β-Thalassemia and ocular implications: a systematic review

BMC Ophthalmology

Research Article

Petros Petrou¹  Dimitris Papaconstantinou¹  Ilias Georgalas¹  Aliki Liaska¹  Constantinos D. Georgakopoulos¹  Menelaos G. Kanakis¹  Ramza Diamanti¹ 

[1] 1st Department of Ophthalmology, Athens University, Mesogeion 154, 11527, Athens, Greece;

关键词: Retinal Pigment Epithelium;    Thalassemia;    Serum Ferritin Level;    Choroidal Thickness;    Polypoidal Choroidal Vasculopathy;   

DOI  :  10.1186/s12886-016-0285-2

 received in 2016-02-09, accepted in 2016-06-13,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundBeta-thalassemia is a severe genetic blood disorder caused by a mutation in the gene encoding for the beta chains of hemoglobin. Individuals with beta-thalassemia major require regular lifelong Red Blood Cell transfusions to survive. Ocular involvement is quite common and may have serious implications.MethodsExtensive review of observational studies on beta-thalassemia, to determine the prevalence and spectrum of ocular abnormalities, by clinical examination and multimodal imaging, and to investigate risk factors for their development.ResultsFrequency of ocular involvement differs among various studies (41.3–85 %, three studies). Ocular findings in beta-thalassemia may correlate to the disease itself, iron overload or the chelating agents used. Beta-thalassemia ocular manifestations include ocular surface disease, as demonstrated by tear function parameters (two studies). Lens opacities are present in 9.3–44 % (five studies). Lenticular opacities and RPE degeneration correlated positively with use of desferrioxamine and deferriprone respectively (two studies). Ocular fundus abnormalities characteristic of pseudoxanthoma elasticum (PXE), including peau d’orange, angioid streaks, pattern dystrophy-like changes, and optic disc drusen are a consistent finding in seven studies. Patients with PXE-like fundus changes were older than patients without these fundus changes (two studies). Age (two studies) and splenectomy (one study) had the strongest association with presence of PXE-like fundus changes. Increased retinal vascular tortuosity independently of the PXE-like fundus changes was found in 11–17.9 % (three studies), which was associated with aspartate amino transferase, hemoglobin and ferritin levels (two studies). Fundus autofluorescence and electrophysiological testing (ERG and EOG) may indicate initial stages or more widespread injury than is suggested by fundus examination (two studies).ConclusionsBeta-thalassemia may present with various signs, both structural and functional. Pseudoxanthoma elasticum like fundus changes are a frequent finding in patients with b-thalassemia. These changes increase with duration or severity of the disease. Retinal vascular tortuosity may be an additional disease manifestation related to the severity and duration of anemia and independent of the PXE-like syndrome. Patients with long-standing disease need regular ophthalmic checkups because they are at risk of developing PXE-like fundus changes and potentially of subsequent choroidal neovascularization.

【 授权许可】

CC BY   
© The Author(s). 2016