Resumen
Objetivo: Describir el diagnóstico tardío de un caso de Síndrome de Usher (SU), analizar las manifestaciones clínicas y clasificar la enfermedad mediante hallazgos oftalmológicos, además de compararlos con la literatura actual. Detalles del caso: G.A.S, una mujer de 32 años, acudió a la consulta quejándose de agudeza visual (AV) baja con empeoramiento de la visión nocturna. Tenía LUPUS, dislipidemia por hipertensión arterial sistémica, hipoacusia neurosensorial mediante dispositivo, cirugías oculares previas, faco + lio en 2009 y 2016. En el examen AV 20/50 en el ojo derecho (OD) y 20/60 en el ojo izquierdo (OI) con lentes correctoras, tonometría de 10 mmhg de OD y 13 mmhg de OI, biomicroscopía sin cambios en ambos ojos (AO). En la campimetría presentó pérdida de Campo Visual (CV) periférico en AO. La funduscopia mostró discos ópticos pálidos, estrechamiento vascular y picos óseos en la AO. Consideraciones finales: La SU se caracteriza por la asociación de Retinosis Pigmentosa (RP) y sordera congénita, parcial o total. Es una enfermedad autosómica, heredada de forma recesiva. Los hallazgos clínicos, junto con los exámenes complementarios, respaldaron el diagnóstico de PR y SU subtipo 2. El diagnóstico precoz permitiría intervenciones que modificarían el curso de la enfermedad y así reducir los daños futuros a la salud del paciente.
Referencias
BLANCO-KELLY F, et al. Clinical aspects of Usher syndrome and the USH2A gene in a cohort of 433 patients. Journal American Medical Association Ophthalmology, 2015; 133: 157–164.
BONNET C, El-AMRAOUI A. Usher syndrome (sensorineural deafness and retinitis pigmentosa): pathogenesis, molecular diagnosis and therapeutic approaches. Curr Opin Neurol., 2012; 25(1): 42-9.
BUCHAIM G, et al. Implante intravítreo de liberação crônica de dexametasona (Ozurdex ®) para o tratamento de edema macular por retinose pigmentar: relato de caso. Arq Bras Oftalmol., 2013; 76(6): 377-9.
DAD S, et al. Usher syndrome in Denmark: mutation spectrum and some clinical observations. Mol Genet Genomic Med, 2016; 4: 527–539.
DJILAS M, et al. Three-dimensional electrode arrays for retinal prostheses: modeling, geometry optimization and experimental validation. J Neural Eng., 2011; 8(4).
FISHMAN GA, et al. Usher’s syndrome. Ophthalmic and neuro-otologic findings suggesting genetic heterogeneity. Arch Ophthalmol, 1983; 101: 1367-74.
FRIEDMAN TB, et al. Usher Syndrome: Hearing Loss with Vision Loss. Adv Otorhinolaryngol, 2011; 70: 56-65.
GENEAD MA, FISHMAN GA. Efficacy of sustained topical dorzolamide therapy for cystic macular lesions in patients with retinitis pigmentosa and Usher syndrome. Arch Ophthalmol., 2010; 128(9): 1146-50.
HARTEL BP, et al. Cochlear implantation in patients with Usher syndrome type IIa increases performance and quality of life. Otol Neurotol, 2017; 38: e120–e127.
HARTONG DT, et al. Retinitis Pigmentosa. Lancet. 2006; 368(9549): 1795-809.
JOURET G, et al. Genetics os Usher Syndrome: New Insights From a Metaanalysis. Otol Neurotol., 2019; 40(1): 121-9.
LE QUESNE STABEJ P, et al. Comprehensive sequence analysis of nine Usher syndrome genes in the UK National Collaborative Usher Study. J Med Genet, 2012; 49: 27–36.
MAGLIULO G, et al. Usher’s syndrome type II: a comparative study of genetic mutations and vestibular system evaluation. Otolaryngol Head Neck Surg, 2017; 157: 853–860.
MARAZITA ML, et al. Genetic epidemiologic studies of early-onset deafness in the United States school-age population. Am J Med Genet, 1993; 46: 486–491.
MATHEUS RJ, et al. Ocular manifestations and conduct in Usher Syndrome. eOftalmo., 2021;7(1):25-30.
MENDIETA L, et al. Acuidade visual e eletrorretinografia de campo total em pacientes com síndrome de Usher. Arq Bras Oftalmol., 2005; 68(2):171-6.
MEYER JS, et al. Embryonic stem cell-derived neural progenitors incorporate into degenerating retina and enhance survival of host photoreceptors. Stem Cells., 2006; 24(2): 274-83.
MILLAN JM, et al. An update on the genetics of Usher syndrome. J Ophthalmol, 2011; 417217.
PIETOLA L, et al. Speech recognition and communication outcomes with cochlear implantation in Usher syndrome type 3. Otol Neurotol, 2012; 33: 38–41.
REINERS J, et al. Molecular basis of human Usher syndrome: deciphering the meshes of the Usher protein network provides insights into the pathomechanisms of the Usher disease. Exp Eye Res, 2006; 83: 97–119.
REISSER CF, et al. Hearing loss in Usher syndrome type II is nonprogressive. Ann Otol Rhinol Laryngol, 2002; 111: 1108–1111.
SADEGHI M, et al. Audiological findings in Usher syndrome types IIa and II (non-IIa). Int J Audiol, 2004; 43: 136–143.
SEILER MJ, ARAMANT RB. Transplantation of neuroblastic progenitor cells as a sheet preserves and restores retinal function. Semin Ophthalmol., 2005; 20(1): 31-42.
TOMS M, et al. Usher syndrome: clinical features, molecular genetics and advancing therapeutics. Ther Adv Ophthalmol, 2020; 12: 25-52.
USHER C. On the inheritance of retinis pigmentosa, with notes of cases. Royal London Ophtalmol Hosp Rep., 1914; 19: 130–236.
VON GRAFFE A. Vereizelle Beobachtungen und bemerkungen-Exceptionnelles verhaller des Gesichts feldes bei Pigmentenarter der Netzhalt. Arch Klin Ophtalmol. 1858; 4: 250–3.
WALIA S, et al: Prevalence of cystic macular lesions in patients with Usher II syndrome. Eye (Lond), 2009; 23: 1206–1209.
ZOU J, et al. Whirlin replacement restores the formation of the USH2 protein complex in whirlin knockout photoreceptors. Invest Ophthalmol Vis Sci., 2011; 52(5): 2343-51.
ZRENNER E, et al. Subretinal electronic chips allow blind patients to read letters and combine them to words. Proc Biol Sci., 2011; 278(1711): 1489-97.
