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. 1985 Jan;69(1):63–75. doi: 10.1136/bjo.69.1.63

Retinal pathology in the Kearns-Sayre syndrome.

N M McKechnie, M King, W R Lee
PMCID: PMC1040525  PMID: 3965031

Abstract

Examination of the retinal tissues obtained at necropsy from a 14-year-old boy with Kearns-Sayre syndrome showed marked photoreceptor and pigment epithelial cell loss in the retinal periphery and around the optic nerve head. Electron microscopy of surviving retinal pigment epithelial (RPE) cells indicated a loss of apical microvilli and basal infoldings. The RPE was unusually devoid of melanosomes and showed no evidence of phagocytosis of photoreceptor debris. The cytoplasm of the RPE contained numerous, often enlarged, mitochondria. These structural changes suggested that a breakdown in the energy dependent interrelationships between the RPE and the photoreceptor layer was responsible for the outer retinal degeneration. The finding of numerous macrophages in the subretinal space suggests a secondary inflammatory component in the retinal degeneration.

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Selected References

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  1. Adachi M., Torii J., Volk B. W., Briet P., Wolintz A., Schneck L. Electron microscopic and enzyme histochemical studies of cerebellum, ocular and skeletal muscles in chronic progressive ophthalmoplegia with cerebellar ataxia. Acta Neuropathol. 1973;23(4):300–312. doi: 10.1007/BF00687459. [DOI] [PubMed] [Google Scholar]
  2. Bastiaensen L. A., Notermans S. L., Ramaekers C. H., van Dijke B. J., Joosten E. M., Jaspar H. H., Stadhouders A. M., Beljaars C. T. Kearns syndrome or Kearns disease. Further evidence of a genuine entity in a case with uncommon features. Ophthalmologica. 1982;184(1):40–50. doi: 10.1159/000309183. [DOI] [PubMed] [Google Scholar]
  3. Bastiaensen L. A. Pigment changes of the retina in chronic progressive external ophthalmoplegia (CPEO). Acta Ophthalmol Suppl. 1978;(138):5–36. doi: 10.1111/j.1755-3768.1978.tb06161.x. [DOI] [PubMed] [Google Scholar]
  4. Berenberg R. A., Pellock J. M., DiMauro S., Schotland D. L., Bonilla E., Eastwood A., Hays A., Vicale C. T., Behrens M., Chutorian A. Lumping or splitting? "Ophthalmoplegia-plus" or Kearns-Sayre syndrome? Ann Neurol. 1977 Jan;1(1):37–54. doi: 10.1002/ana.410010104. [DOI] [PubMed] [Google Scholar]
  5. Brinkman C. J., Pinckers A. J., Broekhuyse R. M. Immune reactivity to different retinal antigens in patients suffering from retinitis pigmentosa. Invest Ophthalmol Vis Sci. 1980 Jul;19(7):743–750. [PubMed] [Google Scholar]
  6. Castaigne P., Lhermitte F., Escourolle R., Chain F., Fardeau M., Hauw J. J., Curet J., Flavigny C. Etude anatomo-clinique d'une observation d' "ophtalmoplegia plus" avec analyse des lésions musculaires, nerveuses centrales, oculaires, myocardiques et thyroïdiennes. Rev Neurol (Paris) 1977 Jun-Jul;133(6-7):369–386. [PubMed] [Google Scholar]
  7. Corwin J. M., Weiter J. J. Immunology of chorioretinal disorders. Surv Ophthalmol. 1981 Mar-Apr;25(5):287–305. doi: 10.1016/0039-6257(81)90155-7. [DOI] [PubMed] [Google Scholar]
  8. Daroff R. B., Solitare G. B., Pincus J. H., Glaser G. H. Spongiform encephalopathy with chronic progressive external ophthalmoplegia. Central ophthalmoplegia mimicking ocular myopathy. Neurology. 1966 Feb;16(2):161–169. doi: 10.1212/wnl.16.2_part_1.161. [DOI] [PubMed] [Google Scholar]
  9. Drachman D. A. Ophthalmoplegia plus. The neurodegenerative disorders associated with progressive external ophthalmoplegia. Arch Neurol. 1968 Jun;18(6):654–674. doi: 10.1001/archneur.1968.00470360076008. [DOI] [PubMed] [Google Scholar]
  10. Eagle R. C., Jr, Hedges T. R., Yanoff M. The atypical pigmentary retinopathy of Kearns-Sayre syndrome. A light and electron microscopic study. Ophthalmology. 1982 Dec;89(12):1433–1440. doi: 10.1016/s0161-6420(82)34619-9. [DOI] [PubMed] [Google Scholar]
  11. François J. Metabolic tapetoretinal degenerations. Surv Ophthalmol. 1982 May-Jun;26(6):293–333. doi: 10.1016/0039-6257(82)90124-2. [DOI] [PubMed] [Google Scholar]
  12. Gonatas N. K. A generalized disorder of nervous system, skeletal muscle and heart resembling Refsum's disease and Hurler's syndrome. II. Ultrastructure. Am J Med. 1967 Feb;42(2):169–178. doi: 10.1016/0002-9343(67)90016-2. [DOI] [PubMed] [Google Scholar]
  13. Horwitz S. J., Roessmann U. Kearns-Sayre syndrome with hypoparathyroidism. Ann Neurol. 1978 Jun;3(6):513–518. doi: 10.1002/ana.410030611. [DOI] [PubMed] [Google Scholar]
  14. JAGER B. V., FRED H. L., BUTLER R. B., CARNES W. H. Occurrence of retinal pigmentation, ophthalmoplegia, ataxia, deafness and heart block. Report of a case, with findings at autopsy. Am J Med. 1960 Nov;29:888–893. doi: 10.1016/0002-9343(60)90122-4. [DOI] [PubMed] [Google Scholar]
  15. Johnson M. A., Turnbull D. M., Dick D. J., Sherratt H. S. A partial deficiency of cytochrome c oxidase in chronic progressive external ophthalmoplegia. J Neurol Sci. 1983 Jul;60(1):31–53. doi: 10.1016/0022-510x(83)90125-9. [DOI] [PubMed] [Google Scholar]
  16. KEARNS T. P., SAYRE G. P. Retinitis pigmentosa, external ophthalmophegia, and complete heart block: unusual syndrome with histologic study in one of two cases. AMA Arch Ophthalmol. 1958 Aug;60(2):280–289. [PubMed] [Google Scholar]
  17. Karpati G., Carpenter S., Larbrisseau A., Lafontaine R. The Kearns-Shy syndrome. A multisystem disease with mitochondrial abnormality demonstrated in skeletal muscle and skin. J Neurol Sci. 1973 Jun;19(2):133–151. doi: 10.1016/0022-510x(73)90158-5. [DOI] [PubMed] [Google Scholar]
  18. Kearns T. P. External Ophthalmoplegia, Pigmentary Degeneration of the Retina, and Cardiomyopathy: A Newly Recognized Syndrome. Trans Am Ophthalmol Soc. 1965;63:559–625. [PMC free article] [PubMed] [Google Scholar]
  19. Mitsumoto H., Aprille J. R., Wray S. H., Nemni R., Bradley W. G. Chronic progressive external ophthalmoplegia (CPEO): clinical, morphologic, and biochemical studies. Neurology. 1983 Apr;33(4):452–461. doi: 10.1212/wnl.33.4.452. [DOI] [PubMed] [Google Scholar]
  20. Morgan-Hughes J. A., Hayes D. J., Clark J. B., Landon D. N., Swash M., Stark R. J., Rudge P. Mitochondrial encephalomyopathies: biochemical studies in two cases revealing defects in the respiratory chain. Brain. 1982 Sep;105(Pt 3):553–582. doi: 10.1093/brain/105.3.553. [DOI] [PubMed] [Google Scholar]
  21. Reske-Nielsen E., Lou H. C., Lowes M. Progressive external ophthalmoplegia. Evidence for a generalised mitochondrial disease with a defect in pyruvate metabolism. Acta Ophthalmol (Copenh) 1976 Oct;54(5):553–573. doi: 10.1111/j.1755-3768.1976.tb01285.x. [DOI] [PubMed] [Google Scholar]
  22. Schneck L., Adachi M., Briet P., Wolintz A., Volk B. W. Ophthalmoplegia plus with morphological and chemical studies of cerebellar and muscle tissue. J Neurol Sci. 1973 May;19(1):37–44. doi: 10.1016/0022-510x(73)90054-3. [DOI] [PubMed] [Google Scholar]
  23. Silverstein S. C., Steinman R. M., Cohn Z. A. Endocytosis. Annu Rev Biochem. 1977;46:669–722. doi: 10.1146/annurev.bi.46.070177.003321. [DOI] [PubMed] [Google Scholar]

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