Background: Congenital aniridia is a rare, panophthalmic disorder that can cause vision loss. Knowledge of aniridia as an isolated ocular abnormality or as a part of systemic abnormalities is important. Management of congenital aniridia should be carried out comprehensively based on it. Objective: To describe clinical features and management of congenital aniridia in a top referral eye hospital in Indonesia. Methods: A retrospective study involving 43 eyes of 22 children (younger than 18 years) diagnosed with congenital aniridia from 2013 to 2018. A detailed history was taken and a complete ophthalmic examination and a systemic examination were performed as required. Clinical characteristics associated with ocular and systemic manifestation and its management were noted. Results: Mean age of patients was 7.6 ± 5.2 years (range 0 - 17 years). Most cases were female (55%) and sporadic (77%). Twenty-one (96%) patients had bilateral involvement at presentation. Foveal hypoplasia was found in 36 eyes (84%), followed by cataract in 26 eyes (61%) and secondary glaucoma in 13 eyes (30%). Nine patients (43%) with cataract had cataract surgery performed. Only 1 patient (5%) with secondary glaucoma underwent filtration surgery. All patients had moderate to severe visual impairment and low vision aid was considered. Regarding its systemic manifestation, none of the patients was diagnosed with an abnormality in the abdomen. Conclusion: There were various ocular features associated with congenital aniridia. Understanding the clinical characteristic and its management could improve the quality of vision in aniridia patients.
References
[1]
Landsend, E.S., Utheim, A., Pedersen, H.R., et al. (2018) The Genetics of Congenital Aniridia—A Guide for the Ophthalmologist. Survey of Ophthalmology, 63, 105-113. https://doi.org/10.1016/j.survophthal.2017.09.004
[2]
Samant, M., Chauchan, B.K., Lathrop, K.L. and Nischal, K.K. (2016) Congenital Aniridia: Etiology, Manifestation and Management. Expert Review of Ophthalmology, 11, 135-144. https://doi.org/10.1586/17469899.2016.1152182
[3]
Park, S.H., Park, Y.G., Lee, M.Y. and Kim, M.S. (2010) Clinical Features of Korean Patients with Congenital Aniridia. Korean Journal of Ophthalmology, 24, 291-296. https://doi.org/10.3341/kjo.2010.24.5.291
[4]
Calvao-Pires, P., Santos-silva, R., Falca-Reis, F. and Rocha-Sousa, A. (2014) Congenital Aniridia: Clinic, Genetics, Therapeutics, and Prognosis. International Scholarly Research Notices, 2014, Article ID: 305350. https://doi.org/10.1155/2014/305350
[5]
Netland, P.A., Scott, M.L., Boyle, J.W. and Lauderdale, J.D. (2011) Ocular and Systemic Findings in a Survey of Aniridia Subjects. Journal of AAPOS, 15, 562-566. https://doi.org/10.1016/j.jaapos.2011.07.009
[6]
Hingorani, M., Hanson, I. and Van Heningen, V. (2012) Aniridia. European Journal of Human Genetics, 20, 1011-1017. https://doi.org/10.1038/ejhg.2012.100
[7]
Singh, B., Mohamed, A., Chaurasia, S., et al. (2014) Clinical Manifestation of Congenital Aniridia. Journal of Pediatric Ophthalmology & Strabismus, 51, 59-62. https://doi.org/10.3928/01913913-20131223-01
[8]
Sawada, M., Sato, M., Hikoya, A., et al. (2011) A Case of Aniridia with Unilateral Peters Anomaly. Journal of AAPOS, 15, 104-106. https://doi.org/10.1016/j.jaapos.2010.11.006
[9]
Bobilev, A.M., McDougal, M.E., Taylor, W.L., et al. (2016) Assesment of PAX6 Alleles in 66 Families with Aniridia. Clinical Genetics, 89, 669-677. https://doi.org/10.1111/cge.12708
[10]
Lim, H.T., Seo, E.J., Kim, G.H., et al. (2012) Comparison between Aniridia with and without PAX6 Mutations: Clinical and Molecular Analysis in 14 Korean Patients with Aniridia. Ophthalmology, 119, 1258-1264. https://doi.org/10.1016/j.ophtha.2011.12.010
[11]
Sannan, N.S., Gregory-Evans, C.Y., Lyons, C.J., et al. (2017) Correlation of Novel PAX6 Gene Abnormalities in Aniridia and Clinical Presentation. Canadian Journal of Ophthalmology, 52, 570-577. https://doi.org/10.1016/j.jcjo.2017.04.006
[12]
Palayil, I., Priya, S.G., Sivan, N.V., et al. (2018) Identification of Novel Frameshift Mutation in PAX6 Gene and the Clinical Management in an Asian Indian Aniridia Family. Indian Journal of Ophthalmology, 66, 229-232.
[13]
Lee, N.Y., Lee, Y.E., Mok, J., Kim, M. and Park, S.H. (2013) Three Cases with Unusual Ophthalmic Phenotypes of Congenital Aniridia. Canadian Journal of Ophthalmology, 48, 340-342. https://doi.org/10.1016/j.jcjo.2013.02.009
[14]
Blanco-Kelly, F., Palomares, M., Vallespin, E., et al. (2017) Improving Molecular Diagnosis of Aniridia and WAGR Syndrome Using Customized Targeted Array-Based CGH. PLoS ONE, 12, e0172363.
Kelly, F.B., Villaverde-Montero, C., Lorda-Sanchez, I., et al. (2013) Guidelines for Genetic Study of Aniridia. Archivos de la Sociedad Española de Oftalmología, 88, 145-152. https://doi.org/10.1016/j.oftale.2012.07.004
[17]
Yang, H., Yu, T., Sun, C., et al. (2011) Spectra-Domain Optical Coherence Tomography in Patients with Congenital Nystagmus. International Journal of Ophthalmology, 4, 627-630.
[18]
Cronin, T.H., Hertle, R.W., Ishikawa, H. and Schuman, J.S. (2009) Spectral Domain Optical Coherence Tomography for Detection of Foveal Morphology in Patients with Nystagmus. Journal of AAPOS, 13, 563-566. https://doi.org/10.1016/j.jaapos.2009.09.019
[19]
Thomas, M.G., Kumar, A., Mohammad, S., et al. (2011) Structural Grading of Foveal Hypoplasia Using Spectral-Domain Optical Coherence Tomography. Ophthalmology, 118, 1653-1660. https://doi.org/10.1016/j.ophtha.2011.01.028
[20]
McCulley, T.J., Mayer, K., Dahrd, K., Simpson, J. and Holland, E.J. (2005) Aniridia and Optic Nerve Hypoplasia. Eye, 19, 762-764. https://doi.org/10.1038/sj.eye.6701642
[21]
Wang, J.D., Zhang, J.S., Xiong, Y., et al. (2017) Congenital Aniridia with Cataract: Case Series. BMC Ophthalmology, 17, 115-120. https://doi.org/10.1186/s12886-017-0503-6
[22]
Lee, H., Khan, R. and O’Keefe, M. (2008) Aniridia: Current Pathology and Management. Acta Ophthalmologica, 86, 708-715. https://doi.org/10.1111/j.1755-3768.2008.01427.x
[23]
Angmo, D., Jha, B. and Panda, A. (2011) Congenital Aniridia. Journal of Current Glaucoma Practice, 5, 1-13.
[24]
Toledo, J.A., Gris, O., Santoja, J. and Teus, M.A. (2009) Spanish Guidelines for the Management of Congenital Aniridia. Spanish Aniridia Association, Salamanca.
[25]
Wiggins, R.E., et al. (1992) The Results of Glaucoma Surgery in Aniridia. Archives of Ophthalmology, 110, 503-505. https://doi.org/10.1001/archopht.1992.01080160081036
[26]
Okada, K., Mishima, H.K., Masumoto, M., et al. (2000) Hiroshima. Journal of Medical Sciences, 49, 135-138. https://doi.org/10.1108/00242530010317723