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Dias PB, Linhares ACB, Urzedo ABDL, Preti RC, Zacharias LC, Cunha LP, Monteiro MLR, Hokazono K. Optical coherence tomography detection of retinal neural loss in patients with tuberous sclerosis. Int J Retina Vitreous 2024; 10:15. [PMID: 38311784 PMCID: PMC10840160 DOI: 10.1186/s40942-024-00535-7] [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: 12/26/2023] [Accepted: 01/19/2024] [Indexed: 02/06/2024] Open
Abstract
PURPOSE Tuberous Sclerosis (TS) is a rare, multisystem genetic disease caused by mutations in the TSC1 and TSC2 genes, leading to abnormalities in cell differentiation and proliferation. This study aimed to evaluate the neural integrity of individuals with TS by using Optical Coherence Tomography (OCT) to examine the peripapillary retinal nerve fiber layer (RNFL) thickness and the macular thickness in patients with TS and to compare with healthy controls. METHODS Peripapillary and macular OCT scans (Optopol Revo NX SD OCT) were performed on 41 eyes from 22 TS patients, divided into two groups based on the presence of retinal hamartomas, and compared to 20 eyes from a control group. The average peripapillary RNFL thickness was measured for each quadrant. The macular total thickness and ganglion cell layer (GCL) + inner plexiform layer (IPL) thickness were measured based on the Early Treatment Diabetic Retinopathy Study (ETDRS) map. All measurements were then compared between the groups and controls. RESULTS The TS group showed significantly reduced RNFL thickness and macular thickness when compared to the control group. Specifically, patients with retinal hamartomas exhibited an even more pronounced thinning of both RNFL and macular thickness. CONCLUSIONS These findings suggest that TS patients undergo significant changes in retinal neurodevelopment and experience axonal loss. This finding may have significant prognostic utility regarding central nervous system degeneration in TS, particularly among patients with retinal hamartomas. OCT may serve as a valuable tool for assessing axonal structural abnormalities in TS patients. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Paula Basso Dias
- Department of Ophthalmology, Hospital de Clínicas, Federal University of Paraná (HC UFPR), R. da Paz, 195 (123), Curitiba, Paraná, 80060-160, Brazil
| | - Anna Carolina Badotti Linhares
- Department of Ophthalmology, Hospital de Clínicas, Federal University of Paraná (HC UFPR), R. da Paz, 195 (123), Curitiba, Paraná, 80060-160, Brazil
| | - Ana Barbara Dias Lopes Urzedo
- Department of Ophthalmology, Hospital de Clínicas, Federal University of Paraná (HC UFPR), R. da Paz, 195 (123), Curitiba, Paraná, 80060-160, Brazil
| | - Rony Carlos Preti
- Department of Ophthalmology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Leandro Cabral Zacharias
- Department of Ophthalmology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Leonardo Provetti Cunha
- Department of Ophthalmology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | | | - Kenzo Hokazono
- Department of Ophthalmology, Hospital de Clínicas, Federal University of Paraná (HC UFPR), R. da Paz, 195 (123), Curitiba, Paraná, 80060-160, Brazil.
- Department of Ophthalmology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
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Dias PB, Linhares ACB, Hokazono K. Retinal hamartomas at different stages in a patient with tuberous sclerosis: A OCT-SS description. Clin Case Rep 2023; 11:e8185. [PMID: 38028108 PMCID: PMC10659914 DOI: 10.1002/ccr3.8185] [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: 06/26/2023] [Revised: 09/21/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Retinal astrocytic hamartoma (RAH) is a benign glial tumor that may be present in patients with tuberous sclerosis (TS), contributing to the diagnosis of this syndrome. While hamartomas identified through indirect ophthalmoscopy are often large enough to affect vessels and optic disc anatomy, RAH not detected in previous fundoscopies may become apparent in optical coherence tomography (OCT). The purpose of this report was to describe and characterize RAH with OCT with swept-source technology (OCT-SS), aiming to establish a more comprehensive classification for these hamartomas due to their diverse presentations. Fundus examination of a 11-year-old girl revealed retinal tumors in both eyes. OCT-SS confirmed the diagnosis of TS, revealing dome-shaped hyperreflective masses at different stages of evolution. Lesion 1: maximum thickness (MT) of 336 μm and ganglion cell layer disorganization. Lesion 2: MT of 438 μm and preserved outer plexiform layer. Lesion 3: posterior shadow, MT of 1478 μm and complete rupture of retinal anatomy. Lesion 4: MT of 342 μm and preserved retinal anatomy. OCT is a noninvasive method which assists the diagnosis of subclinical lesions and clinical characterization of TS patients.
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Affiliation(s)
- Paula Basso Dias
- Department of OphthalmologyUniversidade Federal do ParanáCuritibaBrazil
| | | | - Kenzo Hokazono
- Department of OphthalmologyUniversidade Federal do ParanáCuritibaBrazil
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Aljneibi SH, Aldhanhani AA, Abuhaleeqa K, Pichi F. Orbital Perivascular Epithelioid Cell Tumor in a Case of Tuberous Sclerosis. Case Rep Ophthalmol 2023; 14:282-287. [PMID: 37485243 PMCID: PMC10359681 DOI: 10.1159/000530036] [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: 12/02/2022] [Accepted: 03/02/2023] [Indexed: 07/25/2023] Open
Abstract
The aim of the study was to report a case of orbital perivascular epithelioid cell tumor (PEComa) in a known diagnosed patient of tuberous sclerosis and retinal astrocytic hamartoma. 43-year-old female presented with rapid progressive painful proptosis in the left eye, also reported new mass growing in her upper back. The patient past medical history is significant for left renal angiomyolipoma and multiple bilateral lung cysts of which she underwent right nephrectomy and lung biopsy, respectively. The lung biopsy turned diagnostic for lymphangiomyomatosis. On external examination, the left eye was grossly proptotic with hypoglobus. A typical butterfly distribution of sebaceous adenoma was noted across the patient cheeks and nose. Visual acuity in the right eye was 20/20 and the left eye, 20/25. Funduscopic examination identified type 1, 2, and 3 retinal astrocytic hamartomas. MRI brain and orbit was significant for a lesion arising from the lateral orbital wall with extensive bone destruction, displacing the left optic nerve medially. CT chest showed left extrathoracic mass had same radiological features as the orbital lesion; thus, an incisional biopsy performed on the former was diagnostic for PEComa with atypical features. This is the first observed case of PEComa in a known diagnosed patent with TS and retinal astrocytic hamartoma. The association of tuberous sclerosis complex and orbital PEComa is rarely and poorly reported in the literature compared to extraocular PEComa.
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Affiliation(s)
- Shaikha H. Aljneibi
- Cleveland Clinic AbuFcoi Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Aisha A. Aldhanhani
- Cleveland Clinic AbuFcoi Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Khaled Abuhaleeqa
- Cleveland Clinic AbuFcoi Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Francesco Pichi
- Cleveland Clinic AbuFcoi Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Chandran K, Lekha T, Giridhar A, Neena R. Utility of multimodal imaging in the detection and follow-up of retinal astrocytic hamartomas in a young girl with tuberous sclerosis complex. Indian J Ophthalmol 2022; 70:2725-2727. [PMID: 35791222 PMCID: PMC9426188 DOI: 10.4103/ijo.ijo_1110_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kiran Chandran
- Department of Retina, Giridhar Eye Institute, Kochi, Kerala, India
| | - T Lekha
- Department of Retina, Giridhar Eye Institute, Kochi, Kerala, India
| | - A Giridhar
- Department of Retina, Giridhar Eye Institute, Kochi, Kerala, India
| | - R Neena
- Department of Paediatric Ophthalmology, Giridhar Eye Institute, Kochi, Kerala, India
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Pfirmann P, Combe C, Rigothier C. [Tuberous sclerosis system: A review]. Rev Med Interne 2021; 42:714-721. [PMID: 33836894 DOI: 10.1016/j.revmed.2021.03.003] [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: 10/20/2020] [Revised: 02/11/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder that affects different organs and caused by loss-of-function mutations in one of two genes: TSC1 or TSC2. TSC1 or TSC2 gene mutation lead to dysfunction of hamartin or tuberin, respectively. Hamartin and tuberin form a protein complex that helps regulate cellular proliferation. These proteins form a complex that constitutively inhibits the mammalian target of rapamycin (mTOR) signaling pathway, leading to permanent activation of mTOR signaling within all TSC-associated lesions. Major features of TSC include tumors of the brain, skin, heart, lungs and kidneys, seizures and TSC-associated neuropsychiatric disorders, which can include autism spectrum disorder and cognitive disability. These disorders are usually diagnosed in children and adults. Specific guidelines for diagnosis, surveillance, and management have been proposed by the International Tuberous Sclerosis Complex Consensus Group. Several randomized controlled trials led to regulatory approval of the use of mTOR inhibitors for the treatment of renal angiomyolipomas, brain subependymal giant cell astrocytomas, refractory epilepsy and pulmonary lymphangioleiomyomatosis.
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Affiliation(s)
- P Pfirmann
- Service de néphrologie, transplantation, dialyse et aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Inserm U1026, BioTis, université de Bordeaux, 33076 Bordeaux, France.
| | - C Combe
- Service de néphrologie, transplantation, dialyse et aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Inserm U1026, BioTis, université de Bordeaux, 33076 Bordeaux, France
| | - C Rigothier
- Service de néphrologie, transplantation, dialyse et aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Inserm U1026, BioTis, université de Bordeaux, 33076 Bordeaux, France
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Qin X, Tao Y, Zhang Z. Retinal astrocytic hamartoma in tuberous sclerosis complex in an elderly person: a case report. BMC Ophthalmol 2018; 18:319. [PMID: 30541513 PMCID: PMC6292060 DOI: 10.1186/s12886-018-0991-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 12/03/2018] [Indexed: 11/22/2022] Open
Abstract
Background Spectral domain optical coherence tomography (SD-OCT) is proposed as a way of predicting the development and likelihood of retinal astrocytic hamartoma (RAH) in tuberous sclerosis complex (TSC) in elderly patients. Case presentation This report describes a case of RAH in TSC in an elderly patient. The patient was a 62-year-old woman and experienced pain in the lower left abdomen for two years. Bilateral renal angiomyolipoma, multiple hepatic angiomyolipoma and multiple pulmonary nodules were demonstrated using computed tomography (CT). Brain CT showed bilateral multiple calcification near by the cella lateralis. A clinical diagnosis of TSC was made. Visual acuity (decimal) in the right and left eye was determined to be 0.6 and 0.8, respectively. SD-OCT revealed a retinal tumour in the inner layer of the retina in the right fundus and a pre-retinal membrane which may have evolved later. Conclusions A routine ophthalmic examination is advised for patients suspected of having TSC to prevent this condition from being overlooked. In addition, an OCT examination can be used to predict the development and likelihood of RAH.
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Affiliation(s)
- Xiuhong Qin
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, No 222 Zhongshan Road, Xigang Strict, Dalian, 116011, Liaoning Province, China
| | - Yuan Tao
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, No 222 Zhongshan Road, Xigang Strict, Dalian, 116011, Liaoning Province, China
| | - Zhenzhen Zhang
- Department of Ophthalmology, the Ninth People's Hospital, Shanghai Jiao Tong University, No 639 ZhiZaoJu Road, Shanghai, 200011, China.
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