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Meyer KJ, Mercer HE, Roos BR, Fingert JH, Anderson MG. Minimal phenotypes in transgenic mice with the human LOXL1/LOXL1-AS1 locus associated with exfoliation glaucoma. Vision Res 2024; 223:108464. [PMID: 39151208 PMCID: PMC11381136 DOI: 10.1016/j.visres.2024.108464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 08/18/2024]
Abstract
Exfoliation syndrome is a leading cause of secondary glaucoma worldwide. Among the risk-factors for exfoliation syndrome and exfoliation glaucoma that have been investigated, a genetic association with 15q24.1 is among the most striking. The leading candidates for the causal gene at this locus are LOXL1 and/or LOXL1-AS1, but studies have not yet coalesced in establishing, or ruling out, either candidate. Here, we contribute to studies of the 15q24.1 locus by making a partially humanized mouse model in which 166 kb of human genomic DNA from the 15q24.1 locus was introduced into the mouse genome via BAC transgenesis (B6-Tg(RP11-71M11)Andm). Transgenic expression of human genes in the BAC was only detectable for LOXL1-AS1. One cohort of 34 mice (21 experimental hemizygotes and 13 non-carrier control littermates) was assessed by slit-lamp exams and SD-OCT imaging at early (1-2 months) and mid (4-5 months) time points; fundus exams were performed at 5 months of age. A second smaller cohort (3 hemizygotes) were aged extensively (>12 months) to screen for overt abnormalities. Across all genotypes and ages, 136 slit-lamp exams, 128 SD-OCT exams, and 42 fundus exams detected no overt indices of exfoliation syndrome. Quantitatively, small, but statistically significant, age-related declines in ganglion cell complex thickness and total retinal thickness were detected in the hemizygotes at 4 months of age. Overall, this study demonstrates complexity in gene regulation from the 15q24.1 locus and suggests that LOXL1-AS1 is unlikely to be a monogenic cause of exfoliation syndrome but may contribute to glaucomatous retinal damage.
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Affiliation(s)
- Kacie J Meyer
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States; Institute for Vision Research, University of Iowa, Iowa City, IA, United States
| | - Hannah E Mercer
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States; Institute for Vision Research, University of Iowa, Iowa City, IA, United States
| | - Ben R Roos
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States; Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States
| | - John H Fingert
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States; Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States
| | - Michael G Anderson
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States; Institute for Vision Research, University of Iowa, Iowa City, IA, United States; Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States; Center for the Prevention and Treatment of Visual Loss, Iowa City VA Health Care System, Iowa City, IA, United States.
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Patil VR, Vallabha K, Wali K. Systemic Vascular Parameters in Ocular Pseudoexfoliation. Cureus 2024; 16:e62933. [PMID: 39050290 PMCID: PMC11265965 DOI: 10.7759/cureus.62933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/22/2024] [Indexed: 07/27/2024] Open
Abstract
Background Pseudoexfoliation syndrome (PEX) is characterized by a dandruff-like substance in the anterior chamber, composed of various glycoproteins that have an unclear origin. Its deposition is observed on the pupillary margin, lens zonules, and trabecular meshwork. Proteomic studies have identified numerous proteins in the affected individuals, suggesting associations with systemic conditions like heart disease, stroke, and Alzheimer's disease. However, the systemic associations of PEX remain inconclusive, particularly in regions like southern India. Materials and methods A cross-sectional study was conducted on 114 participants. Pseudoexfoliation was graded as mild, moderate, and severe as per standard photographic grading. Systemic examinations included blood pressure measurements, electrocardiography (ECG), and blood investigations for serum lipid profile, fasting and postprandial blood sugar levels, and serum C-reactive protein levels. Small incision cataract surgery was performed for all the patients. Intraoperative complications and postoperative status were recorded. Results Thirty-eight patients (33.3%) had mild PEX, 44 (38.6%) had moderate PEX, and 32 (28.1%) had severe PEX. Hypertension was present in 54 participants (47.4%), diabetes in 21 (18.4%), coronary artery disease in nine (7.9%), and cerebrovascular accidents in three (2.6%). The mean systolic blood pressure was 140.39 mmHg and the mean diastolic blood pressure was 90.37 mmHg. Systolic blood pressure exceeded 140 mmHg in 29 participants (90.6%) with severe PEX, while diastolic blood pressure surpassed 90 mmHg in 26 participants with severe PEX, both with a p-value of 0.001. Mean fasting and postprandial blood sugar levels were 103.80 ± 31.81 mg/dl and 131.72 ± 48.24 mg/dl, respectively. Serum lipid profiles showed mean low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), cholesterol, and triglyceride levels of 103.00 ± 34.49 mg/dl, 29.04 ± 15.51 mg/dl, 172.73 ± 43.34 mg/dl, and 129.33 ± 64.65 mg/dl respectively. Electrocardiographic results indicated that 54 participants (47.37%) had abnormal ECG including rate abnormality in 13.2%, conduction defects in 12.3%, ischemic changes in 10.5%, and structural defects in 11.4%. Eighty-seven percent of patients had non-dilating pupils and iris atrophy, 13.2% had zonular dialysis and intraoperatively, 78% had capsulorhexis extension, 49.12% had difficult nucleus prolapse, and 28.95% had posterior capsular rent. Conclusion This study highlights the significantly elevated parameters of systemic vascular diseases in PEX patients, like elevated blood pressure and more frequent cardiac anomalies, emphasizing the need for comprehensive systemic evaluation and careful preoperative assessment for ocular comorbidities.
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Affiliation(s)
- Vaishnavi R Patil
- Ophthalmology, Shri B M Patil Medical College, BLDE, Vijayapura, IND
| | - K Vallabha
- Ophthalmology, Shri B M Patil Medical College, BLDE, Vijayapura, IND
| | - Keerti Wali
- Ophthalmology, Shri B M Patil Medical College, BLDE, Vijayapura, IND
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Mueller A, Lam I, Kishor K, Lee RK, Bhattacharya S. Secondary glaucoma: Toward interventions based on molecular underpinnings. WIREs Mech Dis 2024; 16:e1628. [PMID: 37669762 DOI: 10.1002/wsbm.1628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023]
Abstract
Glaucoma is a heterogeneous group of progressive diseases that leads to irreversible blindness. Secondary glaucoma refers to glaucoma caused by a known underlying condition. Pseudoexfoliation and pigment dispersion syndromes are common causes of secondary glaucoma. Their respective deposits may obstruct the trabecular meshwork, leading to aqueous humor outflow resistance, ocular hypertension, and optic neuropathy. There are no disease-specific interventions available for either. Pseudoexfoliation syndrome is characterized by fibrillar deposits (pseudoexfoliative material) on anterior segment structures. Over a decade of multiomics analyses taken together with the current knowledge on pseudoexfoliative glaucoma warrant a re-think of mechanistic possibilities. We propose that the presence of nucleation centers (e.g., vitamin D binding protein), crosslinking enzymes (e.g., transglutaminase 2), aberrant extracellular matrix, flawed endocytosis, and abnormal aqueous-blood barrier contribute to the formation of proteolytically resistant pseudoexfoliative material. Pigment dispersion syndrome is characterized by abnormal iridolenticular contact that disrupts iris pigment epithelium and liberates melanin granules. Iris melanogenesis is aberrant in this condition. Cytotoxic melanogenesis intermediates leak out of melanosomes and cause iris melanocyte and pigment epithelium cell death. Targeting melanogenesis can likely decrease the risk of pigmentary glaucoma. Skin and melanoma research provides insights into potential therapeutics. We propose that specific prostanoid agonists and fenofibrates may reduce melanogenesis by inhibiting cholesterol internalization and de novo synthesis. Additionally, melatonin is a potent melanogenesis suppressor, antioxidant, and hypotensive agent, rendering it a valuable agent for pigmentary glaucoma. In pseudoexfoliative glaucoma, where environmental insults drive pseudoexfoliative material formation, melatonin's antioxidant and hypotensive properties may offer adjunct therapeutic benefits. This article is categorized under: Neurological Diseases > Molecular and Cellular Physiology.
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Affiliation(s)
- Anna Mueller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Isabel Lam
- Idaho College of Osteopathic Medicine, Meridian, Idaho, USA
| | - Krishna Kishor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard K Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sanjoy Bhattacharya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Un Y, Sonmez M. Choroidal thickness measurements of subjects with pseudoexfoliative syndrome and pseudoexfoliative glaucoma: A contralateral eye study. Eur J Ophthalmol 2023; 33:1986-1996. [PMID: 37081772 DOI: 10.1177/11206721231171428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
AIM In this study, we aimed to investigate the peripapillary choroidal thickness (PPCT) and macular choroidal thickness (MCT) in pseudoexfoliation (PEX) syndrome and compare the data of the contralateral eyes according to the presence of biomicroscopic eye involvement and glaucoma. METHOD In this cross-sectional case-control study, PPCT and MCT measurements were analyzed in 162 eyes of 81 subjects with PEX syndrome, diagnosed biomicroscopically with the detection of PEX material. The sample included 63 eyes with pseudoexfoliation glaucoma (PG), 49 eyes with visible PEX material alone without glaucoma (PM), 50 fellow eyes without biomicroscopically visible PEX material (F), and 48 eyes of 24 healthy individuals (controls) without any sign of PEX in the detailed ophthalmologic examination. The PEX syndrome group consisted of 25 PM-F, 25 PG-F, 19 PG-PG, and 12 PM-PM eye pairs. The PPCT and MCT values were compared between the eye-pairs of the subjects with the PEX syndrome. RESULTS The mean PPCT measurements were 183.3 ± 8.1 µm, 158.5 ± 5.4 µm, 167.8 ± 5.9 µm, and 149.9 ± 5.5 µm for the eyes in the control, F, PM, and PG groups, respectively. The eyes in the PG group had statistically significantly lower measurements than those in the control group (p < 0.01). In the contralateral eye comparison of the subjects with PEX syndrome, no significant difference was found in relation to the mean PPCT and MCT measurements between the PM-F, PG-F, and PG-PG eye pairs (p > 0.05 for all). CONCLUSION Although the eye groups with PEX syndrome had lower mean PPCT measurements than the controls, the contralateral eye analysis of the asymmetrically involved eye pairs showed no significant differences.
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Affiliation(s)
- Yasemin Un
- Department of Ophthalmology, Istanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Murat Sonmez
- Department of Ophthalmology, Istanbul Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Mastronikolis S, Pagkalou M, Plotas P, Kagkelaris K, Georgakopoulos C. Emerging roles of oxidative stress in the pathogenesis of pseudoexfoliation syndrome (Review). Exp Ther Med 2022; 24:602. [PMID: 35949329 PMCID: PMC9353531 DOI: 10.3892/etm.2022.11539] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022] Open
Abstract
Pseudoexfoliation syndrome (PEXS) is a systemic disease caused by defects in the extracellular matrix (ECM) remodelling process leading to the chronic deposition of extracellular, fibrillary, white flaky pseudoexfoliation material (PEXM) throughout the body. Specifically, PEXM deposits on the lens capsule cause open-angle glaucoma, cataracts and blindness in patients with PEXS. Several gene single nucleotide polymorphisms are linked to the development of PEXS in humans, including lysyl oxidase-like 1 gene, clusterin and fibulin-5. The exact reason for the PEXM generation and its resulting pathogenesis is not well understood. However, defective ECM remodelling and oxidative stress (OS) have been hypothesized as significant events leading to the PEXM. Specifically, the link between OS and PEXS has been well studied, although the investigation is still ongoing. The present review explored recent advances in various aspects of PEXS and the involvement of OS in the eye for PEXS development.
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Affiliation(s)
| | - Marina Pagkalou
- Department of Chemistry, University of Crete, 70013 Heraklion, Greece
| | - Panagiotis Plotas
- Laboratory of Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, 26334 Patras, Greece
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Mastronikolis S, Pagkalou M, Baroutas G, Kyriakopoulou K, Makri ΟE, Georgakopoulos CD. Pseudoexfoliation syndrome: The critical role of the extracellular matrix in pathogenesis and treatment. IUBMB Life 2022; 74:995-1002. [PMID: 35201654 DOI: 10.1002/iub.2606] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/11/2022]
Abstract
Pseudoexfoliation syndrome (PEXS) is an age-related condition manifesting mainly in ocular tissues. PEXS is manifested through excess aggregation of fibrillary extracellular material at the anterior part of the eye that consists of a plethora of biomolecules, such as different proteoglycans (PGs) and glycosaminoglycans. PEXS is often linked to increased intraocular pressure, and can also lead to pseudoexfoliation glaucoma with very poor prognosis. Various stimuli are known to affect PEXS, including oxidation stress (OS), UV radiation and osmotic pressure. OS, is prominently involved on the progression of the syndrome as it promotes fibrogenesis, possibly via the induction of transforming growth factor-β (TGF-β) and other biomolecular effectors. In addition, PEXS initiation is tightly connected with the dysregulation of extracellular matrix (ECM) homeostasis since aberrant expression of ECM molecules is linked to both the accumulation and low degradation of pseudoexfoliation material. This article aims at uncovering the crucial role of various ECM effectors such as lysyl oxidase-like proteins, matrix metalloproteinases, and TGF-β1, as well as the biochemical pathways involved in the development and the progression of the PEXS.
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Affiliation(s)
- Stylianos Mastronikolis
- Department of Ophthalmology, Medical School, University of Patras, Rion, Achaia, Greece.,Neurosurgery Department, James Cook University Hospital, Middlesbrough, UK
| | - Marina Pagkalou
- Department of Chemistry, University of Crete, Voutes, Heraklion, Greece
| | - Giorgos Baroutas
- Biochemistry Biochemical Analysis & Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Patras, Greece
| | - Konstantina Kyriakopoulou
- Biochemistry Biochemical Analysis & Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Patras, Greece
| | - Οlga E Makri
- Department of Ophthalmology, Medical School, University of Patras, Rion, Achaia, Greece
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Collao V, Morris J, Zain Chauhan M, Abdelrahman L, Martίnez-de-la-Casa JM, Vidal-Villegas B, Burgos-Blasco B, Bhattacharya SK. Analyses of Pseudoexfoliation aqueous humor lipidome. Mol Omics 2022; 18:387-396. [DOI: 10.1039/d1mo00495f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pseudoexfoliation syndrome (PEX) is a systemic disorder that manifests as fluffy, proteinaceous fibrillar material throughout the body. In the eye such deposits result in glaucoma (PEXG), due to impeding aqueous...
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Bell KC, Ozaki M, Mori K, Mizoguchi T, Nakano S, Porporato N, Ikeda Y, Chihara E, Inoue K, Manabe S, Hayashi K, Higashide T, Ideta R, Tokumo K, Kiuchi Y, Nakano M, Ueno M, Kinoshita S, Tashiro K, Sotozono C, Inatani M, Sugiyama K, Kubota T, Li Z, Wang Z, Khor CC, Aung T. Association of the CYP39A1 G204E genetic variant with increased risk of glaucoma and blindness in patients with exfoliation syndrome. Ophthalmology 2021; 129:406-413. [PMID: 34763023 DOI: 10.1016/j.ophtha.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Carriers of functionally deficient mutations in the CYP39A1 gene have been recently reported to have a 2-fold increased risk of exfoliation syndrome (XFS). The aim of this study was to evaluate the risk of blindness and related clinical phenotypes of XFS patients carrying the loss-of-function CYP39A1 G204E mutation in comparison to XFS patients without any CYP39A1 mutation. DESIGN Retrospective case study PARTICIPANTS: 35 patients diagnosed with XFS carrying the CYP39A1 G204E mutation and 150 XFS patients without any CYP39A1 mutation, who were randomly selected from the Japanese XFS cohort. METHODS Two-sided Fisher's Exact Test with an α-level <0.05 was used to estimate the significance of the calculated Odds Ratio (OR) for all categorical measures. Comparisons between groups of subjects were performed using linear mixed effect models with group as random effect and taking possible dependence between eyes within a subject into account. MAIN OUTCOME MEASURES Primary analysis compared the incidence of blindness (defined as visual acuity [VA]<0.05 decimal), prevalence of exfoliation glaucoma (XFG), history of glaucoma surgery, and indices of glaucoma severity such as visual field mean deviation (MD), intraocular pressure (IOP) and vertical cup-disc ratio (CDR), between CYP39A1 G204E carriers and those without any CYP39A1 mutation. RESULTS The overall risk for blindness was significantly higher in XFS patients carrying the CYP39A1 G204E variant (10/35 [28.6%]) compared to XFS patients without any CYP39A1 mutations (8/150 [5.3%]; OR7.1 [95%CI:2.7-20.2]; p<0.001). A higher proportion of XFS patients with the CYP39A1 G204E mutation (23/35 [65.7%]) had evidence of XFG in at least one eye compared to the comparison group (41/150 [27.3%]; OR5.1 [95%CI:2.4-11.4]; p<0.0001). Significantly higher peak IOP, larger vertical CDR and worse visual field MD were also found in CYP39A1 G204E variant carriers (p<0.001). Additionally, patients with the CYP39A1 G204E mutation (18/35 [51.4%]) required more laser or glaucoma surgical interventions compared to those without any CYP39A1 mutation (32/150 [21.3%], p<0.001). CONCLUSIONS Patients with XFS carrying the CYP39A1 G204E mutation had significantly increased risk of blindness, higher occurrence of XFG and more severe glaucoma compared to patients with XFS without any CYP39A1 mutation.
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Affiliation(s)
- Katharina C Bell
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Mineo Ozaki
- Ozaki Eye Hospital, Hyuga, Miyazaki, Japan; Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Satoko Nakano
- Department of Ophthalmology, Oita University Faculty of Medicine, Yufu-City, Oita, Japan
| | - Natalia Porporato
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Yoko Ikeda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | | | - Tomomi Higashide
- Department of Ophthalmology Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | | | - Kana Tokumo
- Hiroshima University Department of Ophthalmology and Visual Sciences, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Hiroshima University Department of Ophthalmology and Visual Sciences, Hiroshima, Japan
| | - Masakazu Nakano
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Morio Ueno
- Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Tashiro
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | | | - Toshiaki Kubota
- Department of Ophthalmology, Oita University Faculty of Medicine, Yufu-City, Oita, Japan
| | - Zheng Li
- Genome Institute of Singapore, Singapore
| | - Zhenxun Wang
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Genome Institute of Singapore, Singapore
| | - Chiea Chuen Khor
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Genome Institute of Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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