title: Coat's like vasculopathy in leber congenital amaurosis secondary to homozygous mutations in CRB1: a case report and discussion of the management options.
abstract: BACKGROUND
  Mutations in the CRB1 gene are associated with variable phenotypes of severe retinal dystrophies, and retinal dystrophies resulting from CRB1 mutations may be accompanied by specific fundus features such as coat's like vasculopathy in retinitis pigmentosa patients. This is the first report of the occurrence of coat's like vasculopathy in a patient diagnosed with Leber congenital amaurosis caused by a CRB1 mutation.
  
  
  METHODS
  An 18-year old Syrian female patient presented with bilateral gradual loss of vision since early childhood, with recent deterioration in her left eye. She appeared to have an asymmetric bilateral coat's like vasculopathy which was more severe in the left eye. The diagnosis of Leber congenital amaurosis was suggested, and a genetic CRB1 sequencing for the patient and her two younger siblings, who also had severe vision loss, was done, upon which the diagnosis of Leber congenital amaurosis associated with exudative retinal detachment due to coat's like vasculopathy was made. Treatment with panretinal photocoagulation was attempted in the worse left eye, but with no improvement. As the disease suddenly progressed in both eyes, pars plana vitrectomy with endolaser and silicone oil tamponade was performed in the better right eye which led to anatomical stabilization of the case without improvement in the visual acuity.
  
  
  CONCLUSIONS
  Leber congenital amaurosis is reported to be associated with multiple systemic and ocular findings, none of which is coat's like vasculopathy. CRB1 gene mutations are associated with remarkable retinal findings in patients with retinitis pigmentosa and other fundus dystrophies. In this unique case we are reporting the incidence of coat's like vasculopathy in a patient diagnosed with Leber congenital amaurosis caused by CRB1 gene mutation, and its management. CRB1 mutant patients should be followed up closely as sudden progression can have permanent poor outcomes and as early management is vital in such cases.
authors.affiliation: Department of Ophthalmology, Damascus University, Almouassat University Hospital, Damascus, Syria. somerh@gmail.com.
authors.forename: Somar M
authors.initials: SM
authors.lastname: Hasan
authors.affiliation: Department of Ophthalmology, Damascus University, Almouassat University Hospital, Damascus, Syria. arwaretina@gmail.com.
authors.forename: Arwa
authors.initials: A
authors.lastname: Azmeh
authors.affiliation: Department of Ophthalmology, Damascus University, Almouassat University Hospital, Damascus, Syria. Osama-mostafa@live.com.
authors.forename: Osama
authors.initials: O
authors.lastname: Mostafa
authors.affiliation: Al-Jawhara Center, Arabian Gulf University, Manama, Kingdom of Bahrain​. megarbane@usj.edu.lb.
authors.forename: Andre
authors.initials: A
authors.lastname: Megarbane
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005136:Eye Proteins / Q000235:genetics*; D005260:Female; D005451:Fluorescein Angiography; D005584:Fovea Centralis / Q000473:pathology; D005654:Fundus Oculi; D006720:Homozygote; D006801:Humans; D057130:Leber Congenital Amaurosis / Q000235:genetics*; D008297:Male; D008565:Membrane Proteins / Q000235:genetics*; D009154:Mutation / Q000235:genetics*; D009419:Nerve Tissue Proteins / Q000235:genetics*; D058456:Retinal Telangiectasis / Q000235:genetics*; D035781:Siblings
chemical_list: C448939:CRB1 protein, human; D005136:Eye Proteins; D008565:Membrane Proteins; D009419:Nerve Tissue Proteins