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Persistent hyperplastic primary vitreous: roto-extraction and other surgical experience.

We discuss nine cases of persistent hyperplastic primary vitreous seen recently, including mode of presentation, management and postsurgical follow-up. Emphasis is placed on early operative intervention in order to preserve the globe, as well as to prevent irremedial stimulus deprivation amblyopia. The advantages of roto-extraction in the surgical approach to this entity are considered, and the difficulties of postoperative visual rehabilitation are also discussed.

Contact Lenses↗

Optic disc parameters and onset of glaucomatous field loss. II. Static screening criteria.

Stereoscopic fundus photographs of 17 abnormal eyes, taken in known temporal relationship to the onset of glaucomatous visual field loss, and 206 eyes of age- and race-matched controls were examined in randomized masked fashion. Width of the narrowest remaining disc rim, size of the vertical and horizontal physical cups, contour of the temporal and nasal slopes (vertical ovalness), and a newly described parameter, thickness of the nerve fiber layer as it crosses the disc rim, were all useful for distinguishing patients with impending or established visual field loss. None, however, was as effective as defects in the nerve fiber layer, the only parameter displaying sufficient promise as a clinical screening tool to warrant initiation of large-scale prospective evaluation.

Glaucoma↗

Frontonasal malformation with tetralogy of Fallot associated with a submicroscopic deletion of 22q11.

We report on a 14-month-old girl with bifid nasal tip and tetralogy of Fallot. Several similar patients have been described with CNS or eye abnormalities. Chromosome analysis with FISH, using Oncor DiGeorge probes, confirmed a submicroscopic deletion of 22q11. Many patients with Shprintzen (velo-cardio-facial) syndrome have a similar deletion with conotruncal cardiac defects and an abnormal nasal shape, suggesting that a gene in this area, possibly affecting neural crest cells, influences facial and other midline development.

Chromosome Deletion↗

Syndromal obesity due to paternal duplication 6(q24.3-q27).

The likelihood of a paternally expressing imprinted gene in chromosome region 6(q23-24) has been highlighted by cases of transient neonatal diabetes mellitus (TNDM) in which paternal uniparental disomy (UPD) for chromosome 6 or paternal duplication 6(q23-qter) was detected. We present the case of a 38-year-old man with moderate to severe intellectual delay, short stature, small hands and feet, eye abnormality, small mouth, and obesity (without hyperphagia) beginning in mid-childhood. The perinatal and neonatal histories were normal. The patient had a duplication within 6q. Fluorescence in situ hybrisation studies were performed with single and dual hybridisations using a chromosome 6 library probe, short and long arm subregional probes, 6q23-24, 6q25.3-6qter locus-specific probes, and a 6q telomere probe. The hybridisation results defined an inverted duplication of 6q24.3 to 6q27. DNA studies with microsatellite markers from 6p and 6q showed regular biparental inheritance of chromosome 6 and confirmed that the duplication was paternal in origin. Our patient appears to be the first one known to have paternal duplication of chromosome area 6(q24-q27) who did not have TNDM as an infant. He has remained nondiabetic, although obesity, without hyperphagia, has been a constant problem since its onset in mid-childhood.

Adult↗

Pax-6 is required for thalamocortical pathway formation in fetal rats.

Pax-6, a transcription regulatory factor, has been demonstrated to play important roles in eye, nose, and brain development by analyzing mice, rats, and humans with a Pax-6 gene mutation. We examined the role of Pax-6 with special attention to the formation of efferent and afferent pathways of the cerebral cortex by using the rat Small eye (rSey2), which has a mutation in the Pax-6 gene. In rSey2/rSey2 fetuses, cortical efferent axons develop with normal trajectory, at least within the cortical anlage, when examined with immunohistochemistry of the neuronal cell adhesion molecule TAG-1 and 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) labeling from the cortical surface. A remarkable disorder was found in the trajectory of dorsal thalamic axons by immunostaining of the neurofilament and the neural cell adhesion molecule L1 and DiI labeling from the dorsal thalamus. In normal rat fetuses, dorsal thalamic axons curved laterally in the ventral thalamus without invading a Pax-6-immunoreactive cell cluster in the ventral part of the ventral thalamus. These axons then coursed up to the cortical anlage, passing just dorsal to another Pax-6-immunoreactive cell cluster in the amygdaloid region. In contrast, in rSey2/rSey2 fetuses, dorsal thalamic axons extended downward to converge in the ventrolateral corner of the ventral thalamus and fanned out in the amygdaloid region without reaching the cortical anlage. These results suggest that Pax-6-expressing cell clusters along the thalamocortical pathway (ventral part of the ventral thalamus and amygdala) are responsible for the determination of the axonal pathfinding of the thalamocortical pathway.

Afferent Pathways↗