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Jiménez-Berríos GA, Vázquez-Folch SJ, Izquierdo N. A Novel Variant in the FBN1 Gene Causing Marfan Syndrome: A Case Report. Cureus 2024; 16:e56948. [PMID: 38665719 PMCID: PMC11044074 DOI: 10.7759/cureus.56948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Our purpose is to report a patient with a novel variant in the fibrillin-1 (FBN1) gene causing the Marfan syndrome (MFS). The 29-year-old female patient with musculoskeletal, cardiovascular, and ocular findings compatible with the MFS had a novel pathogenic mutation on the FBN1 gene. We report on a patient whose clinical findings are compatible with the MFS. This patient's variant on the FBN1 gene leading to the syndrome has not been previously described. Additional investigations are needed to determine whether this variant contributes to the development of camptodactyly in patients with the syndrome.
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Affiliation(s)
| | | | - Natalio Izquierdo
- Department of Surgery, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PRI
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2
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Shi Y, Chen J, Cai L, Zhang X, Chen Z, Yang J, Jiang Y, Lu Y. Uncovering the Hidden World of Aqueous Humor Proteins for Discovery of Biomarkers for Marfan Syndrome. Adv Sci (Weinh) 2024; 11:e2303161. [PMID: 38088571 PMCID: PMC10853735 DOI: 10.1002/advs.202303161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/23/2023] [Indexed: 12/19/2023]
Abstract
Ectopia lentis is a hallmark of Marfan syndrome (MFS), a genetic connective tissue disorder affecting 1/5000 to 1/10 000 individuals worldwide. Early detection in ophthalmology clinics and timely intervention of cardiovascular complications can be lifesaving. In this study, a modified proteomics workflow with liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based data-independent acquisition (DIA) and field asymmetric ion mobility spectrometry (FAIMS) to profile the proteomes of aqueous humor (AH) and lens tissue from MFS children with ectopia lentis is utilized. Over 2300 and 2938 comparable proteins are identified in AH and the lens capsule, respectively. Functional enrichment analyses uncovered dysregulation of complement and coagulation-related pathways, collagen binding, and cell adhesion in MFS. Through weighted correlation network analysis (WGCNA) and machine learning, distinct modules associated with clinical traits are constructed and a unique biomarker panel (Q14376, Q99972, P02760, Q07507; gene names: GALE, MYOC, AMBP, DPT) is defined. These biomarkers are further validated using advanced parallel reaction monitoring (PRM) in an independent patient cohort. The results provide novel insights into the proteome characterization of ectopia lentis and offer a promising approach for developing a valuable biomarker panel to aid in the early diagnosis of Marfan syndrome via AH proteome.
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Affiliation(s)
- Yumeng Shi
- Eye Institute and Department of Ophthalmology, Eye and ENT HospitalFudan UniversityShanghai200031China
- NHC Key Laboratory of MyopiaFudan UniversityShanghai200031China
- Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghai200031China
- Shanghai Key Laboratory of Visual Impairment and RestorationShanghai200031China
| | - Jiahui Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT HospitalFudan UniversityShanghai200031China
- NHC Key Laboratory of MyopiaFudan UniversityShanghai200031China
- Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghai200031China
- Shanghai Key Laboratory of Visual Impairment and RestorationShanghai200031China
| | - Lei Cai
- Eye Institute and Department of Ophthalmology, Eye and ENT HospitalFudan UniversityShanghai200031China
- NHC Key Laboratory of MyopiaFudan UniversityShanghai200031China
- Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghai200031China
- Shanghai Key Laboratory of Visual Impairment and RestorationShanghai200031China
| | - Xueling Zhang
- Eye Institute and Department of Ophthalmology, Eye and ENT HospitalFudan UniversityShanghai200031China
- NHC Key Laboratory of MyopiaFudan UniversityShanghai200031China
- Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghai200031China
- Shanghai Key Laboratory of Visual Impairment and RestorationShanghai200031China
| | - Zexu Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT HospitalFudan UniversityShanghai200031China
- NHC Key Laboratory of MyopiaFudan UniversityShanghai200031China
- Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghai200031China
- Shanghai Key Laboratory of Visual Impairment and RestorationShanghai200031China
| | - Jin Yang
- Eye Institute and Department of Ophthalmology, Eye and ENT HospitalFudan UniversityShanghai200031China
- NHC Key Laboratory of MyopiaFudan UniversityShanghai200031China
- Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghai200031China
- Shanghai Key Laboratory of Visual Impairment and RestorationShanghai200031China
| | - Yongxiang Jiang
- Eye Institute and Department of Ophthalmology, Eye and ENT HospitalFudan UniversityShanghai200031China
- NHC Key Laboratory of MyopiaFudan UniversityShanghai200031China
- Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghai200031China
- Shanghai Key Laboratory of Visual Impairment and RestorationShanghai200031China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye and ENT HospitalFudan UniversityShanghai200031China
- NHC Key Laboratory of MyopiaFudan UniversityShanghai200031China
- Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghai200031China
- Shanghai Key Laboratory of Visual Impairment and RestorationShanghai200031China
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3
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Guo D, Li S, Xiao X, Jiang Y, Wang Y, Jin G, Wang J, Ouyang J, Jia X, Sun W, Wang P, Zheng D, Zhang Q. Clinical and Genetic Landscape of Ectopia Lentis Based on a Cohort of Patients From 156 Families. Invest Ophthalmol Vis Sci 2024; 65:20. [PMID: 38190127 PMCID: PMC10777873 DOI: 10.1167/iovs.65.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose To extend the mutation spectrum and explore the characteristics of genotypes and ocular phenotypes in ectopia lentis (EL). Methods Variants in all 14 reported EL-associated genes were selected from in-house data sets as well as literature review, and available clinical data were analyzed. Results Likely pathogenic variants in three genes were identified in 156 unrelated families with EL from the in-house cohort, of which 97.4% resulted from variants in FBN1, whereas the remaining were caused by variants in ADAMTSL4 (1.3%) and LTBP2 (1.3%). A comparative analysis of the in-house data and literature review suggested several characteristics: (1) a higher proportion of cysteine involvement variants in FBN1, either variants introducing or eliminating cysteine, and an earlier diagnosis age were presented in our cohort than in published literature; (2) the axial length (AL) and refractive error increased more rapidly with age in preschool EL children than normal children, and the increased rate of AL was slower in patients with surgery than those without surgery; (3) aberrant astigmatism was common in EL; and (4) worse vision and earlier onset age were observed in patients with non-FBN1 variants (all P < 0.05). Conclusions Variants in FBN1 are the predominant cause of EL, with the most common cysteine involvement variants. Early-stage EL manifests refractive error but gradually converts to axial myopia through defocus introduced by lens dislocation. Aberrant astigmatism is a suggestive sign of EL. Non-FBN1 variants cause early-onset and severe phenotypes. These results provide evidence for early diagnosis as well as timely treatment for EL.
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Affiliation(s)
- Dongwei Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Shiqiang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xueshan Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yi Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yingwei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Junwen Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jiamin Ouyang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaoyun Jia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Wenmin Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Panfeng Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Qingjiong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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4
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González-Lamuño D, Arrieta-Blanco FJ, Fuentes ED, Forga-Visa MT, Morales-Conejo M, Peña-Quintana L, Vitoria-Miñana I. Hyperhomocysteinemia in Adult Patients: A Treatable Metabolic Condition. Nutrients 2023; 16:135. [PMID: 38201964 PMCID: PMC10780827 DOI: 10.3390/nu16010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Hyperhomocysteinemia (HHcy) is recognized as an independent risk factor for various significant medical conditions, yet controversy persists around its assessment and management. The diagnosis of disorders afffecting homocysteine (Hcy) metabolism faces delays due to insufficient awareness of its clinical presentation and unique biochemical characteristics. In cases of arterial or venous thrombotic vascular events, particularly with other comorbidities, it is crucial to consider moderate to severe HHcy. A nutritional approach to HHcy management involves implementing dietary strategies and targeted supplementation, emphasizing key nutrients like vitamin B6, B12, and folate that are crucial for Hcy conversion. Adequate intake of these vitamins, along with betaine supplementation, supports Hcy remethylation. Lifestyle modifications, such as smoking cessation and regular physical activity, complement the nutritional approach to enhance Hcy metabolism. For individuals with HHcy, maintaining a plasma Hcy concentration below 50 μmol/L consistently is vital to lowering the risk of vascular events. Collaboration with healthcare professionals and dietitians is essential for developing personalized dietary plans addressing the specific needs and underlying health conditions. This integrated approach aims to optimize metabolic processes and reduce the associated health risks.
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Affiliation(s)
| | | | - Elena Dios Fuentes
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, 41013 Sevilla, Spain;
| | | | - Monstserrat Morales-Conejo
- Unit for Congenital Metabolic Diseases and Other Rare Diseases, Internal Medicine Department, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Luis Peña-Quintana
- Pediatric Gastroenterology and Nutrition Unit, Insular Materno-Infantil University Hospital Complex, Asociación Canaria de Investigación Pediátrica, Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain;
| | - Isidro Vitoria-Miñana
- Nutrition and Metabolic Diseases Unit, La Fe University Hospital, 46026 Valencia, Spain
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5
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Rojananuangnit K, Rojnueangnit K. Microspherophakic Angle Closure Glaucoma in a Patient with Coffin-Siris Syndrome: Case Report. Appl Clin Genet 2023; 16:165-170. [PMID: 37663124 PMCID: PMC10474847 DOI: 10.2147/tacg.s422312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background Bilateral secondary angle closure glaucoma is a presenting symptom of microspherophakia and ectopia lentis. Characterizing the associated syndrome and confirmation by genetic testing can identify associated systemic abnormalities and provide appropriate genetic counseling. Case Presentation A 42-year-old woman with severe intellectual disability presented with light perception visual acuity and glaucoma, with intraocular pressure (IOP) in her right and left eyes of 69 and 70 mmHg, respectively. She underwent two sessions of 270-degree laser diode transscleral cytophotocoagulation treatment at a 6-month interval and was prescribed topical anti-glaucoma medication. Her family noticed a progressive decrease in her vision while on treatment for 2 years. She was diagnosed with apparent Weill-Marchesani syndrome, accompanied by angle closure glaucoma and microspherophakia. Cataract surgery and intraocular lens implantation were successful in both eyes and post-operative IOP was controlled with anti-glaucoma medication but her vision did not improve from severe glaucomatous optic neuropathy. Her underlying syndrome was investigated genetically by whole exome sequencing. Results Sequencing showed a pathogenic variant in ARID1B, c.3955dupC (p.Gln1319Profs*14), diagnostic of Coffin-Siris syndrome. This is the first report of Coffin-Siris syndrome associated with microspherophakia and angle closure glaucoma. Conclusion Bilateral angle closure glaucoma from ectopia lentis in patients with genetic syndromes could be an indicator of microspherophakia in adulthood. Ophthalmological surveillance is important in patients with Coffin-Siris syndrome.
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Affiliation(s)
- Kulawan Rojananuangnit
- Glaucoma Unit, Department of Ophthalmology, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand
| | - Kitiwan Rojnueangnit
- Division of Genetics, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Khan TA, Khan AA, Khan A, Zahid MA, Mehboob MA. Bilateral Anteriorly Displaced Microspherophakia in a Female Child With Marfanoid Habitus. Cureus 2023; 15:e38371. [PMID: 37265880 PMCID: PMC10230448 DOI: 10.7759/cureus.38371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Microspherophakia is a rare congenital anomaly characterized by an abnormally small and spherical crystalline lens, which can be associated with several systemic syndromes. We present an extremely rare case of bilateral anteriorly displaced microspherophakia in a female child with Marfanoid habitus. The patient displayed phenotypic features resembling Marfan syndrome, including tall stature, muscle hypotonia, dolichostenomelia, and increased arm span than body length. However, unlike Marfan syndrome, Marfanoid habitus is not associated with mutations in the fibrillin-1 gene. The association between microspherophakia and Marfanoid habitus is a unique presentation that has not been reported in the literature. This case report aims to increase awareness of microspherophakia as a possible ocular association of Marfanoid habitus.
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Affiliation(s)
- Taimoor A Khan
- Ophthalmology, National University of Medical Sciences (NUMS) Rawalpindi, Rawalpindi, PAK
- Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi, PAK
| | - Ali A Khan
- Ophthalmology, Ayub Medical College, Abbottabad, PAK
| | - Asfandyar Khan
- Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi, PAK
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7
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Liu X, Niu L, Zhang L, Jiang L, Liu K, Wu X, Liu X, Wang J. Clinical and genetic findings in Chinese families with congenital ectopia lentis. Mol Genet Genomic Med 2023; 11:e2140. [PMID: 36670079 PMCID: PMC10178797 DOI: 10.1002/mgg3.2140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/23/2022] [Revised: 12/17/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Congenital ectopia lentis (EL) refers to the congenital dysplasia or weakness of the lens suspensory ligament, resulting in an abnormal position of the crystalline lens, which can appear as isolated EL or as an ocular manifestation of a syndrome, such as the Marfan syndrome. The fibrillin-1 protein encoded by the FBN1 gene is an essential component of the lens zonules. Mutations in FBN1 are the leading causes of congenital EL and Marfan syndrome. Owing to the complexity and individual heterogeneity of FBN1 gene mutations, the correlation between FBN1 mutation characteristics and various clinical phenotypes remains unclear. METHODS This study describes the clinical characteristics and identifies possible causative genes in eight families with Marfan syndrome or isolated EL using Sanger and whole-exome sequencing. RESULTS Eight FBN1 mutations were identified in these families, of which three (c.5065G > C, c.1600 T > A, and c.2210G > C) are reported for the first time. Based on in silico analyses, we hypothesized that these mutations may be pathogenic by affecting the fibrillin-1 protein structure and function. CONCLUSION These findings expand the number of known mutations involved in EL and provide a reference for the research on their genotype and phenotype associations.
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Affiliation(s)
- Xin Liu
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Liman Niu
- Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Liyun Zhang
- Postgraduate Training Base of Jinzhou Medical University, Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Shenzhen, Guangdong, China
| | - Liqiong Jiang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Kaiqing Liu
- Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Xueping Wu
- Postgraduate Training Base of Jinzhou Medical University, Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Shenzhen, Guangdong, China
| | - Xinhua Liu
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Jiantao Wang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
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8
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Chizhonkova EA, Avetisov KS, Avetisov SE. [Hereditary ectopia lentis: diagnosis and surgical treatment]. Vestn Oftalmol 2023; 139:129-136. [PMID: 36924525 DOI: 10.17116/oftalma2023139011129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This review describes hereditary diseases in which ectopia lentis may be present as one of the symptoms, considers the basic diagnostic concepts of lens disposition, and analyzes the options in surgical treatment of ectopia lentis and optical correction of aphakia.
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Affiliation(s)
| | - K S Avetisov
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | - S E Avetisov
- Krasnov Research Institute of Eye Disease, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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9
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Avetisov KS, Chizhonkova EA, Avetisov SE, Narbut MN. [Endocapsular fixation of intraocular lens in patients with ectopia lentis and Marfan syndrome (case study)]. Vestn Oftalmol 2023; 139:59-64. [PMID: 37638573 DOI: 10.17116/oftalma202313904159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Modern trends in advancement of phaco surgery techniques in patients with ectopia lentis (including patients with Marfan syndrome) are characterized by the transition from complete removal of the lens (lensectomy) to aspiration of the lens substance and attempts to preserve and reposition the capsular bag. This case study analyzes the results of surgical treatment of bilateral ectopia lentis in a 6-year-old patient with Marfan syndrome. The specifics of microinvasive phaco surgery consisted in capsular bag preservation and endocapsular fixation of the intraocular lens. The article presents the results of ophthalmological observation over a seven-year period.
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Affiliation(s)
- K S Avetisov
- Krasnov Research Institute of Eye Disease, Moscow, Russia
| | | | - S E Avetisov
- Krasnov Research Institute of Eye Disease, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M N Narbut
- Krasnov Research Institute of Eye Disease, Moscow, Russia
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10
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Chen ZX, Jia WN, Sun Y, Chen TH, Zhao ZN, Lan LN, Liu Y, Song LH, Jiang YX. Biallelic ADAMTSL4 variants in a Chinese cohort of congenital ectopia lentis: Implications for genotype-phenotype relationships. Hum Mutat 2022; 43:2141-2152. [PMID: 36208099 DOI: 10.1002/humu.24483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/19/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 01/25/2023]
Abstract
ADAMTSL4 variants are one of the common causes of congenital ectopia lentis (EL), reported ocular comorbidities of which include iris anomalies, cataract, and glaucoma. However, a genotype-phenotype correlation has not been established. Potentially pathogenic ADAMTSL4 variants were screened from a Chinese cohort of congenital EL using panel-based next-generation sequencing followed by multiple bioinformatics analyses. The genotype-phenotype correlation was assessed via a systematic review of ADAMTSL4 variants within our data and those from the literature. A total of 12 variants of ADAMTSL4, including seven frameshift variants, one nonsense variant, two splicing variants, and two missense variants, were found in nine probands. Combing genetic and clinical information from 72 probands in the literature revealed 37 ADAMTSL4 variants known to cause EL, and the ethnic difference was prominent. The lens was inclined to dislocate inferior temporally (22, 27.16%), while the pupil was always located oppositely (9, 81.82%). Several anterior segments anomalies were identified, including ectopia pupillae (15, 18.52%), persistent pupillary membrane (9, 11.10%), poor pupil dilation (4, 30.8%), cataract (13, 24.10%), and glaucoma (8, 13.33%). Genotype-phenotype analysis revealed that truncation variants had higher risks of combined iris anomalies, including either ectopia pupillae or a persistent pupillary membrane (p = 0.007). The data from this study not only extend our knowledge of the ADAMTSL4 variant spectrum but also suggest that deleterious variants of ADAMTSL4 might be associated with severe ocular phenotypes.
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Affiliation(s)
- Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wan-Nan Jia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yang Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Tian-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Zhen-Nan Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Li-Na Lan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yan Liu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Ling-Hao Song
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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11
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Li JT, Chen ZX, Chen XJ, Jiang YX. Mutation analysis of SUOX in isolated sulfite oxidase deficiency with ectopia lentis as the presenting feature: insights into genotype-phenotype correlation. Orphanet J Rare Dis 2022; 17:392. [PMID: 36303223 PMCID: PMC9615255 DOI: 10.1186/s13023-022-02544-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/25/2022] [Accepted: 10/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Isolated sulfite oxidase deficiency (ISOD) caused by sulfite oxidase gene (SUOX) mutations is a rare neurometabolic disease associated with ectopia lentis (EL). However, few genotype–phenotype correlations have been established yet. Methods Potentially pathogenic SUOX mutations were screened from a Chinese cohort of congenital EL using panel-based next-generation sequencing and analyzed with multiple bioinformatics tools. The genotype–phenotype correlations were evaluated via a systematic review of SUOX mutations within our data and from the literature. Results A novel paternal missense mutation, c.205G > C (p.A69P), and a recurrent maternal nonsense mutation, c.1200 C > G (p.Y400*), of SUOX were identified in a 4-year-old boy from 312 probands. The biochemical assays manifested elevated urine sulfite and S-sulfocysteine accompanied by decreased homocysteine in the blood. The patient had bilateral EL and normal fundus, yet minimal neurological involvement and normal brain structure. Molecular modeling simulation revealed the p.A69P mutant had an unstable structure but an unchanged affinity for sulfite, while the truncated p.Y400* mutant showed decreased binding capacity. Genotype–phenotype analysis demonstrated patients with biallelic missense mutations had milder symptoms (P = 0.023), later age of onset (P < 0.001), and a higher incidence of regression (P = 0.017) than other genotypes. No correlations were found regarding EL and other neurological symptoms. Conclusion The data from this study not only enrich the known mutation spectrum of SUOX but also suggest that missense mutations are associated with mild and atypical symptoms. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02544-x.
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Affiliation(s)
- Jia-Tong Li
- Department of Neurology, Huashan Hospital and Institute of Neurology, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, 200031, Shanghai, China.,Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, 200031, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, 200031, Shanghai, China
| | - Xiang-Jun Chen
- Department of Neurology, Huashan Hospital and Institute of Neurology, Fudan University, Shanghai, China. .,National Center for Neurological Disorders, Shanghai, China. .,Human Phenome Institute, Fudan University, Shanghai, China.
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Rd, 200031, Shanghai, China. .,Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, 200031, Shanghai, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, 200031, Shanghai, China.
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12
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Urkude J, Singh R, Titiyal JS, Sharma N. Kissing microvitreoretinal blade technique: A novel approach for safe and effective endocapsular lens aspiration in microspherophakia. Indian J Ophthalmol 2022; 70:3677-3680. [PMID: 36190071 PMCID: PMC9789857 DOI: 10.4103/ijo.ijo_588_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We herein describe the kissing MVR technique in cases of microspherophakia for safe and effective endocapsular lens aspiration. Microspherophakia is associated with abnormally lax and broken zonules, which pose a great challenge to the operating surgeon, especially while creating the openings in the capsular bag. In this novel technique, simultaneous use of two 23 G MVR blades reduces the above problem associated with the severely mobile lens. Here, one MVR blade stabilizes the capsular bag and, at the same time, provides counter-traction for the opposite MVR blade while puncturing the capsular bag. Furthermore, the creation of openings in the lens at the equator or just posterior to it is beneficial as the capsule is relatively thicker and stronger at this location. This also minimizes the risk of premature extension to the anterior or posterior capsule, thereby avoiding complications like dropped lens matter, vitreous prolapse, and vitreous traction.
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Affiliation(s)
- Jayanand Urkude
- Cornea, Cataract, Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Singh
- Cornea, Cataract, Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Cornea, Cataract, Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Cornea, Cataract, Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,Correspondence to: Prof. Namrata Sharma, Cornea, Cataract and Refractive Surgery and Ocular Surface Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi – 110 029, India. E-mail:
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13
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Guan JY, Ma YC, Zhu YT, Xie LL, Aizezi M, Zhuo YH, Wumaier A. Lens nucleus dislocation in hypermature cataract: Case report and literature review. Medicine (Baltimore) 2022; 101:e30428. [PMID: 36107580 PMCID: PMC9439833 DOI: 10.1097/md.0000000000030428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Hypermature cataract is a form of late-stage cataract progression that can lead to a variety of complications. Spontaneous capsular rupture with lens nucleus displacement in hypermature cataracts has rarely been reported. We describe 2 cases of spontaneous dislocation of the lens nucleus in a hypermature cataract and perform a review of the literature on this complication. PATIENT CONCERNS We report 2 rural men aged 50 and 76 years with deteriorating vision. DIAGNOSIS The final diagnosis was senile hypermature cataract with dislocation of the lens nucleus in both patients and secondary glaucoma for the second patient. INTERVENTIONS AND OUTCOMES During admission, both patients complained of deteriorating vision. Slit-lamp examination showed lens nucleus dislocation into the anterior chamber. The 50-year-old patient exhibited a residual lens capsule and a turbid cortex, with a normal anterior chamber and intraocular pressure. The 76-year-old patient presented a shrunken and ruptured capsule and no cortex in the pupillary area, mild inflammation in the anterior chamber, and high intraocular pressure. Both patients underwent intracapsular cataract extraction combined with anterior vitrectomy and achieved good postoperative recovery. CONCLUSION Lens nucleus dislocation in hypermature cataracts can be seen in clinical practice, particularly in underdeveloped areas. Early recognition and surgery can improve vision.
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Affiliation(s)
- Jie-Ying Guan
- Kashgar Hospital Affiliated to Sun Yat-sen University, Xinjiang, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Department of Ophthalmology, the First People’s Hospital of Kashi, Xinjiang, China
| | - Yun-Cheng Ma
- Kashgar Hospital Affiliated to Sun Yat-sen University, Xinjiang, China
- Department of Ophthalmology, the First People’s Hospital of Kashi, Xinjiang, China
| | - Ying-Ting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ling-Ling Xie
- Kashgar Hospital Affiliated to Sun Yat-sen University, Xinjiang, China
- Department of Ophthalmology, the First People’s Hospital of Kashi, Xinjiang, China
| | - Mireayi Aizezi
- Kashgar Hospital Affiliated to Sun Yat-sen University, Xinjiang, China
- Department of Ophthalmology, the First People’s Hospital of Kashi, Xinjiang, China
| | - Ye-Hong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Aizezi Wumaier
- Kashgar Hospital Affiliated to Sun Yat-sen University, Xinjiang, China
- Department of Ophthalmology, the First People’s Hospital of Kashi, Xinjiang, China
- *Correspondence: Aizezi Wumaier, Kashgar Hospital Affiliated to Sun Yat-sen University, The First People’s Hospital of Kashi, No.120 Yingbin Avenue, Kashi, Xinjiang 844000, China (e-mail: )
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14
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Abstract
Homocystinuria is a rare metabolic inborn disorder caused due to dysfunctional cystathionine β-synthase (CBS) enzyme activity, thus resulting in elevated levels of methionine and homocysteine in the blood and urine. The timely recognition of this rare metabolic disorder and prompt methionine-restricted diet are crucial in lessening the systemic consequences. The recalcitrant cases have a higher risk for cardiovascular diseases, neurodegenerative diseases, neural tube defects, and other severe clinical complications. This review aims to present the ophthalmic spectrum of homocystinuria and its molecular basis, the disease management, as well as the current and potential treatment approaches with a greater emphasis on preventive strategies.
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Affiliation(s)
- Mehzabeen Rahman
- Department of Ophthalmology, Tirupati Eye Center, Noida, Uttar Pradesh, India
| | - Mohita Sharma
- Department of Ophthalmology, Tirupati Eye Center, Noida, Uttar Pradesh, India
| | - Pragati Aggarwal
- Department of Ophthalmology, Tirupati Eye Center, Noida, Uttar Pradesh, India
| | - Silkee Singla
- Department of Ophthalmology, Tirupati Eye Center, Noida, Uttar Pradesh, India
| | - Neha Jain
- Department of Ophthalmology, Tirupati Eye Center, Noida, Uttar Pradesh, India
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15
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Abstract
Microspherophakia is a rare developmental abnormality of the crystalline lens with a myriad of ocular and systemic associations. Glaucoma is a serious complication associated with this disorder. Early identification of the disease, timely visual rehabilitation, and appropriate management of the lens and glaucoma can help us prevent blindness from this condition. Multidisciplinary care with lifelong follow-up is recommended, as this typically affects the younger population. Current treatment protocols for this condition are mainly based on case reports and retrospective studies with shorter follow-up. Due to the rarity of this disease, designing a large randomized controlled trial to identify the merits and demerits of each management strategy is challenging. With cataract, glaucoma, and vitreoretinal specialists, each having their preferred way of managing microspherophakic lenses, we decided to do a comprehensive review of the existing literature to devise an integrated approach toward effective management of these patients. This review will collate all evidence and provide a very practical decision-making tree for its management.
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Affiliation(s)
| | | | - Neethu Mohan
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
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16
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Maharana PK, Sahay P, Mandal S, Lakshmi CC, Goel S, Nagpal R, Sinha R, Agarwal T, Sharma N, Titiyal JS. Outcomes of surgical intervention in cases of ectopia lentis. Indian J Ophthalmol 2022; 70:2432-2438. [PMID: 35791125 PMCID: PMC9426199 DOI: 10.4103/ijo.ijo_255_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: To evaluate the outcomes of surgical intervention in cases of ectopia lentis. Methods: This retrospective study included all cases of ectopia lentis that presented between June 2015 and March 2019 in a tertiary care center. They were reviewed retrospectively. The corrected distance visual acuity (CDVA), severity of lens subluxation, type of surgery, intra-operative and post-operative complication, and specular count were recorded. Results: Seventy-eight eyes of 57 cases with a mean age at surgery of 14.73 years were analyzed. Intra-lenticular lens aspiration was the most common (n-62/78; 79.5%) surgical procedure followed by lens aspiration, intra-capsular cataract extraction, phaco-aspiration, and pars-plana lensectomy. Simultaneous intra-ocular lens (IOL) implantation was performed in 46.2% (n-32/78) of the eyes. The mean CDVA improved from 0.85 ± 0.55 logMAR to 0.44 ± 0.29 logMAR at 6 weeks follow-up. The post-operative CDVA was significantly better in the pseudo-phakic group compared to the aphakic group (p-0.02). The patient’s age at the time of surgery and the degree of subluxation did not impact the final visual outcome. Intra-operative complication included vitreous hemorrhage (n-1) and lens matter drop (n-1). Post-operative complications were noted in 26.9% of the eyes (n-21/78) with a higher complication rate in the pseudo-phakic group (p-0.00). A second intervention was required in 7.7% of the eyes (n-6/78). Conclusion: Age and degree of subluxation at the time of surgery do not influence the final visual outcome in cases of ectopia lentis undergoing lens extraction surgery. IOL implantation results in better visual outcomes but is associated with a high complication rate.
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Affiliation(s)
- Prafulla K Maharana
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pranita Sahay
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sohini Mandal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Chandra C Lakshmi
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Siddhi Goel
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Nagpal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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17
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Canabrava S, Pinheiro L, Chaves V, Barrientos R. Late internalized double-flanged polypropylene with canabrava technique in patient with marfan syndrome. Eur J Ophthalmol 2022:11206721221092216. [PMID: 35384783 DOI: 10.1177/11206721221092216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This paper reports the first occurrence of a late internalized flange due to capsular contraction syndrome after undergoing the double-flanged surgical technique. CASE DESCRIPTION A 32-year-old woman with Marfan syndrome underwent phacoemulsification using the double-flanged technique in both eyes. Two years postoperatively, a slit lamp examination revealed a capsular bag with anterior phimosis (capsular contraction syndrome) and the external flange internalized. The patient was submitted for a new surgery to re-fixate the capsular bag. The procedure was successfully accomplished. The intraocular lens was centered by the end of the procedure without areas of traction. The patient presented with best corrected visual acuity of 20/25 in both eyes postoperatively. CONCLUSIONS This paper recounts a successful re-approach of a late internalized double-flange two years after the first procedure in a patient that developed capsular contraction syndrome.
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Affiliation(s)
- Sérgio Canabrava
- Cataract Department, 193570Santa Casa de Belo Horizonte 197, 1704 - Claudio Manoel Av. Belo Horizonte, Minas Gerais - Brazil
| | | | - Vizibelli Chaves
- Cataract Department, 193570Santa Casa de Belo Horizonte 197, 1704 - Claudio Manoel Av. Belo Horizonte, Minas Gerais - Brazil
| | - Robinson Barrientos
- Cataract Department, 193570Santa Casa de Belo Horizonte 197, 1704 - Claudio Manoel Av. Belo Horizonte, Minas Gerais - Brazil
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18
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Scanga HL, Nischal KK. ADAMTSL4-related ectopia lentis: A case of pseudodominance with an asymptomatic parent. Am J Med Genet A 2022; 188:1853-1857. [PMID: 35218299 DOI: 10.1002/ajmg.a.62698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/13/2021] [Revised: 12/15/2021] [Accepted: 01/24/2022] [Indexed: 01/06/2023]
Abstract
Pathogenic variants of ADAMTSL4 are associated with autosomal recessive ectopia lentis et pupillae and isolated ectopia lentis, often presenting congenitally or in childhood. We describe a pedigree of a 4-year-old female child with bilateral ectopia lentis and her asymptomatic 35-year-old father with mild anterior segment findings. Molecular evaluation revealed compound heterozygosity for ADAMTSL4 pathogenic variants in the proband and homozygosity for an ADAMTSL4 pathogenic founder mutation in her father. The results of genetic testing revealed a pseudodominant inheritance pattern in the family. This case expands variability of ADAMTSL4-related ectopia lentis through the first description of an asymptomatic adult in the 4th decade and highlights importance of clinical and molecular evaluations of family members when investigating genetic disorders.
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Affiliation(s)
- Hannah L Scanga
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ken K Nischal
- Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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19
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Abstract
An 11-year-old boy with marfanoid habitus and high myopia presented with multiple episodes of seizures. He was found to have arachnodactyly, hypermobile joints, ectopia lentis, cerebral venous sinus thrombosis (CVST) with very high serum methionine and homocysteine. Genetic evaluation unveiled homocystinuria due to cystathionine beta-synthase deficiency. The patient was treated with high-dose pyridoxine, methionine restricted diet, anticonvulsants, warfarin, and correction of ectopia lentis. Homocystinuria should be suspected in patients with tall stature and pathological myopia. Early treatment can prevent thromboembolic complications.
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Affiliation(s)
| | | | - Jishnu Kr
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | | | - Ramakrushna Gudu
- Paediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Arun K Dash
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Amit R Rup
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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20
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Chizhonkova EA, Avetisov KS, Avetisov SE, Kharlap SI. [Ocular manifestations of Marfan syndrome]. Vestn Oftalmol 2022; 138:94-100. [PMID: 36004597 DOI: 10.17116/oftalma202213804194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Marfan syndrome is an orphan disease that is caused by a mutation in the FBN1 gene located on chromosome 15 (15q21.1) and is usually inherited in an autosomal dominant manner. The article reviews the results of studies concerning the potential ocular manifestations of Marfan syndrome.
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Affiliation(s)
| | - K S Avetisov
- Research Institute of Eye Diseases, Moscow, Russia
| | - S E Avetisov
- Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S I Kharlap
- Research Institute of Eye Diseases, Moscow, Russia
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21
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Yang J, Wang Z, Cao Q, Wang Y, Wu J, Lian Z, Zheng D. Endoscopy-guided in vivo evaluation of ciliary sulcus location in children with ectopia lentis. J Int Med Res 2021; 49:3000605211060980. [PMID: 34898317 PMCID: PMC8679403 DOI: 10.1177/03000605211060980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess a new method to measure the distance of the needle passage from the ciliary sulcus to the corneal limbus anterior border (CTC) in eyes with ectopia lentis directly in vivo via endoscopy and to further evaluate the correlations among the CTC, age, automated horizontal white-to-white distance (WTW), and ocular axial length (AL). METHODS The WTW and AL were measured using an optical biometer. An intraocular endoscope was used during transscleral suture fixation of posterior chamber intraocular lenses to identify the true location of the ciliary sulcus. Linear regression analysis was used to assess the correlation between the CTC and other ocular biological parameters, including age, WTW, and AL. RESULTS Thirty eyes of 30 children with ectopia lentis were evaluated. A statistically significant correlation was found between age and the CTC. The CTC could be predicted by the equation CTC = 0.1313 × Age + 0.9666. No statistically significant correlations were found between CTC and WTW, CTC and AL, WTW and AL, or WTW and age. CONCLUSION Endoscopy is useful for precisely suturing intraocular lens haptics in the real ciliary sulcus. Age can be used as an equivalent parameter for prediction of the true ciliary sulcus location.
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Affiliation(s)
- Jing Yang
- Danying Zheng, State Key Laboratory of
Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie,
Guangzhou, Guangdong 510060, People’s Republic of China.
| | - Zhirong Wang
- Danying Zheng, State Key Laboratory of
Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie,
Guangzhou, Guangdong 510060, People’s Republic of China.
| | | | | | | | | | - Danying Zheng
- Danying Zheng, State Key Laboratory of
Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54S Xianlie,
Guangzhou, Guangdong 510060, People’s Republic of China.
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22
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Chen J, Tang Y, Jing Q, Lu Y, Jiang Y. Analysis of Corneal Spherical Aberrations in Chinese Bilateral Ectopia Lentis Patients. Front Med (Lausanne) 2021; 8:736686. [PMID: 34869429 PMCID: PMC8639512 DOI: 10.3389/fmed.2021.736686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose: To analyze the anterior, posterior, and total corneal spherical aberrations (ASA, PSA, and TSA) in patients with Chinese bilateral ectopia lentis (EL). Methods: A cross-sectional study was conducted to evaluate corneal spherical aberration (CSA) using a Pentacam system at the 6-mm optical zone. Axial length, keratometry, astigmatism, and corneal asphericity were also determined. Results: This study included 247 patients (420 eyes) with a mean age of 18.1 years. The values of ASA, PSA, and TSA were 0.136 ± 0.100 μm, −0.118 ± 0.030 μm, and 0.095 ± 0.095 μm, respectively. In the EL patients with Marfan syndrome (MFS), ASA and TSA were significantly lower than in the non-MFS patients (0.126 ± 0.094 μm vs. 0.155 ± 0.107 μm, P = 0.004 for ASA; 0.085 ± 0.091 μm vs. 0.114 ± 0.099 μm, P = 0.003 for TSA), whereas PSA was not significantly different (P = 0.061). The values of ASA and TSA were significantly higher in the patients with EL aged ≥ 40 years old than in younger patients, whereas ASA and PSA were lower in patients aged <10 years old than in older patients (all P < 0.05). In the multiple linear regression analysis, age, keratometry, astigmatism, anterior asphericity, higher-order aberration (HOA), and lower-order aberration (LOA) were positively or negatively correlated with TSA in the patients with EL (r = 0.681, P < 0.001). Conclusions: Corneal spherical aberration was low in the patients with EL especially for MFS and tended to increase with aging. Preoperatively, individual measurement of CSA was necessary for bilateral EL patients with MFS.
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Affiliation(s)
- Jiahui Chen
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yating Tang
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Qinghe Jing
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yongxiang Jiang
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
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23
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Chen ZX, Chen TH, Zhang M, Chen JH, Lan LN, Deng M, Zheng JL, Jiang YX. Correlation between FBN1 mutations and ocular features with ectopia lentis in the setting of Marfan syndrome and related fibrillinopathies. Hum Mutat 2021; 42:1637-1647. [PMID: 34550612 DOI: 10.1002/humu.24283] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/26/2021] [Revised: 07/07/2021] [Accepted: 09/17/2021] [Indexed: 02/01/2023]
Abstract
Mutations of fibrillin-1 (FBN1) have been associated with Marfan syndrome and pleiotropic connective tissue disorders, collectively termed as "type I fibrillinopathy". However, few genotype-phenotype correlations are known in the ocular system. Patients with congenital ectopia lentis (EL) received panel-based next-generation sequencing, complemented with multiplex ligation-dependent probe amplification. In a total of 125 probands, the ocular phenotypes were compared for different types of FBN1 mutations. Premature termination codons were associated with less severe EL and a thinner central corneal thickness (CCT) than the inframe mutations. The eyes of patients with mutations in the C-terminal region had a higher incidence of posterior staphyloma than those in the middle and N-terminal regions. Mutations in the TGF-β-regulating sequence had larger horizontal corneal diameters (white-to-white [WTW]), higher incidence of posterior staphyloma, but less severe EL than those with mutations in other regions. Mutations in the neonatal region were associated with thinner CCT. Longer axial length (AL) was associated with mutations in the C-terminal region or TGF-β regulating sequence after adjusting for age, EL severity, and corneal curvature radius. FBN1 genotype-phenotype correlations were established for some ocular features, including EL severity, AL, WTW, CCT, and so forth, providing novel perspectives and directions for further mechanistic studies.
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Affiliation(s)
- Ze-Xu Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Tian-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Min Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Hui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Li-Na Lan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Michael Deng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jia-Lei Zheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yong-Xiang Jiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Chee SP, Ti SE, Chan NSW. Management of the subluxated crystalline lens: A review. Clin Exp Ophthalmol 2021; 49:1091-1101. [PMID: 34264007 DOI: 10.1111/ceo.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/29/2021] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Cataract surgery for the subluxated crystalline lens is challenging. A thorough preoperative evaluation is important to determine the appropriate surgical approach for lens removal and the subsequent technique of intraocular lens placement. Important considerations include the extent and location of zonular weakness, and whether the zonular deficiency is caused by a static or progressive disease. The capsular bag should be preserved where possible. Creating a good-sized and centred continuous curvilinear capsulorhexis is crucial to facilitate the use of capsular retractors and capsular tension devices, which provide capsular stability. Nucleus sculpting and rotation should be minimised to reduce zonular stress. Being cognisant of the possible intraoperative complications that may occur at each stage of the surgery and knowing how to reduce the risk of these complications occurring will enable surgeons to perform safe cataract surgery in these complex cases.
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Affiliation(s)
- Soon-Phaik Chee
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore
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25
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Kristianslund O, Sandvik GF, Drolsum L. Long-Term Suture Breakage After Scleral Fixation of a Modified Capsular Tension Ring with Polypropylene 10-0 Suture. Clin Ophthalmol 2021; 15:2473-2479. [PMID: 34163130 PMCID: PMC8214109 DOI: 10.2147/opth.s310648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 12/17/2022] Open
Abstract
Aim To investigate the long-term risk of suture breakage after implantation of a modified capsular tension ring (MCTR) fixated to the sclera with polypropylene 10–0 suture. Methods Retrospective case series of operations for subluxated phakic lenses in 2007–2015 with implantation of an MCTR secured with a 10–0 polypropylene suture as part of an intraocular lens (IOL)-capsular bag complex. Results We identified 132 eyes (92 patients) operated on with an MCTR. Of these eyes, 26 (20%) had suture breakage requiring re-operation, while another eight eyes (6%) had suture breakage that did not require surgery. The re-operations occurred after a mean 4.8±3.3 years. Suture breakage occurred in patients with a mean age of 34.0±23.3, as compared to 43.2±26.0 years for patients who did not experience this complication (p=0.36). In patients aged 40 years or younger at the time of surgery, 47% experienced suture breakage in one or both eyes, as compared to 19% in the age group 41–69 years and 13% in the age group 70 years and older (p=0.004). Of the 132 eyes that were operated on, we registered one case (0.8%) of possible suture-related late endophthalmitis. Conclusion The long-term risk of suture breakage was quite high after scleral fixation of the MCTR in this patient cohort, and it seems as the risk is increased with young age.
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Affiliation(s)
- Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunhild F Sandvik
- Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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26
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Muthukumar B, Chhablani PP, Salman A, Bhandari V, Kapoor R. Comparison of retropupillary fixated iris claw lens versus sclera fixated lens for correction of pediatric aphakia secondary to ectopia lentis. Oman J Ophthalmol 2021; 14:20-26. [PMID: 34084030 PMCID: PMC8095304 DOI: 10.4103/ojo.ojo_91_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/24/2020] [Accepted: 09/06/2020] [Indexed: 11/18/2022] Open
Abstract
AIM: To evaluate the postoperative visual acuity and complications in eyes with ectopia lentis in children who underwent lens removal and then implantation of retropupillary fixated iris claw lens versus scleral fixated intraocular lens (SFIOL) implantation. MATERIALS AND METHODS: A retrospective analysis of pediatric cases who presented with lens subluxation secondary to ectopia lentis and who underwent lens extraction (57 eyes of 38 patients) with either retropupillary iris fixated intraocular lens (IOL) implantation (Group A – 36 eyes of 20 patients) and SFIOL implantation (Group B – 21 eyes of 18 patients) was done over a period of 5 years from March 2010 to February 2015. The main outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA) and secondary postoperative complications. RESULTS: The study patients were divided into two groups: Group A patients were implanted with retropupillary iris claw lens whereas Group B patients were implanted with SFIOL. The mean age of presentation was 12 years, the mean follow-up period was of 24 months (range 14–36 months), and the median follow-up period was 26 months in both the groups. An improvement in the mean BCVA (LogMAR) was seen in both the groups. In Group A, the mean BCVA improved from 1.5 ± 0.2 preoperatively to 0.3 ± 0.2 postoperatively, whereas in Group B, the mean BCVA improved from 1.5 ± 0.3 preoperatively to 0.3 ± 0.2 postoperatively (P < 0.001). None of the eyes in either of the groups had any serious complications such as glaucoma, uveitis, cystoid macular edema, or endophthalmitis. CONCLUSION: Retropupillary iris fixation and scleral fixation of IOL are both safe and viable options for the correction of ectopia lentis in pediatric age group.
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Affiliation(s)
| | - Preeti Patil Chhablani
- Jasti V Ramanamma, Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | - Amjad Salman
- Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirappalli, Tamil Nadu, India
| | | | - Rajat Kapoor
- Jasti V Ramanamma, Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
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27
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Lin Z, Zhu M, Deng H. A Pedigree Report of a Rare Case of Weill-Marchesani Syndrome with New Compound Heterozygous LTBP2 Mutations. Risk Manag Healthc Policy 2021; 14:1785-1789. [PMID: 33958902 PMCID: PMC8096439 DOI: 10.2147/rmhp.s307290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Weill–Marchesani syndrome (WMS) is an autosomal inherited connective tissue disease. Clinical manifestations include microspherophakia (MSP), high myopia, ectopia lentis, open-angle glaucoma, short stature, short fingers, joint stiffness, and (occasionally) cardiovascular defects. At present, a total of four pathogenic gene loci related to WMS have been found: ADAMTS10, ADAMTS17, FBN1, and LTBP2. Case Report The patient was a five-year-old girl whose eyesight had become progressively worse for three years before her parents brought her to the hospital. Computer optometry showed high myopia in both eyes, while a slit lamp examination found that the anterior chamber of both eyes was shallow, and the lens was in a state of dislocation (ectopia lentis). An IOLMaster examination revealed that the lens was spherical (MSP), and the lens thickness (LT) was 5.36 mm. Corneal topography showed that the angle kappa was 0.18 mm in the right eye (OD) and 0.30 mm in the left eye (OS). An intraocular pressure (IOP) (OD: 26.5 mmHg, OS: 30.6 mmHg) examination showed that the fundus cup to disc ratio was normal, but secondary glaucoma caused by lens dislocation could be considered. The IOP was maintained within a normal range using antihypertensive drugs. The patient’s younger sister also had a dislocation of MSP. Gene detection showed a heterozygous mutation in the LTBP2 gene [c.3672delC:p.Thr1225fs and c.3542delT:p.Met1181fs], and a diagnosis of WMS-like syndrome was confirmed. Conclusion WMS syndrome is rare, and the mutation of the LTBP2 gene has not been previously recorded in the GnomAD (Genome Aggregation Database) of East Asia. This case report provides some reference for studying the mechanism of WMS and WMS-like syndrome caused by an LTBP2 gene mutation.
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Affiliation(s)
- ZhiHong Lin
- Department of Strabismus & Pediatric Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, The School of Optometry of Shenzhen University, Shenzhen, 518000, Guangdong Province, People's Republic of China
| | - MinJuan Zhu
- Department of Strabismus & Pediatric Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, The School of Optometry of Shenzhen University, Shenzhen, 518000, Guangdong Province, People's Republic of China
| | - HongWei Deng
- Department of Strabismus & Pediatric Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, The School of Optometry of Shenzhen University, Shenzhen, 518000, Guangdong Province, People's Republic of China
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28
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Glickman A, Szczucki B, Kalivoda EJ, Furiato A, Cabrera G. Bedside Ocular Ultrasound Diagnosis of a Traumatic Lens Dislocation. Cureus 2021; 13:e14666. [PMID: 33927958 PMCID: PMC8075821 DOI: 10.7759/cureus.14666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rapid identification of ophthalmologic emergencies can be challenging in the ED, and a missed or delayed diagnosis may have vision-threatening consequences. The application of ocular point-of-care ultrasound (POCUS) by the emergency physician (EP) can facilitate the timely recognition of a myriad of emergent eye conditions. This report describes a case in which EP-performed POCUS established the prompt diagnosis of a traumatic lens dislocation in a patient with chronic vision changes.
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Affiliation(s)
- Andrew Glickman
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Brian Szczucki
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Eric J Kalivoda
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Anthony Furiato
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
| | - Gabriel Cabrera
- Emergency Medicine, HCA Healthcare/University of South Florida Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Brandon, USA
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29
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Ramakrishnan E, Muthu S, Balasubramaniam P, Chellamuthu G, Priyadharshini K. Holistic Approach in the Management of Skeletal Deformity in a Case of Homocystinuria. J Orthop Case Rep 2021; 11:1-5. [PMID: 34327154 PMCID: PMC8310640 DOI: 10.13107/jocr.2021.v11.i04.2126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Homocystinuria has a wide range of clinical presentations ranging from near normal intelligence and appearance with just lens dislocation and minimal skeletal deformities to severe mental retardation with gross skeletal deformities. In this background, we describe one such case with skeletal deformity managed comprehensively. CASE REPORT A 17-year-old boy presented with complaints of deformity of the left lower limb since childhood more evident for the past 5 years along with a history of blurring of vision. On examination the pubis-heal length > crown-pubis length along with genu valgum of left lower-limb with 16 cm intermalleolar distance. He also had a superolateral subluxation of the lens in both eyes. Valgus angle was 16° on the left leg compared to 6° on the right. The diagnosis of homocystinuria was confirmed by biochemical investigations. The left side genu valgum was addressed with medial closing wedge osteotomy and fixed with distal femur locking compression plating. Lens subluxation was treated with posterior chamber intra-ocular lens surgery. He was also given medical treatment and on regular monitoring of his homocysteine levels. The patient had good functional outcome at 2-year follow-up. CONCLUSION Homocystinuria is a rare disease that needs early identification and effective management to avoid complications. Skeletal complications are common and include genu valgum, pes cavus, chest wall deformities, and skeletal deformities such as kyphosis and scoliosis. Skeletal deformities can be avoided when identified early and associated osteoporosis which is managed effectively. A holistic approach is needed in the management of such patients with inter-departmental coordination to bring quality to the life of patients with homocystinuria.
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Affiliation(s)
- Eswar Ramakrishnan
- Department of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Address of Correspondence: Dr. Sathish Muthu, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India. E-mail:
| | - Pasupathy Balasubramaniam
- Department of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | | | - Kavya Priyadharshini
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Government Hospital, Musiri, Trichy, Tamil Nadu, India
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30
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Zhou Y, Guo D, Cao Q, Zhang X, Jin G, Zheng D. Genotype variant screening and phenotypic analysis of FBN1 in Chinese patients with isolated ectopia lentis. Mol Med Rep 2021; 23:275. [PMID: 33576469 PMCID: PMC7893787 DOI: 10.3892/mmr.2021.11914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/05/2021] [Indexed: 01/28/2023] Open
Abstract
Isolated ectopia lentis (IEL) can lead to blindness as result of severe complications, such as retinal detachment and secondary glaucoma. Pathogenic variants in the fibrillin 1 (FBN1) gene are a common cause of IEL. The aim of the present study was to investigate the frequency of pathogenic FBN1 variants in twelve probands with IEL and to evaluate their associated phenotypes. Systemic clinical examination of the twelve probands indicated that all had bilateral EL with a median age at diagnosis of three years. High myopia was the most common feature among the probands (83.3%; 10/12 cases). No extraocular symptoms (either cardiovascular or skeletal) were observed among these patients. Genomic DNA was extracted from peripheral blood leukocytes from all patients for targeted exome sequencing. Seven heterozygous missense variants in FBN1 were identified by bioinformatics analysis and further verified using Sanger sequencing. The seven variants were all classified as pathogenic after segregation analysis on available family members according to the American College of Medical Genetics and Genomics standards and guidelines. Of the seven variants, three were novel, namely c.2179T>C, c.2496T>G and c.3346G>C. The remaining four, namely c.184C>T, c.367T>C, c.1879C>T and c.4096G>A have been reported in previous studies. The seven pathogenic variants were identified in 8/12 (66.7%) probands with IEL. These results expand the variant spectrum of the FBN1 gene as well as the understanding of the molecular pathogenesis of IEL.
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Affiliation(s)
- Yijing Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat‑sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Dongwei Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat‑sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Qianzhong Cao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat‑sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Xinyu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat‑sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat‑sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat‑sen University, Guangzhou, Guangdong 510060, P.R. China
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31
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Arcot Sadagopan K, Hui G, Radke N, Lin TPH, Lam D. Binocular Triplopia Due to Decompensated Congenital Superior Oblique Paresis in A Patient with Marfan Syndrome; A Case Report and Review of Literature. J Binocul Vis Ocul Motil 2021; 71:24-28. [PMID: 33566747 DOI: 10.1080/2576117x.2021.1874762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Binocular triplopia is a rare symptom and usually has a corneal or lenticular origin. Uniocular diplopia arising from ectopia lentis is quite common in Marfan syndrome. A visual phenomenon related to binocular triplopia due to strabismus was first reported in 1943 by Burian. Both monocular diplopia and binocular triplopia have been reported in concomitant strabismus. Strabismus is also common in Marfan syndrome but congenital superior oblique paresis has never been reported before. We report herein a rare case of binocular triplopia in a patient with Marfan syndrome arising from decompensation of his coexistent congenital superior oblique paresis triggered by his uniocular diplopia. This is the first report of congenital superior oblique paresis in a patient with Marfan syndrome. Though it is unlikely to have any etiological implications and is likely to be a mere coincidental simultaneous occurrence, it had a confounding effect on the clinical interpretation of the signs and symptoms posing an interesting diagnostic and management dilemma. Our case report emphasizes the necessity for careful evaluation of any patient with symptoms of triplopia. We further review and summarize all the causes of binocular triplopia published in English literature and propose an approach to its evaluation and management.
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Affiliation(s)
- Karthikeyan Arcot Sadagopan
- Pediatric Ophthalmology & Ocular Genetics, C-MER (Shenzhen) Dennis Lam Eye Hospital , Shenzhen, China.,Department of Pediatric Ophthalmology and Adult Strabismus, Aravind Eye Hospital , Madurai, India.,Lumbini Eye Institute, Shree Rana Ambika Shah Eye Hospital , Bhairahawa, Nepal
| | - Gong Hui
- Pediatric Ophthalmology & Ocular Genetics, C-MER (Shenzhen) Dennis Lam Eye Hospital , Shenzhen, China.,Shenzhen Eye Hospital , Shenzhen, China
| | - Nishant Radke
- Vitreo-Retina, C-MER (Shenzhen) Dennis Lam Eye Hospital , Shenzhen, China
| | - Timothy P H Lin
- Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong, China
| | - Dennis Lam
- Vitreo-Retina and Refractive Surgery Services C-MER (Shenzhen) Dennis Lam Eye Hospital , Shenzhen, China
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32
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Akram H, Aragon-Martin JA, Chandra A. Marfan syndrome and the eye clinic: from diagnosis to management. Ther Adv Rare Dis 2021; 2:26330040211055738. [PMID: 37181104 PMCID: PMC10032431 DOI: 10.1177/26330040211055738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/06/2021] [Indexed: 05/16/2023]
Abstract
Marfan syndrome (MFS) is an autosomal dominantly inherited disorder affecting the cardiovascular, ocular and musculoskeletal systems. Frequently, clinical suspicion and subsequent diagnosis begins in the ophthalmology clinic. Importantly, the ophthalmologist has a responsibility to cater not only to the eye, but also to be involved in a holistic approach for these patients. In this review, we discuss how MFS may present to an eye clinic, including clinical features, ocular morbidity, genetic diagnosis and management. Although this condition is ideally managed by a multidisciplinary team, our focus will be on MFS and the eye, including other conditions which may present with similar phenotypes. The ophthalmologist's role as the potential first contact for a patient with suspected MFS is crucial in making the proper investigations and referral, with the knowledge that not all ectopia lentis cases are MFS and vice versa. Management of ocular conditions in MFS may range from simple observation to surgical intervention; current options will be discussed.
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Affiliation(s)
- Haseeb Akram
- Southend University Hospital, Prittlewell
Chase, Westcliff-on-Sea SS0 0RY, Essex, UK
| | | | - Aman Chandra
- Southend University Hospital, Westcliff-on-Sea,
UK
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33
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Lei C, Guo T, Ding S, Liao L, Peng H, Tan Z, Luo H. Whole-exome sequencing identified a novel homozygous ASPH frameshift variant causing Traboulsi syndrome in a Chinese family. Mol Genet Genomic Med 2020; 9:e1553. [PMID: 33217155 PMCID: PMC7963421 DOI: 10.1002/mgg3.1553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/07/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022] Open
Abstract
Background Traboulsi syndrome is a rare disorder characterized by ectopia lentis and facial dysmorphism (large beaked nose), which was only reported in 18 individuals to date. It is caused by homozygous/compound heterozygous variants in the aspartate/asparagine‐β‐hydroxylase (ASPH) gene, which hydroxylates the aspartic acid and asparagine in epidermal growth factor‐like domains of various proteins. Methods Whole‐exome and Sanger sequencing were used to identify the disease‐causing gene of the patient in a consanguineous Chinese family. Domain analysis was applied to predict the impact of the variant on ASPH protein. Results Through exome and Sanger sequencing, we identified a novel homozygous ASPH variant (NM_004318.4:c.1910del/NP_004309.2: p.(Asn637MetfsTer15)) in the patient, which may lead to blockage of the ASPH function through truncating the AspH oxygenase domain of the ASPH protein and/or nonsense‐mediated decay of the ASPH transcript. This is the first report of Traboulsi syndrome in a Chinese patient who was combined with ventricular septal defect, lung bullae, and recurrent spontaneous pneumothorax. Conclusion Our results revealed the clinical characteristics of the first Chinese patient with Traboulsi syndrome. Additionally, our study expands the mutational spectrum of Traboulsi syndrome and provides information for clinical genetic counseling to this family.
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Affiliation(s)
- Cheng Lei
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Ting Guo
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Shuizi Ding
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Liyan Liao
- Department of Pathology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Hong Peng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
| | - Zhiping Tan
- Clinical Center for Gene Diagnosis and Therapy, Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China.,Research Unit of Respiratory Disease, Central South University, Changsha, China.,Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, China
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Kumar K, Kohli P, Babu N, Khare G, Ramasamy K. Incidence and management of rhegmatogenous retinal detachment after pars plana vitrectomy and sutureless scleral-fixated intraocular lens. Indian J Ophthalmol 2020; 68:1432-1435. [PMID: 32587183 PMCID: PMC7574060 DOI: 10.4103/ijo.ijo_1974_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the incidence, risk factor(s), and surgical outcomes of rhegmatogenous retinal detachment (RRD) in patients undergoing pars plana vitrectomy (PPV) with sutureless scleral-fixated intraocular lens implantation (SFIOL). Methods Records of patients (1311 eyes, 1234 patients) who underwent PPV and sutureless SFIOL from 2017 to 2018 were retrospectively analyzed. Results The indications SFIOL were subluxated lens (33.7%), dislocated IOL (21.7%), surgical aphakia (20.1%), congenital lens subluxation (11.1%), nucleus drop (6.9%), and post-open globe injury (OGI) repair (6.5%). History of closed-globe injury (CGI) was present in 27.2% eyes.Twenty-two eyes (1.7%) developed RRD. The incidence of RRD in eyes, which underwent SFIOL surgery for subluxated lens, dislocated IOL, surgical aphakia, congenital lens subluxation, nucleus drop, and post-OGI repair was 1.4% (n = 6), 2.5% (n = 7), 1.1% (n = 3), 3.4% (n = 5), 0 and 1.2% (n = 1), respectively (P = 0.382). The incidence of RRD in eyes with and without CGI was 1.7% each (P = 0.996).Twenty-one eyes underwent RD surgery. Retinal reattachment was achieved in 76.2% eyes, while 66.7% eyes required only one surgery. The eyes in which retina failed to reattach had a high grade of proliferative vitreoretinopathy present at the time of presentation. Final best-corrected visual acuity of ≥20/60 and <20/60 to ≥20/200 and <20/200 was seen in 38.1%, 19.0%, and 42.9% eyes. Conclusion Eyes with the congenital subluxated lens are at a marginally higher risk of developing post-SFIOL RRD. The surgical outcome of RD surgery in these eyes is good.
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Affiliation(s)
- Karthik Kumar
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Piyush Kohli
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Naresh Babu
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Gauri Khare
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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35
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Braverman AC, Blinder KJ, Khanna S, Willing M. Ectopia lentis in Loeys-Dietz syndrome type 4. Am J Med Genet A 2020; 182:1957-1959. [PMID: 32462795 DOI: 10.1002/ajmg.a.61633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/30/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 12/16/2022]
Abstract
Loeys-Dietz syndrome is a heritable disorder of the connective tissue leading to multisystem involvement including craniofacial features, skeletal abnormalities, cutaneous findings and early-onset and aggressive disease of the aorta and its branches. There are multiple types of Loeys-Dietz syndrome related to pathogenic variants in TGFBR1, TGFBR2, SMAD3, TGFB2, and TGFB3. Individuals with Loeys-Dietz syndrome may be misdiagnosed as having Marfan syndrome due to shared phenotypic features and aortic root dilation. However, ectopia lentis has been an important discriminating feature, being unique to Marfan syndrome and not reported to be associated with Loeys-Dietz syndrome. We report the case of a 46-year-old woman with Loeys-Dietz syndrome type 4 due to a pathogenic variant in TGFB2 who was diagnosed with ectopia lentis at age 44. The patient underwent whole exome sequencing and no other pathogenic variants were found to explain the ectopia lentis. Our findings indicate that ectopia lentis may be an uncommon finding in Loeys-Dietz syndrome type 4 and emphasize the importance of genetic testing in familial thoracic aortic aneurysm disease.
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Affiliation(s)
- Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Sangeeta Khanna
- Department of Ophthalmology, St. Louis University School of Medicine, St. Louis, Missouri, USA
| | - Marcia Willing
- Division of Medical Genetics, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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36
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Tsai WS, Lee YC, Chang FL, He MS. Double decentred lenses in an eye: a therapeutic dilemma in Marfan syndrome. Clin Exp Optom 2020; 103:911-912. [PMID: 32307733 DOI: 10.1111/cxo.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/12/2020] [Accepted: 03/22/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Wei-Shan Tsai
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Yuan-Chieh Lee
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
| | - Fang-Ling Chang
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Ming-Shan He
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
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37
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Zech JC, Putoux A, Decullier E, Fargeton AE, Edery P, Plauchu H, Dupuis-Girod S. Classifying Ectopia Lentis in Marfan Syndrome into Five Grades of Increasing Severity. J Clin Med 2020; 9:jcm9030721. [PMID: 32155956 PMCID: PMC7141252 DOI: 10.3390/jcm9030721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/12/2020] [Accepted: 02/27/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: To describe a five-grade classification of ectopia lentis in Marfan syndrome (MFS) and to evaluate the positive predictive value of the early grades of ectopia lentis. Methods: We prospectively included MFS patients and their healthy relatives. The anterior segment examination was classified into grades 0 to 5, and we studied the sensitivity, specificity, and positive predictive value of ectopia lentis in this classification. Results: Seventy-four MFS patients and thirty-six healthy controls were examined. In the MFS group, grades 1, 2, 3, and 4 were present in 15, 24, 17, and 7 patients, respectively, whereas 11 patients in this group did not present ectopia lentis. In the control group, grades 0 and 1 were observed in 30 and 6 individuals, respectively. Sensitivity to ectopia lentis of at least grade 2 was 64.9%, with 100% specificity, whereas sensitivity to ectopia lentis of at least grade 1 was 85.1%, with 83.3% specificity. The positive predictive value of ectopia lentis that was greater than or equal to grade 2 was 100%, whereas that of ectopia lentis greater than or equal to grade 1 was 91.3%. Conclusions: High positive predictive values s were found to be associated with grades 2 and higher of the five-grade classification of ectopia lentis. This classification should help to harmonize clinical practices for this major feature of MFS.
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Affiliation(s)
| | - Audrey Putoux
- Service de Génétique, Unité de Génétique Clinique, Centre Labellisé Anomalies du Développement, Hospices Civils de Lyon, 69500 Bron, France; (A.P.); (P.E.)
- Centre de Recherche en Neurosciences de Lyon, Equipe GENDEV, INSERM U1028, UMR CNRS 5292, Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Evelyne Decullier
- Unité de Recherche Clinique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France;
| | - Anne-Emmanuelle Fargeton
- Service de Génétique, Unité de Génétique Clinique, Centre de Compétence Syndrome de Marfan et Apparentés, Hospices Civils de Lyon, 69500 Bron, France; (H.P.); (S.D.-G.)
- Correspondence:
| | - Patrick Edery
- Service de Génétique, Unité de Génétique Clinique, Centre Labellisé Anomalies du Développement, Hospices Civils de Lyon, 69500 Bron, France; (A.P.); (P.E.)
- Centre de Recherche en Neurosciences de Lyon, Equipe GENDEV, INSERM U1028, UMR CNRS 5292, Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Henri Plauchu
- Service de Génétique, Unité de Génétique Clinique, Centre de Compétence Syndrome de Marfan et Apparentés, Hospices Civils de Lyon, 69500 Bron, France; (H.P.); (S.D.-G.)
| | - Sophie Dupuis-Girod
- Service de Génétique, Unité de Génétique Clinique, Centre de Compétence Syndrome de Marfan et Apparentés, Hospices Civils de Lyon, 69500 Bron, France; (H.P.); (S.D.-G.)
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Rastogi A, Kumar P, Dhiman S, Mishra M, Anand K, Bhardwaj A. Evaluation of functional outcome and stability of sutureless scleral tunnel fixated IOLs in children with ectopia lentis. Int J Ophthalmol 2020; 13:66-70. [PMID: 31956572 DOI: 10.18240/ijo.2020.01.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/14/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate functional outcome of sutureless scleral tunnel intraocular lens (SSTIOL) in children with crystalline lens subluxation of more than 7 clock hours. METHODS A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18y having >7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation. Primary outcome was improvement in best corrected visual acuity (BCVA) and secondary outcomes were assessment of intraocular lens (IOL) tilt using ultrasound biomicroscopy (UBM), mean change in astigmatism at last follow-up of 1y and associated complications. RESULTS The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45 (logMAR) respectively (P=0.001) at last follow-up. The mean astigmatism preoperatively and postoperatively was -4.17±2.69 D and -1.86±1.25 D respectively (P=0.011). Significant IOL tilt (>5 degrees) was present in 5 cases. The mean percentage endothelial loss was 3.65%±1.92%. The most serious complication encountered was retinal detachment seen in 2 cases. CONCLUSION SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection. We recommend caution in children having white-to-white distance >12 mm and presence of peripheral retinal degenerations.
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Affiliation(s)
- Anju Rastogi
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Prateek Kumar
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Shweta Dhiman
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Manisha Mishra
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Kamlesh Anand
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
| | - Ankita Bhardwaj
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi 110002, India
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39
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Kasyanov AA. [Cataract surgery in megalocornea (case report)]. Vestn Oftalmol 2020; 136:219-225. [PMID: 33063968 DOI: 10.17116/oftalma2020136052219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The article presents a clinical case of bilateral cataract surgery on megalocornea eyes of a 20-year-old male. The Haigis formula has demonstrated the greatest potential accuracy for IOL calculation in such eyes, while the use of other formulas was associated with a higher risk of significant hyperopic refractive error. An unusually high level of pseudoaccommodation was obtained in both eyes.
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Affiliation(s)
- A A Kasyanov
- Research Institute of Eye Diseases, Moscow, Russia
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40
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Rezar-Dreindl S, Stifter E, Neumayer T, Papp A, Gschliesser A, Schmidt-Erfurth U. Visual outcome and surgical results in children with Marfan syndrome. Clin Exp Ophthalmol 2019; 47:1138-1145. [PMID: 31325202 PMCID: PMC6973035 DOI: 10.1111/ceo.13596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 07/05/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
IMPORTANCE To determine visual and surgical results in children with Marfan syndrome. BACKGROUND Marfan syndrome involves ocular complications which can lead to visual disturbance and amblyopia. Data about the visual and surgical results in children with Marfan syndrome is vital for the clinical management of these patients. DESIGN Retrospective data analysis. PARTICIPANTS Eighty-two eyes of 41 patients with a genetically proved diagnosis of Marfan syndrome. METHODS Medical records of patients with Marfan syndrome were reviewed between 2007 and 2017. Ocular complications, visual acuity (VA) of patients with/without lensectomy and surgical method were evaluated. MAIN OUTCOME MEASURES VA outcomes of patients with Marfan syndrome with/without surgical repair of ectopia lentis. RESULTS In 27 (66%) of the 41 patients a bilateral subluxation of the lens was visible and 14 (52%) patients received lensectomy. The mean age at initial presentation was 12.3 ± 9 years and mean follow-up was 3 years (range 1-7). VA varied from 1.2 to -0.1 logMAR at first examination. At initial presentation, mean VA was 0.1 ± 0.7 logMAR in patients with a normal lens status (n = 14) and 0.3 ± 0.5 logMAR in patients with subluxation of the lens (n = 27) (P < .01). VA improved from 0.2 ± 0.5 logMAR to 0.1 ± 0.5 logMAR (P = .06) in children with subluxation of the lens who did not need a lensectomy (n = 12) and from 0.5 ± 0.5 logMAR to 0.2 ± 0.5 logMAR (P = .02) in patients who were referred to lensectomy with/without secondary lens implantation. CONCLUSIONS AND RELEVANCE In Marfan syndrome subluxation of the lens was found in the majority of children. Improvement of VA resulted in children with subluxation of the lens and following lensectomy.
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Affiliation(s)
- Sandra Rezar-Dreindl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Eva Stifter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Thomas Neumayer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andrea Papp
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andreas Gschliesser
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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41
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Siggs OM, Souzeau E, Craig JE. Loss of ciliary zonule protein hydroxylation and lens stability as a predicted consequence of biallelic ASPH variation. Ophthalmic Genet 2019; 40:12-16. [PMID: 30600741 DOI: 10.1080/13816810.2018.1561904] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Stability of the crystalline lens requires formation of microfibril bundles and their higher-order structures of ciliary zonules. Trauma, malformation, or degeneration of the ciliary zonules can lead to dislocation or displacement of the lens, which in turn can cause transient or permanent loss of visual acuity. The purpose of this study was to identify the predicted substrates of aspartyl/asparaginyl hydroxylase (ASPH), a 2-oxoglutarate- and Fe2+-dependent hydroxylase, which may account for the lens instability phenotype of ASPH-associated syndromes. METHODS A single proband of European ancestry with spherophakia and high myopia was subjected to exome sequencing. Proteins containing the ASPH hydroxylation motif were identified within the SwissProt protein database. RESULTS We identified 105 putative substrates of ASPH-mediated hydroxylation in the human proteome, of which two (fibrillin-1 and latent transforming growth factor beta binding protein-2) are associated with inherited ectopia lentis syndromes, and are essential for microfibril and ciliary zonule development. CONCLUSION Our results implicate ASPH-mediated hydroxylation in the formation of FBN1/LTBP2 microfibril bundles and competent ciliary zonules.
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Affiliation(s)
- Owen M Siggs
- a Department of Ophthalmology , Flinders University, Flinders Medical Centre , Adelaide , Australia
| | - Emmanuelle Souzeau
- a Department of Ophthalmology , Flinders University, Flinders Medical Centre , Adelaide , Australia
| | - Jamie E Craig
- a Department of Ophthalmology , Flinders University, Flinders Medical Centre , Adelaide , Australia
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42
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Sandvik GF, Vanem TT, Rand-Hendriksen S, Cholidis S, Saethre M, Drolsum L. Ten-year reinvestigation of ocular manifestations in Marfan syndrome. Clin Exp Ophthalmol 2018; 47:212-218. [PMID: 30260057 DOI: 10.1111/ceo.13408] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 05/22/2018] [Revised: 09/03/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Long-term follow-up of Marfan syndrome (MFS) patients. BACKGROUND Investigate changes in ocular features in MFS patients fulfilling the Ghent-2 criteria following a period of 10 years. DESIGN Repeated cross-sectional study with two observations. PARTICIPANTS Eighty-four MFS patients were investigated in 2003-2004 (baseline). Forty-four of these patients (52%) were examined after 10 years. METHODS A comprehensive ocular examination performed at baseline and follow-up. MAIN OUTCOME MEASURES Development or progression of ectopia lentis (EL). RESULTS At follow-up, mean age was 50.1 ± 11.9 years (range: 30-80 years), 74% were female and 70% of the patients were diagnosed with EL compared to 66% at baseline. Two patients (3 eyes) had developed EL over the decade, representing a 13% risk. Furthermore, one eye had progressed from a subtle tilt of the lens to dislocation. We found no significant change in the axial length (P = 0.96), the corneal curvature (P = 0.64) or the spherical equivalent (P = 0.23). Best corrected visual acuity was improved at follow-up (P = 0.02). There were 7% and 33% risks for development of retinal detachment and cataract between baseline and follow-up, respectively. CONCLUSIONS AND RELEVANCE Our study indicates that even though EL typically occurs at an early stage in most MFS patients, there is still a risk of developing EL in adulthood. The risk of developing vision-threatening complications such as retinal detachment and cataract was much higher than in the normal population, but even so, the visual potential of the MFS patients was relatively good.
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Affiliation(s)
- Gunhild F Sandvik
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thy T Vanem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svend Rand-Hendriksen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Symira Cholidis
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Marit Saethre
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abarca Barriga HH, Caballero N, Trubnykova M, Castro-Mujica MDC, La Serna-Infantes JE, Vásquez F, Hennekam RC. A novel ASPH variant extends the phenotype of Shawaf-Traboulsi syndrome. Am J Med Genet A 2018; 176:2494-2500. [PMID: 30194805 DOI: 10.1002/ajmg.a.40508] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 03/16/2018] [Revised: 05/14/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022]
Abstract
Shawaf-Traboulsi syndrome (or Traboulsi syndrome; MIM 601552) is an infrequently reported entity characterized by a typical face (long face, large nose, convex nasal ridge, underdeveloped malae, crowded teeth, retrognathia), skeletal signs (long and slender fingers, sometimes pectus deformation and hypermobile joints), and ectopia lentis with conjunctival blebs, shallow anterior chamber and iridocorneal adhesions. The entity is caused by homozygous variants in ASPH. Here, we report on a boy with the clinical diagnosis of Shawaf-Traboulsi syndrome, in whom exome sequencing allowed identification of a novel variant in ASPH. We compare the findings in the present patient to those of earlier reported patients; furthermore add new signs for this entity.
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Affiliation(s)
- Hugo H Abarca Barriga
- Department of Genetic & Inborn Errors of Metabolism, Instituto Nacional de Salud del Niño, Lima, Peru.,Human Medicine Faculty, Universidad Ricardo Palma, Lima, Peru
| | | | - Milana Trubnykova
- Department of Genetic & Inborn Errors of Metabolism, Instituto Nacional de Salud del Niño, Lima, Peru
| | | | | | - Flor Vásquez
- Department of Genetic & Inborn Errors of Metabolism, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Raoul C Hennekam
- Department of Pediatrics and Translational Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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44
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Mohammad AN, Atwal PS. A 2-Year-Old Child with Bilateral Ectopis Lentis and a Novel FBN1 Gene Variant Cys129Ser. J Pediatr Genet 2018; 7:83-85. [PMID: 29707410 DOI: 10.1055/s-0037-1612592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/25/2017] [Accepted: 11/13/2017] [Indexed: 01/16/2023]
Abstract
Marfan syndrome and dominant ectopia lentis are part of type 1 fibrillinopathies that are caused by FBN1 pathogenic variants. Making a diagnosis could be challenging due to the clinical overlap between these disorders. The revised Ghent criteria used for Marfan syndrome diagnosis helped in resolving some of the confusion, especially in younger children. We report on a case of bilateral ectopia lentis in a 2-year-old child with a normal echocardiogram. FBN1 sequencing revealed a novel likely pathogenic variant described as c.385T > A (p.Cys129Ser). The patient's father also has a history of bilateral ectopia lentis and his genetic analysis detected the same FBN1 variant as the proband.
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Affiliation(s)
- Ahmed N Mohammad
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, Florida, United States.,Center for Individualized Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Paldeep S Atwal
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, Florida, United States.,Center for Individualized Medicine, Mayo Clinic, Jacksonville, Florida, United States
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45
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Al Somali AI, Al-Dossari FN, Emara KE, Al Habash A. Outcomes of Scleral-fixated Intraocular-lens in Children with Idiopathic Ectopia Lentis. Middle East Afr J Ophthalmol 2018; 24:167-170. [PMID: 29422749 PMCID: PMC5793446 DOI: 10.4103/meajo.meajo_105_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The purpose of the study was to review the safety and stability of scleral-fixated intraocular lens (IOL) 2 years after implantation in children with idiopathic ectopia lentis (EL). METHODS: This retrospective case series enrolled children with EL managed between 2011 and 2015 at a tertiary eye hospital in the eastern of Saudi Arabia. Data were collected on age, gender, vision, isolated or syndromic pathology, intraoperative and postoperative complications, spherical equivalent refraction, and final best-corrected visual acuity (BCVA). RESULTS: The series included 18 eyes of 11 children with EL (6 males and 5 females). There were 7 bilateral and 4 unilateral cases. The median age was 3.5 years (25% quartile 1 year; range: 1–8 years). Preoperatively, fixation was absent in 3 eyes, 8 eyes were fixating but vision could not be recorded. In the remaining seven eyes, median distant visual acuity was 0.1 (25% quartile: 0.08). The median postoperative follow-up was 24 months (25% quartile, 7 months). Complications included two eyes with iris capture and one eye with lens subluxation requiring re-implantation. Postoperative BCVA was better than 20/60 in 15 (83%) eyes. At last follow-up, 6 eyes required myopic correction, 1 eye was emmetropic, and 11 eyes were hypermetropic. One eye with glaucoma was managed medically. CONCLUSION: Scleral fixated IOL in eyes of young children with EL had good visual outcomes and high stability. However, there is a high incidence of residual refractive error.
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Affiliation(s)
- Abdulaziz I Al Somali
- Department of Ophthalmology, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia
| | - Faisal N Al-Dossari
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Khalid E Emara
- Division of Pediatric Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia
| | - Ahmed Al Habash
- Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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46
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Nam HK, Nam MH, Ha KS, Rhie YJ, Lee KH. A Novel Fibrillin-1 Gene Mutation Leading to Marfan Syndrome in a Korean Girl. Ann Clin Lab Sci 2017; 47:221-225. [PMID: 28442527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Marfan syndrome is an autosomal dominant genetic disorder caused by a connective tissue defect. A nine-year-old girl was referred to our pediatric endocrinology clinic for tall stature. Physical examination revealed a lens dislocation with strabismus, high palate, positive wrist and thumb signs, joint hypermobility, and pes planus. Transthoracic echocardiography revealed dilatation of the aortic root. She was diagnosed with Marfan syndrome based on the revised Ghent diagnostic criteria. Molecular investigation identified a heterozygous c.2810G >A variation in the FBN1 gene in the patient, but not in her parents. To our knowledge, this sequence variant has been reported as a polymorphism (rs113602180), but it is the first report identifying it as the genetic cause of Marfan syndrome. We hypothesize that this de novo novel missense FBN1 mutation disrupts fibrillin-1 function and is probably involved in the development of Marfan syndrome in this patient.
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Affiliation(s)
- Hyo-Kyoung Nam
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Myung-Hyun Nam
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kee-Soo Ha
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young-Jun Rhie
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea
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Català-Mora J, Cuadras D, Díaz-Cascajosa J, Castany-Aregall M, Prat-Bartomeu J, García-Arumí J. Anterior iris-claw intraocular lens implantation for the management of nontraumatic ectopia lentis: long-term outcomes in a paediatric cohort. Acta Ophthalmol 2017; 95:170-174. [PMID: 27535343 DOI: 10.1111/aos.13192] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 04/10/2016] [Accepted: 06/13/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To report the feasibility and long-term safety of lensectomy and iris-claw intraocular lens (IOL) implantation to treat children with severe ectopia lentis in a paediatric tertiary hospital. METHODS Prospective cohort study of 21 eyes from 12 patients with severe ectopia lentis and visual acuity <20/63. All eyes underwent 23-gauge pars plana vitrectomy, lensectomy, iridectomy and Artisan IOL implantation in the anterior chamber with iris-claw enclavation via pars plana. Mean age at surgery was 8.0 ± 5.3 yo (range 3-17 years). A full ophthalmologic examination including best-corrected visual acuity (BCVA), biomicroscopy, intraocular pressure (IOP) measurement, fundus evaluation and central endothelial cell count (cECC) was performed pretreatment, at 3 months' postsurgery, and every 6 months thereafter. Ultrasound biomicroscopy (UBM) was performed 12 months after surgery. RESULTS Mean follow-up was 39.3 ± 13.0 months. Best-corrected visual acuity (BCVA) (mean ± SD) improved from 0.91 ± 0.29 logMar preoperatively to 0.18 ± 0.23 logMar at final follow-up (p < 0.0001). Mean distance from the endothelium to the anterior IOL surface after surgery was 3.11 ± 0.61 mm. Postsurgically, cECC loss was 5.04% ± 9.58% with an annual cECC loss rate of 3.16% ± 4.46%. One patient developed IOL dislocation and retinal detachment after severe ocular contusion requiring vitrectomy, IOL refixation and gas tamponade. Another patient developed cystoid macular oedema, managed with intravitreal dexamethasone. CONCLUSION This technique is both feasible and effective to manage severe ectopia lentis in children. Lifetime ophthalmic follow-up including cECC measurement, IOL position monitoring and fundus examination is mandatory in these patients.
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Affiliation(s)
- Jaume Català-Mora
- Hospital Sant Joan de Déu; Esplugues de Llobregat Barcelona Spain
- Ophthalmological Institute del Pilar; Barcelona Spain
- Surgery Department; Universitat Autònoma Barcelona; Barcelona Spain
| | - Daniel Cuadras
- Advisory Service and Statistical Methodology Research; Fundació Sant Joan de Déu; Esplugues de Llobregat Barcelona Spain
| | | | | | | | - José García-Arumí
- Surgery Department; Universitat Autònoma Barcelona; Barcelona Spain
- Hospital Vall d'Hebron; Barcelona Spain
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Sahu S, Yadav R, Gupta S, Raj Puri L. Bilateral ectopia lentis with isolated lens coloboma in Marfan syndrome. GMS Ophthalmol Cases 2016; 6:Doc14. [PMID: 28028488 PMCID: PMC5144584 DOI: 10.3205/oc000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A rare case of bilateral ectopia lentis with isolated lens coloboma in Marfan syndrome is reported. A 21-year-old female presented with decreased vision in both eyes. Her unaided visual acuity was 20/200 and 20/400 in the right and left eye, respectively, improving to 20/40 with -4.5 DS/-3.0 DC x 10° correction in the right eye and 20/80 with -10.0 DS/-6.5 Dc x10° correction in the left eye. On slit lamp examination under mydriasis, both eyes revealed ectopia lentis with lens coloboma and stretched zonules. Fundus examination revealed pigmentary changes at the fovea. On systemic evaluation, she was diagnosed with Marfan syndrome. She was prescribed a refractive correction in form of a contact lens and kept under observation.
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Affiliation(s)
- Sabin Sahu
- Sagarmatha Choudhary Eye Hospital, Lahan, Nepal,*To whom correspondence should be addressed: Sabin Sahu, Sagarmatha Choudhary Eye Hospital, Lahan - 3, Siraha, Nepal, E-mail:
| | - Reena Yadav
- Sagarmatha Choudhary Eye Hospital, Lahan, Nepal
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Abstract
Marfan syndrome is a genetic disease with variable clinical presentation. This case describes a 36-year-old lady who was diagnosed with Marfan syndrome based on revised Ghent criteria. She was found to have bicuspid aortic valve and sensorineural hearing loss. Inferior vena cava stenosis was suspected on echocardiography due to high velocity flow and visualization of a focal narrowing in the inferior vena cava proximal to hepatic vein entry. Inferior vena cava stenosis was confirmed by computed tomography. Echocardiographic features suggestive of inferior vena cava stenosis include detection of a focal narrowing and high turbulent flow, peak velocity > 1.5 m/s and S/D wave fusion on spectral Doppler.
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Affiliation(s)
- Sami Nimer Ghazal
- Cardiology Division, Internal Medicine Department, King Fahd Hospital of the University, University of Dammam, P.O. Box 2208, Al-Khobar 31952, Saudi Arabia
| | - Shady G Ouf
- Cardiology Division, Internal Medicine Department, King Fahd Hospital of the University, University of Dammam, P.O. Box 2208, Al-Khobar 31952, Saudi Arabia
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Neuhann TM, Stegerer A, Riess A, Blair E, Martin T, Wieser S, Kläs R, Bouman A, Kuechler A, Rittinger O. ADAMTSL4-associated isolated ectopia lentis: Further patients, novel mutations and a detailed phenotype description. Am J Med Genet A 2015; 167A:2376-81. [PMID: 25975359 DOI: 10.1002/ajmg.a.37157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 02/13/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
Abstract
ADAMTSL4 mutations seem to be the most common cause of isolated ectoplia lentis (EL) and thus are important concerning the differential diagnosis of connective tissue syndromes with EL as main feature. In this study, we describe an additional cohort of patients with apparently isolated EL. All underwent a detailed clinical exam with cardiac evaluation combined with ADAMTSL4 mutation analysis. Mutations were identified in 12/15 patients with EL. Besides the European founder mutation p. (Gln256Profs*38) we identified five further mutations not yet described in the literature: p. (Leu249Tyrfs*21), p. (Ala388Glyfs*8), p. (Arg746His), p. (Gly592Ser), and p. (Arg865His). Clinical evaluation showed common additional ocular features such as high myopia, but no major systemic findings. In particular: no dilatation of the aortic root was reported on. This report increases the total number of patients with ADAMTSL4 mutations reported on today and reviews in detail the clinical findings in all patients reported on to date demonstrate, that these patients have a mainly ocular phenotype. There are no consistent systemic findings. The differentiation between syndromic and isolated EL is crucial for the further surveillance, treatment, and counseling of these patients, especially in young children.
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Affiliation(s)
| | | | - Angelika Riess
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Edward Blair
- Department of Clinical Genetics, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Thomas Martin
- Gemeinschaftspraxis für Humangenetik, Homburg, Germany
| | - Stefanie Wieser
- Klinische Genetik, Universitätskinderklinik, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Rüdiger Kläs
- Synlab MVZ Humangenetik Mannheim, Mannheim, Germany
| | - Arjan Bouman
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Alma Kuechler
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Olaf Rittinger
- Klinische Genetik, Universitätskinderklinik, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
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