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# 137600

ANTERIOR SEGMENT DYSGENESIS 4; ASGD4


Alternative titles; symbols

IRIDOGONIODYSGENESIS, TYPE 2; IRID2
IRIDOGONIODYSGENESIS SYNDROME; IGDS
IRIS HYPOPLASIA WITH EARLY-ONSET GLAUCOMA, AUTOSOMAL DOMINANT; IHGA


Phenotype-Gene Relationships

Location Phenotype Phenotype
MIM number
Inheritance Phenotype
mapping key
Gene/Locus Gene/Locus
MIM number
4q25 Anterior segment dysgenesis 4 137600AD 3 PITX2 601542
Clinical Synopsis
 
Phenotypic Series
 

INHERITANCE
- Autosomal dominant[SNOMEDCT:771269000,263681008][UMLS:C0443147,C1867440 HPO:HP:0000006][HPO:HP:0000006]
HEAD & NECK
Face
- Midface hypoplasia (in 2 patients)[SNOMEDCT:1145312002][UMLS:C1853242 HPO:HP:0011800][HPO:HP:0011800]
- Mild prognathism (in 2 patients)[UMLS:C2675138][SNOMEDCT:109504005,22810007,72855002][ICD10CM:M26.213][ICD9CM:524.23][HPO:HP:0000303]
Eyes
- Iris hypoplasia[SNOMEDCT:95714006][UMLS:C0344539 HPO:HP:0007676][HPO:HP:0007676]
- Dark gray or brown eye color
- Glaucoma (in some patient)[SNOMEDCT:23986001][ICD10CM:H40.9,H40-H42,H40][ICD9CM:365.9,365][UMLS:C0997768,C0017601 HPO:HP:0000501][HPO:HP:0000501]
- Peters' anomaly (in 1 patient)[SNOMEDCT:204153003][ICD10CM:Q13.4][UMLS:C0344559 HPO:HP:0000659]
- Corneal ectasia (in 1 patient)[SNOMEDCT:14748007][ICD10CM:H18.71][ICD9CM:371.71][UMLS:C0155135]
- Anterior polar cataract (in 1 patient)[UMLS:C1855179 HPO:HP:0001134][HPO:HP:0001134]
Mouth
- Microdontia (in 2 patients)[SNOMEDCT:32337007][ICD10CM:K00.2][UMLS:C3891292,C0240340 HPO:HP:0000691][HPO:HP:0000691]
- Hypodontia (in 2 patients)[SNOMEDCT:64969001][ICD10CM:K00.0][UMLS:C0020608 HPO:HP:0000668][HPO:HP:0000668]
ABDOMEN
External Features
- Abnormal umbilical skin
MISCELLANEOUS
- Age of diagnosis of glaucoma ranged from 13-52 years (mean age 25)
- Based on reports of a patient and a large Scandinavian family
MOLECULAR BASIS
- Caused by mutation in the paired-like homeodomain transcription factor-2 gene (PITX2,601542.0007)

TEXT

A number sign (#) is used with this entry because of evidence that anterior segment dysgenesis-4 (ASGD4) is caused by heterozygous mutation in the PITX2 gene (601542) on chromosome 4q25.


Description

Anterior segment dysgeneses (ASGD or ASMD) are a heterogeneous group of developmental disorders affecting the anterior segment of the eye, including the cornea, iris, lens, trabecular meshwork, and Schlemm canal. The clinical features of ASGD include iris hypoplasia, an enlarged or reduced corneal diameter, corneal vascularization and opacity, posterior embryotoxon, corectopia, polycoria, an abnormal iridocorneal angle, ectopia lentis, and anterior synechiae between the iris and posterior corneal surface (summary byCheong et al., 2016).

Anterior segment dysgenesis is sometimes divided into subtypes including aniridia (see106210), Axenfeld and Rieger anomalies, iridogoniodysgenesis, Peters anomaly, and posterior embryotoxon (Gould and John, 2002).

Patients with ASGD4 have been reported with iridogoniodysgenesis or Peters anomaly subtypes.

Iridogoniodysgenesis, which is characterized by iris hypoplasia, goniodysgenesis, and juvenile glaucoma, is the result of aberrant migration or terminal induction of the neural crest cells involved in the formation of the anterior segment of the eye (summary byMears et al., 1996).

Peters anomaly consists of a central corneal leukoma, absence of the posterior corneal stroma and Descemet membrane, and a variable degree of iris and lenticular attachments to the central aspect of the posterior cornea (Peters, 1906).


Clinical Features

Berg (1932) described 22 affected individuals in 6 generations.McCulloch (1950) described 18 affected in 5 generations.Weatherill and Hart (1969) observed glaucoma in many members of 5 generations. Not only is the stroma of the iris hypoplastic but the iris is also light in color, a feature that antedates development of glaucoma and permits recognition of affected persons at birth. Jerndal (1970,1972) updated theBerg (1932) pedigree.Jerndal (1983) presented 3 pedigrees in which autosomal dominant glaucoma was shown to be the result of goniodysgenesis. The author suggested that it is improper to classify glaucoma on the basis of age of onset, which can be highly variable. In all 3 pedigrees, glaucoma was congenital in some and as late as age 34, 46, and 68 in others.

The disorder reported byWeatherill and Hart (1969),Jerndal (1970), andPearce et al. (1983) might be referred to as autosomal dominant iris hypoplasia associated with early-onset glaucoma. The term iridogoniodysgenesis has the virtue of correctly emphasizing the maldevelopment of the trabecular meshwork as well as the iris. The pathogenesis of the condition is thought to involve abnormal differentiation of neural crest cells.

Heon et al. (1995) described an extensively affected family of Scandinavian descent in which iris hypoplasia was found in 15 members, 9 of whom had associated glaucoma. Almost all affected individuals had a peculiar eye color (slate gray or chocolate brown) that resulted from the pigmented iris epithelium showing through the markedly hypoplastic anterior iris stroma. The normal pupillary sphincter stood out as an elevated tan-colored ring against a rather featureless background. Glaucoma usually was detected in the second decade of life but might begin at any age; when it did develop, it tended to be resistant to medical therapy, and if left untreated, total blindness could result.


Mapping

In a Scandinavian family segregating iris hypoplasia,Heon et al. (1995) found linkage of the disorder to chromosome 4q25.


Inheritance

The transmission pattern of iris hypoplasia in the family reported byAlward et al. (1998) was consistent with autosomal dominant inheritance.


Molecular Genetics

In the family with autosomal dominant iris hypoplasia with early-onset glaucoma reported byHeon et al. (1995),Alward et al. (1998) identified heterozygosity for a mutation in the PITX2 gene (601542.0007).

Kulak et al. (1998) demonstrated mutation in the PITX2 gene in a family with iridogoniodysgenesis (601542.0008).

In a child with Peters anomaly,Doward et al. (1999) identified a heterozygous splice site mutation in the PITX2 gene (601542.0009).


REFERENCES

  1. Alward, W. L. M., Semina, E. V., Kalenak, J. W., Heon, E., Sheth, B. P., Stone, E. M., Murray, J. C.Autosomal dominant iris hypoplasia is caused by a mutation in the Rieger syndrome (RIEG/PITX2) gene. Am. J. Ophthal. 125: 98-100, 1998. [PubMed:9437321,related citations] [Full Text]

  2. Berg, F.Erbliches jugendliches Glaukom. Acta Ophthal. 10: 568-587, 1932.

  3. Cheong, S.-S., Hentschel, L., Davidson, A. E., Gerrelli, D., Davie, R., Rizzo, R., Pontikos, N., Plagnol, V., Moore, A. T., Sowden, J. C., Michaelides, M., Snead, M., Tuft, S. J., Hardcastle, A. J.Mutations in CPAMD8 cause a unique form of autosomal-recessive anterior segment dysgenesis. Am. J. Hum. Genet. 99: 1338-1352, 2016. [PubMed:27839872,images,related citations] [Full Text]

  4. Doward, W., Perveen, R., Lloyd, I. C., Ridgway, A. E. A., Wilson, L., Black, G. C. M.A mutation in the RIEG1 gene associated with Peters' anomaly. J. Med. Genet. 36: 152-155, 1999. [PubMed:10051017,related citations]

  5. Gould, D. B., John, S. W. M.Anterior segment dysgenesis and the development glaucomas are complex traits. Hum. Molec. Genet. 11: 1185-1193, 2002. [PubMed:12015278,related citations] [Full Text]

  6. Heon, E., Sheth, B. P., Kalenak, J. W., Sunden, S. L. F., Streb, L. M., Taylor, C. M., Alward, W. L. M., Sheffield, V. C., Stone, E. M.Linkage of autosomal dominant iris hypoplasia to the region of the Rieger syndrome locus (4q25). Hum. Molec. Genet. 4: 1435-1439, 1995. [PubMed:7581385,related citations] [Full Text]

  7. Jerndal, T.Goniodysgenesis and hereditary juvenile glaucoma: a clinical study of a Swedish pedigree. Acta Ophthal. Suppl. 107: 3-100, 1970. [PubMed:4320190,related citations]

  8. Jerndal, T.Dominant goniodysgenesis with late congenital glaucoma: a re-examination of Berg's pedigree. Am. J. Ophthal. 74: 28-34, 1972. [PubMed:4624765,related citations] [Full Text]

  9. Jerndal, T.Congenital glaucoma due to dominant goniodysgenesis: a new concept of the heredity of glaucoma. Am. J. Hum. Genet. 35: 645-651, 1983. [PubMed:6881141,related citations]

  10. Kulak, S. C., Kozlowski, K., Semina, E. V., Pearce, W. G., Walter, M. A.Mutation in the RIEG1 gene in patients with iridogoniodysgenesis syndrome. Hum. Molec. Genet. 7: 1113-1117, 1998. [PubMed:9618168,related citations] [Full Text]

  11. McCulloch, J. C.Iridoschisis as a cause of glaucoma. Am. J. Ophthal. 33: 1398-1400, 1950. [PubMed:14771214,related citations] [Full Text]

  12. Mears, A. J., Mirzayans, F., Gould, D. B., Pearce, W. G., Walter, M. A.Autosomal dominant iridogoniodysgenesis anomaly maps to 6p25. Am. J. Hum. Genet. 59: 1321-1327, 1996. [PubMed:8940278,related citations]

  13. Pearce, W. G., Wyatt, H. T., Boyd, T. A., Ombres, R. S., Salter, A. B.Autosomal dominant iridogoniodysgenesis: genetic features. Canad. J. Ophthal. 18: 7-10, 1983. [PubMed:6839205,related citations]

  14. Peters, A.Ueber angeborene Defektbildung der Descemetschen Membran. Klin. Monatsbl. Augenheilkd. 44: 27-40 and 105-119, 1906.

  15. Weatherill, J. R., Hart, C. T.Familial hypoplasia of the iris stroma associated with glaucoma. Brit. J. Ophthal. 53: 433-438, 1969. [PubMed:5804028,related citations] [Full Text]


Carol A. Bocchini - updated : 01/26/2017
Marla J. F. O'Neill - updated : 10/9/2009
Marla J. F. O'Neill - updated : 3/3/2009
Victor A. McKusick - updated : 7/9/1998
Victor A. McKusick - updated : 3/30/1998
Victor A. McKusick - updated : 5/16/1997
Creation Date:
Victor A. McKusick : 6/4/1986
carol : 08/31/2023
carol : 07/25/2023
carol : 07/24/2023
alopez : 07/21/2023
carol : 01/31/2017
carol : 01/26/2017
carol : 05/24/2016
wwang : 10/9/2009
terry : 10/9/2009
carol : 3/3/2009
carol : 7/18/2007
carol : 8/5/2005
tkritzer : 8/6/2004
terry : 7/30/2004
carol : 7/13/1998
terry : 7/9/1998
terry : 5/20/1998
alopez : 3/30/1998
terry : 3/25/1998
terry : 3/25/1998
alopez : 3/10/1998
joanna : 1/7/1998
alopez : 5/20/1997
terry : 5/16/1997
jamie : 1/15/1997
terry : 1/7/1997
terry : 9/11/1995
mark : 9/7/1995
mimadm : 9/24/1994
davew : 6/28/1994
carol : 3/26/1993
supermim : 3/16/1992

# 137600

ANTERIOR SEGMENT DYSGENESIS 4; ASGD4


Alternative titles; symbols

IRIDOGONIODYSGENESIS, TYPE 2; IRID2
IRIDOGONIODYSGENESIS SYNDROME; IGDS
IRIS HYPOPLASIA WITH EARLY-ONSET GLAUCOMA, AUTOSOMAL DOMINANT; IHGA


ORPHA: 91483;  DO: 0080609;  MONDO: 0007662;  


Phenotype-Gene Relationships

Location Phenotype Phenotype
MIM number
Inheritance Phenotype
mapping key
Gene/Locus Gene/Locus
MIM number
4q25 Anterior segment dysgenesis 4 137600 Autosomal dominant 3 PITX2 601542

TEXT

A number sign (#) is used with this entry because of evidence that anterior segment dysgenesis-4 (ASGD4) is caused by heterozygous mutation in the PITX2 gene (601542) on chromosome 4q25.


Description

Anterior segment dysgeneses (ASGD or ASMD) are a heterogeneous group of developmental disorders affecting the anterior segment of the eye, including the cornea, iris, lens, trabecular meshwork, and Schlemm canal. The clinical features of ASGD include iris hypoplasia, an enlarged or reduced corneal diameter, corneal vascularization and opacity, posterior embryotoxon, corectopia, polycoria, an abnormal iridocorneal angle, ectopia lentis, and anterior synechiae between the iris and posterior corneal surface (summary by Cheong et al., 2016).

Anterior segment dysgenesis is sometimes divided into subtypes including aniridia (see 106210), Axenfeld and Rieger anomalies, iridogoniodysgenesis, Peters anomaly, and posterior embryotoxon (Gould and John, 2002).

Patients with ASGD4 have been reported with iridogoniodysgenesis or Peters anomaly subtypes.

Iridogoniodysgenesis, which is characterized by iris hypoplasia, goniodysgenesis, and juvenile glaucoma, is the result of aberrant migration or terminal induction of the neural crest cells involved in the formation of the anterior segment of the eye (summary by Mears et al., 1996).

Peters anomaly consists of a central corneal leukoma, absence of the posterior corneal stroma and Descemet membrane, and a variable degree of iris and lenticular attachments to the central aspect of the posterior cornea (Peters, 1906).


Clinical Features

Berg (1932) described 22 affected individuals in 6 generations. McCulloch (1950) described 18 affected in 5 generations. Weatherill and Hart (1969) observed glaucoma in many members of 5 generations. Not only is the stroma of the iris hypoplastic but the iris is also light in color, a feature that antedates development of glaucoma and permits recognition of affected persons at birth. Jerndal (1970, 1972) updated the Berg (1932) pedigree. Jerndal (1983) presented 3 pedigrees in which autosomal dominant glaucoma was shown to be the result of goniodysgenesis. The author suggested that it is improper to classify glaucoma on the basis of age of onset, which can be highly variable. In all 3 pedigrees, glaucoma was congenital in some and as late as age 34, 46, and 68 in others.

The disorder reported by Weatherill and Hart (1969), Jerndal (1970), and Pearce et al. (1983) might be referred to as autosomal dominant iris hypoplasia associated with early-onset glaucoma. The term iridogoniodysgenesis has the virtue of correctly emphasizing the maldevelopment of the trabecular meshwork as well as the iris. The pathogenesis of the condition is thought to involve abnormal differentiation of neural crest cells.

Heon et al. (1995) described an extensively affected family of Scandinavian descent in which iris hypoplasia was found in 15 members, 9 of whom had associated glaucoma. Almost all affected individuals had a peculiar eye color (slate gray or chocolate brown) that resulted from the pigmented iris epithelium showing through the markedly hypoplastic anterior iris stroma. The normal pupillary sphincter stood out as an elevated tan-colored ring against a rather featureless background. Glaucoma usually was detected in the second decade of life but might begin at any age; when it did develop, it tended to be resistant to medical therapy, and if left untreated, total blindness could result.


Mapping

In a Scandinavian family segregating iris hypoplasia, Heon et al. (1995) found linkage of the disorder to chromosome 4q25.


Inheritance

The transmission pattern of iris hypoplasia in the family reported by Alward et al. (1998) was consistent with autosomal dominant inheritance.


Molecular Genetics

In the family with autosomal dominant iris hypoplasia with early-onset glaucoma reported by Heon et al. (1995), Alward et al. (1998) identified heterozygosity for a mutation in the PITX2 gene (601542.0007).

Kulak et al. (1998) demonstrated mutation in the PITX2 gene in a family with iridogoniodysgenesis (601542.0008).

In a child with Peters anomaly, Doward et al. (1999) identified a heterozygous splice site mutation in the PITX2 gene (601542.0009).


REFERENCES

  1. Alward, W. L. M., Semina, E. V., Kalenak, J. W., Heon, E., Sheth, B. P., Stone, E. M., Murray, J. C.Autosomal dominant iris hypoplasia is caused by a mutation in the Rieger syndrome (RIEG/PITX2) gene. Am. J. Ophthal. 125: 98-100, 1998. [PubMed: 9437321] [Full Text: https://doi.org/10.1016/s0002-9394(99)80242-6]

  2. Berg, F.Erbliches jugendliches Glaukom. Acta Ophthal. 10: 568-587, 1932.

  3. Cheong, S.-S., Hentschel, L., Davidson, A. E., Gerrelli, D., Davie, R., Rizzo, R., Pontikos, N., Plagnol, V., Moore, A. T., Sowden, J. C., Michaelides, M., Snead, M., Tuft, S. J., Hardcastle, A. J.Mutations in CPAMD8 cause a unique form of autosomal-recessive anterior segment dysgenesis. Am. J. Hum. Genet. 99: 1338-1352, 2016. [PubMed: 27839872] [Full Text: https://doi.org/10.1016/j.ajhg.2016.09.022]

  4. Doward, W., Perveen, R., Lloyd, I. C., Ridgway, A. E. A., Wilson, L., Black, G. C. M.A mutation in the RIEG1 gene associated with Peters' anomaly. J. Med. Genet. 36: 152-155, 1999. [PubMed: 10051017]

  5. Gould, D. B., John, S. W. M.Anterior segment dysgenesis and the development glaucomas are complex traits. Hum. Molec. Genet. 11: 1185-1193, 2002. [PubMed: 12015278] [Full Text: https://doi.org/10.1093/hmg/11.10.1185]

  6. Heon, E., Sheth, B. P., Kalenak, J. W., Sunden, S. L. F., Streb, L. M., Taylor, C. M., Alward, W. L. M., Sheffield, V. C., Stone, E. M.Linkage of autosomal dominant iris hypoplasia to the region of the Rieger syndrome locus (4q25). Hum. Molec. Genet. 4: 1435-1439, 1995. [PubMed: 7581385] [Full Text: https://doi.org/10.1093/hmg/4.8.1435]

  7. Jerndal, T.Goniodysgenesis and hereditary juvenile glaucoma: a clinical study of a Swedish pedigree. Acta Ophthal. Suppl. 107: 3-100, 1970. [PubMed: 4320190]

  8. Jerndal, T.Dominant goniodysgenesis with late congenital glaucoma: a re-examination of Berg's pedigree. Am. J. Ophthal. 74: 28-34, 1972. [PubMed: 4624765] [Full Text: https://doi.org/10.1016/0002-9394(72)91121-x]

  9. Jerndal, T.Congenital glaucoma due to dominant goniodysgenesis: a new concept of the heredity of glaucoma. Am. J. Hum. Genet. 35: 645-651, 1983. [PubMed: 6881141]

  10. Kulak, S. C., Kozlowski, K., Semina, E. V., Pearce, W. G., Walter, M. A.Mutation in the RIEG1 gene in patients with iridogoniodysgenesis syndrome. Hum. Molec. Genet. 7: 1113-1117, 1998. [PubMed: 9618168] [Full Text: https://doi.org/10.1093/hmg/7.7.1113]

  11. McCulloch, J. C.Iridoschisis as a cause of glaucoma. Am. J. Ophthal. 33: 1398-1400, 1950. [PubMed: 14771214] [Full Text: https://doi.org/10.1016/0002-9394(50)91835-6]

  12. Mears, A. J., Mirzayans, F., Gould, D. B., Pearce, W. G., Walter, M. A.Autosomal dominant iridogoniodysgenesis anomaly maps to 6p25. Am. J. Hum. Genet. 59: 1321-1327, 1996. [PubMed: 8940278]

  13. Pearce, W. G., Wyatt, H. T., Boyd, T. A., Ombres, R. S., Salter, A. B.Autosomal dominant iridogoniodysgenesis: genetic features. Canad. J. Ophthal. 18: 7-10, 1983. [PubMed: 6839205]

  14. Peters, A.Ueber angeborene Defektbildung der Descemetschen Membran. Klin. Monatsbl. Augenheilkd. 44: 27-40 and 105-119, 1906.

  15. Weatherill, J. R., Hart, C. T.Familial hypoplasia of the iris stroma associated with glaucoma. Brit. J. Ophthal. 53: 433-438, 1969. [PubMed: 5804028] [Full Text: https://doi.org/10.1136/bjo.53.7.433]


Contributors:
Carol A. Bocchini - updated : 01/26/2017
Marla J. F. O'Neill - updated : 10/9/2009
Marla J. F. O'Neill - updated : 3/3/2009
Victor A. McKusick - updated : 7/9/1998
Victor A. McKusick - updated : 3/30/1998
Victor A. McKusick - updated : 5/16/1997

Creation Date:
Victor A. McKusick : 6/4/1986

Edit History:
carol : 08/31/2023
carol : 07/25/2023
carol : 07/24/2023
alopez : 07/21/2023
carol : 01/31/2017
carol : 01/26/2017
carol : 05/24/2016
wwang : 10/9/2009
terry : 10/9/2009
carol : 3/3/2009
carol : 7/18/2007
carol : 8/5/2005
tkritzer : 8/6/2004
terry : 7/30/2004
carol : 7/13/1998
terry : 7/9/1998
terry : 5/20/1998
alopez : 3/30/1998
terry : 3/25/1998
terry : 3/25/1998
alopez : 3/10/1998
joanna : 1/7/1998
alopez : 5/20/1997
terry : 5/16/1997
jamie : 1/15/1997
terry : 1/7/1997
terry : 9/11/1995
mark : 9/7/1995
mimadm : 9/24/1994
davew : 6/28/1994
carol : 3/26/1993
supermim : 3/16/1992



NOTE: OMIM is intended for use primarily by physicians and other professionals concerned with genetic disorders, by genetics researchers, and by advanced students in science and medicine. While the OMIM database is open to the public, users seeking information about a personal medical or genetic condition are urged to consult with a qualified physician for diagnosis and for answers to personal questions.
OMIM® and Online Mendelian Inheritance in Man® are registered trademarks of the Johns Hopkins University.
Copyright® 1966-2026 Johns Hopkins University.

NOTE: OMIM is intended for use primarily by physicians and other professionals concerned with genetic disorders, by genetics researchers, and by advanced students in science and medicine. While the OMIM database is open to the public, users seeking information about a personal medical or genetic condition are urged to consult with a qualified physician for diagnosis and for answers to personal questions.
OMIM® and Online Mendelian Inheritance in Man® are registered trademarks of the Johns Hopkins University.
Copyright® 1966-2026 Johns Hopkins University.
Printed: Feb. 20, 2026

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