A Meta-analysis of the association between different genotypes(G11778A, T14484C and G3460A ) of Leber hereditary optic neuropathy and visual prognosis

AIM：To analyze the influences of different genotypes（G11778A,T14484 C and G3460A） of Leber hereditary optic neuropathy（LHON） on visual prognosis. METHODS： After a systematic literature search,all relevant studies evaluating the association between the three primary mutations of LHON and visual prognosis were included.All statistical tests were calculated with Revman 5.2 and STATA 12.0. RESULTS： Ten independent studies were included finally.A significant association between the three primary mutations and prognostic vision over 0.3 were found in G11778 A versus T14484 C [odds ratio（OR） =0.10,95% confidence interval（CI） =0.05-0.17,P 〈0.001],G11778 A versus G3460A（OR=0.18,95%CI=0.09-0.37,P 〈0.001） and T14484 C versus G3460A（OR =2.45,95% CI =1.10-5.48,P 〈0.05）.In addition,obtained by pairwise comparison,the vision during onset,age of onset and sex ratio of these three kinds of patients,have no statistical significance（P 〉0.05）.CONCLUSION： From pairwise comparison,we conclude that these three different genotypes of LHON are related to patients＇ visual prognosis.The T14484 C patients might have a best prognostic vision,G3460 A second,and G11778 A worst.And there is little relation between the three different genotypes and patients＇ vision,age of onset and sex ratio.

Foveal pit morphological changes in asymptomatic carriers of the G11778A mutation with Leber’s hereditary optic neuropathy

AIM:To investigate the foveal pit morphology changes in unaffected carriers and affected Leber’s hereditary optic neuropathy(LHON)patients with the G11778 A mutation from one family.METHODS:This study was a prospective cross-sectional study.Both eyes from 16 family members(age from 9 to 47 y)with the G11778 A mutation were analyzed and compared with 1 eye from 20 normal control subjects.Eleven family members with the G11778 A mutation but without optic neuropathy were classified as unaffected carriers(n=22 eyes).Five family members(n=10 eyes)expressed the LHON phenotype and were classified as affected patients.Retinal images of all the subjects were taken by optical coherence tomography(OCT),and an automatic algorithm was used to segment the retina to eight layers.Horizontal and vertical OCT images centered on the fovea were used to measure intra-retinal layer thicknesses and foveal morphometry.RESULTS:Thicker foveal thickness,thinner foveal pit depth,and flatter foveal slopes were observed in unaffected carriers and affected LHON patients(all P<0.001).Further,the slopes of all four sectors in the LHON were flatter than those in the unaffected carriers(all P<0.001).Compared with the control group,affected LHON patients had a thinner retinal nerve fiber layer(RNFL),ganglion cell layer and inner plexiform layer(GCL+IPL),and total retina(all P<0.01).The retinal nerve fiber layer(RNFL)of affected patients was 38.0%thinner than that of controls while the GCL+IPL was 40.1%thinner.CONCLUSION:The foveal pit morphology shows changes in both unaffected carriers and affects patients.RNFL and GCL+IPL are thinner in affected LHON patients but not in unaffected carriers.

G11778A位点突变Leber遗传性视神经病变的视野特点和变化趋势

目的观察并分析G11778A位点突变Leber遗传性视神经病变(LHON)患眼视野特点和变化趋势。方法回顾性临床研究。2008年5月至2018年2月在北京中医药大学东方医院眼科经线粒体DNA检测确诊的G11778A位点突变LHON患者22例44只眼纳入研究。患眼均行最佳矫正视力(BCVA)、视野、光相干断层扫描(OCT)检查。BCVA检查采用国际标准视力表进行,统计时换算为最小分辨角对数(logMAR)视力。采用OCT仪测量以视盘为中心1.73 mm外200μm×200μm环形区域的视网膜神经纤维层(RNFL)厚度。采用Octopus 101型视野计于患者病程2、4、8、12、18、24、30个月时间点前后1个月内分别完成至少7次以上视野检查。因初诊时患者BCVA和配合度的不同,其中27只眼采用G2程序进行视野检查(G2程序组),以视野平均缺损(MD)为主要结局指标;17只眼采用LVC程序进行视野检查(LVC程序组),以视野平均光敏感度(MS)为主要结局指标。两组患者性别构成比(χ^(2)=1.896)、年龄(t=0.337)比较,差异无统计学意义(P=0.169、0.708);logMAR BCVA比较,差异有统计学意义(t=4.994,P=0.000)。根据患者发病年龄是否>14岁,再将两组患者分为年龄≤14岁组、>14岁组。组间比较采用独立样本t检验,组内比较采用配对t检验,多组间比较采用单因素方差分析;计数资料比较采用χ^(2)检验。结果G2程序≤14岁组患眼随病程延长视野MD值逐渐降低;与病程2个月比较,病程18个月后视野MD值明显降低,差异有统计学意义(t=3.813、4.590、5.033,P=0.002、0.001、0.000)。G2程序>14岁组患眼不同病程视野MD值比较,差异无统计学意义(P>0.05)。LVC程序≤14岁组、>14岁组患眼不同病程视野MD、MS值比较,差异均无统计学意义(P>0.05)。患眼早期视野缺损主要表现为中心暗点,晚期则为弥漫性视野缺损。早期、晚期视野缺损类型眼数比较,G2程序组差异有统计学意义(χ^(2)=17.414,P=0.015);LVC程序组差异无统计学意义(χ^(2)=4.541,P=0.474)。G2程序组患眼病程8个月内视野MD值基本维持稳定;与病程2个月视野MD值比较,病程18个月后视野明显改善,MD值下降,差异有统计学意义(t=2.100、3.217、3.566,P=0.046、0.003、0.001)。LVC程序组患眼随访期间视野MS无明显改善(P>0.05)。G2程序组患眼,与病程2个月BCVA比较,病程12个月后BCVA明显提高,差异有统计学意义(t=3.039、3.678、4.264、5.078,P=0.008、0.002、0.001、0.000)。G2程序组患眼不同病程BCVA均优于LVC程序组,差异有统计学意义(P≤0.05)。G2程序组(t=8.400、9.330、10.989、11.967、12.211、12.803)、LVC程序组(t=10.668、13.036、13.833、18.922、20.387、20.851)患眼随病程延长RNFL厚度持续降低,差异有统计学意义(P值均为0.000)。G2程序组患眼病程4、8、18、24、30个月RNFL厚度均高于LVC程序组,差异有统计学意义(t=2.471、2.269、2.474、2.509、2.782,P=0.018、0.028、0.017、0.016、0.008)。结论G11778A位点突变LHON患眼视野缺损早期主要表现为中心暗点,晚期主要表现为弥漫性缺损和中心暗点。G2程序组患眼随访期间视野明显改善,BCVA显著提高;G2程序组中年龄≤14岁者视野改善优于年龄>14岁者。LVC程序组患眼随访期间视野MS无明显改善。

Leber遗传性视神经病变相关的线粒体G11778A,T14484C和G3460A突变筛查

目的探讨Leber遗传性视神经病变(Leber's hereditary optic neuropathy,LHON)相关的线粒体DNA致病性的突变位点,为LHON的分子诊断和早期预防提供理论依据。方法收集2016年6月至2018年1月在杭州市第一人民医院就诊的LHON患者100例以及80例性别、年龄相仿的正常对照。使用PCR-Sanger测序法检测线粒体G11778A,T14484C和G3460A这三个原发性突变位点。结果经过测序比对,我们共发现有5例患者携带这3个致病性线粒体突变位点,其中携带线粒体G11778A突变的患者2例,T14484C突变的患者2例,携带G3460A突变的个体1例,这些突变位点在正常人群中均未发现。结论线粒体G11778A,T14484C以及G3460A突变是LHON相关的致病性突变位点,在临床上开展这些突变位点的早期筛查显得非常有必要,这对于LHON的预防和分子诊断具有较好的指导作用。