Clinicopathological case series of four patients with inherited macular disease.
OBJECTIVE
To correlate the phenotype of four patients with inherited macular disease with the immunohistopathology of retinal tissue collected at the time of retinal pigment epithelium (RPE)-choroidal transplantation.


METHODS
A clinicopathologic case series describing the phenotype of four patients, including confocal immunohistochemistry and electron microscopy (EM), and the results of genetic testing.


RESULTS
In Case 1, electrophysiology showed only macular dysfunction. Confocal microscopy revealed minor abnormalities. EM showed abnormal cone inner segments with swollen mitochondria. In case 2 (R172W mutation in RDS), electrophysiology demonstrated generalized cone system dysfunction with severe macular involvement. Peripherin labeling of outer segments was nonuniform, and EM showed discs arranged in whorllike structures. Case 3 showed severe central macular dysfunction on multifocal electroretinogram (ERG). Peripherin staining was irregular and disorganized. EM revealed abnormal inner segment morphology, particularly in rods, and disorganized irregular outer segments. Case 4 had localized central macular dysfunction on multifocal ERG. Confocal microscopy was grossly normal, with evidence of early redistribution of cone opsin to the inner segment. EM showed variable rod morphology and normal cones.


CONCLUSIONS
RPE transplantation provides a unique opportunity to gain insight into retinal disorders by enabling phenotypic correlation with the immunohistopathology of retinal tissue collected during surgery.
Wickham
Louisa
L
Department of Vitreoretinal Surgery, Moorfields Eye Hospital, London, United Kingdom. louisa.wickham@moorfields.nhs.uk
Chen
Fred K
FK
Lewis
Geoffrey P
GP
Uppal
Germit S
GS
Neveu
Magella M
MM
Wright
Genevieve A
GA
Robson
Anthony G
AG
Webster
Andrew R
AR
Grierson
Iain
I
Hiscott
Paul
P
Coffey
Peter J
PJ
Holder
Graham E
GE
Fisher
Steven K
SK
Da Cruz
Lyndon
L
D018528:ATP-Binding Cassette Transporters / Q000235:genetics; D000368:Aged; D017690:Cell Transplantation; D002829:Choroid / Q000637:transplantation; D004596:Electroretinography; D005091:Exons / Q000235:genetics; D005260:Female; D005451:Fluorescein Angiography; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007381:Intermediate Filament Proteins / Q000235:genetics; D008268:Macular Degeneration / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008562:Membrane Glycoproteins / Q000235:genetics; D018613:Microscopy, Confocal; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000235:genetics; D020411:Oligonucleotide Array Sequence Analysis; D064531:Peripherins; D010641:Phenotype; D020419:Photoreceptor Cells, Vertebrate / Q000378:metabolism / Q000648:ultrastructure; D055213:Retinal Pigment Epithelium / Q000637:transplantation; D019717:Tissue Inhibitor of Metalloproteinase-3 / Q000235:genetics
C056475:ABCA4 protein, human; D018528:ATP-Binding Cassette Transporters; D007381:Intermediate Filament Proteins; D008562:Membrane Glycoproteins; D009419:Nerve Tissue Proteins; C578994:PRPH protein, human; C578997:PRPH2 protein, human; D064531:Peripherins; C088390:TIMP3 protein, human; D019717:Tissue Inhibitor of Metalloproteinase-3