Differential diagnosis between the primary total choroidal vascular atrophies

The Finnish genetic heritage in 2022 – from diagnosis to translational research

Isolated populations have been valuable for the discovery of rare monogenic diseases and their causative genetic variants. Finnish disease heritage (FDH) is an example of a group of hereditary monogenic disorders caused by single major, usually autosomal-recessive, variants enriched in the population due to several past genetic drift events. Interestingly, distinct subpopulations have remained in Finland and have maintained their unique genetic repertoire. Thus, FDH diseases have persisted, facilitating vigorous research on the underlying molecular mechanisms and development of treatment options. This Review summarizes the current status of FDH, including the most recently discovered FDH disorders, and introduces a set of other recently identified diseases that share common features with the traditional FDH diseases. The Review also discusses a new era for population-based studies, which combine various forms of big data to identify novel genotype–phenotype associations behind more complex conditions, as exemplified here by the FinnGen project. In addition to the pathogenic variants with an unequivocal causative role in the disease phenotype, several risk alleles that correlate with certain phenotypic features have been identified among the Finns, further emphasizing the broad value of studying genetically isolated populations.

The Finnish Disease Heritage III: the individual diseases

This article is the third and last in a series entitled The Finnish Disease Heritage I-III. All the 36 rare hereditary diseases belonging to this entity are described for clinical and molecular genetic purposes, based on the Finnish experience gathered over a period of half a century. In addition, five other diseases are mentioned. They may be included in the list of the "Finnish diseases" after adequate complementary studies.

Retinitis pigmentosa

Retinitis pigmentosa is a clinically and genetically heterogeneous group of hereditary disorders in which there is progressive loss of photoreceptor and pigment epithelial function. The prevalence of retinitis pigmentosa is between 1/3000 and 1/5000 making it one of the most common causes of visual impairment in all age groups. The natural history, differential diagnosis, diagnostic clinical and electrophysiologic findings are reviewed. Generalization about the different genetic subtypes of retinitis pigmentosa are reviewed along with the uses of DNA probes for linkage studies. Syndromes in which retinitis pigmentosa is a manifestation are summarized.

The eye and inherited metabolic disease: a review

Images

Differential diagnosis of normoornithinaemic gyrate atrophy of the choroid and retina

A case of localized chorioretinal atrophy resembling gyrate atrophy of the choroid and retina is presented. Plasma ornithine concentration was normal and the clinical course characterized by late onset of relatively mild symptoms. The differential diagnoses are discussed and the term normoornithinaemic gyrate atrophy of the choroid and retina is suggested for similar variant cases.

Gyrate atrophy of choroid associated with hyperornithinaemia: report of the first case in Italy

The first case in Italy and the youngest case in the world of gyrate atrophy of the choroid associated with hyperornithinaemia is reported. A therapeutical attempt has been made and the possibility of following the evolution of the ocular lesion is very interesting.

Gyrate atrophy of the choroid and retina with reticular pigmentary dystrophy and ornithine-ketoacid-transaminase deficiency

A 10 year old white girl is presented with gyrate atrophy of the choroid and retina (atrofia gyrata). She also showed reticular pigmentations at the level of the retinal pigment epithelium temporal to both maculas. A generalized hyperornithinaemia was demonstrated in this patient and cultured fibroblasts established the underlying ornithine-keto-acid-transaminase (OKT) deficiency for the first time. Pharmacologic doses of vitamin B6 nor restriction of dietary protein resulted in a significant decrease of the serum ornithine concentration. It is probable that hyperornithinaemia in itself is not the cause of the gyrate atrophy.

Fluorescein and indocyanine green fluorescence angiography in study of affected males and in female carriers with choroidermia. A preliminary report

26 males and 13 female carriers of different ages with choroideremia of varying severity were investigated using sodium fluorescein (FAG) and/or indocyanine green (ICG) fluorescence angiography. Females with minor changes present in pigment epithelium amy stay unchanged throughout life or gradually develop into a more advanced stage resembling the fundus picture of severely affected males. In moderately affected females there is a patchy degeneration of pigment epithelium in the macula. Peripapillary degeneration is seen also in indocyanine green fluorescence angiograms. In males, atrophic areas and the remaining choriocapillaris are clearly demonstrated in FAG and less well visible in ICG angiograms. ICG angiograms show choroidal vessels more clearly in cases where the pigment epithelium and the choriocapillaris are still present. In advanced cases in males and females, the choroidal blood circulation is slow.

A histologic study of regional choroidal dystrophy

Light and electron microscopy studies of eyes removed from an 84-year-old man after death indicated a normal optic nerve despite severe peripapillary choroidal atrophy. In the area of atrophy, the choriocapillaris, retinal pigment epithelium, and photoreceptors were absent and there was a marked decrease in choroidal arteries and veins. Bruch's membrane was intact except for several breaks in the peripapillary region. Müller cells, in the region of atrophy, produced an aberrant, thick basement membrane either in the outer layers of the neurosensory retina or directly applied to Bruch's membrane. On the basis of this study, we postulate that the primary abnormality in this disease is of the choroidal vasculature.