Sanae Oda

Magnetic resonance imaging measurements of extraocular muscle path shift and posterior eyeball prolapse from the muscle cone in acquired esotropia with high myopia

PURPOSE To investigate extraocular muscle (EOM) path shift and prolapse of posterior eyeball from muscle cone in acquired esotropia with high myopia (AEHM), using magnetic resonance imaging. DESIGN A case-control study. METHODS There were 16 eyes with AEHM, 11 with high myopia (HM), 12 with moderate myopia (MM), and 11 control eyes. Extraocular muscle shift was evaluated by measuring angles formed by the line connecting orbital centroids and the line connecting each orbital centroid and each EOM centroid. The ratio of the prolapse in the posterior eyeball from the muscle cone was also measured. RESULTS Both inferior shift of lateral rectus (LR) and nasal shift of superior rectus (SR) muscle were observed in the AEHM group, compared with HM, MM, and control groups. Neither shifted significantly in the HM group compared with control group. The prolapse ratio in AEHM group was higher than in the HM, MM, and control groups. Greater EOM shifts and eyeball prolapse were observed when the AEHM was more severe, as in esotropia fixus. CONCLUSIONS In AEHM, a prolapsing eyeball shifts LR inferiorly and SR nasally; these findings were not observed in high myopia with neither ocular deviation nor restriction. These shifts reduce abduction and supraduction and increase infraduction and adduction in AEHM. The shifts would be predicted to create a hypoesodeviation, which is a common finding in AEHM. Both EOM shifts and superotemporal eyeball prolapse tend to be greater in esotropia fixus.

Novel missense mutations in red/green opsin genes in congenital color-vision deficiencies

The DNAs from 217 Japanese males with congenital red/green color-vision deficiencies were analyzed. Twenty-three subjects had the normal genotype of a single red gene, followed by a green gene. Four of the 23 were from the 69 protan subject group and 19 of the 23 were from the 148 deutan subject group. Three of the 23 subjects had missense mutations. The mutation Asn94Lys (AAC-->AAA) occurred in the single green gene of a deutan subject (A155). The Arg330Gln (CGA-->CAA) mutation was detected in both green genes of another deutan subject (A164). The Gly338Glu (GGG-->GAG) mutation occurred in the single red gene of a protan subject (A89). Both normal and mutant opsins were expressed in cultured COS-7 cells and visual pigments were regenerated with 11-cis-retinal. The normal red and green opsins showed absorbance spectra with lambda(max) of 560 and 530 nm, respectively, but the three mutant opsins had altered spectra. The mutations in Asn94Lys and Gly338Glu resulted in no absorbance and the Arg330Gln mutation gave a low absorbance spectrum with a lambda(max) of 530 nm. Therefore these three mutant opsins are likely to be affected in the folding process, resulting in a loss of function as a visual pigment.

An A−71C substitution in a green gene at the second position in the red/green visual-pigment gene array is associated with deutan color-vision deficiency

We studied 247 Japanese males with congenital deutan color-vision deficiency and found that 37 subjects (15.0%) had a normal genotype of a single red gene followed by a green gene(s). Two of them had missense mutations in the green gene(s), but the other 35 subjects had no mutations in either the exons or their flanking introns. However, 32 of the 35 subjects, including all 8 subjects with pigment-color defect, a special category of deuteranomaly, had a nucleotide substitution, A−71C, in the promoter of a green gene at the second position in the red/green visual-pigment gene array. Although the −71C substitution was also present in color-normal Japanese males at a frequency of 24.3%, it was never at the second position but always found further downstream. The substitution was found in 19.4% of Chinese males and 7.7% of Thai males but rarely in Caucasians or African Americans. These results suggest that the A−71C substitution in the green gene at the second position is closely associated with deutan color-vision deficiency. In Japanese and presumably other Asian populations further downstream genes with −71C comprise a reservoir of the visual-pigment genes that cause deutan color-vision deficiency by unequal crossing over between the intergenic regions.

A Muscle Transposition Procedure for Abducens Palsy, in Which the Halves of the Vertical Rectus Muscle Bellies Are Sutured Onto the Sclera

PURPOSE To review the results of a muscle transposition procedure in which the halves of the vertical rectus muscle bellies are sutured onto the sclera, without tenotomy of vertical recti as in Hummelsheims procedure or surgical treatment of the lateral rectus (LR) as in Jensens procedure. METHODS Ten patients with abducens palsy received the procedure. We measured the ocular deviation and the field of single binocular vision, and observed the LR using magnetic resonance imaging (MRI). RESULTS Preoperative or postoperative deviation was distributed from +27 to +58 prism diopters (PD) or orthophoria to +12 PD, respectively, in 7 patients with unilateral paresis, and +75 to +120 PD or +2 to +37 PD in 3 patients with bilateral paresis. The average correction was 42.4 PD per eye. Seven patients were able to regain the field of single binocular vision at least in the primary position. No postoperative complications were observed. MRI showed that the LR was atrophic and floppy, lacking muscle tension. CONCLUSIONS Our procedure enabled the patients to obtain satisfactory postoperative results without treatment of the LR or tenotomy of the transposed muscles. This procedure can reduce operative damage to the eye more than Hummelsheims or Jensens procedure.

Analysis of L-cone/M-cone visual pigment gene arrays in females by long-range PCR.

The L-cone/M-cone visual pigment gene arrays were analyzed in a group of 63 Japanese females consisting of 7 applicants for examination of their carrier status, 14 color-deficient females, 6 obligate carriers with no genotypic data available for affected father or sons, and 36 color-normals. The first and the downstream genes, the entire region from the promoter to exon 6, were each amplified very efficiently by the long-range PCR to give products of 15.8 and 14.4 kb, respectively. The products were gel-purified and used as the template in the second PCR for exon 5. The region from intron 4 of the last genes, to the nearest neighbor gene, TEX28, was also efficiently amplified by the long-range PCR and the gel-purified products (27.5 kb) were used as the template in the second PCR for exon 5. The status of the 7 applicants was thought to be 3 non-carriers, 2 protan carriers and 2 deutan carriers. All of the 14 color-deficient females had unusual arrays in which an M gene was present as the first gene, an L gene(s) was present downstream, or a single L gene constituted both of the two arrays. One protanopic subject, A348, had an L gene as one of the first genes. The 6 obligate carriers also had unusual arrays with the exception of the mother of the A187, a male subject with pigment color defect. In the 36 color-normal individuals, 4 had downstream L genes. The long-range PCR method is useful for analysis of the L/M visual pigment genes.

A simple muscle transposition procedure for abducens palsy without tenotomy or splitting muscles.

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An insertion/deletion TEX28 polymorphism and its application to analysis of red/green visual pigment gene arrays

AbstractTEX28 gene (fTEX) is present immediately downstream of the red/green visual pigment gene array on the human X chromosome. Its pseudogene (pTEX) that lacks exon 1 is present within the array between pigment genes. We found that both fTEX and pTEX genes had a 697 bp insertion/deletion polymorphism in their introns 3. In color-normal male subjects, the frequency of the 697 bp region was 43% (40/94) in pTEX and 97% (91/94) in fTEX in the array of Red-pTEX-Green-fTEX and 10% (9/94) in pTEX and 87% (41/47) in fTEX in the array of Red-pTEX-Green-pTEX-Green-fTEX. These results suggest that normal arrays with multiple green genes may have arisen through gene duplication rather than unequal homologous crossover. In color-vision-deficient male subjects with a single-gene array, the frequency of the 697 bp region was 83% (25/30) in the array of Green-fTEX and 66% (74/112) in the array of Red-fTEX. In color-vision-deficient male subjects with a 2-gene array, the frequency of the region was 44% (16/36) in pTEX and 97% (35/36) in fTEX in the array of Green-pTEX-Green-fTEX and 75% (18/24) in pTEX and 92% (22/24) in fTEX in the array of Red-pTEX-Red-fTEX. These results suggest that 2-green-gene arrays have arisen through unequal homologous crossover between a normal 2-gene array and a single-green-gene array. With data from a long-range PCR method using the insertion/deletion polymorphism, we proposed a structure of the second gene of 3-gene arrays, Green-pTEX-Green-pTEX-Green-fTEX and Red-pTEX-Red-pTEX-Red-fTEX, in color-vision-deficient subjects.

Detection of female carriers of congenital color-vision deficiencies by visual pigment gene analysis.

Purpose. Congenital color-vision deficiencies are frequent among males, 4.7–8.0%, suggesting that female carriers are present at a frequency of 9–15%. The purpose of this study was to determine whether carriers could be detected by analysis of the visual pigment genes. Methods. DNA from 29 males with congenital color-vision deficiencies, from their mothers, and from 117 randomly-selected females was analyzed. The most upstream genes, the downstream genes, and the most downstream genes in the red/green pigment gene arrays were amplified separately by PCR. Exon 5 of each gene was analyzed by single-strand conformation polymorphisms (SSCP). Results. Analysis of the visual pigment genes suggests that one of the 29 mothers examined is a female protan and two others are carriers of both protan and deutan defects. The remaining 26 mothers were confirmed to be carriers of congenital color-vision deficiencies. Unusual patterns were observed in 15 (13%) of the randomly-selected females; among them, 5 appeared to be protan carriers and at least 4 to be deutan carriers. Conclusions. Female carriers of congenital color-vision deficiencies can be detected by analysis of the visual pigment genes. Since the proportion of females showing unusual patterns was slightly higher than expected, some must be false-positives and require more detailed examination.