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Jiang X, Zhang H. Deterioration of Avellino corneal dystrophy in a Chinese family after LASIK. Int J Ophthalmol 2021; 14:795-799. [PMID: 34150532 DOI: 10.18240/ijo.2021.06.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To reveal the importance of TGFBI gene screening for candidates with a family history of corneal disease or granular opacities in corneal stroma before refractive surgery. METHODS A 37-year-old male (proband) underwent bilateral laser-assisted in situ keratomileusis (LASIK) in 2002, with right vision decreased significantly in 2006. The proband and other 32 members of the family underwent a detailed ophthalmic examination, including vision acuity, intraocular pressure, slit-lamp photograph, fundus examination, optical coherence tomography (OCT) of cornea, and in vivo confocal microscope (IVCM) and peripheral blood was used for genomic DNA extraction. Seventeen TGFBI gene exons were analyzed via polymerase chain reaction amplification and direct sequencing. RESULTS Slit-lamp, IVCM, and OCT images showed that a large amount of dense and confluent granular opaque were seen at the interfaces of the flap and remnant stromal bed in right and light degree in left eye. Sanger sequencing showed that there was a 371G>A mutation (CGC>CAC) in exon 4, which indicated that he harbored a heterozygote R124H mutation, identifying the diagnosis of Avellino corneal dystrophy (ACD). Among the other 32 family members, 6 of them harbored the identical mutation to that in the proband. CONCLUSION ACD will worsen and recur after LASIK. Preoperative gene-screening for TGFBI mutations is important in diagnosing ACD.
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Affiliation(s)
- Xue Jiang
- Eye Hospital, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Harbin 150001, Heilongjiang Province, China
| | - Hong Zhang
- Eye Hospital, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Harbin 150001, Heilongjiang Province, China
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Surgical outcomes of re-excimer laser phototherapeutic keratectomy (re-PTK). Sci Rep 2021; 11:11503. [PMID: 34075184 PMCID: PMC8169735 DOI: 10.1038/s41598-021-91121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
To assess the surgical outcomes of re-excimer laser phototherapeutic keratectomy (re-PTK) for recurrent disease after initial PTK. Retrospective cohort study with historical comparison group. This study involved 56 patients who underwent re-PTK (mean follow-up period: 47.9 ± 36.2 months) at the Baptist Eye Institute, Kyoto, Japan. In all subjects, corrected-distance visual acuity (CDVA) before and after re-PTK was compared. Postoperative recurrence of corneal lesion with a decrease of CDVA of two lines or more was compared with postoperative best CDVA deemed as a significant relapse. The Kaplan–Meier method was used to compare the recurrence rate post-re-PTK with that after the initial PTK. The disease classification in the 78 eyes was heterozygous-type GCD (hetero-GCD, n = 47 eyes), homozygous-type GCD (homo-GCD, n = 13 eyes), band keratopathy (n = 7 eyes), lattice corneal dystrophy (n = 6 eyes), and other (n = 5 eyes). After re-PTK, homo-GCD recurred statistically significantly earlier than hetero-GCD (P = 0.0042). No significant difference was found in the recurrence rate for all diseases between post-re-PTK and post initial PTK (P > 0.05). Surgical outcomes after re-PTK were nearly equal to those after initial-PTK.
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Sridhar U, Tripathy K, Bansal Y. Repeated phototherapeutic keratectomy (PTK) followed by PTK with photorefractive keratectomy for anterior granular corneal dystrophy. Indian J Ophthalmol 2020; 68:3038-3040. [PMID: 33229698 PMCID: PMC7856955 DOI: 10.4103/ijo.ijo_975_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Two preteen siblings with the anterior-stromal variant of granular corneal dystrophy type 1 underwent multiple phototherapeutic keratectomies (PTK) (due to recurrences of the dystrophy) with progressively increasing hyperopia after each procedure. The last procedure performed was an additional photorefractive keratectomy along with the PTK which led to a decrease in the hyperopia with better refractive outcomes. The addition of mitomycin C may have led to a delay in the recurrence of the dystrophy.
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Affiliation(s)
- Uma Sridhar
- Department of Cornea and Cataract Services, ICARE Eye Hospital and Post Graduate Institute, Noida, Uttar Pradesh, India
| | - Koushik Tripathy
- Department of Ophthalmology, ASG Eye Hospital, 149 BT Road, Kolkata, West Bengal, India
| | - Yogeshwari Bansal
- Department of Cornea and Cataract Services, ICARE Eye Hospital and Post Graduate Institute, Noida, Uttar Pradesh, India
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Zeng L, Zhao J, Chen Y, Shang J, Aruma A, Zhou X. Multiple phototherapeutic keratectomy treatments in a Chinese pedigree with corneal dystrophy and an R124L mutation: a 20-year observational study. BMC Ophthalmol 2019; 19:191. [PMID: 31438893 PMCID: PMC6704665 DOI: 10.1186/s12886-019-1167-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background To investigate the efficacy and safety of repeated phototherapeutic keratectomies (PTKs) during long-term treatment for corneal dystrophy (CD) in a Chinese pedigree carrying the R124L mutation in TGFBI. Methods This was a retrospective review of 20-year medical and genetic records involving five CD patients (10 eyes) from one pedigree. During this period, PTK was conducted for an eye when best-corrected distance visual acuity (BCDVA) reached > 1.0 (LogMAR), due to either primary or recurrent opacities in the cornea. All PTKs were performed by 193-nm excimer laser with or without creation of epithelial flaps. For each eye, routine measurements were conducted for the number of PTKs during follow-up, mean time to recurrence, and BCDVA pre- and post- every PTK (measurements within 3 months from each PTK). Corneal thicknesses measured after the last PTK and at the last visit were analyzed, and subjective satisfaction was assessed. Results Gene testing revealed an R124L mutation in TGFBI. During 19.60 ± 1.78 years of follow-up, PTKs were conducted twice for three eyes, three times for six eyes, and four times for one eye. After each PTK, effective visual acuity was maintained for 3.60 ± 1.12 years before significant recurrence. BCDVA improved significantly postoperatively than preoperatively for the first PTK for each eye (p < 0.001), as well as the second (p < 0.001) and third one (p < 0.001). After the last PTK and at the final visit, the thinnest corneal thickness was 371.50 ± 56.47 μm and 358.40 ± 101.11 μm, respectively. The average subjective satisfaction score was 8.60 ± 0.89. Conclusions Multiple repeated PTKs were effective and safe in a long-term study of CD patients with an R124L mutation in TGFBI.
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Affiliation(s)
- Li Zeng
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Yingjun Chen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Aruma Aruma
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China. .,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China. .,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China.
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Lee J, Kim JH, Lee D, Chang JW, Shin JY, Seo JW, Seo MH, Moon NJ. Long-term clinical outcome of femtosecond laser-assisted lamellar keratectomy with phototherapeutic keratectomy in anterior corneal stromal dystrophy. Br J Ophthalmol 2017; 102:31-36. [DOI: 10.1136/bjophthalmol-2017-310189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/03/2017] [Accepted: 04/30/2017] [Indexed: 11/04/2022]
Abstract
PurposeTo evaluate long-term outcome of femtosecond laser-assisted lamellar keratectomy (FLK) with phototherapeutic keratectomy (PTK) in patients with anterior corneal stromal dystrophies.MethodsA total of 10 eyes from seven patients who underwent FLK were included. The patients had suffered from recurrent corneal erosion or visual disturbance in anterior corneal dystrophies (five Avellino dystrophies and two lattice dystrophies). Planar-shaped lamellar keratectomy was performed using femtosecond laser. The amount of corneal excision was determined by the depth of corneal opacity. Additional PTK with mitomycin C application was performed for smoothening of corneal cut surface. The patients were evaluated with following parameters: uncorrected visual acuity, best-corrected visual acuity (BCVA), mean anterior keratometric value, corneal irregularity, corneal high-order aberrations (HOA) and the recurrence of corneal erosion.ResultsMean duration of follow-up was 64 months (2.5–9.5 years). The BCVA improved more than two lines of Snellen chart at last visit. The changes of keratometric values were within ±1 D in eight out of 10 eyes. Corneal irregularities in central 5 mm cornea and the values of total corneal HOA in central 6 mm cornea decreased by 0.3–3.1 D and 0.01–2.2 µm, respectively. Corneal erosion did not recur in any of those patients during follow-up and corneal dystrophy did not recur in eight out of 10 eyes.ConclusionIn anterior corneal stromal dystrophies, FLK with PTK can be an effective surgical option to improve VA through decreasing corneal irregularities and HOA, while minimising corneal curvature changes.
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Sati A, Ramappa M, Sharma N, Chaurasia S, Vemuganti GK, Kannabiran C, Garg P. Bilateral granular dystrophy: A clinicopathogenetic correlation after alcohol assisted debridement with phototherapeutic keratectomy. Med J Armed Forces India 2012; 71:S1-4. [PMID: 26265796 DOI: 10.1016/j.mjafi.2012.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 08/12/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- Alok Sati
- Fellow Cornea & Anterior Segment, L V Prasad Eye Institute, Banjara Hills, Hyderabad-500038, AP, India
| | - Muralidhar Ramappa
- Consultant, Cornea & Anterior Segment, L V Prasad Eye Institute, Banjara Hills, Hyderabad-500038, AP, India
| | - Neeraja Sharma
- Fellow, Kallam Anji Reddy Molecular Genetics Laboratory, L V Prasad Eye Institute, Banjara Hills, Hyderabad-500038, AP, India
| | - Sunita Chaurasia
- Consultant, Cornea & Anterior Segment, L V Prasad Eye Institute, Banjara Hills, Hyderabad-500038, AP, India
| | - Geeta K Vemuganti
- Consultant (Ocular Pathology), L V Prasad Eye Institute, Banjara Hills, Hyderabad-500038, AP, India
| | - Chitra Kannabiran
- Consultant, Kallam Anji Reddy Molecular Genetics Laboratory, L V Prasad Eye Institute, Banjara Hills, Hyderabad-500038, AP, India
| | - Prashant Garg
- Consultant, Cornea & Anterior Segment, L V Prasad Eye Institute, Banjara Hills, Hyderabad-500038, AP, India
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Heterozygous Avellino Corneal Dystrophy 9 Years After Photorefractive Keratectomy: Natural or Laser-Induced Accelerated Course? Cornea 2009; 28:465-7. [DOI: 10.1097/ico.0b013e31818a7df7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gruenauer-Kloevekorn C, Braeutigam S, Froster UG, Duncker GIW. Surgical outcome after phototherapeutic keratectomy in patients with TGFBI-linked corneal dystrophies in relation to molecular genetic findings. Graefes Arch Clin Exp Ophthalmol 2008; 247:93-9. [DOI: 10.1007/s00417-008-0931-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 06/30/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022] Open
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Lee WB, Himmel KS, Hamilton SM, Zhao XC, Yee RW, Kang SJ, Grossniklaus HE. Excimer laser exacerbation of Avellino corneal dystrophy. J Cataract Refract Surg 2007; 33:133-8. [PMID: 17189809 DOI: 10.1016/j.jcrs.2006.09.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 08/14/2006] [Indexed: 11/18/2022]
Abstract
We review the clinical, histopathological, and ultrastructural findings and DNA phenotyping of a patient with Avellino corneal dystrophy exacerbated by laser in situ keratomileusis. The findings are reported and interpreted in the context of a literature review. The case highlights the possible difficulty of recognizing subtle dystrophic findings, as well as the importance of avoiding refractive surgical intervention in patients with Avellino corneal dystrophy to avoid exacerbation of dystrophic deposits in the cornea and subsequent reduction in vision.
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Affiliation(s)
- W Barry Lee
- Cornea, External Disease and Refractive Surgery Section, Emory University School of Medicine, Atlanta, Georgia, USA.
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Banning CS, Kim WC, Randleman JB, Kim EK, Stulting RD. Exacerbation of Avellino corneal dystrophy after LASIK in North America. Cornea 2006; 25:482-4. [PMID: 16670492 DOI: 10.1097/01.ico.0000195949.93695.37] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the first case of Avellino corneal dystrophy exacerbation after LASIK in a white or North American patient. METHODS Case report and literature review. RESULTS A 25-year-old white female developed progressive corneal opacities after LASIK. Preoperative examination had revealed only subtle white corneal opacities in each eye. The patient's mother had similar corneal opacities. DNA analysis of the patient revealed a heterozygous mutation at the R124H location in the BIGH3 gene. CONCLUSIONS LASIK can exacerbate Avellino corneal dystrophy and should be avoided in patients with this condition. A careful history and genetic analysis can identify affected patients and those at risk.
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Abstract
Technological advances in the field of gene therapy has prompted more than three hundred phase I and phase II gene-based clinical trials for the treatment of cancer, AIDS, macular degeneration, cardiovascular, and other monogenic diseases. Besides treating diseases, gene transfer technology has been utilized for the development of preventive and therapeutic vaccines for malaria, tuberculosis, hepatitis A, B and C viruses, AIDS, and influenza. The potential therapeutic applications of gene transfer technology are enormous. The cornea is an excellent candidate for gene therapy because of its accessibility and immune-privileged nature. In the last two decades, various viral vectors, such as adeno, adeno-associated, retro, lenti, and herpes simplex, as well as non-viral methods, were examined for introducing DNA into corneal cells in vitro, in vivo and ex vivo. Most of these studies used fluorescent or non-fluorescent marker genes to track the level and duration of transgene expression in corneal cells. However, limited studies were directed to evaluate prospects of gene-based interventions for corneal diseases or disorders such as allograft rejection, laser-induced post-operative haze, herpes simplex keratitis, and wound healing in animal models. We will review the successes and obstacles impeding gene therapy approaches used for delivering genes into the cornea.
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Affiliation(s)
- Rajiv R Mohan
- The Cole Eye Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Code i-31, Cleveland, OH 44195, USA.
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Yamada N, Chikama TI, Morishige N, Yanai R, Nishida T, Inui M, Seki K. Homozygous mutation (L527R) of TGFBI in an individual with lattice corneal dystrophy. Br J Ophthalmol 2005; 89:771-3. [PMID: 15923518 PMCID: PMC1772697 DOI: 10.1136/bjo.2004.056168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yoshida S, Yamaji Y, Yoshida A, Noda Y, Kumano Y, Ishibashi T. Rapid genotyping for most common TGFBI mutations with real-time polymerase chain reaction. Hum Genet 2005; 116:518-24. [PMID: 15744520 DOI: 10.1007/s00439-005-1269-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Accepted: 01/05/2005] [Indexed: 01/20/2023]
Abstract
Recent studies of the corneal dystrophies (CDs) have shown that most cases of granular CD, Avellino CD, and lattice CD type I are caused by mutations in the human transforming growth factor beta-induced (TGFBI) gene. The aim of this study was to develop a rapid diagnostic assay to detect mutations in the TGFBI gene. Sixty-six patients from 64 families with TGFBI-associated CD were studied. A primer probe set was designed to examine the genome from exons 4 and 12 of the TGFBI gene in order to identify mutant and wild-type alleles. A region spanning the mutations was amplified by the polymerase chain reaction (PCR) in a commercial cycler. Mutations were then identified by melting curve analysis of the hybrid formed between the PCR product and a specific fluorescent probe. Using this system, we clearly distinguished each CD genotype (homozygous and heterozygous 418G-->A, heterozygous 417C-->T, heterozygous 1710C-->T, and wild-type) of all the patients by means of the clearly distinct melting peaks at different temperatures. One thermal cycling took approximately 54 min, and all results were completely in concordance with the genotypes determined by conventional DNA sequencing. Thus, the technique is accurate and can be used for routine clinical diagnosis. We expect that our new method will help in making precise diagnoses of patients with atypical CDs and aid the revision of the clinical classification of inherited corneal diseases based on the genetic pathogenesis.
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Affiliation(s)
- Shigeo Yoshida
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
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Abstract
PURPOSE OF REVIEW Characteristics of corneal dystrophies have been described with regards to such as location in the cornea, morphology, material composition, and recurrence after penetrating keratoplasty. The main goal of this review is to describe the surgical methods in treating corneal dystrophies. RECENT FINDINGS Laser in situ keratomileusis (LASIK) has been shown to aggravate corneal deposits in Avellino dystrophy exacerbation LASIK and hence should be avoided. Phototherapeutic keratectomy (PTK) has shown its usefulness in clearing opacities with visual improvement and prevents painful erosion, resulting in delay or postponement of corneal grafting in some corneal dystrophies. Mitomycin-C may be used topically in conjunction with PTK to reduce the recurrence of the opacities. Topical use of antibody to TGF-beta can also be considered to suppress recurrence of corneal opacities after PTK or lamellar keratectomy. SUMMARY Clinicians must become more adept at choosing a treatment depending on different genotypes and future studies on treatment of corneal dystrophies should be focused on establishing treatment of categorized corneal dystrophies based on their chromosomal mutation.
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Affiliation(s)
- Eun Suk Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Inoue T, Watanabe H, Yamamoto S, Maeda N, Inoue Y, Shimomura Y, Tano Y. Recurrence of corneal dystrophy resulting from an R124H Big-h3 mutation after phototherapeutic keratectomy. Cornea 2002; 21:570-3. [PMID: 12131032 DOI: 10.1097/00003226-200208000-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was to investigate the recurrence-free interval after phototherapeutic keratectomy (PTK) in patients with corneal dystrophies resulting from an Arg124His (R124H) mutation of the Big-h3 gene. METHODS Patients with corneal dystrophy resulting from a genetically confirmed Big-h3 R124H mutation were examined with a slit lamp. The patients were divided into two groups on the basis of the mutation genotype, and the recurrence-free interval was analyzed. RESULTS In the 4 eyes of 3 homozygous patients, the mean (+/- standard deviation [SD]) recurrence-free interval was 9.5 +/- 3.1 months, whereas in the 7 eyes of 4 heterozygous patients it was 38.4 +/- 6.2 months. The former interval was statistically shorter than the latter (Kaplan-Meier survival analysis with log-rank test, p = 0.004). CONCLUSIONS These results strongly suggest that the mutation genotype of Big-h3 gene determined the recurrence-free interval as well as the clinical picture after PTK. Therefore, PTK should be considered for patients with Big-h3 R124H corneal dystrophy, on the basis of the expected recurrence-free interval deduced from molecular analysis of the zygosity of the Big-h3 R124H mutation.
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Affiliation(s)
- Tomoyuki Inoue
- Department of Ophthalmology, Osaka University Medical School E-7, 2-2 Yamadaoka, Suita 565-0871, Osaka, Japan
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