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Abbasi Mehrabadi A, Sadeghi J, Shoeibi N, Heravian Shandiz J, Motamed Shariati M, Derakhshan A, Yazdani N. Macular choroidal thickness in keratoconus. Clin Exp Optom 2024:1-6. [PMID: 39189829 DOI: 10.1080/08164622.2024.2393189] [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: 06/03/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
CLINICAL RELEVANCE Expanding practitioner knowledge regarding potential changes in ocular structure of keratoconic eyes will improve the eye care practice and patient management. BACKGROUND This study aimed to compare the difference in choroidal thickness between keratoconus patients and two control groups of myopic-astigmatism and emmetropic subjects. METHODS A case-control study was undertaken which included 50 patients with keratoconus, 50 with myopic-astigmatism, 30 with emmetropia aged between 18 and 39 years. Choroidal thickness was measured at three different locations, including the subfoveal, nasal, and temporal (750 micrometres) to the fovea, using a spectral-domain optical coherence tomography with an enhanced depth imaging technique. RESULTS The mean spherical equivalents were 0.03 ± 0.05, -3.00 ± 0.2, and -3.00 ± 0.3 dioptre in emmetropic, myopic-astigmatism and keratoconus subjects, respectively. The choroid was significantly thicker in keratoconus patients than in myopic-astigmatism and emmetropic subjects in the subfoveal (396 ± 14, 314 ± 12, and 320 ± 18 μm, respectively, p < 0.001), temporal (405 ± 14, 317 ± 12, and 328 ± 19 μm, respectively, p < 0.001) and nasal (376 ± 14, 285 ± 12, and 311 ± 18 μm, respectively; p < 0.001). CONCLUSION Choroidal thickness is increased in keratoconus. The exact mechanism for choroidal thickening in individuals with keratoconus is unknown, but inflammatory responses could be the reason.
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Affiliation(s)
| | - Javad Sadeghi
- Eye Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Shoeibi
- Eye Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Akbar Derakhshan
- Eye Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negareh Yazdani
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Itoi M, Itoi M. Association Between Family History and the Corneal Characteristics of Keratoconus in Japan. Eye Contact Lens 2024; 50:357-360. [PMID: 38861231 DOI: 10.1097/icl.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE The aim of this study was to determine the association between family history and corneal characteristics of keratoconus in Japan. METHODS The clinical records of patients with keratoconus who were interviewed regarding family history of keratoconus were retrospectively reviewed. Corneal indices derived from anterior segment optical coherence tomography were compared between the positive and negative family history groups using multiple linear regression analysis adjusted with age, sex, and history of atopy and eye rubbing. RESULTS A total of 2,701 eyes, including 122 eyes with positive family history, were enrolled. Based on the adjusted multiple linear regression analysis, no significant differences were found between groups with and without a family history except for paracentral and mid-peripheral corneal thickness. The adjusted mean differences in paracentral and mid-peripheral corneal thicknesses between the two groups were -10.33 (95% confidence interval -20.29 to -0.37 P -value <0.05) and -9.78 (95% confidence interval -16.70 to -2.85, P -value <0.01), respectively. CONCLUSIONS There was no significant association between family history and corneal indices in Japanese patients with keratoconus, except for paracentral and mid-peripheral corneal thicknesses. A Japanese patient with keratoconus who had a family history showed significantly lower paracentral and mid-peripheral corneal thicknesses than those with no family history.
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Affiliation(s)
- Motohiro Itoi
- Dougenzaka Itoi Eye Clinic (M.I.), Tokyo, Japan; and School of Optometry and Vision Science (M.I.), University of New South Wales, Sydney, Australia
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Nugent L, Son HS, Wang J, Varadaraj V, Smith K, Soiberman US, Srikumaran D. Racial Variation in Visual Impairment of Patients With Keratoconus at Presentation. Cornea 2024; 43:31-37. [PMID: 37294677 PMCID: PMC10709529 DOI: 10.1097/ico.0000000000003302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/30/2023] [Indexed: 06/11/2023]
Abstract
PURPOSE This study aimed to investigate racial disparities in the severity of keratoconus (KCN) at presentation, their intersection with socioeconomic variables, and other factors associated with visual impairment. METHODS This retrospective cohort study examined medical records of 1989 patients (3978 treatment-naive eyes) with a diagnosis of KCN seen at Wilmer Eye Institute between 2013 and 2020. A multivariable regression model adjusting for age, sex, race, insurance type, KCN family history, atopy, smoking status, and vision correction method examined factors associated with visual impairment, defined as a best available visual acuity of worse than 20/40 in the better eye. RESULTS Demographically, Asian patients were the youngest (33.4 ± 14.0 years) ( P < 0.001), and Black patients had the highest median area deprivation index (ADI) of 37.0 [interquartile range (IQR): 21.0-60.5] ( P < 0.001). Multivariable analysis showed a higher risk of visual impairment for Black (OR 2.25, 95% CI, 1.71-2.95) versus White patients. Medicaid (OR 2.59, 95% CI, 1.75-3.83) and Medicare (OR 2.48, 95% CI, 1.51-4.07) were also associated with a higher odds of visual impairment compared with private insurance, and active smokers were more likely to have visual impairment than those with no prior smoking history (OR 2.17, 95% CI, 1.42-3.30). Eyes of Black patients had the highest maximum keratometry (Kmax) (56.0 ± 11.0D) ( P = 0.003) and the lowest thinnest pachymetry (463.2 ± 62.5 µm) ( P = 0.006) compared with eyes of other races. CONCLUSIONS Black race, government-funded insurance, and active smoking were significantly associated with increased odds of visual impairment in adjusted analyses. Black race was also associated with higher Kmax and lower thinnest pachymetry, suggesting that Black patients have more severe disease at presentation.
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Affiliation(s)
- Liam Nugent
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Varshini Varadaraj
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Kerry Smith
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Uri S. Soiberman
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Wang YC, Zolnik OB, Yasoda S, Yeh LK, Yuan Y, Kao W, Saika S, Liu CY. Transforming growth factor beta receptor 2 (Tgfbr2) deficiency in keratocytes results in corneal ectasia. Ocul Surf 2023; 29:557-565. [PMID: 37393064 DOI: 10.1016/j.jtos.2023.06.014] [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: 04/17/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE We hypothesized that Transforming growth factor beta receptor 2 (Tgfbr2) deletion in keratocyte (Tgfbr2kera-cko), the corneal stroma cell, can result in corneal thinning and generate a potential model for Cornea Ectasia (CE). METHODS Corneal thickness of Tgfbr2kera-cko and Tgfbr2Ctrl was examined with Optical Coherence Tomography (OCT) at post-natal (P) days 42 and 70, respectively. Histological H&E staining, transmission electron micrograph (TEM), and immunofluorescence staining (IFS) were harnessed to examine corneal cell morphology, proliferation, differentiation, and collagen fibrils. RESULTS Slit-Lamp revealed that corneas were transparent in both Tgfbr2kera-cko and Tgfbr2Ctrl, however, Tgfbr2kera-cko cornea was 33.5% and 42.9% thinner as compared with those of Tgfbr2Ctrl at P42 and P70, respectively. H&E and semithin section staining with toluidine blue-O confirmed that Tgfbr2kera-cko cornea has a thinner stroma. In contrast, the epithelium in Tgfbr2kera-cko was substantially thicker. The cell proliferation marker Ki67 expression level increased ∼9% in Tgfbr2kera-cko corneal epithelium as compared with that in Tgfbr2Ctrl, however, the Krt14 and Krt12 expression pattern was not obviously changed in Tgfbr2kera-cko corneal epithelium. It was noticed that Col1a1 expression was substantially reduced in Tgfbr2kera-cko as compared with that in Tgfbr2Ctrl. TEM showed that keratocytes were unhealthy and stromal collagen fibril density was significantly reduced in Tgfbr2kera-cko as compared with that in Tgfbr2Ctrl cornea. Moreover, mechanical eye-rubbing on Tgfbr2kera-cko resulted in corneal hydrops and edema. CONCLUSION Tgfbr2 in keratocytes is indispensable for the corneal stroma at postnatal homeostasis. The cornea phenotype manifested in these Tgfbr2kera-cko mice resembles corneal ectasia disease in humans.
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Affiliation(s)
- Yen-Chiao Wang
- Edith Crawley Vision Research Center, Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Anesthesiology, School of Medicine, Washington University in St. Louis, MO, USA; School of Optometry, Indiana University, Bloomington, IN, USA.
| | | | - Shingo Yasoda
- Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yong Yuan
- Edith Crawley Vision Research Center, Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Winston Kao
- Edith Crawley Vision Research Center, Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Shizuya Saika
- Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan
| | - Chia-Yang Liu
- Edith Crawley Vision Research Center, Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; School of Optometry, Indiana University, Bloomington, IN, USA
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Yang Q, Wang S, He Y, Zhang Y. The research progress on the molecular mechanism of corneal cross-linking in keratoconus treatment. Cont Lens Anterior Eye 2023; 46:101795. [PMID: 36549953 DOI: 10.1016/j.clae.2022.101795] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Keratoconus (KC) is a corneal anomaly that is manifested in a limited cone-like bulge with corneal thinning. Many molecules in the cornea change during the development of KC, including various components of the extracellular matrix, cytokines, cell connection, and cell adhesion-related proteins. Several treatment options are available, with corneal cross-linking (CXL) being the treatment of choice for early KC. However, postoperative complications have been reported in some CXL patients, mainly caused by corneal epithelial resection. Despite the fact that some novel approaches have helped to reduce some of the initial post-operative issues, their effectiveness seems to be inferior to that of the original CXL. To keep effectiveness while avoiding these negative effects, it is necessary to study the mechanism of CXL in KC treatment at the molecular level. This article provides a review of the molecular mechanism of CXL in the treatment of KC from four aspects: enzyme activity, signal transduction pathway, corneal-related proteins, and other KC-related molecules, further confirming the feasibility of CXL treatment of KC, providing new ideas for improving CXL.
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Affiliation(s)
- Qingyu Yang
- Department of Ophthalmology, 2nd Hospital of Jilin University, Changchun 130041, China.
| | - Shurong Wang
- Department of Ophthalmology, 2nd Hospital of Jilin University, Changchun 130041, China.
| | - Yuxi He
- Department of Ophthalmology, 2nd Hospital of Jilin University, Changchun 130041, China
| | - Yan Zhang
- Department of Ophthalmology, 2nd Hospital of Jilin University, Changchun 130041, China.
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A Hospital-Based Study on the Prevalence of Keratoconus in First-Degree Relatives of Patients with Keratoconus in Central China. J Ophthalmol 2022; 2022:6609531. [PMID: 35663517 PMCID: PMC9162836 DOI: 10.1155/2022/6609531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The present study investigated the prevalence of keratoconus (KC) among first-degree relatives of KC patients in Central China. Methods From July 2018 to March 2022, 661 first-degree relatives of 384 KC patients were included in the present study. Corneal tomography, uncorrected distance visual acuity, manifest refraction with corrected distance visual acuity, intraocular pressure, slit-lamp microscopy, and fundus examination were performed. The diagnosis of KC was based on the Belin/Ambrosio enhanced ectasia total deviation value (BAD-D value) on the Pentacam® system (Oculus GmbH). BAD-D value <1.6 was diagnosed as healthy, 1.6≤ BAD-D value <2.6 was diagnosed as suspected KC, and BAD-D value ≥2.6 was diagnosed as KC. Results The present study included 337 (50.98%) female and 324 (49.02%) male subjects. The prevalence of KC and suspected KC in first-degree relatives was 8.77% (n = 58) and 29.05% (n = 192), respectively. The prevalence of KC was 9.70% among parents and 7.23% among siblings. Conclusions The higher prevalence of KC among first-degree relatives of patients with KC suggests that first-degree relatives of KC are at high risk of developing KC.
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de Barros MRM, Chakravarti S. Pathogenesis of keratoconus: NRF2-antioxidant, extracellular matrix and cellular dysfunctions. Exp Eye Res 2022; 219:109062. [PMID: 35385756 DOI: 10.1016/j.exer.2022.109062] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/19/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022]
Abstract
Keratoconus (KC) is a degenerative disease associated with cell and extracellular matrix (ECM) loss that causes gradual thinning and steepening of the cornea and loss of vision. Collagen cross linking with ultraviolet light treatment can strengthen the ECM and delay weakening of the cornea, but severe cases require corneal transplantation. KC is multifactorial and multigenic, but its pathophysiology is still an enigma. Multiple approaches are being pursued to elucidate the molecular changes that underlie the corneal phenotype to identify relevant genes for tailored candidate searches and to develop potential biomarkers and targets for therapeutic interventions. Recent proteomic and transcriptomic studies suggest dysregulations in oxidative stress, NRF2-regulated antioxidant programs, WNT-signaling, TGF-β, ECM and matrix metalloproteinases. This review aims to provide a broad update on the transcriptomic and proteomic studies of KC with a focus on findings that relate to oxidative stress, and dysregulations in cellular and extracellular matrix functions.
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Affiliation(s)
| | - Shukti Chakravarti
- Department of Ophthalmology, NYU Grossman School of Medicine, NY, 10016, USA; Department of Pathology, NYU Grossman School of Medicine, NY, 10016, USA.
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Elubous KA, Al Bdour M, Alshammari T, Jeris I, AlRyalat SA, Roto A, Abu Ameerha M. Environmental Risk Factors Associated With the Need for Penetrating Keratoplasty in Patients With Keratoconus. Cureus 2021; 13:e16506. [PMID: 34430120 PMCID: PMC8375353 DOI: 10.7759/cureus.16506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/05/2022] Open
Abstract
Purpose To identify environmental risk factors associated with the need for penetrating keratoplasty (PKP) (full-thickness corneal transplantation) in patients with keratoconus in a Middle Eastern country. Methods This is a retrospective case-control study. This study included patients with keratoconus who underwent PKPor were waitlisted for PKP. Controls were patients diagnosed with keratoconus who did not reach a stage that necessitates PKP. Groups were matched by age and gender. Chi-square test was used to figure out the association between different risk factors including eye rubbing, vernal keratoconjunctivitis (VKC), smoking, paternal consanguinity, eye dryness, family history, asthma, eczema, and diabetes with the need for PKP. Results A total of 111 patients were included in this study, there were 48 (43.26%) men and 63 (56.75%) women. The case group included 42 subjects and the control group included 69 subjects. We found statistically significant differences between the two groups in relation to eye rubbing (p=0.0005), VKC (p=0.005), paternal consanguinity (p=0.02), and smoking rate (p=0.04), all being significant in the group in need of PKP. On the other hand, we did not find out a statistically significant difference between the two groups in relation to family history (p=0.31), dryness (p=0.58), asthma (p=0.15), eczema (p=0.28), or diabetes (p=0.29). Conclusion This study has identified several risk factors associated with the need for PKP in patients with keratoconus, part of which are modifiable. These findings can benefit clinicians in community counseling and give recommendations that can help in preventing or - at least - delaying the need for PKP surgery in keratoconus, such as smoking cessation, aggressive treatment of VKC disease, eye rubbing avoidance, as well as raising awareness regarding the potential risks of paternal consanguinity in this disease entity.
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Affiliation(s)
- Khaled A Elubous
- Department of Ophthalmology, The University of Jordan, Amman, JOR
| | - Muawyah Al Bdour
- Department of Ophthalmology, The University of Jordan, Amman, JOR
| | - Taher Alshammari
- Department of Ophthalmology, The University of Jordan, Amman, JOR
| | - Issa Jeris
- Department of Ophthalmology, The University of Jordan, Amman, JOR
| | | | - Allaa Roto
- Department of Ophthalmology, The University of Jordan, Amman, JOR
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Yang K, Xu L, Fan Q, Gu Y, Zhang B, Meng F, Zhao D, Pang C, Ren S. A hospital-based study on clinical data, demographic data and visual function of keratoconus patients in Central China. Sci Rep 2021; 11:7559. [PMID: 33824422 PMCID: PMC8024332 DOI: 10.1038/s41598-021-87291-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
China is a populous country but lacks epidemiological data on keratoconus (KC). The present study aimed to investigate the clinical data, demographic data, and visual function (VF) data of KC patients in Central China. A total of 524 KC eyes in 307 KC patients (217 bilateral and 90 unilateral) from Henan Eye Hospital were included in the current study. Demographic and VF data were assessed with questionnaires administered by well-trained staff during face-to-face interviews. Visual acuity value was examined by a qualified optometrist, and the clinical data were measured by professional clinicians. The distributions of sex, residence and education level of KC patients were compared by Chi-square tests, and the ratios of people wearing glasses and rigid gas permeable (RGP) lenses were compared by McNemar tests. General linear models/Chi-squared tests were used to compare the clinical and demographic data according to KC severity. Spearman’s correlation analysis was used to test the associations between the data and KC severity. The mean age at diagnosis was 20.98 ± 6.06 years, and males had a higher ratio of KC than females (P < 0.001). Patients in rural areas had a higher rate of KC than those in urban areas (P = 0.039), and the proportion of KC patients with a higher education level (above high school) was high (P < 0.001). A total of 68.40% of the patients reported eye rubbing and 3.52% had a positive family history. The percentage of people wearing glasses was higher than that of patients wearing RGP lenses (P < 0.001). The total VF score of KC patients was 69.35 ± 15.25. The thinnest corneal thickness (TCT) and stiffness parameter at the first applanation (SP-A1) values were inversely correlated with KC severity (P < 0.05). The mean, steep, and max keratometry (Km, Ks and Kmax) values, the RGP lens use and keratoplasty were positively correlated with KC severity (all P < 0.05). The total VF score of the eye with better VA decreased as the severity increased (r = − 0.21, P = 0.002). The present study comprehensively describes various associated features of KC patients from a tertiary hospital in Central China, providing a reference for understanding the characteristics of KC patients in China.
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Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Bo Zhang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Feiying Meng
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Dongqing Zhao
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China.
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Resequencing of candidate genes for Keratoconus reveals a role for Ehlers-Danlos Syndrome genes. Eur J Hum Genet 2021; 29:1745-1755. [PMID: 33737726 DOI: 10.1038/s41431-021-00849-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/22/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023] Open
Abstract
The involvement of genetic factors in the pathogenesis of KC has long been recognized but the identification of variants affecting the underlying protein functions has been challenging. In this study, we selected 34 candidate genes for KC based on previous whole-exome sequencing (WES) and the literature, and resequenced them in 745 KC patients and 810 ethnically matched controls from Belgium, France and Italy. Data analysis was performed using the single variant association test as well as gene-based mutation burden and variance components tests. In our study, we detected enrichment of genetic variation across multiple gene-based tests for the genes COL2A1, COL5A1, TNXB, and ZNF469. The top hit in the single variant association test was obtained for a common variant in the COL12A1 gene. These associations were consistently found across independent subpopulations. Interestingly, COL5A1, TNXB, ZNF469 and COL12A1 are all known Ehlers-Danlos Syndrome (EDS) genes. Though the co-occurrence of KC and EDS has been reported previously, this study is the first to demonstrate a consistent role of genetic variants in EDS genes in the etiology of KC. In conclusion, our data show a shared genetic etiology between KC and EDS, and clearly confirm the currently disputed role of ZNF469 in disease susceptibility for KC.
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Shinde V, Sobreira N, Wohler ES, Maiti G, Hu N, Silvestri G, George S, Jackson J, Chakravarti A, Willoughby CE, Chakravarti S. Pathogenic alleles in microtubule, secretory granule and extracellular matrix-related genes in familial keratoconus. Hum Mol Genet 2021; 30:658-671. [PMID: 33729517 DOI: 10.1093/hmg/ddab075] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
Keratoconus is a common corneal defect with a complex genetic basis. By whole exome sequencing of affected members from 11 multiplex families of European ancestry, we identified 23 rare, heterozygous, potentially pathogenic variants in 8 genes. These include nonsynonymous single amino acid substitutions in HSPG2, EML6 and CENPF in two families each, and in NBEAL2, LRP1B, PIK3CG and MRGPRD in three families each; ITGAX had nonsynonymous single amino acid substitutions in two families and an indel with a base substitution producing a nonsense allele in the third family. Only HSPG2, EML6 and CENPF have been associated with ocular phenotypes previously. With the exception of MRGPRD and ITGAX, we detected the transcript and encoded protein of the remaining genes in the cornea and corneal cell cultures. Cultured stromal cells showed cytoplasmic punctate staining of NBEAL2, staining of the fibrillar cytoskeletal network by EML6, while CENPF localized to the basal body of primary cilia. We inhibited the expression of HSPG2, EML6, NBEAL2 and CENPF in stromal cell cultures and assayed for the expression of COL1A1 as a readout of corneal matrix production. An upregulation in COL1A1 after siRNA inhibition indicated their functional link to stromal cell biology. For ITGAX, encoding a leukocyte integrin, we assayed its level in the sera of 3 affected families compared with 10 unrelated controls to detect an increase in all affecteds. Our study identified genes that regulate the cytoskeleton, protein trafficking and secretion, barrier tissue function and response to injury and inflammation, as being relevant to keratoconus.
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Affiliation(s)
- Vishal Shinde
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Nara Sobreira
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Elizabeth S Wohler
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - George Maiti
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Nan Hu
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Giuliana Silvestri
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA UK
| | - Sonia George
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA UK
| | - Jonathan Jackson
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA UK
| | - Aravinda Chakravarti
- Center for Human Genetics and Genomics, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Colin E Willoughby
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA UK.,Genomic Medicine, Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, UK
| | - Shukti Chakravarti
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA.,Department of Pathology, NYU Grossman School of Medicine, New York, NY 10016, USA
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Alqudah N, Jammal H, Khader Y, Al-dolat W, Alshamarti S, Shannak Z. Characteristics of Keratoconus Patients in Jordan: Hospital-Based Population. Clin Ophthalmol 2021; 15:881-887. [PMID: 33688155 PMCID: PMC7935342 DOI: 10.2147/opth.s298400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To study the demographic, clinical and topographic characteristics of keratoconus patients in Jordan. METHODS A retrospective study which was conducted at King Abdullah University Hospital, Northern Jordan. The patients who visited our outpatient clinic from March 2015 to September 2020 and had a definite diagnosis of keratoconus were included in this study. Demographic and clinical data, including age, gender, family history, past ocular history, ophthalmic examination, and topographic parameters, were collected and analysed. Keratoconus severity was classified according to K mean readings. RESULTS A total of 234 patients with keratoconus were evaluated in this study. The majority of patients (73, 31.2%) were between the ages of 20 and 24. Allergic conjunctivitis was the most frequent past ocular history. Fifty-five patients (23.5%) had a family history of keratoconus. Regarding severity, most of the eyes were mild (63.3%), followed by moderate (24.7%), and then severe (11.9%). The severity of keratoconus was significantly associated with gender (p<0.001). No correlation was found between family history and severity. CONCLUSION Most of the Keratoconus patients were young, with a mean age of 25.9 years. The majority were mild in severity, with more females presented in the severe stage. The study reported high rate of family history (23.5%) in comparison to similar studies. Therefore, screening of family members of Keratoconus patients is advisable.
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Affiliation(s)
- Noor Alqudah
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hisham Jammal
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Public Health, Community Medicine and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wedad Al-dolat
- Department of Ophthalmology, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Sarah Alshamarti
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Zaki Shannak
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Shneor E, Frucht‐Pery J, Granit E, Gordon‐Shaag A. The prevalence of corneal abnormalities in first-degree relatives of patients with keratoconus: a prospective case-control study. Ophthalmic Physiol Opt 2020; 40:442-451. [PMID: 32706487 PMCID: PMC7496242 DOI: 10.1111/opo.12706] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/20/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Although there is a high prevalence of keratoconus in the Middle East including Israel, limited data is available describing first-degree relatives of patients with sporadic keratoconus (KC) using Scheimpflug imaging. The purpose of this study is to accurately phenotype first-degree relatives of patients with sporadic KC in Israel using corneal tomography, which may help determine the genetic aetiology of KC. METHODS First-degree relatives (N = 56) of 16 KC probands participated in this prospective case-control study. Healthy controls (N = 96) were from a previous study. Autorefraction, visual acuity, slit lamp biomicroscopy, retinoscopy, subjective refraction and Scheimpflug imaging (CSO Sirius Topographer) of keratoconus patients and their first-degree relatives were evaluated. The worse eye was used for KC and KC suspects. The main outcome measure was prevalence of abnormal corneal topography and tomography parameters, which was compared between first-degree relatives vs controls. p values < 0.05 were considered significant. RESULTS KC (N = 2) or KC suspect (N = 8) was diagnosed in 18% (95% CI 8-28%) of the first-degree relatives. At least one abnormal corneal parameter was evident in 34% of first-degree relatives, while this was significantly lower for controls (14%, χ2(1,N = 152) = 8.8, p = 0.01). Qualitative analysis showed KC first-degree relatives had significantly more abnormal anterior corneal topography patterns than controls (34% vs 17%, χ2(1,N = 152) = 5.9, p = 0.02). For first-degree relatives, sex was not a factor influencing prevalence of corneal abnormalities (18% for both men and women, χ2(1,N = 56) = 0.0, p = 1.0). A significant correlation was found for first-degree relatives between age and most corneal parameters, while this was not evident for the control group. CONCLUSIONS AND RELEVANCE Eye care practitioners should consider first-degree relatives of patients with KC at moderate risk for the disease and/or corneal abnormalities.
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Affiliation(s)
- Einat Shneor
- Department of Optometry and Vision ScienceHadassah Academic CollegeJerusalemIsrael
| | - Joseph Frucht‐Pery
- Department of Optometry and Vision ScienceHadassah Academic CollegeJerusalemIsrael
| | - Edna Granit
- Department of Optometry and Vision ScienceHadassah Academic CollegeJerusalemIsrael
| | - Ariela Gordon‐Shaag
- Department of Optometry and Vision ScienceHadassah Academic CollegeJerusalemIsrael
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Shinde V, Hu N, Mahale A, Maiti G, Daoud Y, Eberhart CG, Maktabi A, Jun AS, Al-Swailem SA, Chakravarti S. RNA sequencing of corneas from two keratoconus patient groups identifies potential biomarkers and decreased NRF2-antioxidant responses. Sci Rep 2020; 10:9907. [PMID: 32555404 PMCID: PMC7303170 DOI: 10.1038/s41598-020-66735-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/17/2020] [Indexed: 12/21/2022] Open
Abstract
Keratoconus is a highly prevalent (1 in 2000), genetically complex and multifactorial, degenerative disease of the cornea whose pathogenesis and underlying transcriptomic changes are poorly understood. To identify disease-specific changes and gene expression networks, we performed next generation RNA sequencing from individual corneas of two distinct patient populations - one from the Middle East, as keratoconus is particularly severe in this group, and the second from an African American population in the United States. We conducted a case: control RNA sequencing study of 7 African American, 12 Middle Eastern subjects, and 7 controls. A Principal Component Analysis of all expressed genes was used to ascertain differences between samples. Differentially expressed genes were identified using Cuffdiff and DESeq2 analyses, and identification of over-represented signaling pathways by Ingenuity Pathway Analysis. Although separated by geography and ancestry, key commonalities in the two patient transcriptomes speak of disease - intrinsic gene expression networks. We identified an overwhelming decrease in the expression of anti-oxidant genes regulated by NRF2 and those of the acute phase and tissue injury response pathways, in both patient groups. Concordantly, NRF2 immunofluorescence staining was decreased in patient corneas, while KEAP1, which helps to degrade NRF2, was increased. Diminished NRF2 signaling raises the possibility of NRF2 activators as future treatment strategies in keratoconus. The African American patient group showed increases in extracellular matrix transcripts that may be due to underlying profibrogenic changes in this group. Transcripts increased across all patient samples include Thrombospondin 2 (THBS2), encoding a matricellular protein, and cellular proteins, GAS1, CASR and OTOP2, and are promising biomarker candidates. Our approach of analyzing transcriptomic data from different populations and patient groups will help to develop signatures and biomarkers for keratoconus subtypes. Further, RNA sequence data on individual patients obtained from multiple studies may lead to a core keratoconus signature of deregulated genes and a better understanding of its pathogenesis.
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Affiliation(s)
- Vishal Shinde
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Nan Hu
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Alka Mahale
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - George Maiti
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Yassine Daoud
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles G Eberhart
- Ophthalmology and Oncology Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Azza Maktabi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Shukti Chakravarti
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA.
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA.
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Awwad ST, Yehia M, Mehanna CJ, Fattah MA, Saad A, Hatoum A, Al-Haddad C. Tomographic and Refractive Characteristics of Pediatric First-Degree Relatives of Keratoconus Patients. Am J Ophthalmol 2019; 207:71-76. [PMID: 31194951 DOI: 10.1016/j.ajo.2019.05.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the tomographic and refractive characteristics of pediatric first-degree relatives of patients with keratoconus. DESIGN Cross-sectional study. METHODS Setting: Department of Ophthalmology at the American University of Beirut Medical, Beirut, Lebanon. STUDY POPULATION Pediatric first-degree relatives of patients with keratoconus. Both eyes of all participants aged between 6 and 18 years were included and studied. EXCLUSION CRITERIA Soft contact lens use in the past 2 weeks or rigid gas-permeable lens wear within 4 weeks, history of prior ocular surgery or infectious keratitis, and unreliable corneal tomography. Masking and Randomization: Two masked cornea and refractive surgeons of different training backgrounds independently evaluated the participants' tomographic outputs. Additionally, the tomographic data were analyzed using Smadja's decision tree. OBSERVATION PROCEDURES Scheimpflug tomography, manifest refraction, and slit-lamp examination. MAIN OUTCOME MEASURES Anterior curvature indices, posterior elevation values, thinnest pachymetry, and subjective and objective tomographic interpretation. RESULTS One hundred eighty-three subjects were recruited. Tomographic evaluation after Cohen's kappa coefficient analysis revealed 32 patients as having keratoconus (17.5%), while 35 patients (19.1%) were labeled as keratoconus by objective analysis. There were 11.5%-15.5% of patients with keratoconus aged less than 11 years, 18.0% aged 12-15 years, and 25.5% aged 16-18 years. Their respective steepest anterior curvature and thinnest pachymetry are 44.8 ± 6.5 diopters (D) and 515.9 ± 39.2 μm, 47.34 ± 3.4 D and 496.1 ± 37.9 μm, and 49.7 ± 6.1 D and 486.0 ± 66.5 μm. A total of 37.5% of the keratoconus patients were unilateral as evaluated by tomography alone. CONCLUSIONS The prevalence of keratoconus in pediatric first-degree relatives of diagnosed keratoconus patients is high. Screening in this high-risk group is warranted.
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Loukovitis E, Kozeis N, Gatzioufas Z, Kozei A, Tsotridou E, Stoila M, Koronis S, Sfakianakis K, Tranos P, Balidis M, Zachariadis Z, Mikropoulos DG, Anogeianakis G, Katsanos A, Konstas AG. The Proteins of Keratoconus: a Literature Review Exploring Their Contribution to the Pathophysiology of the Disease. Adv Ther 2019; 36:2205-2222. [PMID: 31363996 PMCID: PMC6822850 DOI: 10.1007/s12325-019-01026-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Keratoconus (KC) is a complex, genetically heterogeneous multifactorial degenerative disorder characterized by corneal ectasia and thinning. Its incidence is approximately 1/2000-1/50,000 in the general population. KC is associated with moderate to high myopia and irregular astigmatism, resulting in severe visual impairment. KC structural abnormalities primarily relate to the weakening of the corneal collagen. Their understanding is crucial and could contribute to effective management of the disease, such as with the aid of corneal cross-linking (CXL). The present article critically reviews the proteins involved in the pathophysiology of KC, with particular emphasis on the characteristics of collagen that pertain to CXL. METHODS PubMed, MEDLINE, Google Scholar and GeneCards databases were screened for relevant articles published in English between January 2006 and June 2018. Keyword combinations of the words "keratoconus," "risk factor(s)," "genetics," "genes," "genetic association(s)," "proteins", "collagen" and "cornea'' were used. In total, 272 articles were retrieved, reviewed and selected, with greater weight placed on more recently published evidence. Based on the reviewed literature, an attempt was made to tabulate the up- and down-regulation of genes involved in KC and their protein products and to delineate the mechanisms involved in CXL. RESULTS A total of 117 proteins and protein classes have been implicated in the pathogenesis and pathophysiology of KC. These have been tabulated in seven distinct tables according to their gene coding, their biochemistry and their metabolic control. CONCLUSION The pathogenesis and pathophysiology of KC remain enigmatic. Emerging evidence has improved our understanding of the molecular characteristics of KC and could further improve the success rate of CXL therapies.
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Hashemi H, Heydarian S, Yekta A, Ostadimoghaddam H, Aghamirsalim M, Derakhshan A, Khabazkhoob M. High prevalence and familial aggregation of keratoconus in an Iranian rural population: a population-based study. Ophthalmic Physiol Opt 2018; 38:447-455. [DOI: 10.1111/opo.12448] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 02/02/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology; Noor Eye Hospital; Tehran Iran
| | - Samira Heydarian
- Department of Optometry; School of Paramedical Sciences; Mashhad University of Medical Sciences; Mashhad Iran
| | - Abbasali Yekta
- Refractive Errors Research Center; Mashhad University of Medical Sciences; Mashhad Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center; Mashhad University of Medical Sciences; Mashhad Iran
| | | | - Akbar Derakhshan
- Khatam-al-Anbia Hospital; Mashhad University of Medical Sciences; Mashhad Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing; School of Nursing and Midwifery; Shahid Beheshti University of Medical Sciences; Tehran Iran
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Valgaeren H, Koppen C, Van Camp G. A new perspective on the genetics of keratoconus: why have we not been more successful? Ophthalmic Genet 2017; 39:158-174. [DOI: 10.1080/13816810.2017.1393831] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Hanne Valgaeren
- Department of Biomedical Sciences, Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | - Carina Koppen
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Department of Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Guy Van Camp
- Department of Biomedical Sciences, Center of Medical Genetics, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
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Analysis of the VSX1 gene in sporadic keratoconus patients from China. BMC Ophthalmol 2017; 17:173. [PMID: 28950846 PMCID: PMC5615802 DOI: 10.1186/s12886-017-0567-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/20/2017] [Indexed: 12/15/2022] Open
Abstract
Background Keratoconus normally presents as a sporadic disease. Although different studies have found sequence variants of the visual system homeobox 1 (VSX1) gene associated with keratoconus in humans, no research has detected such variants in sporadic keratoconus patients from China. To investigate the possibility of VSX1 being a candidate susceptibility gene for Chinese patients with sporadic keratoconus, we performed sequence screening of this gene in such patients. Methods Whole DNA was obtained from the leukocytes in the peripheral venous blood of 50 patients with sporadic keratoconus and 50 control subjects without this ocular disorder. Polymerase chain reaction single-strand conformation polymorphism analysis and direct DNA sequencing technology were used to detect sequence variation in the five exons and splicing regions of the introns of the VSX1 gene. The sequencing results were analyzed using DNAstar software. Results One novel missense heterozygous sequence variant (p.Arg131Pro) was found in the first exon of the VSX1 gene in one keratoconus patient. Another heterozygous sequence variant (p.Gly160Val) in the second exon was found in two keratoconus patients. These variants were not detected in the control subjects. In the third intron of the VSX1 gene, c.8326G > A nucleotide substitution (including heterozygous and homozygous change) was also discovered. The frequency of this variation did not differ significantly between patients and controls, it should belong to single-nucleotide polymorphism of the VSX1 gene. Bioinformatic analysis also predicted that one missense sequence variation (p.Arg131Pro) may not cause a pathogenic change. Conclusions In this study, we added one novel missense sequence variation (p.Arg131Pro) in the coding region of the VSX1 gene to the range of VSX1 coding region variations observed in patients with sporadic keratoconus from China. Our work suggests that VSX1 sequence variants might be involved in the pathogenesis of sporadic keratoconus, but their precise role in disease causation requires further investigation.
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Rong SS, Ma STU, Yu XT, Ma L, Chu WK, Chan TCY, Wang YM, Young AL, Pang CP, Jhanji V, Chen LJ. Genetic associations for keratoconus: a systematic review and meta-analysis. Sci Rep 2017; 7:4620. [PMID: 28676647 PMCID: PMC5496893 DOI: 10.1038/s41598-017-04393-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/15/2017] [Indexed: 12/21/2022] Open
Abstract
Genetic associations for keratoconus could be useful for understanding disease pathogenesis and discovering biomarkers for early detection of the disease. We conducted a systematic review and meta-analysis to summarize all reported genetic associations for the disease. We searched in the MEDLINE, Embase, Web of Science, and HuGENET databases for genetic studies of keratoconus published from 1950 to June 2016. The summary odds ratio and 95% confidence intervals of all polymorphisms were estimated using the random-effect model. Among 639 reports that were retrieved, 24 fulfilled required criteria as eligible studies for meta-analysis, involving a total of 53 polymorphisms in 28 genes/loci. Results of our meta-analysis lead to the prioritization of 8 single-nucleotide polymorphisms (SNPs) in 6 genes/loci for keratoconus in Whites. Of them 5 genes/loci were originally detected in genome-wide association studies, including FOXO1 (rs2721051, P = 5.6 × 10-11), RXRA-COL5A1 (rs1536482, P = 2.5 × 10-9), FNDC3B (rs4894535, P = 1.4 × 10-8), IMMP2L (rs757219, P = 6.1 × 10-7; rs214884, P = 2.3 × 10-5), and BANP-ZNF469 (rs9938149, P = 1.3 × 10-5). The gene COL4A4 (rs2229813, P = 1.3 × 10-12; rs2228557, P = 4.5 × 10-7) was identified in previous candidate gene studies. We also found SNPs in 10 genes/loci that had a summary P value < 0.05. Sensitivity analysis indicated that the results were robust. Replication studies and understanding the roles of these genes in keratoconus are warranted.
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Affiliation(s)
- Shi Song Rong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Sarah Tsz Ue Ma
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Xin Ting Yu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Li Ma
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Kit Chu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tommy Chung Yan Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Vishal Jhanji
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.
- UPMC Eye Centre, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.
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Du GL, Chen WY, Li XN, He R, Feng PF. Induction of MMP‑1 and ‑3 by cyclical mechanical stretch is mediated by IL‑6 in cultured fibroblasts of keratoconus. Mol Med Rep 2017; 15:3885-3892. [PMID: 28393195 DOI: 10.3892/mmr.2017.6433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/16/2017] [Indexed: 11/06/2022] Open
Abstract
In order to understand the effect of mechanical stretch on corneal extracellular matrix remodeling, human keratoconus fibroblasts (HKCFBs) were subjected to cyclic stretch in vitro and the expression of matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinases (TIMPs), and inflammatory cytokines were evaluated. HKCFBs were seeded into a flexible membrane base and subjected to a cyclic stretch regimen of 10% equibiaxial stretch at a stretching frequency of 1 Hz for 6 h using a Flexcell tension unit. An antibody directed against interleukin‑6 (IL‑6 Ab) was used to investigate the roles of IL‑6 on mechanical stretch mediated regulation of MMP in HKCFBs. Culture supernatants were assayed using an enzyme‑linked immunosorbent assay for MMP‑1 and ‑3, TIMP‑1 and ‑2, and IL‑6. Total RNA from the cells was extracted, and quantitative polymerase chain reaction was used to determine mRNA for MMP‑1 and ‑3, TIMP‑1 and ‑2, and IL‑6. In stretched cells, levels of MMP‑1 and ‑3 demonstrated an increase compared with unstretched cells, but levels of TIMP‑1, and ‑2 revealed a decrease. Mechanical stretch significantly increased the mRNA expression and protein synthesis of IL‑6 compared with unstretched cells. IL‑6 induced MMP‑1 and ‑3 expression, whereas no significant effects were observed in levels of TIMP‑1 and ‑2 compared with the untreated control groups. Additionally, the IL‑6 Ab markedly inhibited the stretch‑induced increase in MMP‑1 and ‑3 in culture supernatants in a dose‑dependent manner. No significant differences in TIMP‑1 and ‑2 protein levels were detected between stretched cells treated with IL‑6 Ab and stretched cells without IL‑6 Ab treatment. These results indicate that cyclical mechanical stretch augments IL‑6 production and MMP expression, and reduces levels of TIMP in HKCFBs. Thus, it is suggested that IL‑6 mediates the stretch‑induced MMP expression.
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Affiliation(s)
- Gen-Lai Du
- Shanxi Key Lab of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi 030024, P.R. China
| | - Wei-Yi Chen
- Shanxi Key Lab of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi 030024, P.R. China
| | - Xiao-Na Li
- Shanxi Key Lab of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi 030024, P.R. China
| | - Rui He
- Department of Excimer Laser, Shanxi Eye Hospital, Taiyuan, Shanxi 030002, P.R. China
| | - Peng-Fei Feng
- Shanxi Key Lab of Material Strength & Structural Impact, Taiyuan University of Technology, Taiyuan, Shanxi 030024, P.R. China
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Naderan M, Rajabi MT, Zarrinbakhsh P, Naderan M, Bakhshi A. Association between Family History and Keratoconus Severity. Curr Eye Res 2016; 41:1414-1418. [PMID: 27158890 DOI: 10.3109/02713683.2015.1128553] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The high prevalence of positive family history of keratoconus (KC) in KC patients is well-known. However, the results regarding the association between family history of KC and disease severity are controversial. The aim of this study was to evaluate the possible association between family history and severity of KC. METHOD Clinical data of 1496 KC patients were evaluated. All participants were asked if they had had a family member with KC. Topographic and keratometric measurements of KC patients, including central corneal thickness (CCT), thinnest corneal thickness (TCT), mean, flat, and steep keratometry values (K) by the use of Pentacam, best-spectacle corrected visual acuity (BCVA), spherical equivalent (SE), and astigmatism were recorded and compared according to patients with and without a family history of KC, first- or second-degree family members, and the number of family members with KC. Severity of KC was classified according to the Amsler-Krumeich classification. RESULTS Family history of KC was present in 292 (19.5%) patients. Of those 292 patients who had a family history of KC, 159 (54.5%) had one family member with KC and 133 (45.5%) had two or more family members with KC. There was not a significant difference between corneal pachymetry and K values of the patients with and without a family history of KC (p > 0.05). However, those with a positive family history of KC had more severe disease, according to the Amsler-Krumeich classification (p < 0.05). KC patients who had more family members with KC had significantly lower TCT and significantly higher steep K and astigmatism (p < 0.05), and had more severe disease, according to the Amsler-Krumeich classification (p < 0.05). CONCLUSION We suggest that patients with more family members with KC should be subject to screening to identify early disease.
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Affiliation(s)
- Mohammad Naderan
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Taher Rajabi
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Parviz Zarrinbakhsh
- b Zarrinbakhsh Eye Clinic , Tehran University of Medical Sciences , Tehran , Iran
| | - Morteza Naderan
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Anahita Bakhshi
- a Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Sciences , Tehran , Iran
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Gordon-Shaag A, Millodot M, Kaiserman I, Sela T, Barnett Itzhaki G, Zerbib Y, Matityahu E, Shkedi S, Miroshnichenko S, Shneor E. Risk factors for keratoconus in Israel: a case-control study. Ophthalmic Physiol Opt 2015; 35:673-81. [DOI: 10.1111/opo.12237] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/22/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Ariela Gordon-Shaag
- Department of Optometry and Vision Science; Hadassah Academic College; Jerusalem Israel
| | - Michel Millodot
- School of Optometry and Vision Sciences; Cardiff University; Cardiff Wales
| | | | - Tzahi Sela
- CARE Laser Medical Group; Tel Aviv Israel
| | - Guy Barnett Itzhaki
- Department of Optometry and Vision Science; Hadassah Academic College; Jerusalem Israel
| | - Yaffa Zerbib
- Department of Optometry and Vision Science; Hadassah Academic College; Jerusalem Israel
| | - Efrat Matityahu
- Department of Optometry and Vision Science; Hadassah Academic College; Jerusalem Israel
| | - Shira Shkedi
- Department of Optometry and Vision Science; Hadassah Academic College; Jerusalem Israel
| | | | - Einat Shneor
- Department of Optometry and Vision Science; Hadassah Academic College; Jerusalem Israel
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Wolffsohn JS, Naroo SA, Christie C, Morris J, Conway R, Maldonado-Codina C, Retalic N, Purslow C. History and symptom taking in contact lens fitting and aftercare. Cont Lens Anterior Eye 2015; 38:258-65. [DOI: 10.1016/j.clae.2015.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/20/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
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Naderan M, Shoar S, Rezagholizadeh F, Zolfaghari M, Naderan M. Characteristics and associations of keratoconus patients. Cont Lens Anterior Eye 2015; 38:199-205. [DOI: 10.1016/j.clae.2015.01.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 12/13/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
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The genetic and environmental factors for keratoconus. BIOMED RESEARCH INTERNATIONAL 2015; 2015:795738. [PMID: 26075261 PMCID: PMC4449900 DOI: 10.1155/2015/795738] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/08/2015] [Accepted: 01/09/2015] [Indexed: 12/22/2022]
Abstract
Keratoconus (KC) is the most common cornea ectatic disorder. It is characterized by a cone-shaped thin cornea leading to myopia, irregular astigmatism, and vision impairment. It affects all ethnic groups and both genders. Both environmental and genetic factors may contribute to its pathogenesis. This review is to summarize the current research development in KC epidemiology and genetic etiology. Environmental factors include but are not limited to eye rubbing, atopy, sun exposure, and geography. Genetic discoveries have been reviewed with evidence from family-based linkage analysis and fine mapping in linkage region, genome-wide association studies, and candidate genes analyses. A number of genes have been discovered at a relatively rapid pace. The detailed molecular mechanism underlying KC pathogenesis will significantly advance our understanding of KC and promote the development of potential therapies.
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Foster J, Wu WH, Scott SG, Bassi M, Mohan D, Daoud Y, Stark WJ, Jun AS, Chakravarti S. Transforming growth factor β and insulin signal changes in stromal fibroblasts of individual keratoconus patients. PLoS One 2014; 9:e106556. [PMID: 25247416 PMCID: PMC4172437 DOI: 10.1371/journal.pone.0106556] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022] Open
Abstract
Keratoconus (KC) is a complex thinning disease of the cornea that often requires transplantation. The underlying pathogenic molecular changes in this disease are poorly understood. Earlier studies reported oxidative stress, metabolic dysfunctions and accelerated death of stromal keratocytes in keratoconus (KC) patients. Utilizing mass spectrometry we found reduced stromal extracellular matrix (ECM) proteins in KC, suggesting ECM-regulatory changes that may be due to altered TGFβ signals. Here we investigated properties of stromal cells from donor (DN) and KC corneas grown as fibroblasts in serum containing DMEM: F12 or in serum-free medium containing insulin, transferrin, selenium (ITS). Phosphorylation of SMAD2/3 of the canonical TGFβ pathway, was high in serum-starved DN and KC fibroblast protein extracts, but pSMAD1/5/8 low at base line, was induced within 30 minutes of TGFβ1 stimulation, more so in KC than DN, suggesting a novel TGFβ1-SMAD1/5/8 axis in the cornea, that may be altered in KC. The serine/threonine kinases AKT, known to regulate proliferation, survival and biosynthetic activities of cells, were poorly activated in KC fibroblasts in high glucose media. Concordantly, alcohol dehydrogenase 1 (ADH1), an indicator of increased glucose uptake and metabolism, was reduced in KC compared to DN fibroblasts. By contrast, in low glucose (5.5 mM, normoglycemic) serum-free DMEM and ITS, cell survival and pAKT levels were comparable in KC and DN cells. Therefore, high glucose combined with serum-deprivation presents some cellular stress difficult to overcome by the KC stromal cells. Our study provides molecular insights into AKT and TGFβ signal changes in KC, and a mechanism for functional studies of stromal cells from KC corneas.
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Affiliation(s)
- James Foster
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Wai-Hong Wu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sherri-Gae Scott
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Mehak Bassi
- All India Institute of Medical Sciences, New Delhi, India
| | - Divya Mohan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Yassine Daoud
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Walter J. Stark
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Albert S. Jun
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Shukti Chakravarti
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Hashemi H, Khabazkhoob M, Yazdani N, Ostadimoghaddam H, Norouzirad R, Amanzadeh K, Miraftab M, Derakhshan A, Yekta A. The prevalence of keratoconus in a young population in Mashhad, Iran. Ophthalmic Physiol Opt 2014; 34:519-27. [DOI: 10.1111/opo.12147] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 06/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center; Noor Eye Hospital; Tehran Iran
| | - Mehdi Khabazkhoob
- Department of Epidemiology; Faculty of Public Health; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Negareh Yazdani
- Department of Optometry; School of Paramedical Sciences; Mashhad University of Medical Sciences; Mashhad Iran
| | - Hadi Ostadimoghaddam
- Department of Optometry; School of Paramedical Sciences; Mashhad University of Medical Sciences; Mashhad Iran
| | | | - Kazem Amanzadeh
- Noor Ophthalmology Research Center; Noor Eye Hospital; Tehran Iran
| | | | - Akbar Derakhshan
- Department of Ophthalmology; Mashhad University of Medical Sciences; Mashhad Iran
| | - AbbasAli Yekta
- Department of Optometry; School of Paramedical Sciences; Mashhad University of Medical Sciences; Mashhad Iran
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Barbara R, Gordon-Shaag A, Millodot M, Shneor E, Essa M, Anton M. Prevalence of Keratoconus among Young Arab students in Israel. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10025-1070] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Purpose
To determine the prevalence of keratoconus (KC) in an Arab population in Israel.
Materials and methods
Videokeratography was performed on volunteer students from the Academic Arab College of Education, in Haifa, Israel. All participants filled out a self-administered questionnaire to evaluate possible risk factors for KC. Univariate and multivariate analysis were performed.
Results
Data of 314 participants were analyzed and a prevalence of (N = 10), 3.18% (95% CI, 1.2 to 5.1%) was found. The only significant factor (both in univariate and multivariate analysis) that was associated with KC was parental consanguinity (OR 5.10, p = 0.02). Druzes and Bedouins had a higher prevalence than Muslims and Christians. However, the differences were not significant possibly due to the small size of the sample.
Conclusion
The result of this study was similar to other studies conducted in the Middle East, which indicate a higher prevalence of KC than in western countries. It is also recommended that people who have consanguinity in their family should be topographically tested to detect the early stages of KC.
How to cite this article
Shneor E, Millodot M, Gordon-Shaag A, Essa M, Anton M, Barbara R, Barbara A. Prevalence of Keratoconus among Young Arab Students in Israel. Int J Kerat Ect Cor Dis 2014;3(1):9-14.
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Abstract
Keratoconus (KC) is a common degenerative condition that frequently results in visual loss with an onset typically in early adulthood. It is the single most common reason for keratoplasty in the developed world. The cause and underlying pathological mechanism are unknown, but both environmental and genetic factors are thought to contribute to the development of the disease. Various strategies have been employed to address the gap in our understanding of this complex disease, with the expectation that over time more sophisticated therapies will be developed. In this review we summarise our current knowledge of the aetiology and risk factors associated with KC.
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Abstract
PURPOSE To determine whether consanguinity is a risk factor for keratoconus (KC). METHODS A questionnaire was distributed to all patients presenting to St. John Eye Hospital, Jerusalem, Israel. Questionnaire included data on demographic characteristics and potential risk factors. Patients were divided into two groups: cases with KC, in at least one eye, who were diagnosed by the attending ophthalmologist on the basis of abnormal corneal topography and at least one of the common signs of the disease; and controls presenting for problems other than KC and free of systemic and ocular conditions associated with KC. Multivariate logistic analyses were performed to identify risk factors for KC. RESULTS Seventy cases and 140 controls participated in the study. Groups were similar with respect to sex and age. Univariate analyses found a significant association between KC and parental first-cousin consanguinity, eye rubbing, allergy, positive family history, education (>12 years), and sunglass wear, whereas asthma, eczema, smoking, and second-cousin consanguinity were not. Multivariate analyses showed that total consanguinity (first-cousin and second-cousin) (adjusted odds ratio, 3.96; p = 0.001), eye rubbing and absence of sunglass wear were significant risk factors. Education was also associated with KC, but family history was not so in the multivariate analysis. CONCLUSIONS This study supports the hypothesis that consanguinity is a significant risk factor for KC and provides strong support for a genetic contribution to the disease. Wearing sunglasses in this environment is beneficial, and the study confirmed that eye rubbing, allergy, and education are also significantly associated with KC after adjusting for other predictors.
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Shneor E, Millodot M, Blumberg S, Ortenberg I, Behrman S, Gordon-Shaag A. Characteristics of 244 patients with keratoconus seen in an optometric contact lens practice. Clin Exp Optom 2012; 96:219-24. [PMID: 23278637 DOI: 10.1111/cxo.12005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/07/2012] [Accepted: 08/21/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe the characteristics of keratoconic patients seen in a specialised contact lens practice from a general population with a high prevalence of the disease. METHODS Patients attending a contact lens practice for management of keratoconus were asked to complete a questionnaire. Data were collected on demographic characteristics, general health, family history, eye rubbing, allergy, asthma, eczema, education level, history of keratoplasty and smoking. RESULTS Two hundred and forty-four patients completed the questionnaire. There was a male bias (54.5 per cent). The majority of the patients (78.7 per cent) wore contact lenses, of whom 67.7 per cent wore hard, 13 per cent soft and 4.2 per cent scleral contact lenses. Some of the patients (21.3 per cent) had undergone corneal graft surgery. Eighteen per cent had an associated systemic disease, the most common of which was type 2 diabetes, although this disease was less prevalent, but not significantly, in the keratoconic sample than in the general population (p = 0.19). The prevalence of eye rubbing (65.6 per cent) was similar to other studies. Compared to the general population, asthma (13.2 per cent) was slightly, but not significantly, less prevalent (p = 0.17), eczema (6.6 per cent) was significantly less (p < 0.001) and allergy (34.4 per cent) was more prevalent (p < 0.001). A high proportion of patients reported a family history of the disease (27.9 per cent) and most were better educated than the general population. CONCLUSION The results of this survey concur with those of other studies with regard to most known characteristics of keratoconus; however, the proportion of asthma and eczema tended to be less than in other surveys and may be linked to the environmental influence of a hot and sunny country. The high prevalence of positive family history of the disease in this cohort suggests a genetic influence.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel.
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Jordan CA, Zamri A, Wheeldon C, Patel DV, Johnson R, McGhee CN. Computerized corneal tomography and associated features in a large New Zealand keratoconic population. J Cataract Refract Surg 2011; 37:1493-501. [DOI: 10.1016/j.jcrs.2011.03.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 02/04/2011] [Accepted: 03/06/2011] [Indexed: 10/18/2022]
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