autosomal recessive?

Fibrosis of Extraocular Muscles, Tukel CFEOM Syndrome

Clinical Characteristics
Ocular Features: 

A single consanguineous Turkish family with six affected individuals with non-progressive restrictive ophthalmoplegia, ptosis, and ulnar hand anomalies has been reported.  The restriction of ocular motility and ptosis was most pronounced on the right side.  Four patients had a combination of 12-18 PD XT and 25 PD hypotropia (OD).  Visual acuity was 20/20 in at least one eye while 3 had 5/200 or 20/200 in the right eye.  Restriction of elevation of the right eye was noted and this was more pronounced on adduction.  The dysfunctional extraocular muscles were determined to be the superior rectus and/or the inferior oblique.  Forced ductions were usually negative.  All patients had a head tilt or turn and three had some degree of ptosis with restriction of elevation. 

Systemic Features: 

Hand anomalies consisting of post-axial (ulnar) digital anomalies were most pronounced on the right side.  The 5th digit was hypoplastic or missing from all hands, right and left, while various wrist bones were absent or anomalous primarily in the right hand.  One patient had syndactyly of the 4th and 5th fingers on the left hand and another had both 4th and 5th fingers missing from the left hand.

Genetics

The consanguinity in this Turkish kindred suggests autosomal recessive inheritance.  A locus at 21qter has been associated with the disorder but no specific mutation has been found. 

Other nonsyndromal forms of congenital fibrosis of extraocular muscles include: CFEOM1 (135700), CFEOM2 (602078), CFEOM3C (609384), CFEOM5 (616219), and CFEOM with synergistic divergence (609612).

Pedigree: 
Autosomal recessive
Treatment
Treatment Options: 

No treatment has been reported but it is likely that some cosmetic and head position improvement could be achieved with muscle and ptosis surgery. 

References
Article Title: 

Cone Dystrophy, Peripheral

Clinical Characteristics
Ocular Features: 

Several families have been reported in which rod function was normal while cone function was impaired, more so peripherally than centrally.  Visual acuity ranges from normal to 20/200.  Color vision may be normal in some patients while others have some degree of dyschromatopsia.  Full-field ERG cone responses are reduced significantly but focal macular cone ERGs are normal.   Visual fields are normal except for small paracentral scotomas.  Temporal pallor has been noted in the optic discs of 2 patients.  Cone responses on ERG were demonstrated to decrease in one patient during a 4 year interval.  Photophobia as commonly seen in cone-rod dystrophies was not reported.  No abnormalities are seen on fundus examination or fluorescein angiography. 

Systemic Features: 

No systemic disease has been reported. 

Genetics

No responsible mutation has been reported.  Two of the three reported patients were siblings born to presumably unaffected parents, compatible with autosomal recessive inheritance. 

It is questionable whether a 'pure' cone dystrophy exists as most patients have evidence (at least eventually) of both rod and cone disease.  However, an autosomal dominant form of cone dystrophy (602093) has been reported in which cone dysfunction predominates and evidence of rod damage occurs much later.

Pedigree: 
Autosomal recessive
Treatment
Treatment Options: 

No treatment is available but visual function can be enhanced with low vision aids.  

References
Article Title: 

Peripheral cone disease

Pinckers A, Deutman AF. Peripheral cone disease. Ophthalmologica. 1977;174(3):145-50.

PubMed ID: 
854266

Potter Disease, Type I

Clinical Characteristics
Ocular Features: 

As part of the facial morphology said to be characteristic of Potter disease, there is usually hypertelorism, telecanthus and epicanthal folds.  Cataracts and angiomas of the optic disc area have also been described.

Systemic Features: 

Polycystic kidney disease and hepatic system anomalies are major features of Potter disease.   Pulmonary hypoplasia with neonatal respiratory distress, however, is often the most immediate cause of death in most infants.  Antenatal oligohydramnios and low birth weight are commonly present.  As many as 33% of fetuses die in utero, often the result of bilateral renal agenesis.  Infants that survive can have chronic lung disease and renal dysfunction.  Congenital heart malformations are common, including septal defects, tetralogy of Fallot and patent ductus arteriosis.  Vertebrae may have a ‘butterfly’ shape but other skeletal findings include hemivertebrae and sacral agenesis.  The neck has been described as short and the skull is brachycephalic.

The facial appearance, known as Potter facies, is said to be characteristic and may be helpful in distinguishing this type of polycystic kidney disease.  In addition to the ocular findings, the nares are often anteverted, and the external ears are large and often posteriorly rotated.

Genetics

The uniqueness of this syndrome remains to be established.  There are several polycystic kidney disorders which have a monogenic basis. These often have overlapping renal features with the condition described here but lack the facial features said to be characteristic of Potter type I disease.  Autosomal recessive inheritance has been suggested on the basis of several reported families with affected sibs from consanguineous parents but so far no gene locus or mutation has been identified.

Pedigree: 
Autosomal recessive
Treatment
Treatment Options: 

There is no treatment for the condition but symptoms of respiratory distress and renal failure may need to be addressed acutely.  Long-term therapy for pulmonary disease and renal dysfunction can be considered for older individuals.  Many infants die in the neonatal period.

References
Article Title: 

Syndrome of autosomal recessive polycystic kidneys with skeletal and facial anomalies is not linked to the ARPKD gene locus on chromosome 6p

Hallermann C, M?ocher G, Kohlschmidt N, Wellek B, Schumacher R, Bahlmann F, Shahidi-Asl P, Theile U, Rudnik-Schoneborn S, M?ontefering H, Zerres K. Syndrome of autosomal recessive polycystic kidneys with skeletal and facial anomalies is not linked to the ARPKD gene locus on chromosome 6p. Am J Med Genet. 2000 Jan 17;90(2):115-9. Review.

PubMed ID: 
10607948

Keratoconus Posticus Circumscriptus

Clinical Characteristics
Ocular Features: 

The posterior corneal surface has area(s) of excavation (indentation) associated with overlying opacification.  The lens-corneal separation is reduced and iridocorneal adhesions are often present.  The clinical picture has been described as ‘posterior conical cornea’ or posterior keratoconus.

Systemic Features: 

The neck is short and has webbing.  The facies appear ‘coarse’, the posterior hairline is low, the nose is prominent, digits are short, and the vertebral anomalies may lead to scoliosis.  Individuals are short of stature and brachydactyly is often present.  Developmental delays and mental retardation are usually features.  Other variable anomalies have been reported.

Genetics

Autosomal recessive inheritance seems most likely in view of the family patterns.  Based on the few families reported, it is uncertain if this is a single entity with variable expression or a combination of disorders.  No gene or locus has been associated with this condition.

Pedigree: 
Autosomal recessive
Treatment
Treatment Options: 

No treatment beyond surgical repair of the cleft lip and palate or scoliosis is available.  Peripheral iridotomies have been done in the presence of shallow anterior chambers.

References
Article Title: 

Gorlin-Chaudhry-Moss Syndrome

Clinical Characteristics
Ocular Features: 

Orbital hypoplasia, short, abnormally slanted (up or down) lid fissures, and sometimes lid notching (colobomas?) are characteristic facial features as are bushy eyebrows and synophrys.  Lacrimal duct stenosis has been noted.  The eyes are described as 'small' but no ophthalmological examination has been performed to document microphthalmia or other ocular anomalies.  No mention is made of visual problems.

Systemic Features: 

Premature closure of the coronal suture and midface hypoplasia lead to striking brachycephaly.  The scalp hairline is low and scalp hair is abundant and coarse.  In fact, hypertrichosis is seen throughout the body.  Hypo- and microdontia with irregularly spaced teeth and a high arched palate are common features.  Clefts of the soft palate has been observed.  The ears can be small and rotated posteriorly.  The labia majora are hypoplastic as are the distal phalanges of the fingers and toes.  Mild syndactyly of the second and third fingers and toes have been described.  The nails may be abormally small.  Conductive hearing loss may be present.  Growth and psychomotor development seem to be normal although some patients have been described to have a 'stocky' build.  The facial features tend to coarsen over time.

Genetics

Autosomal recessive inheritance has been suggested but nothing is known about the gene locus.  All 5 reported patients have been female.

Pedigree: 
Autosomal recessive
Treatment
Treatment Options: 

No treatment is known.

References
Article Title: 

Möebius Syndrome

Clinical Characteristics
Ocular Features: 

This is an ill-defined syndrome with the primary features of facial weakness and limited ocular abduction, usually bilateral and nonprogresssive. Those who first described this entity in the 19th century, von Graefe and M√∂ebius, accepted only cases with facial diplegia and bilateral 6th nerve palsy.  Since then, however, a large number of associated nerve palsies and systemic malformations have been reported. More than a third of patients have features of Duane’s syndrome.  Beyond the oculomotor dysfunction, no ocular abnormalities are consistently associated.

Systemic Features: 

A large number of neurological and skeletal anomalies have been reported in association with what is called M√∂ebius syndrome.  Orofacial dysmorphism, limb malformations and other cranial nerve palsies are the most common.  The lack of specific diagnostic criteria for this ‘syndrome’ may explain why many of these associations have been reported, and it is beyond the scope of this database to enumerate or document the validity of including coexistent malformations as part of the M√∂ebius sequence.  A significant number of patients have more general motor and coordination disabilities.  It is not unusual for young patients to have respiratory difficulties and to suffer an early demise.  Necropsy findings often reveal diffuse brainstem pathology.

Genetics

This is either a clinically heterogeneous disorder or a category with multiple disorders.  Familial occurrence is uncommon and recurrence risk is generally higher among families with simple 6th and 7th nerve palsies suggesting that cases in which other major anomalies occur are more likely to be the result of environmentally-induced maldevelopment.  Both autosomal dominant and autosomal recessive inheritance patterns have been reported in familial cases.

Based on the pattern of chromosomal aberrations found in a multigenerational family, it has been proposed that a locus for Moebius syndrome resides somewhere in 13q12.2-q13.

Pedigree: 
Autosomal dominant
Autosomal recessive
Treatment
Treatment Options: 

No treatment is available.

References
Article Title: 

Marshall Syndrome

Clinical Characteristics
Ocular Features: 

Myopia is a common feature.  The globes appear prominent with evident hypertelorism, perhaps in part due to shallow orbits.  The vitreous is abnormally fluid.  The beaded vitreous pattern seen in Stickler syndrome type II (604841), with which Marshall syndrome is sometimes confused, is not seen in Marshall syndrome, nor is the same frequency of retinal detachments.  Congenital or juvenile cataracts were present in Marshall’s original family.

Systemic Features: 

The midface is flat with some features of the Pierre-Robin phenotype.  The nasal root is flat and the nares anteverted.  Patients tend to be short in stature and joints are often stiff.  Small iliac wings and a thickened calvarium can be seen radiologically together with other bone deformities.  Abnormal frontal sinuses and intracranial calcifications have also been reported.  Sensorineural hearing loss may be noted during the first year of life with age-related progression.  Osteoarthritis of the knees and lumbosacral spine begins in the 4th and 5th decades.  Features of anhidrotic ectodermal dysplasia such as hypohidrosis and hypotrichosis are present in some patients.  Individuals may have linear areas of hyperpigmentation on the trunk and limbs.

Genetics

The syndromal status of Marshall syndrome as a unique entity remains uncertain inasmuch as there are many overlapping clinical features with Stickler syndrome type II (604841) and both result from mutations in the COL11A1 gene (1p21).  Autosomal dominant inheritance is common to both although autosomal recessive inheritance has been proposed for a few families with presumed Marshall syndrome. Stickler syndrome type II (604841) and Marshall syndrome may be allelic or even the same disorder.

Pedigree: 
Autosomal dominant
Autosomal recessive
Treatment
Treatment Options: 

No treatment is available for this disorder beyond cataract removal.  Patients need to be monitored for retinal breaks and detachments.

References
Article Title: 

Oculocerebral Syndrome with Hypopigmentation

Clinical Characteristics
Ocular Features: 

Patients have severe ocular malformations which so far lack full characterization.  Nearly complete scleralization of the cornea prevents internal evaluation in most cases.  There may be extensive neovascularization of corneal clouding.  Anterior synechiae and cataracts have been described.  Other patients presumed to have the same disorder have normal fundi or diffuse pigmentary changes.  No limbal landmarks can be seen.  The central cornea can be more transparent but no iris can be visualized.  The eyes are microphthalmic as well.  Slow, wandering eye movements are constant.  Spastic ectropion of the lower lids is present. Lashes and eyebrows have minimal pigmentation and like the scalp hair have a slight yellowish tinge.  There is no response to bright light in severe cases whereas in other more mildly affected individuals presumed to have this disorder there is only hypoplasia of the fovea with diffuse retinal pigmentary changes.

Systemic Features: 

Individuals have severe mental retardation from birth and never respond to environmental cues beyond having a marked startle response to auditory stimuli.  Grasp and sucking responses persist at least into the second decade.  The developmental delay persists from birth and patients never achieve normal milestones.  Athetoid, writhing movements are prominent.  The limbs are spastic, and deep tendon reflexes are hyperactive. Contractures are common.  Hypodontia, diastema, and gingival hyperplasia are usually present and the hard palate is highly arched.  The skin is hypopigmented but pigmented nevi may be present and the distribution of melanocytes is uneven microscopically. Cerebellar hypoplasia has been reported in some patients.

Genetics

This is a presumed autosomal recessive disorder based on its familial occurrence and parental consanguinity in some families.  An interstitial deletion [del(3)(q27.1-1q29)] has been identified in the paternal chromosome of a 4-year-old female but the molecular defect remains unknown. 

Clinically heterogeneous cases from Africa, Germany, Italy, Great Britain, and Belgium may not all have the same disorder and evidence for a distinctive phenotype remains elusive.

Pedigree: 
Autosomal recessive
Treatment
Treatment Options: 

None available

References
Article Title: 

Oculocerebral syndrome with hypopigmentation (Cross

De Jong G, Fryns JP. Oculocerebral syndrome with hypopigmentation (Cross syndrome): the mixed pattern of hair pigmentation as an important diagnostic sign. Genet Couns. 1991;2(3):151-5.

PubMed ID: 
1801851

Macular Dystrophy, Vitelliform 2

Clinical Characteristics
Ocular Features: 

Best disease primarily affects the macular and paramacular areas.  The classical lesion resembles an egg yolk centered on the fovea.  Most patients, however, never exhibit the typical vitelliform lesion and may instead have normal maculae, or irregular yellowish deposits that may even be extrafoveal.  Histologically the RPE contains increased amounts of lipofuscin.  The ‘egg yolk’ is located beneath the neurosensory retina and the overlying retinal circulation often remains intact.  It can evolve into a ‘scrambled egg’ appearance and an apparent fluid level may be evident.  Some patients exhibit only RPE changes including hyper-  or hypopigmentation throughout the macula.  Choroidal neovasculariztion with hemorrhage leading to scarring and gliosis are uncommon but present a serious risk to vision.  The common end point for symptomatic patients is some degree of photoreceptor damage.

Until recently, most reports of Best macular dystrophy did not include genotypic data.  It is therefore difficult to classify families with variants of the disease, such as adult-onset or atypical vitelliform dystrophy but these at least suggest that this may be a heterogeneous disorder.  At the present time, the diagnosis should be reserved for those with an abnormal light-to-dark (Arden) ratio on electro-oculography and a mutation in the BEST1 gene. 

Visual function varies widely and has considerable fluctuation.   As many as 7-9 percent of patients are asymptomatic throughout life and few have vision loss to 20/200.  Many individuals maintain vision of 20/40 or better throughout life.  Some experience episodic acute vision loss to 20/80 or worse but often recover to at least 20/30.  It has been reported that as many as 76 per cent under the age of 40 retain 20/40 and 30 per cent retain this level of vision into the 5th and 6th decade of life.

Other ocular manifestations include hyperopia, esotropia, and, rarely, shallow anterior chambers with angle closure glaucoma.

Systemic Features: 

None have been reported.

Genetics

A mutation in the bestrophin gene (BEST1) located on chromosome 11 (11q13) is responsible for the disease in most patients.  Best disease is usually transmitted in an autosomal dominant pattern from parent to offspring.  A large number of mutations have been found in the BEST1 gene but so far no correlation with severity of disease is possible.  In fact, there is a great deal of clinical variation within families having identical mutations resembling that of the variation found among different mutations.

Several families have also been reported with autosomal recessive inheritance.  Affected offspring had homozygous mutations in the bestrophin gene with reduced light/dark responses and vision loss.  Some have atypical vitelliform retinal and sometimes multifocal lesions.  They may develop angle closure glaucoma.  Their heterozygous parents  have either normal or abnormal EOGs and no visible fundus disease.  So far no families with presumed recessive inheritance of Best macular dystrophy have demonstrated parent-to-child transmission of typical vitelliform lesions.

Genotyping has identified at least 5 forms of vitelliform macular dystrophy.  In addition to the iconic Best disease described here we know of at least four more variants and specific mutations have been identified in three.  No mutation or locus has yet been identified in VMD1 (153840) but it is likely a unique condition since mutations in other genes known to cause vitelliform dystrophy have been ruled out.  Other forms are VMD3 (608161) due to mutations in the PRPH2 gene, VMD4 (616151) resulting from mutations in the IMPG1 gene, and VMD5 (616152) caused by mutations in the IMPG2 gene.

Autosomal dominant vitreoretinochoroidopathy (193220) is an allelic disorder.

Pedigree: 
Autosomal dominant
Autosomal recessive
Treatment
Treatment Options: 

None known for disease.  Subretinal neovascularization may benefit from ablation treatments.

References
Article Title: 

Mutations in IMPG1 Cause Vitelliform Macular Dystrophies. Am

Manes G, Meunier I, Avila-Fern?degndez A, Banfi S, Le Meur G, Zanlonghi X, Corton M, Simonelli F, Brabet P, Labesse G, Audo I, Mohand-Said S, Zeitz C, Sahel JA, Weber M, Dollfus H, Dhaenens CM, Allorge D, De Baere E, Koenekoop RK, Kohl S, Cremers FP, Hollyfield JG, S?(c)n?(c)chal A, Hebrard M, Bocquet B, Garc??a CA, Hamel CP. Mutations in IMPG1 Cause Vitelliform Macular Dystrophies. Am J Hum Genet. 2013 Aug 29. [Epub ahead of print] PubMed PMID: 23993198.

PubMed ID: 
23993198

Biallelic mutation of BEST1 causes a distinct retinopathy in humans

Burgess R, Millar ID, Leroy BP, Urquhart JE, Fearon IM, De Baere E, Brown PD, Robson AG, Wright GA, Kestelyn P, Holder GE, Webster AR, Manson FD, Black GC. Biallelic mutation of BEST1 causes a distinct retinopathy in humans. Am J Hum Genet. 2008 Jan;82(1):19-31. PubMed PMID: 18179881

PubMed ID: 
18179881

Identification of the gene responsible for Best macular dystrophy

Petrukhin K, Koisti MJ, Bakall B, Li W, Xie G, Marknell T, Sandgren O, Forsman K, Holmgren G, Andreasson S, Vujic M, Bergen AA, McGarty-Dugan V, Figueroa D, Austin CP, Metzker ML, Caskey CT, Wadelius C. Identification of the gene responsible for Best macular dystrophy. Nat Genet. 1998 Jul;19(3):241-7.

PubMed ID: 
9662395

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