Microspherophakic Angle Closure Glaucoma in a Patient with Coffin-Siris Syndrome: Case Report

Kulawan Rojananuangnit,1,* Kitiwan Rojnueangnit2,* 1Glaucoma Unit, Department of Ophthalmology, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand; 2Division of Genetics, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand*These authors contributed equally to this workCorrespondence: Kitiwan Rojnueangnit, Division of Genetics, Department of Pediatrics, Faculty of Medicine, Thammasat University, 99/209 Moo 18, Phahonyothin Road, Pathumthani, 12120, Thailand, Tel +66-2-926-9514, Fax +66-2-926-9513, Email rkitiwan@tu.ac.thBackground: Bilateral secondary angle closure glaucoma is a presenting symptom of microspherophakia and ectopia lentis. Characterizing the associated syndrome and confirmation by genetic testing can identify associated systemic abnormalities and provide appropriate genetic counseling.Case Presentation: A 42-year-old woman with severe intellectual disability presented with light perception visual acuity and glaucoma, with intraocular pressure (IOP) in her right and left eyes of 69 and 70 mmHg, respectively. She underwent two sessions of 270-degree laser diode transscleral cytophotocoagulation treatment at a 6-month interval and was prescribed topical anti-glaucoma medication. Her family noticed a progressive decrease in her vision while on treatment for 2 years. She was diagnosed with apparent Weill-Marchesani syndrome, accompanied by angle closure glaucoma and microspherophakia. Cataract surgery and intraocular lens implantation were successful in both eyes and post-operative IOP was controlled with anti-glaucoma medication but her vision did not improve from severe glaucomatous optic neuropathy. Her underlying syndrome was investigated genetically by whole exome sequencing.Results: Sequencing showed a pathogenic variant in ARID1B, c.3955dupC (p.Gln1319Profs*14), diagnostic of Coffin-Siris syndrome. This is the first report of Coffin-Siris syndrome associated with microspherophakia and angle closure glaucoma.Conclusion: Bilateral angle closure glaucoma from ectopia lentis in patients with genetic syndromes could be an indicator of microspherophakia in adulthood. Ophthalmological surveillance is important in patients with Coffin-Siris syndrome.Keywords: angle closure glaucoma, ARID1B, Coffin-Siris syndrome, ectopia lentis, intellectual disability, microspherophakia