Identification of a novel mutation in the PTCH gene in a patient with Gorlin-Goltz syndrome with unusual ocular disorders

摘要

Purpose. To document the clinical, functional, and in vivo microanatomic characteristics of a patientwith Gorlin-Goltz syndrome with a novel nonsense mutation in PTCH (patched).Methods. Optical coherence tomography (OCT), fluorescein angiography, electrophysiologic testing,visual field, magnetic resonance imaging, and mutation screening of PTCH gene.Results. Visual acuity was 20/20 in the right eye and 20/25 in the left. Fundus examination revealedmyelinated nerve fibers in the left eye and bilateral epiretinal membranes with lamellar macular holealso documented with macular OCT. A reduction of the retinal nerve fiber layers in both eyes was foundwith fiber nervous OCT. Fluorescein angiography showed bilaterally foveal hyperfluorescence and thevisual field revealed inferior hemianopia in the right eye. Pattern visual evoked potentials registered areduction of amplitude in both eyes and latency was delayed in the left eye. Pattern electroretinogramshowed a reduction in P50 and N95 peak time and a delay in P50 peak time in the left eye. Flash electroretinogramwas reduced in rod response, maximal response, and oscillatory potentials in both eyes.Cone response was normal and 30-Hz flicker was slightly reduced in both eyes. Mutation screeningidentified a novel nonsense mutation in PTCH.Conclusions. A novel nonsense mutation in the PTCH gene was found. We report the occurrence ofepiretinal membranes and the persistence of myelinated nerve fibers. Electrophysiologic and visualfield alterations, supporting a neuroretinal dysfunction, were also documented.