Ptosis as an associated finding in maternally inherited diabetes and deafness.
OBJECTIVE
To report ptosis as an associated finding in 2 patients with maternally inherited diabetes and deafness (MIDD).


METHODS
Two unrelated female patients with genetically proven MIDD are described. A complete ophthalmological examination included evaluation of levator muscle function, vertical fissure height and upper lid crease position measurements, the ice pack test and extensive imaging. In addition, pathology of the levator muscle was performed in 1 patient.


RESULTS
The first patient had an asymmetric ptosis at presentation. Levator muscle function was initially normal and decreased 3 years after, suggestive of a myogenic ptosis. Fundus examination revealed a macular pattern dystrophy. The second MIDD patient was referred for bilateral pigment alterations at the posterior pole. Gradually bilateral ptosis developed over a 3-year period. In both patients, ocular motility testing revealed a reduced upgaze.


CONCLUSIONS
Myogenic ptosis has been described in association with several of the phenotypes caused by the m.3243A>G mutation, but up to now it had not been described as a finding in MIDD. MIDD has pleomorphic manifestations, and myogenic ptosis should be added to the list of associated clinical features. The additional symmetric elevation deficit in both patients may be an early sign of chronic progressive external ophthalmoplegia (CPEO). The results provide further evidence to suggest that MIDD represents only a part of a continuous spectrum of disease related to the m.3243A>G point mutation in the tRNA(Leu) gene.
Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.
Kirsten
K
Robberecht
Christian
C
Decock
Annemie
A
Stevens
Sara
S
Seneca
Jan
J
De Bleecker
Bart P
BP
Leroy
D000328:Adult; D000368:Aged; D001763:Blepharoptosis / Q000175:diagnosis / Q000235:genetics*; D004252:DNA Mutational Analysis; D004272:DNA, Mitochondrial / Q000235:genetics*; D003638:Deafness / Q000175:diagnosis / Q000235:genetics; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000235:genetics; D004596:Electroretinography; D005260:Female; D006801:Humans; D008875:Middle Aged; D028361:Mitochondrial Diseases / Q000175:diagnosis / Q000235:genetics*; D009154:Mutation; D009801:Oculomotor Muscles / Q000473:pathology / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D012356:RNA, Transfer, Leu / Q000235:genetics; D014792:Visual Acuity
D004272:DNA, Mitochondrial; D012356:RNA, Transfer, Leu