CLINICAL SCIENCE Progession of phenotype in Leber’s congenital amaurosis with a mutation at the LCA5 locus

Background: Leber’s congenital amaurosis (LCA) accounts for 5 % of inherited retinal disease and is usually inherited as an autosomal recessive trait. Genetic and clinical heterogeneity exist. Mutations have been described in the RPE65, CRB1, RPGRIP1, AIPL1, GUCY2D, and CRX genes and other pedi-grees show linkage to the LCA3 and LCA5 loci. The latter is a new locus which maps to 6q11-q16. The ocular findings and the evolution of the macula staphyloma are described in five members of a Paki-stani family with consanguinity and a mutation in the LCA5 gene. Methods: 13 family members including five affected individuals consented to DNA analysis and ocu-lar examination including fundal photography. Results: Ocular abnormalities are described. The most striking feature was the progression of macula abnormalities in three brothers resulting in a colobomatous appearance in the eldest compared to only mild atrophy in the youngest. The phenotypic pattern of this mutation in this Pakistani family contrasts with the “Old Order River Brethren ” who were of Swiss descent, in whom the mutation was first described. Conclusion: The evolution of a new phenotypic picture is presented to a mutation in LCA5. Leber’s congenital amaurosis (LCA) is the name ascribed to agroup of inherited retinal dystrophies representing thecommonest genetic cause of visual impairment in infant