IVI) with anti-VEGF (vascular endothelial growth factor) at the Ophthalmology Department of a tertiary hospital in São Paulo, Brazil. Methods This is a descriptive study based on medical charts and Spectral-domain Optical Coherence Tomography (Sd-OCT) scans of 142 patients (158 eyes) treated between 2012 and 2014 with IVI of anti-VEGF for CNV. The patients’ data was analysed according to age, gender, pathology, presence of ORTs, and best corrected visual acuity (BCVA). Patients with and without ORTs were compared according to the last BCVA obtained using Chi square corrected by the Yates factor. Results ORTs were found in a total of 40 out of 158 eyes (25.31 %) with CNV; in 33 out of 119 eyes (27.7 %) with neovascular age-related macular disease (AMD); in 5 out of 8 eyes (62.5 %) with neovascular angioid streaks; and in 2 out of 12 eyes (16.67 %) with myopic neovascular membranes. Most patients with ORTs had BCVA worse than 20/200, significantly worse BCVA than patients without ORTs. Conclusions Recent studies have considered that the presence of ORTs is indicative of a photoreceptor degeneration process and may represent a final stage of multiple retinal degenerative pathologies. The prevalence of ORTs in eyes with CNV has not been well described, especially when considering the Brazilian population treated in a public health care system. In our study, ORTs were observed in only three different pathologies: neovascular AMD, neovascular angioid streaks and myopic neovascular membranes. The correct recognition of ORTs is fundamental for its differentiation from intraretinal cysts, for the latter is related to the activity of neovascular diseases, and usually guides anti-angiogenic therapy. We conclude that ORTs have a high prevalence in the population studied, and their correct identification presents relevant therapeutic implications.
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Affiliation(s)
- Richard Geraldo Giachetti Filho
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Eneas Carvalho de Aguiar, 155-Bloco 8-6º andar, São Paulo, Brazil
| | - Leandro Cabral Zacharias
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Eneas Carvalho de Aguiar, 155-Bloco 8-6º andar, São Paulo, Brazil
| | - Thaís Vera Monteiro
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Eneas Carvalho de Aguiar, 155-Bloco 8-6º andar, São Paulo, Brazil
| | - Rony Carlos Preti
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Eneas Carvalho de Aguiar, 155-Bloco 8-6º andar, São Paulo, Brazil
| | - Sérgio Gianoti Pimentel
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Eneas Carvalho de Aguiar, 155-Bloco 8-6º andar, São Paulo, Brazil
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Şahin M, Yıldırım A, Türkcü FM, Yüksel H, Şahin A. Bietti Crystalline Retinal Dystrophy: A Case Report. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2016. [DOI: 10.5799/jcei.328695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Park YJ, Hwang DJ, Seong MW, Park SS, Woo SJ. Bietti Crystalline Retinopathy Confirmed by Mutation of CYP4V2 Gene in a Korean Patient. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:81-3. [PMID: 26865810 PMCID: PMC4742652 DOI: 10.3341/kjo.2016.30.1.81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Young Joo Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.; Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Evaluation of Photoreceptors in Bietti Crystalline Dystrophy with CYP4V2 Mutations Using Adaptive Optics Scanning Laser Ophthalmoscopy. Am J Ophthalmol 2016; 161:196-205.e1. [PMID: 26521715 DOI: 10.1016/j.ajo.2015.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate photoreceptors in Bietti crystalline dystrophy patients with CYP4V2 mutations using high-resolution images of the macula obtained with adaptive optics scanning laser ophthalmoscopy (AO-SLO). DESIGN Prospective observational case series with comparison to healthy controls. METHODS Seven eyes of 7 Bietti crystalline dystrophy patients with CYP4V2 mutations and 12 normal eyes of 12 age- and axial length-matched healthy volunteers were studied. All participants underwent ophthalmologic examinations and AO-SLO assessments. All patients underwent spectral-domain optical coherence tomography, fundus autofluorescence, Humphrey field analysis, and electroretinography. AO-SLO images were analyzed 0.5 mm and 1.0 mm from the center of the fovea in the superior, inferior, nasal, and temporal quadrants. RESULTS Mean ± standard deviation cone density (cells/mm(2)) 0.5 mm from the center of the fovea was 17,209 ± 2276 in patients and 20 493 ± 2758 in controls, which was statistically different (P = .001); however, mean cone density 1.0 mm from the center of the fovea was 15 685 ± 2302 in patients and 15 705 ± 1848 in controls, which was not statistically different (P = .20). There was no correlation between cone density and mean deviation measured using a Humphrey field analysis or visual acuity in patients. CONCLUSIONS In Bietti crystalline dystrophy patients with CYP4V2 mutations, cone density remained for visual dysfunction by evaluation using high-resolution AO-SLO. These findings support the theory that disorder of the retinal pigment epithelium and the photoreceptors in the patients are the primary and secondary pathologic changes, respectively. This is consistent with results from previous basic studies.
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Hua R, Chen K, Hu Y, Wang X, Chen L. Relapse of choroidal neovascularization in Bietti's crystalline retinopathy following anti-vascular endothelial growth factor therapy: A case report. Exp Ther Med 2015; 10:1704-1706. [PMID: 26640540 PMCID: PMC4665965 DOI: 10.3892/etm.2015.2716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 07/14/2015] [Indexed: 01/14/2023] Open
Abstract
Choroidal neovascularization secondary to retinitis pigmentosa is rarely observed in clinical practice. The present study describes a case of atypical retinitis pigmentosa, crystalline retinal pigmentary degeneration, complicated by choroidal neovascularization (CNV) in a 26-year-old man presenting with blurred vision in the right eye. Heidelberg multimodality imaging was performed to achieve a confirmed diagnosis. Bevacizumab was injected once intravitreally. The 3-month follow-up included visualization of the lesion's regression with spectral domain optical coherence tomography (SD-OCT). However, at 3 months after the injection, the CNV reoccurred. To the best of our knowledge, this is the first time that a case of CNV secondary to retinitis pigmentosa, in which the diagnosis was confirmed via multimodality imaging and the therapeutic efficacy was evaluated by SD-OCT, has been reported in China.
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Affiliation(s)
- Rui Hua
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Kang Chen
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yuedong Hu
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Xinling Wang
- Department of Ophthalmology, Fourth Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Lei Chen
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Abstract
PURPOSE To investigate the incidence of outer retinal tubulation (ORT) in ranibizumab-treated neovascular age-related macular degeneration patients. METHODS We included 480 consecutive patients (546 eyes) with neovascular age-related macular degeneration, who were treated with variable-dosing intravitreal ranibizumab, evaluated with spectral domain optical coherence tomography, and followed-up for a minimum period of 6 months. Optical coherence tomographies were evaluated for the first appearance of ORT, precursor signs, and type of underlying lesion. Visual acuity was also recorded. RESULTS Outer retinal tubulation was observed in 30% of eyes during a mean follow-up period of 26.7 months (SD, 13.5). Kaplan-Meier survival analysis revealed that the ORT incidence (2.5, 17.5, 28.4, and 41.6% at baseline, after 1, 2, and 4 years, respectively) continuously increased, despite visually effective anti-vascular endothelial growth factor treatment. Outer retinal tubulation was associated with a poorer functional benefit. Lower baseline visual acuity was associated with a higher risk of developing ORT. CONCLUSION Incidence of ORT continuously increases despite visually optimal anti-vascular endothelial growth factor treatment of age-related macular degeneration. Outer retinal tubulation might be considered a prognostic factor for functional outcome and is relevant to avoid overtreatment.
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UTILIZATION OF FUNDUS AUTOFLUORESCENCE, SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY, AND ENHANCED DEPTH IMAGING IN THE CHARACTERIZATION OF BIETTI CRYSTALLINE DYSTROPHY IN DIFFERENT STAGES. Retina 2015; 35:2074-84. [DOI: 10.1097/iae.0000000000000592] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Al-Halafi AM. Outer retinal tubulation in diabetic macular edema following anti-VEGF treatment. EYE AND VISION 2015; 2:9. [PMID: 26613090 PMCID: PMC4660850 DOI: 10.1186/s40662-015-0018-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/19/2015] [Indexed: 11/19/2022]
Abstract
Background To address the presence and features of outer retinal tubulation (ORT) found in diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (anti-VEGF) and to differentiate between ORT and cystoid DME, which have different plans of management. Methods This was a retrospective review of a total of 514 patients investigated with spectral domain optical coherence tomography (OCT) in patients with diabetic macular edema treated with anti-VEGF. ORT was seen in 12 eyes of 11 patients. The morphologic characteristics of ORT and its progress over time were examined using OCT data. The retinal images were obtained by horizontal and vertical scans to analyze the possible presence of ORT and to explore their morphologic features and location in the retinal layers. Results ORT was seen in DME treated with anti-VEGF. ORT was shown as round or ovoid hyporeflective spaces with hyperreflective borders on the B-scans, measuring 30 to 120 μm high and 30 to 1775 μm wide. The tubules generally remained stable over time. In a retinal practice specializing in advanced diabetic retinopathy clinic, this ORT was seen in 12 eyes of 11 patients during a 12-month period. ORT presented either after receiving 0.05 mL open-label intravitreal injections of 0.5 mg ranibizumab or 1.25 mg bevacizumab. Conclusion ORT is found in DME treated with anti-VEGF that may show damage to the outer retina secondary to the severity and chronicity of the DME. ORT may be a result of underlying chronic and severe diabetic macular edema that may occur later possibly secondary to retinal layers rearrangement after several anti-VEGF injections. It is important to differentiate between ORT and cystoids DME. The presence of the ORT entity alone without the presence of DME does not require further anti-VEGF re-injections.
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Affiliation(s)
- Ali M Al-Halafi
- Department of Surgery, Ophthalmology Division, Consultant and Vitreoretinal Surgeon Security forces Hospital, PO Box 3643, Riyadh, 11481 Kingdom of Saudi Arabia
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Kim YI, Kim IT, Kim JS. Three Cases of Outer Retinal Tubulation in Bietti's Crystalline Dystrophy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.7.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - In Taek Kim
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
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Spectral domain optical coherence tomographic findings of bietti crystalline dystrophy. J Ophthalmol 2014; 2014:739271. [PMID: 25505979 PMCID: PMC4258374 DOI: 10.1155/2014/739271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/25/2014] [Accepted: 10/30/2014] [Indexed: 11/30/2022] Open
Abstract
We analyzed the OCT features of 24 eyes of 12 patients with Bietti crystalline dystrophy (BCD) with the Heidelberg HRA2-OCT. Seventeen of 24 eyes were in intermediate stage of the disease and seven in advanced stage of the disease at the time of latest OCT examination performed in 2014. Outer retinal tubulations and retinal hyperreflective dots were present in 20 of 24 eyes. The remaining four eyes had advanced disease with very thin retina. Appearance of bright plaque on top of RPE-Bruch membrane was present in all eyes. Choroidal hyperreflective spots were noted in 19 of 24 eyes. The remaining five eyes had advanced disease stage with very thin choroid. Mean central macular thickness was 163.08 μm ± 62.52 for all eyes (170.35 μm ± 56.46 in eyes with intermediate disease and 145.42 μm ± 77.2 in eyes with advanced disease). Mean subfoveal choroidal thickness was 95.37 μm ± 55.93 for the study eyes (116.47 ± 46.92 μm in eyes with intermediate disease and 44.14 μm ± 42.43 in eyes with advanced disease). Choroidal hyperreflective spots were noted in 21 of 24 eyes (87.5%). SD-OCT shows the disease progression in retinal and choroidal layers delicately in eyes with BCD and expands our knowledge about the ongoing disease process.
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Astuti GDN, Sun V, Bauwens M, Zobor D, Leroy BP, Omar A, Jurklies B, Lopez I, Ren H, Yazar V, Hamel C, Kellner U, Wissinger B, Kohl S, De Baere E, Collin RWJ, Koenekoop RK. Novel insights into the molecular pathogenesis of CYP4V2-associated Bietti's retinal dystrophy. Mol Genet Genomic Med 2014; 3:14-29. [PMID: 25629076 PMCID: PMC4299712 DOI: 10.1002/mgg3.109] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/09/2022] Open
Abstract
Bietti's crystalline dystrophy (BCD) is a rare, autosomal recessive retinal degenerative disease associated with mutations in CYP4V2. In this study, we describe the genetic and clinical findings in 19 unrelated BCD patients recruited from five international retinal dystrophy clinics. Patients underwent ophthalmic examinations and were screened for CYP4V2 mutations by Sanger sequencing and quantitative polymerase chain reaction (qPCR) copy number variation screening. Eight CYP4V2 mutations were found in 10/19 patients, including three patients in whom only monoallelic mutations were detected. Four novel mutations were identified: c.604G>A; p.(Glu202Lys), c.242C>G; p.(Thr81Arg), c.604+4A>G; p.(?), and c.1249dup; p.(Thr417Asnfs*2). In addition, we identified a heterozygous paternally inherited genomic deletion of at least 3.8 Mb, encompassing the complete CYP4V2 gene and several other genes, which is novel. Clinically, patients demonstrated phenotypic variability, predominantly showing choroidal sclerosis, attenuated vessels, and crystalline deposits of varying degrees of severity. To our knowledge, our study reports the first heterozygous CYP4V2 deletion and hence a novel mutational mechanism underlying BCD. Our results emphasize the importance of copy number screening in BCD. Finally, the identification of CYP4V2-negative patients with indistinguishable phenotypes from CYP4V2-positive patients might suggest the presence of mutations outside the coding regions of CYP4V2, or locus heterogeneity, which is unreported so far.
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Affiliation(s)
- Galuh D N Astuti
- Department of Human Genetics, Radboud University Medical Centre Nijmegen, The Netherlands ; Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre Nijmegen, The Netherlands ; Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University Semarang, Indonesia
| | - Vincent Sun
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada
| | - Miriam Bauwens
- Center for Medical Genetics, Ghent University Hospital Ghent, Belgium
| | - Ditta Zobor
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen Tübingen, Germany
| | - Bart P Leroy
- Center for Medical Genetics, Ghent University Hospital Ghent, Belgium ; Department of Ophthalmology, Ghent University Hospital Ghent, Belgium
| | - Amer Omar
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada ; Moorfields Eye Hospital London, United Kingdom
| | | | - Irma Lopez
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada
| | - Huanan Ren
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada
| | - Volkan Yazar
- Department of Human Genetics, Radboud University Medical Centre Nijmegen, The Netherlands
| | - Christian Hamel
- Institute of Neurosciences of Montpellier, Hôpital Saint Eloi Montpellier, France
| | - Ulrich Kellner
- Rare Retinal Disease Center, AugenZentrum Siegburg, MVZ ADTC Siegburg GmbH Siegburg, Germany
| | - Bernd Wissinger
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen Tübingen, Germany
| | - Susanne Kohl
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen Tübingen, Germany
| | - Elfride De Baere
- Center for Medical Genetics, Ghent University Hospital Ghent, Belgium
| | - Rob W J Collin
- Department of Human Genetics, Radboud University Medical Centre Nijmegen, The Netherlands ; Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre Nijmegen, The Netherlands
| | - Robert K Koenekoop
- McGill Ocular Genetics Laboratory, Departments of Paediatric Surgery, Human Genetics and Ophthalmology, Montreal Children's Hospital, McGill University Health Centre Montreal, Quebec, Canada
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High-Resolution Imaging of Patients with Bietti Crystalline Dystrophy with CYP4V2 Mutation. J Ophthalmol 2014; 2014:283603. [PMID: 25276414 PMCID: PMC4167809 DOI: 10.1155/2014/283603] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/02/2014] [Accepted: 08/03/2014] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to determine the retinal morphology of eyes with Bietti crystalline dystrophy (BCD) associated with a CYP4V2 mutation using high-resolution imaging techniques. Three subjects with BCD underwent detailed ophthalmic examinations. High-resolution fundus images were obtained with an adaptive optics (AO) fundus camera. A common homozygous mutation was detected in the three patients. Funduscopic examination of the three patients revealed the presence of crystalline deposits in the retina, and all of the crystalline deposits were also detected in the infrared (IR) images. The crystals observed in the IR images were seen as bright reflective plaques located on the RPE layer in the SD-OCT images. The clusters of hyperreflective signals in the AO images corresponded to the crystals in the IR images. High-magnification AO images revealed that the clusters of hyperreflective signals consisted of circular spots that are similar to the signals of cone photoreceptors. Most of these circular spots were detected in healthy areas in the FAF images. There is a possibility that circular spots observed by AO are residual cone photoreceptors located over the crystals.
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Halford S, Liew G, Mackay DS, Sergouniotis PI, Holt R, Broadgate S, Volpi EV, Ocaka L, Robson AG, Holder GE, Moore AT, Michaelides M, Webster AR. Detailed Phenotypic and Genotypic Characterization of Bietti Crystalline Dystrophy. Ophthalmology 2014; 121:1174-84. [DOI: 10.1016/j.ophtha.2013.11.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022] Open
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Molecular analysis and phenotypic study in 14 Chinese families with Bietti crystalline dystrophy. PLoS One 2014; 9:e94960. [PMID: 24739949 PMCID: PMC3989252 DOI: 10.1371/journal.pone.0094960] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/21/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the clinical features and cytochrome P450 family 4 subfamily V polypeptide 2 (CYP4V2) gene mutations in 14 Chinese families with Bietti crystalline dystrophy (BCD). Methods Seventeen patients from 14 unrelated Chinese families with BCD were recruited for complete clinical ophthalmic examination and genetic study. The 11 exons of CYP4V2 were amplified from genomic DNA of all patients and their family members by polymerase chain reaction (PCR) and then sequenced. Exons of TIMP3 were also sequenced in BCD patient associated with choroidal neovascularization (CNV). One hundred and seventy unrelated healthy Chinese subjects were screened for mutations in CYP4V2. Results All 17 patients with BCD had mutations in CYP4V2; one of these mutations was novel (c.219T>A, p.F73L) and four other mutations had been reported. The p.F73L mutation was a commonly detected mutation in our study (seven out of 34 alleles), either in the homozygous state or in the heterozygous state. Among the patients, considerable phenotypic variability was detected, both within and between families. Screening of TIMP3 did not find any mutation in the BCD patient associated with CNV. Conclusion The novel CYP4V2 c.219T>A (p.F73L) mutation may be another recurrent mutation in Chinese patients with BCD. Our study expands the mutation spectrum of CYP4V2 and characterizes novel genotype–phenotype associations in Chinese patients with BCD.
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Abstract
PURPOSE To investigate the prevalence and characteristics of outer retinal tubulation (ORT) seen in inherited retinal degenerative diseases. METHODS A total of 354 eyes of 177 patients were examined with spectral domain optical coherence tomography. One hundred and twelve patients had retinitis pigmentosa, 58 patients had cone dystrophy, and 7 patients had the Bietti crystalline dystrophy. The images obtained by horizontal and vertical scans were analyzed to explore the possible presence of ORT, estimate their prevalence, morphologic character, and their location in the retinal layers. RESULTS With spectral domain optical coherence tomography, ORT was identified in 0 of 112 patients with retinitis pigmentosa, unilaterally in 3 of 58 patients with cone dystrophy, and bilaterally in 5 of 7 patients with the Bietti crystalline dystrophy. Outer retinal tubulation was detected under the fovea, and in the outer nuclear layer, ORT was detected in the Bietti crystalline dystrophy with a significantly higher frequency than in cone dystrophy (P < 0.001). CONCLUSION There was a higher rate of ORT in the Bietti crystalline dystrophy among inherited retinal degenerative diseases.
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Zerbib J, Ores R, Querques G, Bouzitou-Mfoumou R, Souied EH. Choroidal findings in Bietti's crystalline dystrophy. Retin Cases Brief Rep 2014; 8:130-131. [PMID: 25372328 DOI: 10.1097/icb.0000000000000022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To describe the choroidal findings in a patient with Bietti's crystalline dystrophy. METHODS A 43-year-old woman with Bietti's crystalline dystrophy underwent a complete ophthalmologic examination including enhanced depth imaging spectral domain optical coherence tomography and en face optical coherence tomography. RESULTS We observed a severe thinning of the choroid, 123 μm in the right eye and 110 μm in the left eye. Crystal deposits were found not only in the retina but also in the choroid. En face optical coherence tomography clearly showed the intraretinal crystals as small hyperreflective dots in the different retinal layers and in the choroid. CONCLUSION Our study gives new information on the aspect and the location of crystal deposits in the choroid and the abnormalities of the outer retina associated with the disease.
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Affiliation(s)
- Jennyfer Zerbib
- Department of Ophthalmology, Hopital Intercommunal de Creteil, University Paris Est, Creteil, France
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Optical coherence tomographic findings of crystal deposits in the lens and cornea in Bietti crystalline corneoretinopathy associated with mutation in the CYP4V2 gene. Jpn J Ophthalmol 2013; 57:447-50. [DOI: 10.1007/s10384-013-0256-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
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Roth BM, Yuan A, Ehlers JP. Retinal and Choroidal Findings in Oxalate Retinopathy Using EDI-OCT. Ophthalmic Surg Lasers Imaging Retina 2012; 43:S142-4. [DOI: 10.3928/15428877-20121001-05] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/27/2012] [Indexed: 11/20/2022]
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