1
|
Voros GM, Pandit R, Snow M, Griffiths PG. Unilateral Recurrent Acute Retinal Necrosis Syndrome Caused by Cytomegalovirus in an Immune-Competent Adult. Eur J Ophthalmol 2018; 16:484-6. [PMID: 16761257 DOI: 10.1177/112067210601600323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report an immune-competent patient with unilateral recurrent acute retinal necrosis syndrome caused by cytomegalovirus, and to highlight the importance of diagnostic vitreous biopsy and specific antiviral therapy in this condition. METHODS Case report. RESULTS A 75-year-old man with good general health had two episodes of acute retinal necrosis syndrome affecting his left eye. Vitreous biopsy was performed in each episode, and polymerase chain reaction analysis on the vitreous specimen was positive for cytomegalovirus and negative for varicella zoster virus and herpes simplex virus 1 and 2. On each occasion, investigations indicated past cytomegalovirus infection but no evidence of a systemic re-activation. No indication of immunodeficiency was found over a 2-year follow-up period. His management, which included systemic and intravitreal antiviral therapy, is discussed. CONCLUSIONS To the authors' knowledge, only two other cases of acute retinal necrosis syndrome caused by cytomegalovirus have been reported previously in immune-competent patients. This case illustrates the importance of vitreous biopsy for viral polymerase chain re-action studies in cases of acute retinal necrosis syndrome, in order to direct appropriate antiviral treatment. It also illustrates the role of an intravitreal antiviral drug that is effective against all three herpetic viruses.
Collapse
Affiliation(s)
- G M Voros
- Dept. of Ophthalmology, Royal Victoria Infirmary, Univ. of Newcastle upon Tyne, Newcastle upon Tyne, UK.
| | | | | | | |
Collapse
|
2
|
Griffiths PG, Taylor RH, Henderson LM, Barrett BT. Letter to the Editor concerning "A systematic review of controlled trials on visual stress using intuitive overlays or colorimeter". J Optom 2017; 10:199-200. [PMID: 28063870 PMCID: PMC5484786 DOI: 10.1016/j.optom.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/09/2016] [Indexed: 06/06/2023]
Affiliation(s)
| | - Robert H Taylor
- University of Bradford, Bradford, West Yorkshire, United Kingdom
| | - Lisa M Henderson
- University of Bradford, Bradford, West Yorkshire, United Kingdom
| | | |
Collapse
|
3
|
Griffiths PG, Taylor RH, Henderson LM, Barrett BT. The effect of coloured overlays and lenses on reading: a systematic review of the literature. Ophthalmic Physiol Opt 2017; 36:519-44. [PMID: 27580753 DOI: 10.1111/opo.12316] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/19/2016] [Indexed: 01/29/2023]
Abstract
PURPOSE There are many anecdotal claims and research reports that coloured lenses and overlays improve reading performance. Here we present the results of a systematic review of this literature and examine the quality of the evidence. METHODS We systematically reviewed the literature concerning the effect of coloured lenses or overlays on reading performance by searching the PsychInfo, Medline and Embase databases. This revealed 51 published items (containing 54 data sets). Given that different systems are in use for issuing coloured overlays or lenses, we reviewed the evidence under four separate system headings (Intuitive, Irlen, Harris/Chromagen and Other), classifying each published item using the Cochrane Risk of Bias tool. RESULTS Although the different colour systems have been subjected to different amounts of scientific scrutiny, the results do not differ according to the system type, or whether the sample under investigation was classified as having visual stress (or a similarly defined condition), reading difficulty, or both. The majority of studies are subject to 'high' or 'uncertain' risk of bias in one or more key aspects of study design or outcome, with studies at lower risk from bias providing less support for the benefit of coloured lenses/overlays on reading ability. While many studies report improvements with coloured lenses, the effect size is generally small and/or similar to the improvement found with a placebo condition. We discuss the strengths and shortcomings of the published literature and, whilst acknowledging the difficulties associated with conducting trials of this type, offer some suggestions about how future trials might be conducted. CONCLUSIONS Consistent with previous reviews and advice from several professional bodies, we conclude that the use of coloured lenses or overlays to ameliorate reading difficulties cannot be endorsed and that any benefits reported by individuals in clinical settings are likely to be the result of placebo, practice or Hawthorne effects.
Collapse
Affiliation(s)
- Philip G Griffiths
- Department of Ophthalmology, St Bernard's Hospital, Gibraltar, Gibraltar
| | - Robert H Taylor
- Department of Ophthalmology, York Teaching Hospital Foundation Trust, York, UK
| | | | - Brendan T Barrett
- School of Optometry & Vision Science, University of Bradford, Bradford, UK
| |
Collapse
|
4
|
Griffiths PG, Taylor RH, Henderson LM, Barrett BT. Authors' response. Ophthalmic Physiol Opt 2016; 37:109-112. [PMID: 27905118 DOI: 10.1111/opo.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Robert H Taylor
- Department of Ophthalmology, York Teaching Hospital Foundation Trust, York, UK
| | | | - Brendan T Barrett
- School of Optometry & Vision Science, University of Bradford, Bradford, UK
| |
Collapse
|
5
|
Yu-Wai-Man P, Griffiths PG, Howell N, Turnbull DM, Chinnery PF. The Epidemiology of Leber Hereditary Optic Neuropathy in the North East of England. Am J Hum Genet 2016; 98:1271. [PMID: 27259056 DOI: 10.1016/j.ajhg.2016.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
6
|
Abstract
The way citation distortion can create unfounded authority in a subject area is exemplified in the paper "Coloured filters to reduce the symptoms of visual stress in children with reading delay", published early online in the Scandinavian Journal of Occupational Therapy. The diagnostic criteria for visual stress remain unclear, for which reason the prevalence figures should be viewed with scepticism. Randomized controlled trials with placebo control groups consistently show improvements in experimental and control lenses. This letter is a critical review of the evidence cited in the introduction to the paper. In the light of this the most likely explanation for their results is the placebo effect.
Collapse
|
7
|
Griffiths PG, Henderson LM, Taylor RH, Barrett B. Authors' reply to Evans and Allen. BMJ 2014; 349:g5889. [PMID: 25270367 DOI: 10.1136/bmj.g5889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | | | - Brendan Barrett
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
| |
Collapse
|
8
|
Affiliation(s)
| | | | - Brendan Barrett
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | | |
Collapse
|
9
|
Yu-Wai-Man P, Klopstock T, Metz G, Büchner B, Gallenmüller C, Bailie M, Nwali N, Griffiths PG, von Livonius B, Reznicek L, Rouleau J, Coppard N, Meier T, Chinnery PF. Idebenone treatment for Leber hereditary optic neuropathy — Past, present, and future. Mitochondrion 2013. [DOI: 10.1016/j.mito.2013.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Yu-Wai-Man C, Smith FE, Firbank MJ, Guthrie G, Guthrie S, Gorman GS, Taylor RW, Turnbull DM, Griffiths PG, Blamire AM, Chinnery PF, Yu-Wai-Man P. Extraocular muscle atrophy and central nervous system involvement in chronic progressive external ophthalmoplegia. PLoS One 2013; 8:e75048. [PMID: 24086434 PMCID: PMC3785524 DOI: 10.1371/journal.pone.0075048] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 08/07/2013] [Indexed: 11/19/2022] Open
Abstract
Background Chronic progressive external ophthalmoplegia (CPEO) is a classical mitochondrial ocular disorder characterised by bilateral progressive ptosis and ophthalmoplegia. These ocular features can develop either in isolation or in association with other prominent neurological deficits (CPEO+). Molecularly, CPEO can be classified into two distinct genetic subgroups depending on whether patients harbour single, large-scale mitochondrial DNA (mtDNA) deletions or multiple mtDNA deletions secondary to a nuclear mutation disrupting mtDNA replication or repair. The aim of this magnetic resonance imaging (MRI) study was to investigate whether the ophthalmoplegia in CPEO is primarily myopathic in origin or whether there is evidence of contributory supranuclear pathway dysfunction. Methods Ten age-matched normal controls and twenty patients with CPEO were recruited nine patients with single, large-scale mtDNA deletions and eleven patients with multiple mtDNA deletions secondary to mutations in POLG, PEO1, OPA1, and RRM2B. All subjects underwent a standardised brain and orbital MRI protocol, together with proton magnetic resonance spectroscopy in two voxels located within the parietal white matter and the brainstem. Results There was evidence of significant extraocular muscle atrophy in patients with single or multiple mtDNA deletions compared with controls. There was no significant difference in metabolite concentrations between the patient and control groups in both the parietal white matter and brainstem voxels. Volumetric brain measurements revealed marked cortical and cerebellar atrophy among patients with CPEO+ phenotypes. Conclusion The results of this study support a primary myopathic aetiology for the progressive limitation of eye movements that develops in CPEO.
Collapse
Affiliation(s)
- Cynthia Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Fiona E. Smith
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael J. Firbank
- Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Grant Guthrie
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Stuart Guthrie
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Grainne S. Gorman
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert W. Taylor
- Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Douglass M. Turnbull
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Philip G. Griffiths
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Andrew M. Blamire
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Patrick F. Chinnery
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Patrick Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| |
Collapse
|
11
|
Bailie M, Votruba M, Griffiths PG, Chinnery PF, Yu-Wai-Man P. Visual and psychological morbidity among patients with autosomal dominant optic atrophy. Acta Ophthalmol 2013; 91:e413-4. [PMID: 23452392 PMCID: PMC3798121 DOI: 10.1111/aos.12077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/11/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Maura Bailie
- Department of Ophthalmology, Royal Victoria InfirmaryNewcastle upon Tyne, UK
| | - Marcela Votruba
- School of Optometry and Vision Sciences, Cardiff UniversityCardiff, UK
- Cardiff Eye Unit, University Hospital of WalesCardiff, UK
| | - Philip G Griffiths
- Department of Ophthalmology, Royal Victoria InfirmaryNewcastle upon Tyne, UK
| | - Patrick F Chinnery
- Department of Neurology, Royal Victoria InfirmaryNewcastle upon Tyne, UK
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle UniversityNewcastle upon Tyne, UK
| | - Patrick Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria InfirmaryNewcastle upon Tyne, UK
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle UniversityNewcastle upon Tyne, UK
| |
Collapse
|
12
|
Abstract
BACKGROUND Traumatic optic neuropathy (TON) is an important cause of severe visual loss following blunt or penetrating head trauma. Following the initial insult optic nerve swelling within the optic nerve canal or compression by bone fragments are thought to result in secondary retinal ganglion cell loss. Optic nerve decompression with steroids or surgical interventions or both have therefore been advocated to improve visual prognosis in TON. OBJECTIVES To examine the effects and safety of surgical interventions in the management of TON. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to May 2013), EMBASE (January 1980 to May 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to May 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (http://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 28 May 2013. We also searched the reference lists of other reviews and book chapters on TON. We also contacted researchers in the field. SELECTION CRITERIA We planned to include only randomised controlled trials (RCTs) of TON in which any form of surgical intervention either on its own or in combination with steroids was compared to steroids alone or no treatment. DATA COLLECTION AND ANALYSIS Two authors independently assessed the titles and abstracts identified from the search strategy. No studies were found that met our inclusion criteria and therefore none were included for analysis. MAIN RESULTS No studies were found that met our inclusion criteria. AUTHORS' CONCLUSIONS The current body of evidence consists mostly of small, retrospective case series. Given the wide range of surgical interventions used in TON it is very difficult to compare these studies, even qualitatively. However, there is a relatively high rate of spontaneous visual recovery and no evidence that surgical decompression of the optic nerve provides any additional benefit. On the other hand, surgery carries a definite risk of complications such as postoperative cerebrospinal fluid leak and meningitis. The decision to proceed with surgery in TON therefore remains controversial and each case needs to be assessed on its own merits. Although there is an urgent need for an adequately powered, RCT of surgical intervention in TON, this will prove a difficult endeavour.
Collapse
Affiliation(s)
- Patrick Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
| | | |
Collapse
|
13
|
Abstract
BACKGROUND Traumatic optic neuropathy (TON) is an important cause of severe visual loss following blunt or penetrating head trauma. Following the initial injury, optic nerve swelling within the optic nerve canal can result in secondary retinal ganglion cell loss. Optic nerve decompression with steroids or surgical interventions or both has therefore been advocated as a means of improving visual prognosis in TON. OBJECTIVES The aim of this review was to examine the effectiveness and safety of using steroids in TON. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to May 2013), EMBASE (January 1980 to May 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to May 2013), Web of Science Conference Proceedings Citation Index- Science (CPCI-S) (January 1990 to May 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (http://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 21 May 2013. We also searched the reference lists of included studies, other reviews and book chapters on TON to find references to additional trials. The Science Citation Index was used to look for papers that cited the studies included in this review. We did not manually search any journals or conference proceedings. We contacted trial investigators and experts in the field to identify additional published and unpublished studies. SELECTION CRITERIA We planned to include only randomised controlled trials (RCTs) of TON in which any steroid regime, either on its own or in combination with surgical optic nerve decompression, was compared to surgery alone or no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the titles and abstracts identified from the electronic searches. MAIN RESULTS We included one study that met our selection criteria; a double-masked, placebo-controlled, randomised trial of high dose intravenous steroids in patients with indirect TON diagnosed within seven days of the initial injury. A total of 31 eligible participants were randomised to receive either high dose intravenous steroids (n = 16) or placebo (n = 15), and they were all followed-up for three months. Mean final best corrected visual acuity (BCVA) was 1.78±1.23 Logarithm of the Minimum Angle of Resolution (LogMAR) in the placebo group, and 1.11±1.14 LogMAR in the steroid group. The mean difference in BCVA between the placebo and steroid groups was 0.67 LogMAR (95% confidence interval -1.54 to 0.20), and this difference was not statistically significant (P = 0.13). At three months follow-up, an improvement in BCVA of 0.40 LogMAR occurred in eight eyes (8/15, 53.3%) in the placebo group, and in 11 eyes (11/16, 68.8%) in the treatment group. This difference was not statistically significant (P = 0.38). AUTHORS' CONCLUSIONS There is a relatively high rate of spontaneous visual recovery in TON and there is no convincing data that steroids provide any additional visual benefit over observation alone. Recent evidence also suggests a possible detrimental effect of steroids in TON and further studies are urgently needed to clarify this important issue. Each case therefore needs to be assessed on an individual basis and proper informed consent is paramount.
Collapse
Affiliation(s)
- Patrick Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
| | | |
Collapse
|
14
|
Thouin A, Griffiths PG, Hudson G, Chinnery PF, Yu-Wai-Man P. Raised intraocular pressure as a potential risk factor for visual loss in Leber Hereditary Optic Neuropathy. PLoS One 2013; 8:e63446. [PMID: 23667621 PMCID: PMC3646743 DOI: 10.1371/journal.pone.0063446] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 04/03/2013] [Indexed: 01/22/2023] Open
Abstract
Leber Hereditary Optic Neuropathy (LHON) is an important cause of inherited mitochondrial blindness among young adults. The majority of patients carry one of three mitochondrial DNA (mtDNA) point mutations: m.3460G>A, m.11778G>A and m.14484T>C, all of which affect critical complex I subunits of the mitochondrial respiratory chain. LHON is characterised by marked incomplete penetrance, clearly implying that the mtDNA mutation is insufficient on its own to trigger retinal ganglion cell dysfunction and visual loss. In this case series of three affected patients harbouring the m.11778G>A mutation, we provide evidence suggesting that raised intraocular pressure could be a risk factor triggering visual loss in at-risk LHON carriers.
Collapse
Affiliation(s)
- Anais Thouin
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Philip G. Griffiths
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Gavin Hudson
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Patrick F. Chinnery
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Patrick Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| |
Collapse
|
15
|
Klopstock T, Metz G, Yu-Wai-Man P, Büchner B, Gallenmüller C, Bailie M, Nwali N, Griffiths PG, von Livonius B, Reznicek L, Rouleau J, Coppard N, Meier T, Chinnery PF. Persistence of the treatment effect of idebenone in Leber's hereditary optic neuropathy. ACTA ACUST UNITED AC 2013; 136:e230. [PMID: 23388409 PMCID: PMC3572931 DOI: 10.1093/brain/aws279] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
16
|
Abstract
OBJECTIVE To retrospectively analyse surgical outcome and complications in patients with ocular myopathy undergoing ptosis correction and to introduce preoperative prophylactic lower lid elevation in this group. METHODS The medical records of all ocular myopathy patients who had undergone oculoplastic surgery between June 1995 and May 2006 were obtained. Patients' demographics, surgical details and measurements, and complications were recorded. RESULTS 29 patients were identified; 21 with chronic progressive external ophthalmoplegia (CPEO), 7 with myotonic dystrophy (MD) and 1 with oculopharyngeal muscular dystrophy (OPMD). Then, 61 procedures to adjust eyelid height were performed, comprising levator resection, brow suspension, anterior lamellar repositioning, lower lid elevation and upper lid lowering. Palpebral aperture was significantly increased in all patient groups, by procedure and diagnosis, more significantly following brow suspension compared with levator resection. The patients' feedback was very positive. Post-operative complications were few, included corneal exposure and ulceration, ptosis recurrence, arched brow, and sling infection, all of which were successfully treated. CONCLUSION Our results demonstrate subjective and objective benefit following surgery in these patients, with a low complication rate. The use of pre-operative prophylactic lower lid elevation procedures is a promising modality.
Collapse
Affiliation(s)
- Mark Doherty
- Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
| | | | | |
Collapse
|
17
|
Baker MR, Fisher KM, Whittaker RG, Griffiths PG, Yu-Wai-Man P, Chinnery PF. Subclinical multisystem neurologic disease in "pure" OPA1 autosomal dominant optic atrophy. Neurology 2011; 77:1309-12. [PMID: 21917770 PMCID: PMC3179647 DOI: 10.1212/wnl.0b013e318230a15a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M R Baker
- Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | | | | | | | | | | |
Collapse
|
18
|
Klopstock T, Yu-Wai-Man P, Dimitriadis K, Rouleau J, Heck S, Bailie M, Atawan A, Chattopadhyay S, Schubert M, Garip A, Kernt M, Petraki D, Rummey C, Leinonen M, Metz G, Griffiths PG, Meier T, Chinnery PF. A randomized placebo-controlled trial of idebenone in Leber's hereditary optic neuropathy. ACTA ACUST UNITED AC 2011; 134:2677-86. [PMID: 21788663 PMCID: PMC3170530 DOI: 10.1093/brain/awr170] [Citation(s) in RCA: 340] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Major advances in understanding the pathogenesis of inherited metabolic disease caused by mitochondrial DNA mutations have yet to translate into treatments of proven efficacy. Leber’s hereditary optic neuropathy is the most common mitochondrial DNA disorder causing irreversible blindness in young adult life. Anecdotal reports support the use of idebenone in Leber’s hereditary optic neuropathy, but this has not been evaluated in a randomized controlled trial. We conducted a 24-week multi-centre double-blind, randomized, placebo-controlled trial in 85 patients with Leber’s hereditary optic neuropathy due to m.3460G>A, m.11778G>A, and m.14484T>C or mitochondrial DNA mutations. The active drug was idebenone 900 mg/day. The primary end-point was the best recovery in visual acuity. The main secondary end-point was the change in best visual acuity. Other secondary end-points were changes in visual acuity of the best eye at baseline and changes in visual acuity for both eyes in each patient. Colour-contrast sensitivity and retinal nerve fibre layer thickness were measured in subgroups. Idebenone was safe and well tolerated. The primary end-point did not reach statistical significance in the intention to treat population. However, post hoc interaction analysis showed a different response to idebenone in patients with discordant visual acuities at baseline; in these patients, all secondary end-points were significantly different between the idebenone and placebo groups. This first randomized controlled trial in the mitochondrial disorder, Leber’s hereditary optic neuropathy, provides evidence that patients with discordant visual acuities are the most likely to benefit from idebenone treatment, which is safe and well tolerated.
Collapse
Affiliation(s)
- Thomas Klopstock
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Yu-Wai-Man P, Bailie M, Atawan A, Chinnery PF, Griffiths PG. Pattern of retinal ganglion cell loss in dominant optic atrophy due to OPA1 mutations. Eye (Lond) 2011; 25:596-602. [PMID: 21378995 DOI: 10.1038/eye.2011.2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The majority of patients with autosomal dominant optic atrophy (DOA) harbour pathogenic OPA1 mutations. Although DOA is characterised by the preferential loss of retinal ganglion cells (RGCs), about 20% of patients with OPA1 mutations will develop a more severe disease variant (DOA+), with additional neuromuscular features. In this prospective, observational case series, optical coherence tomography (OCT) was used to define the pattern of retinal nerve fibre layer (RNFL) loss in patients with both the pure and syndromal forms of DOA. METHODS Forty patients with a molecular diagnosis of DOA due to OPA1 mutations were prospectively recruited from our neuro-ophthalmology clinic: 26 patients with isolated optic atrophy and 14 patients manifesting DOA+ features. Peripapillary RNFL thickness was measured with the Fast RNFL (3.4) acquisition protocol on a Stratus OCT. RESULTS There was a statistically significant reduction in average RNFL thickness in the OPA1 group compared with normal controls (P<0.0001). The percentage decrease was greatest in the temporal quadrant (59.0%), followed by the inferior (49.6%), superior (41.8%), and nasal (25.9%) quadrants. Patients with DOA+ features had worse visual outcomes compared with patients with pure DOA. Except in the temporal quadrant, RNFL measurements were significantly thinner for the DOA+ group. There was an inverse correlation between average RNFL thickness and logarithm of the minimum angle of resolution (LogMAR) visual acuity (P<0.0001). CONCLUSIONS RGC loss in DOA is characterised by severe involvement of the temporal papillomacular bundle, with relative sparing of the nasal fibres. RNFL thinning is more pronounced in patients with DOA+ phenotypes.
Collapse
Affiliation(s)
- P Yu-Wai-Man
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, UK.
| | | | | | | | | |
Collapse
|
20
|
Abstract
Leber hereditary optic neuropathy (LHON) and autosomal-dominant optic atrophy (DOA) are the two most common inherited optic neuropathies in the general population. Both disorders share striking pathological similarities, marked by the selective loss of retinal ganglion cells (RGCs) and the early involvement of the papillomacular bundle. Three mitochondrial DNA (mtDNA) point mutations; m.3460G>A, m.11778G>A, and m.14484T>C account for over 90% of LHON cases, and in DOA, the majority of affected families harbour mutations in the OPA1 gene, which codes for a mitochondrial inner membrane protein. Optic nerve degeneration in LHON and DOA is therefore due to disturbed mitochondrial function and a predominantly complex I respiratory chain defect has been identified using both in vitro and in vivo biochemical assays. However, the trigger for RGC loss is much more complex than a simple bioenergetic crisis and other important disease mechanisms have emerged relating to mitochondrial network dynamics, mtDNA maintenance, axonal transport, and the involvement of the cytoskeleton in maintaining a differential mitochondrial gradient at sites such as the lamina cribosa. The downstream consequences of these mitochondrial disturbances are likely to be influenced by the local cellular milieu. The vulnerability of RGCs in LHON and DOA could derive not only from tissue-specific, genetically-determined biological factors, but also from an increased susceptibility to exogenous influences such as light exposure, smoking, and pharmacological agents with putative mitochondrial toxic effects. Our concept of inherited mitochondrial optic neuropathies has evolved over the past decade, with the observation that patients with LHON and DOA can manifest a much broader phenotypic spectrum than pure optic nerve involvement. Interestingly, these phenotypes are sometimes clinically indistinguishable from other neurodegenerative disorders such as Charcot-Marie-Tooth disease, hereditary spastic paraplegia, and multiple sclerosis, where mitochondrial dysfunction is also thought to be an important pathophysiological player. A number of vertebrate and invertebrate disease models has recently been established to circumvent the lack of human tissues, and these have already provided considerable insight by allowing direct RGC experimentation. The ultimate goal is to translate these research advances into clinical practice and new treatment strategies are currently being investigated to improve the visual prognosis for patients with mitochondrial optic neuropathies.
Collapse
MESH Headings
- Animals
- DNA, Mitochondrial/genetics
- Disease Models, Animal
- Humans
- Optic Atrophy, Autosomal Dominant/pathology
- Optic Atrophy, Autosomal Dominant/physiopathology
- Optic Atrophy, Autosomal Dominant/therapy
- Optic Atrophy, Hereditary, Leber/pathology
- Optic Atrophy, Hereditary, Leber/physiopathology
- Optic Atrophy, Hereditary, Leber/therapy
- Optic Nerve/pathology
- Phenotype
- Point Mutation
- Retinal Ganglion Cells/pathology
Collapse
Affiliation(s)
- Patrick Yu-Wai-Man
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, UK.
| | | | | |
Collapse
|
21
|
Abstract
BACKGROUND Traumatic optic neuropathy (TON) is an important cause of severe visual loss following blunt or penetrating head trauma. Following the initial injury, optic nerve swelling within the optic nerve canal can result in secondary retinal ganglion cell loss. Optic nerve decompression with steroids or surgical interventions or both has therefore been advocated as a means of improving visual prognosis in TON. OBJECTIVES The aim of this review was to examine the effectiveness and safety of using steroids in TON. SEARCH STRATEGY We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2010, Issue 11), MEDLINE (January 1950 to November 2010), EMBASE (January 1980 to November 2010), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to November 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (http://clinicaltrials.gov) and Web of Science Conference Proceedings Citation Index- Science (CPCI-S). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 23 November 2010. We also searched the reference lists of included studies, other reviews and book chapters on TON to find references to additional trials. The Science Citation Index was used to look for papers that cited the studies included in this review. We did not manually search any journals or conference proceedings. We contacted trial investigators and experts in the field to identify additional published and unpublished studies. SELECTION CRITERIA We planned to include only randomised controlled trials (RCTs) of TON in which any steroid regime, either on its own or in combination with surgical optic nerve decompression, was compared to surgery alone or no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the titles and abstracts identified from the electronic searches. MAIN RESULTS We included one study that met our selection criteria; a double-masked, placebo-controlled, randomised trial of high dose intravenous steroids in patients with indirect TON diagnosed within seven days of the initial injury. A total of 31 eligible participants were randomised to receive either high dose intravenous steroids (n = 16) or placebo (n = 15), and they were all followed-up for three months. Mean final best corrected visual acuity (BCVA) was 1.78±1.23 Logarithm of the Minimum Angle of Resolution (LogMAR) in the placebo group, and 1.11±1.14 LogMAR in the steroid group. The mean difference in BCVA between the placebo and steroid groups was 0.67 LogMAR (95% confidence interval -1.54 to 0.20), and this difference was not statistically significant (P = 0.13). At three months follow-up, an improvement in BCVA of 0.40 LogMAR occurred in eight eyes (8/15, 53.3%) in the placebo group, and in 11 eyes (11/16, 68.8%) in the treatment group. This difference was not statistically significant (P = 0.38). AUTHORS' CONCLUSIONS There is a relatively high rate of spontaneous visual recovery in TON and there is no convincing data that steroids provide any additional visual benefit over observation alone. Recent evidence also suggests a possible detrimental effect of steroids in TON and further studies are urgently needed to clarify this important issue. Each case therefore needs to be assessed on an individual basis and proper informed consent is paramount.
Collapse
Affiliation(s)
- Patrick Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK, NE1 4LP
| | | |
Collapse
|
22
|
Yu-Wai-Man P, Trenell MI, Hollingsworth KG, Griffiths PG, Chinnery PF. OPA1 mutations impair mitochondrial function in both pure and complicated dominant optic atrophy. Brain 2010; 134:e164. [PMID: 20952381 PMCID: PMC3069699 DOI: 10.1093/brain/awq288] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrick Yu-Wai-Man
- 1 Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, UK
- 2 Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- 3 Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, UK
| | - Michael I. Trenell
- 4 Newcastle Magnetic Resonance Centre, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G. Hollingsworth
- 4 Newcastle Magnetic Resonance Centre, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Philip G. Griffiths
- 1 Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, UK
- 2 Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Patrick F. Chinnery
- 1 Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne, UK
- 3 Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
23
|
Ritchie AE, Griffiths PG, Chinnery PF, Davidson AW. Eye movement recordings to investigate a supranuclear component in chronic progressive external ophthalmoplegia: a cross-sectional study. Br J Ophthalmol 2010; 94:1165-8. [PMID: 20576783 DOI: 10.1136/bjo.2009.165639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND It has been postulated that eye movement disorders in chronic progressive external ophthalmoplegia (CPEO) have a neurological as well as a myopathic component to them. AIM To investigate whether there is a supranuclear component to eye movement disorders in CPEO using eye movement recordings. METHODS Saccade and smooth pursuit (SP) characteristics together with vestibulo-ocular reflex (VOR) gain and VOR suppression (VORS) gain in 18 patients with CPEO and 34 normal patients were measured using Eyelink II video-oculography. RESULTS The asymptotic values of the peak velocity main sequence curves were reduced in the CPEO group compared to those of normal patients, with a mean of 161 degrees/s (95% CI 126 degrees/s to 197 degrees/s) compared with 453 degrees/s (95% CI 430 to 475 degrees/s), respectively. Saccadic latency was longer in CPEO (263 ms; 95% CI 250 to 278), compared to controls (185 ms; 95% CI 181 to 189). Smooth pursuit and VOR gains were impaired in CPEO, although this could be explained by non-supranuclear causes. VORS gain was identical in the two groups. CONCLUSIONS This study does not support a supranuclear component to the ophthalmoplegia of CPEO, although the increased latencies observed may warrant further investigation.
Collapse
Affiliation(s)
- A E Ritchie
- Department of Ophthalmology, The Royal Free Hospital, London, UK
| | | | | | | |
Collapse
|
24
|
Yu-Wai-Man P, Sitarz KS, Samuels DC, Griffiths PG, Reeve AK, Bindoff LA, Horvath R, Chinnery PF. OPA1 mutations cause cytochrome c oxidase deficiency due to loss of wild-type mtDNA molecules. Hum Mol Genet 2010; 19:3043-52. [PMID: 20484224 PMCID: PMC2901142 DOI: 10.1093/hmg/ddq209] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Pathogenic OPA1 mutations cause autosomal dominant optic atrophy (DOA), a condition characterized by the preferential loss of retinal ganglion cells and progressive optic nerve degeneration. Approximately 20% of affected patients will also develop more severe neuromuscular complications, an important disease subgroup known as DOA+. Cytochrome c oxidase (COX)-negative fibres and multiple mitochondrial DNA (mtDNA) deletions have been identified in skeletal muscle biopsies from patients manifesting both the pure and syndromal variants, raising the possibility that the accumulation of somatic mtDNA defects contribute to the disease process. In this study, we investigated the mtDNA changes induced by OPA1 mutations in skeletal muscle biopsies from 15 patients with both pure DOA and DOA+ phenotypes. We observed a 2- to 4-fold increase in mtDNA copy number at the single-fibre level, and patients with DOA+ features had significantly greater mtDNA proliferation in their COX-negative skeletal muscle fibres compared with patients with isolated optic neuropathy. Low levels of wild-type mtDNA molecules were present in COX-deficient muscle fibres from both pure DOA and DOA+ patients, implicating haplo-insufficiency as the mechanism responsible for the biochemical defect. Our findings are consistent with the ‘maintenance of wild-type’ hypothesis, the secondary mtDNA deletions induced by OPA1 mutations triggering a compensatory mitochondrial proliferative response in order to maintain an optimal level of wild-type mtDNA genomes. However, when deletion levels reach a critical level, further mitochondrial proliferation leads to replication of the mutant species at the expense of wild-type mtDNA, resulting in the loss of respiratory chain COX activity.
Collapse
Affiliation(s)
- Patrick Yu-Wai-Man
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Kamil S. Sitarz
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - David C. Samuels
- Department of Molecular Physiology and Biophysics, Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Philip G. Griffiths
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Amy K. Reeve
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Laurence A. Bindoff
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway and
| | - Rita Horvath
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Patrick F. Chinnery
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, UK
- To whom correspondence should be addressed. Tel: +44 1912824375; Fax: +44 1912824373;
| |
Collapse
|
25
|
Greaves LC, Yu-Wai-Man P, Blakely EL, Krishnan KJ, Beadle NE, Kerin J, Barron MJ, Griffiths PG, Dickinson AJ, Turnbull DM, Taylor RW. Mitochondrial DNA defects and selective extraocular muscle involvement in CPEO. Invest Ophthalmol Vis Sci 2010; 51:3340-6. [PMID: 20164463 DOI: 10.1167/iovs.09-4659] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE. Chronic progressive external ophthalmoplegia (CPEO) is a prominent, and often the only, presentation among patients with mitochondrial diseases. The mechanisms underlying the preferential involvement of extraocular muscles (EOMs) in CPEO were explored in a comprehensive histologic and molecular genetic study, to define the extent of mitochondrial dysfunction in EOMs compared with that in skeletal muscle from the same patient. METHODS. A well-characterized cohort of 13 CPEO patients harboring a variety of primary and secondary mitochondrial (mt)DNA defects was studied. Mitochondrial enzyme function was determined in EOM and quadriceps muscle sections with cytochrome c oxidase (COX)/succinate dehydrogenase (SDH) histochemistry, and the mutation load in single muscle fibers was quantified by real-time PCR and PCR-RFLP assays. RESULTS. CPEO patients with mtDNA deletions had more COX-deficient fibers in EOM (41.6%) than in skeletal muscle (13.7%, P > 0.0001), and single-fiber analysis revealed a lower mutational threshold for COX deficiency in EOM. Patients with mtDNA point mutations had a less severe ocular phenotype, and there was no significant difference in the absolute level of COX deficiency or mutational threshold between these two muscle groups. CONCLUSIONS. The more pronounced mitochondrial biochemical defect and lower mutational threshold in EOM compared with skeletal muscle fibers provide an explanation of the selective muscle involvement in CPEO. The data also suggest that tissue-specific mechanisms are involved in the clonal expansion and expression of secondary mtDNA deletions in CPEO patients with nuclear genetic defects.
Collapse
Affiliation(s)
- Laura C Greaves
- Mitochondrial Research Group, Institute for Ageing and Health, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Yu-Wai-Man P, Lai-Cheong J, Borthwick GM, He L, Taylor GA, Greaves LC, Taylor RW, Griffiths PG, Turnbull DM. Somatic mitochondrial DNA deletions accumulate to high levels in aging human extraocular muscles. Invest Ophthalmol Vis Sci 2010; 51:3347-53. [PMID: 20164450 DOI: 10.1167/iovs.09-4660] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE. Mitochondrial function and the presence of somatic mitochondrial DNA (mtDNA) defects were investigated in extraocular muscles (EOMs) collected from individuals covering a wide age range, to document the changes seen with normal aging. METHODS. Cytochrome c oxidase (COX) and succinate dehydrogenase (SDH) histochemistry was performed on 46 EOM samples to determine the level of COX deficiency in serial cryostat muscle sections (mean age, 42.6 years; range, 3.0-96.0 years). Competitive three-primer and real-time PCR were performed on single-fiber lysates to detect and quantify mtDNA deletions. Whole-genome mitochondrial sequencing was also performed to evaluate the contribution of mtDNA point mutations to the overall mutational load. RESULTS. COX-negative fibers were seen in EOMs beginning in the third decade of life, and there was a significant age-related increase: <30 years, 0.05% (n = 17); 30 to 60 years, 1.94% (n = 13); and >60 years, 3.34% (n = 16, P = 0.0001). Higher levels of COX deficiency were also present in EOM than in skeletal muscle in all three age groups (P < 0.0001). Most of the COX-negative fibers harbored high levels (>70%) of mtDNA deletions (206/284, 72.54%) and the mean deletion level was 66.64% (SD 36.45%). The mutational yield from whole mitochondrial genome sequencing was relatively low (1/19, 5.3%), with only a single mtDNA point mutation identified among COX-negative fibers with low deletion levels < or =70%. CONCLUSIONS. The results show an exponential increase in COX deficiency in EOMs beginning in early adulthood, which suggests an accelerated aging process compared with other postmitotic tissues.
Collapse
Affiliation(s)
- Patrick Yu-Wai-Man
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Yu-Wai-Man P, Griffiths PG, Gorman GS, Lourenco CM, Wright AF, Auer-Grumbach M, Toscano A, Musumeci O, Valentino ML, Caporali L, Lamperti C, Tallaksen CM, Duffey P, Miller J, Whittaker RG, Baker MR, Jackson MJ, Clarke MP, Dhillon B, Czermin B, Stewart JD, Hudson G, Reynier P, Bonneau D, Marques W, Lenaers G, McFarland R, Taylor RW, Turnbull DM, Votruba M, Zeviani M, Carelli V, Bindoff LA, Horvath R, Amati-Bonneau P, Chinnery PF. Multi-system neurological disease is common in patients with OPA1 mutations. ACTA ACUST UNITED AC 2010; 133:771-86. [PMID: 20157015 PMCID: PMC2842512 DOI: 10.1093/brain/awq007] [Citation(s) in RCA: 314] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Additional neurological features have recently been described in seven families transmitting pathogenic mutations in OPA1, the most common cause of autosomal dominant optic atrophy. However, the frequency of these syndromal 'dominant optic atrophy plus' variants and the extent of neurological involvement have not been established. In this large multi-centre study of 104 patients from 45 independent families, including 60 new cases, we show that extra-ocular neurological complications are common in OPA1 disease, and affect up to 20% of all mutational carriers. Bilateral sensorineural deafness beginning in late childhood and early adulthood was a prominent manifestation, followed by a combination of ataxia, myopathy, peripheral neuropathy and progressive external ophthalmoplegia from the third decade of life onwards. We also identified novel clinical presentations with spastic paraparesis mimicking hereditary spastic paraplegia, and a multiple sclerosis-like illness. In contrast to initial reports, multi-system neurological disease was associated with all mutational subtypes, although there was an increased risk with missense mutations [odds ratio = 3.06, 95% confidence interval = 1.44-6.49; P = 0.0027], and mutations located within the guanosine triphosphate-ase region (odds ratio = 2.29, 95% confidence interval = 1.08-4.82; P = 0.0271). Histochemical and molecular characterization of skeletal muscle biopsies revealed the presence of cytochrome c oxidase-deficient fibres and multiple mitochondrial DNA deletions in the majority of patients harbouring OPA1 mutations, even in those with isolated optic nerve involvement. However, the cytochrome c oxidase-deficient load was over four times higher in the dominant optic atrophy + group compared to the pure optic neuropathy group, implicating a causal role for these secondary mitochondrial DNA defects in disease pathophysiology. Individuals with dominant optic atrophy plus phenotypes also had significantly worse visual outcomes, and careful surveillance is therefore mandatory to optimize the detection and management of neurological disability in a group of patients who already have significant visual impairment.
Collapse
Affiliation(s)
- P Yu-Wai-Man
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Yu-Wai-Man P, Stewart JD, Hudson G, Andrews RM, Griffiths PG, Birch MK, Chinnery PF. OPA1 increases the risk of normal but not high tension glaucoma. J Med Genet 2009; 47:120-5. [PMID: 19581274 DOI: 10.1136/jmg.2009.067512] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Primary open angle glaucoma is a progressive optic neuropathy characterised by the selective loss of retinal ganglion cells, pathological optic disc cupping and visual field defects. The OPA1 gene encodes an inner mitochondrial membrane protein crucial for normal mitochondrial function, and pathogenic mutations cause autosomal dominant optic atrophy by specifically targeting retinal ganglion cells. This raises the distinct possibility that more subtle genetic variations in OPA1 could alter the risk of developing glaucoma. METHODS 137 patients with primary open angle glaucoma (67 patients with high-tension glaucoma (HTG), 70 patients with normal-tension glaucoma (NTG)) and 75 controls from the North East of England were studied. Three single-nucleotide polymorphisms in intron 8 (IVS8+4c-->t and IVS8+32t-->c) and exon 4 (c.473A-->G) of the OPA1 gene were genotyped in the study group. In addition, the entire OPA1 coding region was sequenced in 24 individuals with the CT/TT compound genotype using standard BigDye chemistries. RESULTS There was no difference in either allele or genotype frequency for the IVS8+32t-->c single-nucleotide polymorphisms between patients and controls, but there was a significant association between the T allele at IVS8+4c-->t and the risk of developing NTG (OR=2.04, 95% CI=1.10 to 3.81, p=0.004), but not HTG. Logistic regression analysis also confirmed a strong association between the CT/TT compound genotype at IVS8+4 and IVS8+32 with NTG (OR=29.75, 95% CI=3.83 to 231.21, p=0.001). CONCLUSIONS The CT/TT compound genotype at IVS8+4 and IVS8+32 is a strong genetic risk determinant for NTG but not HTG.
Collapse
|
29
|
Kirkman MA, Korsten A, Leonhardt M, Dimitriadis K, De Coo IF, Klopstock T, Griffiths PG, Hudson G, Chinnery PF, Yu-Wai-Man P. Quality of life in patients with leber hereditary optic neuropathy. Invest Ophthalmol Vis Sci 2009; 50:3112-5. [PMID: 19255150 DOI: 10.1167/iovs.08-3166] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Leber hereditary optic neuropathy (LHON) is an inherited mitochondrial optic neuropathy characterized by bilateral, severe loss of central vision. In this study, the first formal assessment was conducted of visual disability in affected and unaffected individuals from molecularly confirmed LHON pedigrees. METHODS Four hundred two LHON carriers--196 affected and 206 unaffected--from 125 genealogically distinct pedigrees were prospectively interviewed using the well-validated visual function index (VF-14) questionnaire: m.3460G>A (n = 71), m.11778G>A (n = 270), and m.14484T>C (n = 61). RESULTS The mean age of onset of visual loss was 27.9 years (SD, 14.9) and mean disease duration was 15.5 years (SD, 15.4), with 74.5% of the affected subjects being men. The mean VF-14 score was 25.1 (SD, 20.8) in the affected patients, compared with 97.3 (SD, 7.1) in the unaffected carriers. Within the affected group, VF-14 score did not worsen with increasing disease duration and individuals with the m.14484T>C mutation had higher VF-14 scores compared with those in the m.3460G>A and m.11778G>A groups. Reading small print and reading a newspaper or book were the two VF-14 items that presented the greatest difficulty. CONCLUSIONS LHON has a severe negative impact on quality of life and has the worst VF-14 score when compared with other previously studied ophthalmic disorders. However, affected LHON carriers can be reassured that their level of visual impairment is unlikely to progress with time. The VF-14 questionnaire will be a useful tool for assessing the natural history of LHON and measuring outcome in future treatment trials.
Collapse
Affiliation(s)
- Matthew Anthony Kirkman
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Leber hereditary optic neuropathy (LHON) and autosomal dominant optic atrophy (DOA) are the two most common inherited optic neuropathies and they result in significant visual morbidity among young adults. Both disorders are the result of mitochondrial dysfunction: LHON from primary mitochondrial DNA (mtDNA) mutations affecting the respiratory chain complexes; and the majority of DOA families have mutations in the OPA1 gene, which codes for an inner mitochondrial membrane protein critical for mtDNA maintenance and oxidative phosphorylation. Additional genetic and environmental factors modulate the penetrance of LHON, and the same is likely to be the case for DOA which has a markedly variable clinical phenotype. The selective vulnerability of retinal ganglion cells (RGCs) is a key pathological feature and understanding the fundamental mechanisms that underlie RGC loss in these disorders is a prerequisite for the development of effective therapeutic strategies which are currently limited.
Collapse
MESH Headings
- DNA, Mitochondrial
- Female
- GTP Phosphohydrolases/genetics
- Humans
- Male
- Optic Atrophy, Autosomal Dominant/diagnosis
- Optic Atrophy, Autosomal Dominant/epidemiology
- Optic Atrophy, Autosomal Dominant/genetics
- Optic Atrophy, Autosomal Dominant/pathology
- Optic Atrophy, Hereditary, Leber/diagnosis
- Optic Atrophy, Hereditary, Leber/epidemiology
- Optic Atrophy, Hereditary, Leber/genetics
- Optic Atrophy, Hereditary, Leber/pathology
- Point Mutation
Collapse
Affiliation(s)
- P Yu-Wai-Man
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P G Griffiths
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - G Hudson
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - P F Chinnery
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
- Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| |
Collapse
|
31
|
Abstract
PURPOSE To investigate the possibility of auditory dysfunction in patients with Leber hereditary optic neuropathy (LHON). METHODS We prospectively recruited 10 affected patients from the north-east of England harbouring one of the three primary mitochondrial LHON mutations (3460G>A n = 3, 11778G>A n = 5 and 14484T>C n = 2). A detailed auditory history was taken and they were asked to complete a validated hearing questionnaire. Each patient then underwent a comprehensive topographic neuroauditory assessment to evaluate both middle- and inner-ear functions and the integrity of the brainstem auditory pathways. RESULTS We found no evidence of cochlear nerve dysfunction or abnormalities of the central brainstem auditory pathways in our LHON cohort and five patients had completely normal hearing tests. The remainder had mild conductive hearing loss from childhood ear infections and/or high-frequency sensorineural hearing loss from previous noise injury. CONCLUSION Although further studies are required to confirm our findings, auditory dysfunction as a result of a primary LHON mutation is probably uncommon.
Collapse
Affiliation(s)
- Patrick Yu-Wai-Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
| | | | | | | | | |
Collapse
|
32
|
Hadid OH, Wride NK, Griffiths PG, Strong NP, Clarke MP. Opaque intraocular lens for intractable diplopia: experience and patients' expectations and satisfaction. Br J Ophthalmol 2008; 92:912-5. [DOI: 10.1136/bjo.2007.132639] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
33
|
Hudson G, Amati-Bonneau P, Blakely EL, Stewart JD, He L, Schaefer AM, Griffiths PG, Ahlqvist K, Suomalainen A, Reynier P, McFarland R, Turnbull DM, Chinnery PF, Taylor RW. Mutation of OPA1 causes dominant optic atrophy with external ophthalmoplegia, ataxia, deafness and multiple mitochondrial DNA deletions: a novel disorder of mtDNA maintenance. ACTA ACUST UNITED AC 2007; 131:329-37. [PMID: 18065439 DOI: 10.1093/brain/awm272] [Citation(s) in RCA: 295] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mutations in nuclear genes involved in mitochondrial DNA (mtDNA) maintenance cause a wide range of clinical phenotypes associated with the secondary accumulation of multiple mtDNA deletions in affected tissues. The majority of families with autosomal dominant progressive external ophthalmoplegia (PEO) harbour mutations in genes encoding one of three well-characterized proteins--pol gamma, Twinkle or Ant 1. Here we show that a heterozygous mis-sense mutation in OPA1 leads to multiple mtDNA deletions in skeletal muscle and a mosaic defect of cytochrome c oxidase (COX). The disorder presented with visual failure and optic atrophy in childhood, followed by PEO, ataxia, deafness and a sensory-motor neuropathy in adult life. COX-deficient skeletal muscle fibres contained supra-threshold levels of multiple mtDNA deletions, and genetic linkage, sequencing and expression analysis excluded POLG1, PEO1 and SLC25A4, the gene encoding Ant 1, as the cause. This demonstrates the importance of OPA1 in mtDNA maintenance, and implicates OPA1 in diseases associated with secondary defects of mtDNA.
Collapse
Affiliation(s)
- Gavin Hudson
- Mitochondrial Research Group, School of Neurology, Neurobiology and Psychiatry, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
BACKGROUND Traumatic optic neuropathy (TON) is an important cause of severe visual loss following blunt or penetrating head trauma. Following the initial injury, optic nerve swelling within the optic nerve canal can result in secondary retinal ganglion cell loss. Optic nerve decompression with steroids or surgical interventions or both has therefore been advocated as a means of improving visual prognosis in TON. OBJECTIVES The aim of this review was to examine the effectiveness and safety of using steroids in TON. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 1, 2007), MEDLINE (1966 to February 2007), EMBASE (1980 to February 2007), LILACS (March 2007) and NRR (Issue 1, 2007). We also searched the reference lists of included studies, other reviews and book chapters on TON to find references to additional trials. The Science Citation Index was used to look for papers that cited the studies included in this review. We did not manually search any journals or conference proceedings. Trial investigators and experts in the field were contacted to identify additional published and unpublished studies. There were no date or language restrictions in the electronic searches for trials. SELECTION CRITERIA We planned to include only randomised controlled trials (RCTs) of TON in which any steroid regime, either on its own or in combination with surgical optic nerve decompression, was compared to surgery alone or no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the titles and abstracts identified from the electronic searches. MAIN RESULTS No studies were found that met our selection criteria and therefore none were included for analysis. AUTHORS' CONCLUSIONS There is a relatively high rate of spontaneous visual recovery in TON and no convincing data that steroids provide any additional benefit over observation alone. Recent evidence also suggests a possible detrimental effect of steroids in TON and further studies are urgently needed to clarify this important issue. Based on the current literature, TON cases presenting more than eight hours after the initial injury should not be treated with steroids. The decision to initiate treatment for patients seen within the eight-hour window remains controversial and the supporting evidence is weak. Each case therefore needs to be assessed on an individual basis and proper informed consent is paramount. An adequately powered RCT of steroids in TON poses difficult challenges and is probably not feasible.
Collapse
Affiliation(s)
- P Yu-Wai-Man
- Royal Victoria Infirmary, Department of Ophthalmology, Newcastle upon Tyne, UK, NE1 4LP.
| | | |
Collapse
|
35
|
Jaros E, Mahad DJ, Hudson G, Birchall D, Sawcer SJ, Griffiths PG, Sunter J, Compston DAS, Perry RH, Chinnery PF. Primary spinal cord neurodegeneration in Leber hereditary optic neuropathy. Neurology 2007; 69:214-6. [PMID: 17620555 DOI: 10.1212/01.wnl.0000265598.76172.59] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E Jaros
- Mitochondrial Research Group, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Sandhu SS, Birch MK, Griffiths PG, Talks SJ. Short-term effects of focal argon laser treatment in diabetic maculopathy as demonstrated by optical coherence tomography. Retina 2007; 27:13-20. [PMID: 17218910 DOI: 10.1097/01.iae.0000256657.64240.a1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the short-term effects of argon laser on retinal thickening as demonstrated by optical coherence tomography (OCT). METHODS A prospectively collected consecutive series of patients undergoing routine focal argon laser treatment for sight-threatening diabetic maculopathy had bilateral OCT performed before laser treatment and 1 hour, 24 hours, and 2 weeks after treatment. The main outcome measure was change in retinal thickness in the region of laser treatment. RESULTS Forty-six eyes were analyzed. There was a small increase in retinal thickness in the treated area 1 hour after laser treatment, with a mean change from before laser treatment of +2.6 microm (95% confidence interval [CI], +0.2 to + 5.0). However, there was a larger change 24 hours after treatment of +39.0 microm (95% CI, +31.6 to + 46.4) and a significant decrease 2 weeks after treatment of -14.6 microm (95% CI, -21.6 to -7.7) from before laser treatment values. CONCLUSION Focal argon laser treatment remains the first-line treatment for sight-threatening diabetic maculopathy. This study shows that in the short-term, areas of retinal thickening worsen before settling in response to argon laser treatment as demonstrated by OCT.
Collapse
Affiliation(s)
- Sukhpal S Sandhu
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | | | | | |
Collapse
|
37
|
Smith JM, Griffiths PG, Fraser SG. Acute red eye and back pain as a presentation for systemic illness: case report. BMC Ophthalmol 2006; 6:31. [PMID: 16995931 PMCID: PMC1592121 DOI: 10.1186/1471-2415-6-31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 09/22/2006] [Indexed: 12/03/2022] Open
Abstract
Background Acute red eye is a common presentation in both primary and secondary care. Presentation in combination with other systemic symptoms can indicate serious underlying pathology. Case presentation 73-year-old lady presenting with endogenous endophthalmitis and thoracic discitis secondary to sub-acute bacterial endocarditis. Conclusion Acute red eye in combination with systemic symptoms requires immediate investigation. If endogenous endophthalmitis is diagnosed, a source of sepsis should be comprehensively investigated and referral made to individual specialities if necessary.
Collapse
|
38
|
Andrews R, Ressiniotis T, Turnbull DM, Birch M, Keers S, Chinnery PF, Griffiths PG. The role of mitochondrial haplogroups in primary open angle glaucoma. Br J Ophthalmol 2006; 90:488-90. [PMID: 16547333 PMCID: PMC1857003 DOI: 10.1136/bjo.2005.084335] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate a possible association between mitochondrial haplogroups and primary open angle glaucoma (POAG). METHODS Genomic DNA was extracted from 140 POAG patients and 75 healthy individuals. Restriction enzyme digest analysis of polymerase chain reaction (PCR) amplified fragments was used to determine the mitochondrial haplogroup of each patient and control. RESULTS The median age was 73 years for the POAG patients (range 51-87, SD 8.01) and 78 years for the controls (range 68-90, SD 4.4). Mean IOP was 20.8 mm Hg for the patients (SD 2.6) and 16.2 mm Hg for the controls (SD 3.4). Median cup/disc ratio was 0.8 and 0.3 for patients and controls respectively. No statistically significant difference was found in the haplogroup distribution between the POAG patients and the healthy individuals (Fisher's exact test). CONCLUSION In this cohort, mitochondrial haplogroups do not appear to contribute to the pathogenesis of POAG.
Collapse
Affiliation(s)
- R Andrews
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND Traumatic optic neuropathy (TON) is an important cause of severe visual loss following blunt or penetrating head trauma. Following the initial insult optic nerve swelling within the optic nerve canal or compression by bone fragments are thought to result in secondary retinal ganglion cell loss. Optic nerve decompression with steroids or surgical interventions or both have therefore been advocated to improve visual prognosis in TON. OBJECTIVES The aim of this review was to examine the effects and safety of surgical interventions in the management of TON. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 3, 2005), MEDLINE (1966 to August 2005), EMBASE (1980 to 2005 wk 31), NRR 2005 Issue 3, LILACS (September 2004) and the reference lists of other reviews and book chapters on TON. We also contacted researchers in the field. There were no date or language restrictions in the electronic searches for trials. SELECTION CRITERIA We planned to include only randomised controlled trials of TON in which any form of surgical intervention either on its own or in combination with steroids was compared to steroids alone or no treatment. DATA COLLECTION AND ANALYSIS Two authors independently assessed the titles and abstracts identified from the search strategy. No studies were found that met our inclusion criteria and therefore none were included for analysis. MAIN RESULTS No studies were found that met our inclusion criteria. AUTHORS' CONCLUSIONS The current body of evidence consists mostly of small, retrospective case series. Given the wide range of surgical interventions used in TON it is very difficult to compare these studies, even qualitatively. However, there is a relatively high rate of spontaneous visual recovery and no evidence that surgical decompression of the optic nerve provides any additional benefit. On the other hand surgery carries a definite risk of complications such as postoperative cerebrospinal fluid leak and meningitis. The decision to proceed with surgery in TON therefore remains controversial and each case needs to be assessed on its own merits. Although there is an urgent need for an adequately powered, randomised controlled trial of surgical intervention in TON, this will prove a difficult endeavour.
Collapse
Affiliation(s)
- P Yu-Wai-Man
- Royal Victoria Infirmary, Department of Ophthalmology, Newcastle upon Tyne, UK NE1 4LP.
| | | |
Collapse
|
40
|
Yu Wai Man CY, Chinnery PF, Griffiths PG. Optic neuropathies--importance of spatial distribution of mitochondria as well as function. Med Hypotheses 2005; 65:1038-42. [PMID: 16098682 DOI: 10.1016/j.mehy.2004.10.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Revised: 10/05/2004] [Accepted: 10/11/2004] [Indexed: 11/28/2022]
Abstract
Optic neuropathies such as Leber's hereditary optic neuropathy, dominant optic atrophy and toxic amblyopia are an important cause of irreversible visual failure. Although they are associated with a defect of mitochondrial energy production, their pathogenesis is poorly understood. A common feature to all these disorders is relatively selective degeneration of the papillomacular bundle of retinal ganglion cells resulting central or caecocentral visual field defects. The striking similarity in the pattern of clinical involvement seen with these disparate disorders suggests a common pathway in their aetiology. The existing hypothesis that the optic nerve head has higher energy demands than other tissues making it uniquely dependent on oxidative phosporylation is not satisfactory. First, other ocular tissues such as photoreceptors, which are more dependent on oxidative phosporylation are not affected. Second, other mitochondrial disorders, which have a greater impact on mitochondrial energy function, do not affect the optic nerve. The optic nerve head has certain unique ultra structural features. Ganglion cell axons exit the eye through a perforated collagen plate, the lamina cribrosa. There is a sharp discontinuity in the density of mitochondria at the optic nerve head, with a very high concentration in the prelaminar nerve fibre layer and low concentration behind the lamina. This has previously been attributed to a mechanical hold up of axoplasmic flow, which has itself been proposed as a factor in the pathogenesis of a number of optic neuropathies. More recent evidence shows that mitochondrial distribution reflects the different energy requirements of the unmyelinated prelaminar axons in comparison to the myelinated retrolaminar axons. The heterogeous distribution of mitochondria is actively maintained to support conduction through the optic nerve head. We propose that factors that disrupt the heterogeneous distribution of mitochondria can result in ganglion cell death. Evidence for this comes from studies of cultured cells with the dominant optic atrophy mutation in which mitochondrial distribution is altered and from some forms of hereditary spastic paraparesis which are associated with optic atrophy. The responsible mutations do not affect ATP production until late in the disease but do affect mitochondrial arrangement, again showing that mitochondrial distribution as well as energy production by individual mitochondria may be important in the pathogenesis of ganglion cell death. Greater understanding of the factors localising mitochondria within the ganglion cell axon in particular the interaction with cytoskeleton is required to formulate new treatments. Boosting energy production alone may not be an effective treatment.
Collapse
Affiliation(s)
- C Y Yu Wai Man
- Department of Neurology, The Medical School, University of Newcastle upon Tyne, UK
| | | | | |
Collapse
|
41
|
Abstract
AIMS To assess the visual function of patients with chronic progressive external ophthalmoplegia (CPEO) using the Visual Function Index (VF-14). To identify discriminatory questions that reflect visual disability in mitochondrial ocular myopathies. To investigate the relationship between visual impairment and the ocular parameters routinely measured in clinical practice. METHODS We studied 40 CPEO patients. Each patient underwent ophthalmological assessment, including best-corrected visual acuity, ptosis measures, and fundus examination for pigmentary retinopathy, and orthoptic assessment including cover test in the primary position, assessment of diplopia, and measurement of uniocular fields of fixation using the Goldmann perimeter. Patients were interviewed by telephone by an independent observer and their visual function was assessed using the VF-14. RESULTS A total of 38 patients (95%) were visually impaired. The mean VF-14 was 72 (95% CI 66-79). Patients reported having the most difficulty with reading small print and driving at night. No significant correlation was found between the VF-14 and ocular motility parameters, ptosis, or pigmentary retinopathy. CONCLUSIONS CPEO is associated with significant visual impairment. Measures of visual disability should be included in studies of natural history and treatment of mitochondrial ocular myopathies.
Collapse
Affiliation(s)
- C Y Yu Wai Man
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | | | | | | |
Collapse
|
42
|
Ressiniotis T, Griffiths PG, Keers SM, Chinnery PF, Birch M. A polymorphism at codon 31 of gene p21 is not associated with primary open angle glaucoma in Caucasians. BMC Ophthalmol 2005; 5:5. [PMID: 15807891 PMCID: PMC1079871 DOI: 10.1186/1471-2415-5-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Accepted: 04/04/2005] [Indexed: 11/14/2022] Open
Abstract
Background Primary open angle glaucoma (POAG) is considered to be a neurodegenerative optic neuropathy, in which cell death occurs by apoptosis. p21, is an important protective component of the apoptotic pathway, regulating cellular arrest in the presence of DNA damage. An unstable or altered p21 protein could modify the cellular response to genomic injury and abolish the effect of p21. A previous study on a Chinese cohort suggested that the p21 codon 31 polymorphism may alter the state of apoptosis in glaucomatous optic neuropathy, failing to protect the ganglion cells. The aim of this study was to test the hypothesis that a p21 codon 31 polymorphism is associated with POAG on a Caucasian cohort. Methods 140 POAG patients and a control group of 73 healthy individuals were included in the study. All the subjects were of Caucasian origin. Genomic DNA was amplified by polymerase chain reaction, followed by enzymatic restriction fragment length polymorphism technique (PCR-RFLP). Patients and controls were genotyped for a single nucleotide polymorphism (C/A transversion) in the third base of codon 31 of p21, which leads to a serine (Ser)/arginine (Arg) substitution. Results The distribution of the genotypes in the POAG patients showed 128 (91.4%) Ser homozygotes, 10 (7.1%) Ser/Arg heterozygotes and 2 (1.5%) Arg homozygotes. In the control cohort, there were 61 (83.6%) Ser homozygotes and 12 (16.4%) Ser/Arg heterozygotes. No Arg homozygotes were present amongst the control group. Both the allelic and genotypic frequencies of the Ser or Arg residues at codon 31 were not significantly different between POAG patients and controls (Fisher's exact test, P = 0.20 for alleles and P = 0.0561 for genotypes). Conclusion This study suggests that the p21 codon 31 polymorphism does not contribute to the risk of POAG in the Caucasian population.
Collapse
Affiliation(s)
- Thomas Ressiniotis
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Department of Neurology, The Medical School, The University of Newcastle upon Tyne, UK
| | - Philip G Griffiths
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Sharon M Keers
- Department of Neurology, The Medical School, The University of Newcastle upon Tyne, UK
| | - Patrick F Chinnery
- Department of Neurology, The Medical School, The University of Newcastle upon Tyne, UK
| | - Michael Birch
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| |
Collapse
|
43
|
|
44
|
Abstract
We describe a patient with chronic progressive external ophthalmoplegia (CPEO) who underwent muscle biopsy for suspected mitochondrial disease. In spite of normal histocytochemical cytochrome c oxidase (COX) activity and respiratory chain enzyme measurements in muscle, subsequent molecular genetic analysis revealed the presence of a single, large-scale deletion of mitochondrial DNA (mtDNA). The case serves to illustrate the importance of pursuing the proposed mitochondrial genetic abnormality, even in patients with normal biopsy findings.
Collapse
Affiliation(s)
- Andrew M Schaefer
- School of Neurology, Neurobiology and Psychiatry, The Medical School, Framlington Place, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, United Kingdom
| | | | | | | | | |
Collapse
|
45
|
Yu Wai Man CY, Chinnery PF, Griffiths PG. Extraocular muscles have fundamentally distinct properties that make them selectively vulnerable to certain disorders. Neuromuscul Disord 2005; 15:17-23. [PMID: 15639116 DOI: 10.1016/j.nmd.2004.10.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Revised: 09/22/2004] [Accepted: 10/01/2004] [Indexed: 11/23/2022]
Abstract
While skeletal muscles generally perform specific limited roles, extraocular muscles (EOMs) have to be responsive over a wider dynamic range. As a result, EOMs have fundamentally distinct structural, functional, biochemical and immunological properties compared to other skeletal muscles. While these properties enable high fatigue resistance and the rapid and precise control of extraocular motility, they might also explain why EOMs are selectively involved in certain disorders, such as chronic progressive external ophthalmoplegia (CPEO), myasthenia gravis and Graves' ophthalmopathy. This review first gives an overview of the novel myofibre classification in EOMs and then focuses on those properties that might explain why ophthalmoplegia should be so prominent in these disorders.
Collapse
Affiliation(s)
- C Y Yu Wai Man
- Department of Neurology, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK
| | | | | |
Collapse
|
46
|
Ressiniotis T, Griffiths PG, Birch M, Keers SM, Chinnery PF. Apolipoprotein E promoter polymorphisms do not have a major influence on the risk of developing primary open angle glaucoma. Mol Vis 2004; 10:805-7. [PMID: 15525904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
PURPOSE Primary open angle glaucoma (POAG) is a major cause of late onset visual failure of unknown etiology. Recent genetic association studies have implicated the apolipoprotein E (APOE) gene in the pathophysiology of primary open angle glaucoma, but there have been conflicting findings. METHODS To resolve this issue we studied 140 cases and 73 controls that were carefully phenotyped, and used a logistic regression model to simultaneously analyze the effect of apolipoprotein E genotype and functional polymorphisms in the apolipoprotein E gene promoter while controlling for potentially confounding variables. RESULTS We found no evidence of an association between the apolipoprotein E promoter region polymorphisms and primary open angle glaucoma. CONCLUSIONS Apolipoprotein E promoter polymorphisms are unlikely to have a major impact on the pathophysiology of primary open angle glaucoma.
Collapse
Affiliation(s)
- Thomas Ressiniotis
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | | | | | | | |
Collapse
|
47
|
Ressiniotis T, Griffiths PG, Birch M, Keers S, Chinnery PF. Primary open angle glaucoma is associated with a specific p53 gene haplotype. J Med Genet 2004; 41:296-8. [PMID: 15060108 PMCID: PMC1735739 DOI: 10.1136/jmg.2003.016089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
48
|
Abstract
PURPOSE To evaluate the characteristics of patients with nonorganic or medically unexplained visual loss (MUVL) presenting to a neuro-ophthalmology clinic. METHODS A retrospective review of the case notes of patients identified from our diagnostic register. All patients had been followed up for at least 18 months and investigations (including, in all cases, neuroimaging) had failed to reveal any underlying pathology. To be included, patients had to have at least one inconsistent feature on visual function testing. RESULTS : We identified 58 patients with MUVL. A total of 79% of patients were female and 21% were male. In total, 36% of patients had been seen in other medical specialties with unexplained symptoms. In all, 60% of patients complained of glare or pain. Of the patients with bilateral visual loss, the acuities were frequently the same in each eye and the most common pattern of visual field loss was concentric contraction. Those with unilateral visual loss had a more variable pattern of visual failure. In total, 22% of patients showed some visual recovery though this was usually incomplete. In one patient, organic pathology accounting for the visual symptoms became apparent after the end of the 18 month follow-up period. CONCLUSIONS Medically unexplained symptoms, in general, form an important part of the workload in most medical specialties. Unexplained symptoms in ophthalmology have not been well studied. Terminology should be brought into line with that used in other medical specialties. Further work may help in the identification of positive diagnostic features of MUVL which should not be simply a 'diagnosis of exclusion'.
Collapse
Affiliation(s)
- P G Griffiths
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
| | | |
Collapse
|
49
|
Abstract
OBJECTIVE To test the hypothesis that genetic polymorphisms of the apolipoprotein E (APOE) gene are associated with primary open-angle glaucoma (POAG), based on the association between neurodegenerative diseases and the APOE genotype. METHODS Genomic DNA was examined from an unrelated cohort of 137 POAG patients and 75 control subjects from the ophthalmology department of the Royal Victoria Infirmary. The APOE allele frequency (epsilon2, epsilon3, and epsilon4 alleles) was studied by polymerase chain reaction amplification of the related locus (19q13.2), enzymatic digestion of the products, gel electrophoresis, and imaging under UV illumination. For statistical analysis, we used a logistic regression model that included intraocular pressure as a continuous variable to study the possible correlation between POAG and APOE allele frequency. RESULTS Logistic regression analysis showed no statistically significant association between the frequency of the APOE allele and POAG for the population studied, irrespective of the IOP (epsilon2 odds ratio, 0.82; 95% confidence interval, 0.12-5.79 [P =.84]; epsilon3 odds ratio, 0.39; 95% confidence interval, 0.10-1.49 [P =.17]; and epsilon4 odds ratio, 3.84; 95% confidence interval, 0.80-18.49 [P =.09]). CONCLUSION In our cohort, the APOE genotype does not constitute a risk factor for developing POAG, even in patients with normal-tension glaucoma.Clinical Relevance Apolipoprotein E polymorphisms do not appear to be contributory to POAG.
Collapse
Affiliation(s)
- Thomas Ressiniotis
- Department of Ophthalmology, Royal Victoria Infirmary, and Department of Neurology, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, England.
| | | | | | | | | |
Collapse
|
50
|
|