Ocular features of the congenital cataracts facial dysmorphism neuropathy syndrome.
OBJECTIVE
To determine the nature and course of ophthalmologic abnormalities in congenital cataracts facial dysmorphism neuropathy (CCFDN) syndrome in a genetically verified group of 9 patients.


METHODS
Observational case series.


METHODS
Nine affected male individuals of 5 pedigrees aged 1.3 to 16.8 years were examined. Four individuals were recruited during an ongoing prospective study of congenital cataracts; 5 individuals could be assigned to the CCFDN group on the basis of our retrospective data.


METHODS
Linkage and haplotype analysis, neurologic examinations, bilateral cataracts, axial length, corneal diameter, pupil diameter and pupillary reactions, intraoperative and postoperative complications, lid changes, aphakic correction problems, refractive results, and visual function.


RESULTS
All families originated from the eastern part of Serbia, close to the border with Romania. The 8 tested individuals were homozygous for the conserved ancestral CCFDN haplotype in the telomeric region of chromosome 18q. All patients showed a peripheral, demyelinating neuropathy and varying degrees of ataxia. In the older patients, muscular atrophy in distal muscles and facial dysmorphism was evident. Early-onset bilateral congenital cataracts associated with microcornea, microphthalmos, and micropupil could be found in all patients. All children had floppy eyelid syndrome and pseudoptosis. An increased inflammatory reaction to contact lenses and intraocular lenses could be documented in all. All patients had syndrome-associated nystagmus and congenital esotropia. Distant visual acuity could be classified as severe to moderate impairment, whereas near visual acuity was much better (mild to moderate impairment).


CONCLUSIONS
Early-onset congenital cataracts associated with microcornea, microphthalmos, and micropupil are essential ocular features of the CCFDN syndrome and are the first recognizable signs during early infancy. Awareness of this syndrome by pediatric ophthalmologists is important, because these typical findings, combined with information on ethnic origin, may lead to very early diagnosis at an age when the nature and severity of nonophthalmologic features are not apparent. Affected individuals may benefit from careful ophthalmologic treatment and follow-up, as well as from early management of the neurologic problems and developmental delay. Affected families will benefit from genetic counseling and predictive testing.
Müllner-Eidenböck
Andrea
A
Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria. andrea.muellner-eidenboeck@akh-wien.ac.at
Moser
Elisabeth
E
Klebermass
Nina
N
Amon
Michael
M
Walter
Maggie C
MC
Lochmüller
Hanns
H
Gooding
Rebecca
R
Kalaydjieva
Luba
L
D000293:Adolescent; D002386:Cataract / Q000151:congenital* / Q000473:pathology; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000002:abnormalities*; D019465:Craniofacial Abnormalities / Q000235:genetics* / Q000473:pathology; D004948:Esotropia / Q000235:genetics; D005141:Eyelid Diseases / Q000235:genetics; D006801:Humans; D007223:Infant; D007498:Iris / Q000002:abnormalities*; D019654:Lens Implantation, Intraocular; D008297:Male; D008850:Microphthalmos / Q000235:genetics* / Q000473:pathology; D009759:Nystagmus, Pathologic / Q000235:genetics; D010375:Pedigree; D010523:Peripheral Nervous System Diseases / Q000235:genetics* / Q000473:pathology; D013577:Syndrome