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Miller DD, Wagner IV, Hasan SA, Stewart MW, Towne CM, Li Z, Baratz KH. Anatomic Characteristics of Eyes With Fuchs Endothelial Corneal Dystrophy. Cornea 2024:00003226-990000000-00679. [PMID: 39231632 DOI: 10.1097/ico.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 08/07/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE The purpose of this study was to evaluate and compare the anatomic characteristics of eyes with Fuchs endothelial corneal dystrophy (FECD) with eyes without FECD. METHODS This study was a retrospective chart review performed at an academic medical center. Patients with FECD were identified through a search of the electronic medical records. Eligible patients underwent Scheimpflug imaging and optical biometry and were compared with age and sex-matched control subjects who underwent similar testing in preparation for cataract surgery. Several measurements of the cornea, anterior chamber, and eyes were evaluated using multivariable linear regression models and multivariable logistic regression models. RESULTS A total of 404 eyes (202 eyes with FECD and 202 control eyes) were included in this study. Compared with controls, eyes with FECD had shallower AC depths, lower AC volumes, and narrower angles. Conversely, the spherical equivalent before cataract surgery, corneal pachymetry, and corneal volume were higher in eyes with FECD. On Scheimpflug imaging analysis, these anatomical differences were present in FECD eyes with and without corneal edema. After adjusting for sex, these differences remained statistically significant. Shorter axial length was found to be statistically significant in male eyes but not in female eyes with FECD. CONCLUSIONS This study reports new ocular characteristics in FECD eyes with and without edema. Optical biometry and Scheimpflug imaging established that the anatomic findings in eyes with FECD were not simply due to the larger volume of an edematous cornea but rather unique to eyes with FECD. These findings will provide reliable, normative data for future studies examining surgical, medical, and anatomical factors in FECD.
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Affiliation(s)
| | | | | | | | | | - Zhuo Li
- Quantitative Health Science, Mayo Clinic, Jacksonville, FL; and
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Kahale F, Alemi H, Naderi A, Deshpande N, Lee S, Wang S, Singh RB, Dohlman T, Yin J, Jurkunas U, Dana R. Neuropeptide alpha-Melanocyte stimulating hormone preserves corneal endothelial morphology in a murine model of Fuchs dystrophy. Sci Rep 2024; 14:18842. [PMID: 39138334 PMCID: PMC11322312 DOI: 10.1038/s41598-024-69416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024] Open
Abstract
Fuchs endothelial corneal dystrophy is a heterogenous disease with multifactorial etiology, and genetic, epigenetic, and exogenous factors contributing to its pathogenesis. DNA damage plays a significant role, with ultraviolet-A (UV-A) emerging as a key contributing factor. We investigate the potential application of neuropeptide α-melanocyte stimulating hormone (α-MSH) in mitigating oxidative stress induced endothelial damage. First, we examined the effects of α-MSH on a cultured human corneal endothelial cell line (HCEnC-21T) exposed to hydrogen peroxide (H2O2) induced oxidative DNA damage. We performed immunofluorescence and flow cytometry to assess DNA damage and cell death in the cultured cells. Additionally, we used an established mouse model that utilizes ultraviolet light to induce corneal endothelial cell damage resulting in decreased CEnC number, increased cell size variability, and decreased percentage of hexagonal cells. This endothelial decompensation leads to an increase in corneal thickness. Following UV-A exposure, the mice were systemically treated with α-MSH, either immediately after exposure (early treatment) or beginning two weeks post-exposure (delayed treatment). To evaluate treatment efficacy, we analyzed CEnC density and morphology using in vivo confocal microscopy, and central corneal thickness using anterior segment optical coherence tomography. Our findings demonstrated that α-MSH treatment effectively protects HCEnC-21T from free-radical induced oxidative DNA damage and subsequent cell death. In vivo, α-MSH treatment, mitigated the loss of CEnC density, deterioration of cell morphology and suppression of the resultant corneal swelling. These results underline the potential application of α-MSH as a therapeutic agent for mitigating corneal endothelial damage.
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Affiliation(s)
- Francesca Kahale
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Hamid Alemi
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Amirreza Naderi
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Neha Deshpande
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Seokjoo Lee
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Shudan Wang
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Rohan Bir Singh
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Thomas Dohlman
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Jia Yin
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Ula Jurkunas
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - Reza Dana
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA.
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Singh RB, Parmar UPS, Kahale F, Jeng BH, Jhanji V. Prevalence and Economic Burden of Fuchs Endothelial Corneal Dystrophy in the Medicare Population in the United States. Cornea 2024; 43:1022-1027. [PMID: 37906001 DOI: 10.1097/ico.0000000000003416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/23/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE The aim of this study was to assess the prevalence and economic burden of Fuchs endothelial corneal dystrophy (FECD) in patients older than 65 years in the United States. METHODS A retrospective analysis of the Medicare data reported to the Vision and Eye Health Surveillance System including patients diagnosed with FECD between 2014 and 2019 was performed. The crude prevalence rate of FECD was assessed and extrapolated to estimate the total case burden in the United States. The prevalence data were further compared between men and women and different racial groups. In addition, the economic burden was computed using inflation-adjusted direct costs of treatment to patients. RESULTS The Medicare database included 25,432,700 patients older than 65 years. The national prevalence of FECD in this population cohort was calculated to be 1.12% in 2019. In 2019, FECD case burden in Medicare patients older than 65 years was 284,846 and total estimated FECD case count in the country in this age group was 591,226. FECD prevalence was significantly higher in women as compared to men during the 6-year period evaluated in this study. The intergroup comparison revealed that FECD prevalence in the White population was significantly higher than all other racial groups ( P < 0.0001). The total inflation-adjusted economic burden of FECD in the United States in 2019 was USD 291.648 million and has increased from USD 243.998 million over the 6-year study period. CONCLUSIONS The estimated prevalence of FECD in the individuals older than 65 years is 1.12% in the United States. FECD prevalence is significantly higher in women and White population compared with other ethnicities.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
- Department of Population, Policy and Practice Research, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Discipline of Ophthalmology and Visual Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Francesca Kahale
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Bennie H Jeng
- Scheie Eye Institute, Perelman School of Medicine, University of Pennslyvania, Philadelphia, PA; and
| | - Vishal Jhanji
- Vision Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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De Piano M, Abicca I, Dinu V, Roszkowska AM, Micera A, Schiano-Lomoriello D. Expression of Hormones' Receptors in Human Corneal Endothelium from Fuchs' Dystrophy: A Possible Gender' Association. J Clin Med 2024; 13:3787. [PMID: 38999352 PMCID: PMC11242089 DOI: 10.3390/jcm13133787] [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: 05/22/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Age and sex are the most significant risk of factors for advanced Fuchs dystrophy. Nevertheless, few data are available on the hormone's receptor pattern expressed in adult and advanced fuchs endothelial corneal dystrophy (FECD). We investigated the impact of gender, growth factors and extracellular matrix (ECM) regulatory proteins expressed by the dystrophic endothelia. Methods: Ten dystrophic endothelial tissues and 10 normal endothelial sheets (corneoscleral specimens; Eye Bank) were used for this characterization study. Hormones' receptors (ERα, AR, PR, SHBG), few growth factors (VEGFA, βNGF, TGFβ1), some ECM regulators (MMP1, MMP7) and few inflammatory cytokines (IFNγ, IL10) were analyzed by real-time RT-PCR. Results: ERα transcripts were significantly increased, AR and SHBG transcripts were decreased in Fuchs endothelia from female patients, and no changes were detected for PR transcripts. VEGFA, βNGF and TGFβ1 transcripts were upregulated in Fuchs' endothelia, but not significantly linked to gender. High MMP1 and low MMP7 transcripts' expression were detected in Fuchs' specimens, mainly in males than females. An increased IFNγ (Th1) transcript expression was observed in females than males, and a trend to increase for IL10 (Th2) transcripts was detected in males than females. Conclusions: Our findings clearly indicate that hormone receptors, growth factors and matrix mediators as well as a Th1 pathway are predominant in Fuchs' dystrophy, displaying a pattern of expression specific for the female phenotype. The differential expression of hormones' receptors and the Th1/Th2 ratio might prompt to new theories to be tested in vitro and in vivo models, such as the use of hormonal substitute for counteracting this endothelial cell lost.
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Affiliation(s)
- Maria De Piano
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS-Fondazione Bietti, 00184 Rome, Italy
| | | | - Valentin Dinu
- Department of Ophthalmology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| | - Anna Maria Roszkowska
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
- Ophthalmology Department, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS-Fondazione Bietti, 00184 Rome, Italy
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Han SB, Liu YC, Liu C, Mehta JS. Applications of Imaging Technologies in Fuchs Endothelial Corneal Dystrophy: A Narrative Literature Review. Bioengineering (Basel) 2024; 11:271. [PMID: 38534545 DOI: 10.3390/bioengineering11030271] [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: 01/27/2024] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 03/28/2024] Open
Abstract
Fuchs endothelial corneal dystrophy (FECD) is a complex genetic disorder characterized by the slow and progressive degeneration of corneal endothelial cells. Thus, it may result in corneal endothelial decompensation and irreversible corneal edema. Moreover, FECD is associated with alterations in all corneal layers, such as thickening of the Descemet membrane, stromal scarring, subepithelial fibrosis, and the formation of epithelial bullae. Hence, anterior segment imaging devices that enable precise measurement of functional and anatomical changes in the cornea are essential for the management of FECD. In this review, the authors will introduce studies on the application of various imaging modalities, such as anterior segment optical coherence tomography, Scheimpflug corneal tomography, specular microscopy, in vitro confocal microscopy, and retroillumination photography, in the diagnosis and monitoring of FECD and discuss the results of these studies. The application of novel technologies, including image processing technology and artificial intelligence, that are expected to further enhance the accuracy, precision, and speed of the imaging technologies will also be discussed.
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Affiliation(s)
- Sang Beom Han
- Saevit Eye Hospital, Goyang 10447, Republic of Korea
| | - Yu-Chi Liu
- Singapore National Eye Centre, Singapore 168751, Singapore
- Singapore Eye Research Institute, Singapore 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Chang Liu
- Singapore Eye Research Institute, Singapore 168751, Singapore
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore 168751, Singapore
- Singapore Eye Research Institute, Singapore 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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Viola P, Neri E, Occhipinti T, Parekh M, Cian R, Ponzin D, Moramarco A, Iovieno A. Predicting Long-Term Endothelial Cell Loss after Preloaded Descemet Membrane Endothelial Keratoplasty in Fuchs' Endothelial Corneal Dystrophy: A Mathematical Model. J Clin Med 2024; 13:877. [PMID: 38337570 PMCID: PMC10856122 DOI: 10.3390/jcm13030877] [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: 12/04/2023] [Revised: 12/25/2023] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: This study offers a biexponential model to estimate corneal endothelial cell decay (ECD) following preloaded "endothelium-in" Descemet membrane endothelial keratoplasty (DMEK) in Fuchs' endothelial corneal dystrophy (FECD) patients; (2) Methods: A total of 65 eyes undergoing DMEK alone or combined with cataract surgery were evaluated. The follow-up period was divided into an early phase (first 6 months) and a late phase (up to 36 months). Endothelial cell count (ECC) and endothelial cell loss (ECL) were analyzed; (3) Results: The half time of the ECD was 3.03 months for the early phase and 131.50 months for the late phase. The predicted time-lapse interval to reach 500 cells/mm2 was 218 months (18.17 years), while the time-lapse interval to reach 250 cells/mm2 was 349 months (29.08 years). There was no statistically significant difference between the ECL in DMEK combined with cataract extraction and DMEK alone at 24 months (p ≥ 0.20). At the late phase, long-term ECL prediction revealed a lower ECC half time in patients undergoing DMEK combined with cataract surgery (98.05 months) than DMEK alone (250.32 months); (4) Conclusions: Based on the mathematical modeling, a predicted average half-life of a DMEK graft could reach 18 years in FECD. Moreover, combining cataract extraction with DMEK could result in excessive ECL in the long term.
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Affiliation(s)
- Pietro Viola
- Ophthalmology Unit, San Bortolo Hospital, 36100 Vicenza, Italy; (P.V.)
| | - Enrico Neri
- Ophthalmology Unit, San Bortolo Hospital, 36100 Vicenza, Italy; (P.V.)
| | | | - Mohit Parekh
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02115, USA;
| | - Roberto Cian
- Ophthalmology Unit, San Bortolo Hospital, 36100 Vicenza, Italy; (P.V.)
| | - Diego Ponzin
- Fondazione Banca degli Occhi del Veneto Onlus, 30174 Venice, Italy
| | - Antonio Moramarco
- Ophthalmology Unit, IRCCS, Azienda Ospedaliero-Universitaria, 40138 Bologna, Italy
| | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC V5Z 1L3, Canada
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Liu JX, Chiang TL, Hung KF, Sun YC. Therapeutic future of Fuchs endothelial corneal dystrophy: An ongoing way to explore. Taiwan J Ophthalmol 2024; 14:15-26. [PMID: 38654984 PMCID: PMC11034696 DOI: 10.4103/tjo.tjo-d-23-00115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/06/2023] [Indexed: 04/26/2024] Open
Abstract
Fuchs endothelial corneal dystrophy (FECD) is one of the most common corneal diseases that causes loss of visual acuity in the world. FECD is a genetically and pathogenetically heterogeneous disease that results in the failure of corneal endothelial cells to maintain fluid balance and functional homeostasis of the cornea. Corneal edema, central guttae formation, and bullae development are common corneal pathologies. Currently, the mainstay of FECD treatment is surgery. However, limited sources of corneal graft and postsurgical complications remain problematic. In recent years, with advances in medical science and technology, there have been a few promising trials of new treatment modalities for FECD. In addition to new surgical methods, novel modalities can be classified into pharmacological-associated treatment, cell therapy-associated treatment, and gene therapy-associated treatment. In this article, our primary focus is on the most recent clinical trials related to FECD, and we present a stepwise approach to enhance FECD management and ultimately improve patient outcomes. We thoroughly searched for FECD clinical trials and reviewed the study designs, methodologies, and outcomes of each trial conducted within the past decade. It is imperative for physicians to stay up-to-date with these cutting-edge treatment approaches.
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Affiliation(s)
- Jia-Xin Liu
- College of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Tung-Lin Chiang
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kai-Feng Hung
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chen Sun
- College of Medicine, Tzu-Chi University, Hualien, Taiwan
- Department of Ophthalmology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
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Sarkar S, Panikker P, D’Souza S, Shetty R, Mohan RR, Ghosh A. Corneal Regeneration Using Gene Therapy Approaches. Cells 2023; 12:1280. [PMID: 37174680 PMCID: PMC10177166 DOI: 10.3390/cells12091280] [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: 01/28/2023] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
One of the most remarkable advancements in medical treatments of corneal diseases in recent decades has been corneal transplantation. However, corneal transplants, including lamellar strategies, have their own set of challenges, such as graft rejection, delayed graft failure, shortage of donor corneas, repeated treatments, and post-surgical complications. Corneal defects and diseases are one of the leading causes of blindness globally; therefore, there is a need for gene-based interventions that may mitigate some of these challenges and help reduce the burden of blindness. Corneas being immune-advantaged, uniquely avascular, and transparent is ideal for gene therapy approaches. Well-established corneal surgical techniques as well as their ease of accessibility for examination and manipulation makes corneas suitable for in vivo and ex vivo gene therapy. In this review, we focus on the most recent advances in the area of corneal regeneration using gene therapy and on the strategies involved in the development of such therapies. We also discuss the challenges and potential of gene therapy for the treatment of corneal diseases. Additionally, we discuss the translational aspects of gene therapy, including different types of vectors, particularly focusing on recombinant AAV that may help advance targeted therapeutics for corneal defects and diseases.
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Affiliation(s)
- Subhradeep Sarkar
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560099, Karnataka, India
- Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Priyalakshmi Panikker
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560099, Karnataka, India
| | - Sharon D’Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore 560010, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore 560010, Karnataka, India
| | - Rajiv R. Mohan
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO 65201, USA
- One-Health Vision Research Program, Departments of Veterinary Medicine and Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
- Mason Eye Institute, School of Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560099, Karnataka, India
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Ayilam Ramachandran R, Sanches JM, Robertson DM. The roles of autophagy and mitophagy in corneal pathology: current knowledge and future perspectives. Front Med (Lausanne) 2023; 10:1064938. [PMID: 37153108 PMCID: PMC10160402 DOI: 10.3389/fmed.2023.1064938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/16/2023] [Indexed: 05/09/2023] Open
Abstract
The cornea is the clear dome that covers the front portion of the globe. The primary functions of the cornea are to promote the refraction of light and to protect the eye from invading pathogens, both of which are essential for the preservation of vision. Homeostasis of each cellular layer of the cornea requires the orchestration of multiple processes, including the ability to respond to stress. One mechanism whereby cells respond to stress is autophagy, or the process of "self-eating." Autophagy functions to clear damaged proteins and organelles. During nutrient deprivation, amino acids released from protein breakdown via autophagy are used as a fuel source. Mitophagy, a selective form of autophagy, functions to clear damaged mitochondria. Thus, autophagy and mitophagy are important intracellular degradative processes that sustain tissue homeostasis. Importantly, the inhibition or excessive activation of these processes result in deleterious effects on the cell. In the eye, impairment or inhibition of these mechanisms have been associated with corneal disease, degenerations, and dystrophies. This review summarizes the current body of knowledge on autophagy and mitophagy at all layers in the cornea in both non-infectious and infectious corneal disease, dystrophies, and degenerations. It further highlights the critical gaps in our understanding of mitochondrial dysfunction, with implications for novel therapeutics in clinical practice.
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Affiliation(s)
| | - Jose Marcos Sanches
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Danielle M Robertson
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
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Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium Inward: A 24-Month Comparative Analysis Between Fuchs Endothelial Corneal Dystrophy and Bullous Keratopathy. Cornea 2022:00003226-990000000-00121. [PMID: 36538420 DOI: 10.1097/ico.0000000000003138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to compare long-term clinical outcomes of preloaded Descemet membrane endothelial keratoplasty (DMEK) between Fuchs endothelial corneal dystrophy (FECD) and bullous keratopathy (BK). METHODS In this single-center retrospective clinical case series, 71 eyes of 64 patients indicated with FECD (62%) or BK (38%) (with or without cataract) were treated with preloaded DMEK grafts between March 2018 and February 2020. Standard DMEK peeling, followed by manual folding of the tissue with endothelium-inward orientation and storing in a preloaded fashion inside a 2.2-mm intraocular lens cartridge. All tissues were delivered using a bimanual pull-through technique, followed by air tamponade. Graft unfolding time, endothelial cell loss, corrected distance visual acuity, central corneal thickness, rebubbling rate, and intraoperative and postoperative complications at 1, 3, 6, 12, and 24 months were recorded. RESULTS The mean intraoperative graft unfolding time in FECD did not differ from the BK group ( P = 0.6061). Cystoid macular edema did not differ in either group ( P = 0.6866). The rebubbling rate was found to be significantly higher in FECD compared with the BK group ( P = 0.0423). Corrected distance visual acuity significantly improved at the first month after surgery ( P = 0.0012), with no differences between FECD and BK at 24 months ( P = 0.2578). Central corneal thickness was stable postoperatively and showed no differences between the groups ( P = 0.3693). Significantly higher endothelial cell counts were observed in the FECD group at 24 months ( P = 0.0002). CONCLUSIONS Preloaded DMEK with "endothelium-in" offers acceptable intraoperative time, rebubbling rate, and clinical outcomes in both FECD and BK groups. Patients with FECD show better postoperative clinical outcomes even if the rebubbling rate is relatively high.
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Chang YS, Ho CH, Wang JJ, Tseng SH, Jan RL. The Sociodemographic and Risk Factors for Fuchs’ Endothelial Dystrophy: A Nationwide, Matched Case–Control Study in Taiwan. J Pers Med 2022; 12:jpm12020305. [PMID: 35207793 PMCID: PMC8877330 DOI: 10.3390/jpm12020305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/05/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023] Open
Abstract
This nationwide, population-based, retrospective, matched case–control study included 4334 newly diagnosed Fuchs’ endothelial dystrophy (FED) patients who were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 371.57, and selected from the Taiwan National Health Insurance Research Database. The age-, sex-, and index-date-matched control group included 4334 non-FED controls selected from the Taiwan Longitudinal Health Insurance Database 2000. Ocular allergic conditions and sociodemographic conditions were examined using univariate logistic regression analyses and paired t-test was used for continuous variables. Adjusted logistic regression was used to compare the odds ratio (OR) of the FED development. Patients with ocular allergic conditions were more likely to have FED than the controls (OR = 25.50, 95% CI = 12.58–51.68, p < 0.0001) even after conditional logistic regression was conducted (adjusted OR = 25.26, 95% CI = 11.24–56.77, p < 0.0001). Regarding the sociodemographic factors, we found that more than half of the FED patients in Taiwan were aged ≥45 years old, there was an equal female-to-male ratio (1.06:1), and patients with a lower income and living in northern Taiwan had higher odds of developing FED. The results strongly support an association between ocular allergic conditions, geographic region, residential status, income, and FED.
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Affiliation(s)
- Yuh-Shin Chang
- Department of Ophthalmology, Chi Mei Medical Center, Tainan 710, Taiwan; (Y.-S.C.); (S.-H.T.)
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan 711, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan; (C.-H.H.); (J.-J.W.)
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan; (C.-H.H.); (J.-J.W.)
- Department of Anesthesiology, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Sung-Huei Tseng
- Department of Ophthalmology, Chi Mei Medical Center, Tainan 710, Taiwan; (Y.-S.C.); (S.-H.T.)
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Ren-Long Jan
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan 711, Taiwan
- Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan 736, Taiwan
- Correspondence: ; Tel.: +886-6-622-6999 (ext. 77601)
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Chalimeswamy A, Thanuja MY, Ranganath SH, Pandya K, Kompella UB, Srinivas SP. Oxidative Stress Induces a Breakdown of the Cytoskeleton and Tight Junctions of the Corneal Endothelial Cells. J Ocul Pharmacol Ther 2021; 38:74-84. [PMID: 34818079 DOI: 10.1089/jop.2021.0037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: To investigate the impact of oxidative stress, which is a hallmark of Fuchs dystrophy, on the barrier function of the corneal endothelial cells. Methods: Experiments were carried out with cultured bovine and porcine corneal endothelial cells. For oxidative stress, cells were supplemented with riboflavin (Rf) and exposed to UV-A (15-30 min) to induce Type-1 photochemical reactions that release H2O2. The effect of the stress on the barrier function was assayed by transendothelial electrical resistance (TER) measurement. In addition, the associated changes in the organization of the microtubules, perijunctional actomyosin ring (PAMR), and ZO-1 were evaluated by immunocytochemistry, which was also repeated after direct exposure to H2O2 (100 μM, 1 h). Results: Exposure to H2O2 led to the disassembly of microtubules and the destruction of PAMR. In parallel, the contiguous locus of ZO-1 was disrupted, marking a loss of barrier integrity. Accordingly, a sustained loss in TER was induced when cells in the Rf-supplemented medium were exposed to UV-A. However, the addition of catalase (7,000 U/mL) to rapidly decompose H2O2 limited the loss in TER. Furthermore, the adverse effects on microtubules, PAMR, and ZO-1 were suppressed by including catalase, ascorbic acid (1 mM; 30 min), or pretreatment with p38 MAP kinase inhibitor (SB-203580; 10 μM, 1 h). Conclusions: Acute oxidative stress induces microtubule disassembly by a p38 MAP kinase-dependent mechanism, leading to the destruction of PAMR and loss of barrier function. The response to oxidative stress is reminiscent of the (TNF-α)-induced breakdown of barrier failure in the corneal endothelium.
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Affiliation(s)
- Anupama Chalimeswamy
- Department of Biotechnology, Siddaganga Institute of Technology, Tumakuru, India.,Bio-INvENT Lab, Department of Chemical Engineering, Siddaganga Institute of Technology, Tumakuru, India
| | | | - Sudhir H Ranganath
- Bio-INvENT Lab, Department of Chemical Engineering, Siddaganga Institute of Technology, Tumakuru, India
| | - Kaveet Pandya
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Uday B Kompella
- Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
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Liu X, Zheng T, Zhao C, Zhang Y, Liu H, Wang L, Liu P. Genetic mutations and molecular mechanisms of Fuchs endothelial corneal dystrophy. EYE AND VISION 2021; 8:24. [PMID: 34130750 PMCID: PMC8204469 DOI: 10.1186/s40662-021-00246-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/18/2021] [Indexed: 11/10/2022]
Abstract
Background Fuchs endothelial corneal dystrophy is a hereditary disease and the most frequent cause of corneal transplantation in the worldwide. Its main clinical signs are an accelerated decrease in the number of endothelial cells, thickening of Descemet’s membrane and formation of guttae in the extracellular matrix. The cornea’s ability to maintain stromal dehydration is impaired, causing painful epithelial bullae and loss of vision at the point when the amount of corneal endothelial cells cannot be compensated. At present, apart from corneal transplantation, there is no other effective treatment that prevents blindness. Main text In this review, we first summarized the mutations of COL8A2, TCF4, TCF8, SLC4A11 and AGBL1 genes in Fuchs endothelial corneal dystrophy. The molecular mechanisms associated with Fuchs endothelial corneal dystrophy, such as endoplasmic reticulum stress and unfolded protein response pathway, oxidative stress, mitochondrial dysregulation pathway, apoptosis pathway, mitophagy, epithelial-mesenchymal transition pathway, RNA toxicity and repeat-associated non-ATG translation, and other pathogenesis, were then explored. Finally, we discussed several potential treatments related to the pathogenesis of Fuchs endothelial corneal dystrophy, which may be the focus of future research. Conclusions The pathogenesis of Fuchs endothelial corneal dystrophy is very complicated. Currently, corneal transplantation is an important method in the treatment of Fuchs endothelial corneal dystrophy. It is necessary to continuously explore the pathogenesis of Fuchs endothelial corneal dystrophy and establish the scientific foundations for the development of next-generation corneal therapeutics.
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Affiliation(s)
- Xuerui Liu
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tao Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Chuchu Zhao
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yi Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hanruo Liu
- The Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liyuan Wang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Ping Liu
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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Elsawy A, Eleiwa T, Chase C, Ozcan E, Tolba M, Feuer W, Abdel-Mottaleb M, Abou Shousha M. Multidisease Deep Learning Neural Network for the Diagnosis of Corneal Diseases. Am J Ophthalmol 2021; 226:252-261. [PMID: 33529589 DOI: 10.1016/j.ajo.2021.01.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To report a multidisease deep learning diagnostic network (MDDN) of common corneal diseases: dry eye syndrome (DES), Fuchs endothelial dystrophy (FED), and keratoconus (KCN) using anterior segment optical coherence tomography (AS-OCT) images. STUDY DESIGN Development of a deep learning neural network diagnosis algorithm. METHODS A total of 158,220 AS-OCT images from 879 eyes of 478 subjects were used to develop and validate a classification deep network. After a quality check, the network was trained and validated using 134,460 images. We tested the network using a test set of consecutive patients involving 23,760 AS-OCT images of 132 eyes of 69 patients. The area under receiver operating characteristic curve (AUROC), area under precision-recall curve (AUPRC), and F1 score and 95% confidence intervals (CIs) were computed. RESULTS The MDDN achieved eye-level AUROCs >0.99 (95% CI: 0.90, 1.0), AUPRCs > 0.96 (95% CI: 0.90, 1.0), and F1 scores > 0.90 (95% CI: 0.81, 1.0) for DES, FED, and KCN, respectively. CONCLUSIONS MDDN is a novel diagnostic tool for corneal diseases that can be used to automatically diagnose KCN, FED, and DES using only AS-OCT images.
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Affiliation(s)
- Amr Elsawy
- Bascom Palmer Eye institute, Miller School of Medicine, University of Miami, Miami; Electrical and Computer Engineering, University of Miami, Coral Gables
| | - Taher Eleiwa
- Bascom Palmer Eye institute, Miller School of Medicine, University of Miami, Miami; Department of Ophthalmology, Faculty of Medicine, Benha University, Egypt
| | - Collin Chase
- Bascom Palmer Eye institute, Miller School of Medicine, University of Miami, Miami
| | - Eyup Ozcan
- Bascom Palmer Eye institute, Miller School of Medicine, University of Miami, Miami; Net Eye Medical Center, Gaziantep, Turkey
| | - Mohamed Tolba
- Bascom Palmer Eye institute, Miller School of Medicine, University of Miami, Miami
| | - William Feuer
- Bascom Palmer Eye institute, Miller School of Medicine, University of Miami, Miami
| | | | - Mohamed Abou Shousha
- Bascom Palmer Eye institute, Miller School of Medicine, University of Miami, Miami; Electrical and Computer Engineering, University of Miami, Coral Gables; Biomedical Engineering, University of Miami, Coral Gables, Florida, USA.
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15
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Matrix metalloproteinases and their inhibitors in Fuchs endothelial corneal dystrophy. Exp Eye Res 2021; 205:108500. [PMID: 33617849 DOI: 10.1016/j.exer.2021.108500] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/23/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022]
Abstract
Fuchs endothelial corneal dystrophy (FECD) is characterized by a progressive loss of corneal endothelial cells (CECs) and an abnormal accumulation of extracellular matrix in Descemet's membrane leading to increased thickness and formation of excrescences called guttae. Extracellular matrix homeostasis is modulated by an equilibrium between matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs). This study aimed to investigate MMPs and TIMPs profile in FECD, taking into account cell morphology. Populations of FECD and healthy CECs were cultured and their conditioned media collected for analysis. The presence of proteases in the conditioned media was studied using a semi-quantitative proteome profiler array, and MMPs levels were assessed using quantitative assays (ELISA and quantitative antibody array). MMP activity was determined by zymography and fluorometry. The expression pattern of the membrane type 1-MMP (MT1-MMP, also known as MMP-14) was examined by immunofluorescence on ex vivo FECD and healthy explants of CECs attached to Descemet's membrane. Finally, MMPs and TIMPs protein expression was compared to gene expression obtained from previously collected data. FECD and healthy CEC populations generated cultures of endothelial, intermediate, and fibroblastic-like morphology. Various MMPs (MMP-1, -2, -3, -7, -8, -9, -10, and -12) and TIMPs (TIMP-1 to -4) were detected in both FECD and healthy CECs culture supernatants. Quantitative assays revealed a decrease in MMP-2 and MMP-10 among FECD samples. Both these MMPs can degrade the main extracellular matrix components forming guttae (fibronectin, laminin, collagen IV). Moreover, MMPs/TIMPs ratio was also decreased among FECD cell populations. Activity assays showed greater MMPs/Pro-MMPs proportions for MMP-2 and MMP-10 in FECD cell populations, although overall activities were similar. Moreover, the analysis according to cell morphology revealed among healthy CECs, both increased (MMP-3 and -13) and decreased (MMP-1, -9, -10, and -12) MMPs proteins along with increased MMPs activity (MMP-2, -3, -9, and -10) in the fibroblastic-like subgroup when compared to the endothelial subgroup. However, FECD CECs did not show similar behaviors between the different morphology subgroups. Immunostaining of MT1-MMP on ex vivo FECD and healthy explants revealed a redistribution of MT1-MMP around guttae in FECD explants. At the transcriptional level, no statistically significant differences were detected, but cultured FECD cells had a 12.2-fold increase in MMP1 and a 4.7-fold increase in TIMP3. These results collectively indicate different, and perhaps pathological, MMPs and TIMPs profile in FECD CECs compared to healthy CECs. This is an important finding suggesting the implication of MMPs and TIMPs in FECD pathophysiology.
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Ong Tone S, Kocaba V, Böhm M, Wylegala A, White TL, Jurkunas UV. Fuchs endothelial corneal dystrophy: The vicious cycle of Fuchs pathogenesis. Prog Retin Eye Res 2021; 80:100863. [PMID: 32438095 PMCID: PMC7648733 DOI: 10.1016/j.preteyeres.2020.100863] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
Fuchs endothelial corneal dystrophy (FECD) is the most common primary corneal endothelial dystrophy and the leading indication for corneal transplantation worldwide. FECD is characterized by the progressive decline of corneal endothelial cells (CECs) and the formation of extracellular matrix (ECM) excrescences in Descemet's membrane (DM), called guttae, that lead to corneal edema and loss of vision. FECD typically manifests in the fifth decades of life and has a greater incidence in women. FECD is a complex and heterogeneous genetic disease where interaction between genetic and environmental factors results in cellular apoptosis and aberrant ECM deposition. In this review, we will discuss a complex interplay of genetic, epigenetic, and exogenous factors in inciting oxidative stress, auto(mito)phagy, unfolded protein response, and mitochondrial dysfunction during CEC degeneration. Specifically, we explore the factors that influence cellular fate to undergo apoptosis, senescence, and endothelial-to-mesenchymal transition. These findings will highlight the importance of abnormal CEC-DM interactions in triggering the vicious cycle of FECD pathogenesis. We will also review clinical characteristics, diagnostic tools, and current medical and surgical management options for FECD patients. These new paradigms in FECD pathogenesis present an opportunity to develop novel therapeutics for the treatment of FECD.
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Affiliation(s)
- Stephan Ong Tone
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Viridiana Kocaba
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Myriam Böhm
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Adam Wylegala
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Tomas L White
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Ula V Jurkunas
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States.
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Transcriptome dataset of human corneal endothelium based on ribosomal RNA-depleted RNA-Seq data. Sci Data 2020; 7:407. [PMID: 33219220 PMCID: PMC7680133 DOI: 10.1038/s41597-020-00754-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022] Open
Abstract
The corneal endothelium maintains corneal transparency; consequently, damage to this endothelium by a number of pathological conditions results in severe vision loss. Publicly available expression databases of human tissues are useful for investigating the pathogenesis of diseases and for developing new therapeutic modalities; however, databases for ocular tissues, and especially the corneal endothelium, are poor. Here, we have generated a transcriptome dataset from the ribosomal RNA-depleted total RNA from the corneal endothelium of eyes from seven Caucasians without ocular diseases. The results of principal component analysis and correlation coefficients (ranged from 0.87 to 0.96) suggested high homogeneity of our RNA-Seq dataset among the samples, as well as sufficient amount and quality. The expression profile of tissue-specific marker genes indicated only limited, if any, contamination by other layers of the cornea, while the Smirnov-Grubbs test confirmed the absence of outlier samples. The dataset presented here should be useful for investigating the function/dysfunction of the cornea, as well as for extended transcriptome analyses integrated with expression data for non-coding RNAs. Measurement(s) | RNA | Technology Type(s) | RNA sequencing | Factor Type(s) | sex | Sample Characteristic - Organism | Homo sapiens |
Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.13186868
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Chen E, Bohm K, Rosenblatt M, Kang K. Epigenetic regulation of anterior segment diseases and potential therapeutics. Ocul Surf 2020; 18:383-395. [PMID: 32344150 DOI: 10.1016/j.jtos.2020.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/31/2020] [Accepted: 04/03/2020] [Indexed: 12/22/2022]
Abstract
In recent years, technological advances in sequencing have accelerated our understanding of epigenetics in ocular development and ophthalmic diseases. We now know that epigenetic modifications are necessary for normal ocular development and biological processes such as corneal wound healing and ocular surface repair, while aberrant epigenetic regulation underlies the pathogenesis of a wide range of ocular diseases, including cataracts and various diseases of the ocular surface. As the epigenetics of the eye is a constantly changing field of medicine, this comprehensive review focuses on innovations and scientific discoveries related to epigenetic control of anterior segment diseases that were published in the English literature in the past five years. These recent studies attempt to elucidate therapeutic targets for the anterior segment pathological processes. Already, recent studies have shown therapeutic potential in targeting epigenetic mechanisms of ocular diseases, and new epigenetic therapies are on the verge of being introduced to clinical practice. New drug targets can potentially emerge as we make further discoveries within this field.
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Affiliation(s)
- Eric Chen
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Kelley Bohm
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Mark Rosenblatt
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Kai Kang
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States.
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Moschos MM, Diamantopoulou A, Gouliopoulos N, Droutsas K, Bagli E, Chatzistefanou K, Kitsos G, Kroupis C. TCF4 and COL8A2 Gene Polymorphism Screening in a Greek Population of Late-onset Fuchs Endothelial Corneal Dystrophy. In Vivo 2019; 33:963-971. [PMID: 31028223 DOI: 10.21873/invivo.11565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIM Fuchs' endothelial corneal dystrophy (FECD) is a hereditary, progressive, bilateral, and irreversible disorder of the corneal endothelium. The purpose of this study was to develop a novel, accurate and high-throughput real-time polymerase chain reaction (PCR) method and melting-curve analysis in order to genotype the rs613872 polymorphism in the transcription factor 4 (TCF4) gene and to implement it on a well-ascertained sample of 22 Greek FECD patients and 58 healthy individuals, age- and sex-matched. PATIENTS AND METHODS DNA was extracted from blood samples, which were screened with the DNA sequencing method in order to detect the g.31753T>G/p.L450W (rs8035192) and g.31767C>A/p.Q455K (rs8035191) mutations in a COL8A2 genomic region. RESULTS TCF4 risk G allele frequency increased to 48% in FECD patients compared to 17% in healthy-subjects [OR=4.82 (95% CI=1.98-11.73)]. No p.L450W and p.Q455K COL8A2 gene mutations were detected. CONCLUSION We confirmed that rs613872 in the TCF4 gene is strongly and statistically associated with late-onset FECD in a Greek population.
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Affiliation(s)
- Marilita M Moschos
- First Department of Ophthalmology, G. Gennimatas General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andriana Diamantopoulou
- Department of Clinical Biochemistry, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Gouliopoulos
- First Department of Ophthalmology, G. Gennimatas General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Droutsas
- First Department of Ophthalmology, G. Gennimatas General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Bagli
- Department of Ophthalmology, Ioannina University General Hospital, University of Ioannina, Ioannina, Greece
| | - Klio Chatzistefanou
- First Department of Ophthalmology, G. Gennimatas General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Kitsos
- Department of Ophthalmology, Ioannina University General Hospital, University of Ioannina, Ioannina, Greece
| | - Christos Kroupis
- Department of Clinical Biochemistry, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tone SO, Jurkunas U. Imaging the Corneal Endothelium in Fuchs Corneal Endothelial Dystrophy. Semin Ophthalmol 2019; 34:340-346. [PMID: 31215821 PMCID: PMC6629500 DOI: 10.1080/08820538.2019.1632355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
Fuchs endothelial corneal dystrophy (FECD) is characterized by the progressive degeneration of the corneal endothelium (CE). The purpose of this article is to review the diagnostic tools available to image and assess the CE in FECD. Slit-lamp biomicroscopy with specular reflection and retroillumination are important techniques to assess the CE. Objective diagnostic tests, such as retroillumination photographic analysis, specular microscopy, in vivo confocal microscopy (IVCM), and anterior segment optical coherence tomography, are valuable tools to evaluate the CE in FECD. Specular microscopy can be performed rapidly without touching the eye but requires a clear cornea with a smooth CE. In contrast, IVCM can image all layers of the cornea, even in advanced FECD. However, IVCM is contact-based and more technically challenging. It is important to select the appropriate objective diagnostic test to image and assess the CE in managing patients with FECD.
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Affiliation(s)
- Stephan Ong Tone
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA USA
| | - Ula Jurkunas
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA USA
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21
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Ong Tone S, Bruha MJ, Böhm M, Prescott C, Jurkunas U. Regional variability in corneal endothelial cell density between guttae and non-guttae areas in Fuchs endothelial corneal dystrophy. Can J Ophthalmol 2019; 54:570-576. [PMID: 31564347 DOI: 10.1016/j.jcjo.2018.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/07/2018] [Accepted: 12/31/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the regional variability of corneal endothelial cell density (ECD) between guttae and non-guttae areas in subjects with Fuchs endothelial corneal dystrophy (FECD) using non-contact specular microscopy and confocal microscopy. DESIGN Retrospective chart review from 2009 to 2014 at the Massachusetts Eye and Ear Infirmary. PARTICIPANTS One hundred fifteen eyes of 73 subjects with FECD. METHODS Subjects with FECD underwent same-day specular and confocal microscopy in the same eye. Clinical stage of disease was documented on the day of image acquisition. Regional variability of ECD associated with guttae and non-guttae areas was assessed. Manual endothelial cell counts were performed. RESULTS Thirty-two percent of subjects had high quality endothelial images by both specular and confocal microscopy. Of these subjects, 83% were classified clinically as early-stage FECD. There was a significant association between stage of disease and the ability to obtain high quality specular images (χ2; p = 0.0012). There was no difference in mean ECD derived from specular (1363 ± 594 cells/mm2) or confocal (1391 ± 493 cells/mm2; p = 0.75) images. There was a statistically significant decrease of 31.8 ± 21.7% in mean ECD in areas surrounding guttae (1296 ± 560 cells/mm2) compared to non-guttae areas (1926 ± 674 cells/mm2; p < 0.0001) as determined by confocal microscopy. CONCLUSION These findings support confocal microscopy as an alternative to specular microscopy for evaluating the corneal endothelium of patients with FECD, especially those with advanced disease. Confocal microscopy also revealed regional differences in ECD in guttae and non-guttae areas in patients with FECD.
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Affiliation(s)
- Stephan Ong Tone
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Mass
| | | | - Myriam Böhm
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Mass
| | | | - Ula Jurkunas
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Mass.
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Mounir A, Zidan OF, Awny I, Mostafa EM. A Case of Artificial Snow Foam induced Corneal Endotheliitis Followed up by Scheimpflug Densitometry. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2019; 8:64-68. [PMID: 31263714 PMCID: PMC6592304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim was to present a rare case of artificial snow foam induced corneal endotheliitis followed up by Scheimpflug Densitometry. A 15-year-old male complained of redness, tearing and reduced vision in the left eye after artificial snow foam entered his left eye 4 days before the presentation. Slit lamp examination of the same eye showed ciliary injection with corneal edema with no epithelial defect and endothelial lesion measuring 3 × 4 millimeters (mm) with large keratic precipitates (KP). Examining the left eye by the Scheimpflug densitometry of the Sirius device (CSO, Florence, Italy) showed plaque on the back of the cornea. Aqueous tab Polymerase chain reaction analysis (PCR) results for the affected eye had negative results for viral infection. Improvement of ocular symptoms occurred after treatment with topical steroid therapy. Scheimpflug densitometry showed disappearance of the saw-tooth protrusions on the back of the cornea with decreased reflectivity. Corneal endotheliitis can be triggered by chemical ocular trauma. The Scheimpflug densitometry examination may be a useful noninvasive method for reaching a clinical diagnosis of corneal endotheliitis and monitoring treatment effectiveness.
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Affiliation(s)
- Amr Mounir
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Islam Awny
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Engy Mohamed Mostafa
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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In Vivo Confocal Microscopy Shows Alterations in Nerve Density and Dendritiform Cell Density in Fuchs' Endothelial Corneal Dystrophy. Am J Ophthalmol 2018; 196:136-144. [PMID: 30194928 DOI: 10.1016/j.ajo.2018.08.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate corneal nerve and immune cell alterations in Fuchs' endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK) by laser in vivo confocal microscopy (IVCM) as correlated to corneal sensation and endothelial cell loss. DESIGN Prospective, cross-sectional, controlled study. METHODS Thirty-three eyes with FECD were compared to 13 eyes with PBK and 17 normal age-matched control eyes at a tertiary referral center. FECD was classified into early (without edema) and late stage (with edema). Corneal IVCM and esthesiometry were performed. Corneal nerve and immune dendritiform cell (DC) alterations were evaluated and correlated to clinical parameters. RESULTS FECD and PBK eyes showed significantly (P = .001) diminished total nerve length (11.5 ± 1.3 and 2.9 ± 0.7 mm/mm2) and number (8.8 ± 1.1 and 2.2 ± 0.4 n/frame), compared to controls (23.3 ± 8.1 mm/mm2 and 25.9 ± 1.3 n/frame). Decreased nerves corresponded to diminished sensation in FECD (4.9 ± 0.2 cm; R = 0.32; P = .045), compared to controls (5.9 ± 0.04 cm). Early- and late-stage FECD showed significantly reduced total nerve length (13.1 ± 1.4 and 9.9 ± 1.2 mm/mm2, respectively) and number (8.2 ± 2.5 and 6.5 ± 2.1 n/frame), compared to controls (P < .001). DC density was significantly increased in FECD (57.8 ± 10.4 cells/mm2; P = .01), but not in PBK (47.7 ± 11.6 cells/mm2; P = .60) compared to controls (22.5 ± 4.5 cells/mm2). A subset of early FECD patients (7/22) demonstrated very high DC density (>100/mm2). CONCLUSION IVCM demonstrates profound diminishment of subbasal corneal nerves in early- and late-stage FECD and in PBK, correlating to decreased sensation. Increased DC density in early FECD demonstrates potential subclinical inflammation. The data suggest that reduction in subbasal nerves and increased immune activation may play a role in the pathophysiology of FECD.
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Ahmed Mohamed ET, Perone JM, Brand S, Koegel M, Declercq NF. Scanning Acoustic Microscopy Comparison of Descemet's Membrane Normal Tissue and Tissue With Fuchs' Endothelial Dystrophy. Invest Ophthalmol Vis Sci 2018; 59:5627-5632. [PMID: 30481279 DOI: 10.1167/iovs.18-25516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the application of scanning acoustic microscopy in the GHz-range (GHz-SAM) for qualitative imaging and quantitative characterization of the micromechanical properties of the Descemet's membrane and endothelial cells of cornea tissue. Methods Investigated were samples of a normal tissue and a tissue with Fuchs' endothelial dystrophy (FECD, cornea Guttata). Descemet's membranes were fixed on glass substrates and imaged utilizing a focused acoustic lens operating at a center frequency of 1 GHz. Results GHz-SAM data, based on the well-established V(z) technique, revealed discrepancies in the velocity of the propagation of Rayleigh surface acoustic waves (RSAW). RSAW were found to be slower in glass substrates with FECD samples than in the same glass substrates (soda-lime) with normal Descemet membrane, which indicates lower shear and bulk moduli of elasticity in tissues affected by FECD. Conclusions Noninvasive/nondestructive GHz-SAM, is utilized in this study for the imaging and characterization of Descemet membranes, fixated on glass substrates. V(z) signatures containing sufficient oscillations were obtained for the system of Descemet membranes on glass substrates. The observed variation in the microelastic properties indicates potential for further investigations with GHz-SAM based on the V(z) technique.
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Affiliation(s)
- Esam T Ahmed Mohamed
- Laboratory for Ultrasonic Nondestructive Evaluation "LUNE", UMI Georgia Tech-CNRS 2958, Metz, France
| | - Jean-Marc Perone
- Ophthalmology Department of the Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, France
| | - Sebastian Brand
- Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Center for Applied Microstructure Diagnostics CAM, Halle, Germany
| | - Michael Koegel
- Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Center for Applied Microstructure Diagnostics CAM, Halle, Germany
| | - Nico F Declercq
- Laboratory for Ultrasonic Nondestructive Evaluation "LUNE", UMI Georgia Tech-CNRS 2958, Metz, France
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Wagoner MD, Bohrer LR, Aldrich BT, Greiner MA, Mullins RF, Worthington KS, Tucker BA, Wiley LA. Feeder-free differentiation of cells exhibiting characteristics of corneal endothelium from human induced pluripotent stem cells. Biol Open 2018; 7:bio032102. [PMID: 29685994 PMCID: PMC5992532 DOI: 10.1242/bio.032102] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/11/2018] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to devise a strategy for the derivation of corneal endothelial cells (CEnCs) from adult fibroblast-derived induced pluripotent stem cells (iPSCs). IPSCs were generated from an adult human with normal ocular history via expression of OCT4, SOX2, KLF4 and c-MYC Neural crest cells (NCCs) were differentiated from iPSCs via addition of CHIR99021 and SB4315542. NCCs were driven toward a CEnC fate via addition of B27, PDGF-BB and DKK-2 to CEnC media. Differentiation of NCCs and CEnCs was evaluated via rt-PCR, morphological and immunocytochemical analysis. At 17 days post-NCC induction, there were notable changes in cell morphology and upregulation of the neural crest lineage transcripts PAX3, SOX9, TFAP2A, SOX10 and p75NTR and the proteins p75/NGFR and SOX10. Exposure of NCCs to B27, PDGF-BB and DKK-2 induced a shift in morphology from a spindle-shaped neural phenotype to a tightly-packed hexagonal appearance and increased expression of the transcripts ATP1A1, COL8A1, COL8A2, AQP1 and CDH2 and the proteins ZO-1, N-Cad, AQP-1 and Na+/K+ATPase. Replacement of NCC media with CEnC media on day 3, 5 or 8 reduced the differentiation time needed to yield CEnCs. IPSC-derived CEnCs could be used for evaluation of cornea endothelial disease pathophysiology and for testing of novel therapeutics.
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Affiliation(s)
- Michael D Wagoner
- Cornea Research Unit, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Laura R Bohrer
- Cornea Research Unit, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Benjamin T Aldrich
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Iowa Lions Eye Bank, Coralville, IA 52241, USA
| | - Mark A Greiner
- Cornea Research Unit, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Iowa Lions Eye Bank, Coralville, IA 52241, USA
| | - Robert F Mullins
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Kristan S Worthington
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Budd A Tucker
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Luke A Wiley
- Cornea Research Unit, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Institute for Vision Research, Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Ophthalmology & Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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Kuot A, Hewitt AW, Snibson GR, Souzeau E, Mills R, Craig JE, Burdon KP, Sharma S. TGC repeat expansion in the TCF4 gene increases the risk of Fuchs' endothelial corneal dystrophy in Australian cases. PLoS One 2017; 12:e0183719. [PMID: 28832669 PMCID: PMC5568371 DOI: 10.1371/journal.pone.0183719] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 08/09/2017] [Indexed: 11/18/2022] Open
Abstract
Fuchs' endothelial corneal dystrophy (FECD) is a progressive, vision impairing disease. Common single nucleotide polymorphisms (SNPs) and a trinucleotide repeat polymorphism, thymine-guanine-cytosine (TGC), in the TCF4 gene have been associated with the risk of FECD in some populations. We previously reported association of SNPs in TCF4 with FECD risk in the Australian population. The aim of this study was to determine whether TGC repeat polymorphism in TCF4 is associated with FECD in the Australian population. In 189 unrelated Australian cases with advanced late-onset FECD and 183 matched controls, the TGC repeat polymorphism located in intron 3 of TCF4 was genotyped using a short tandem repeat (STR) assay. The repeat length was verified by direct sequencing in selected homozygous carriers. We found significant association between the expanded TGC repeat (≥ 40 repeats) in TCF4 and advanced FECD (P = 2.58 × 10-22; OR = 15.66 (95% CI: 7.79-31.49)). Genotypic analysis showed that 51% of cases (97) compared to 5% of controls (9) were heterozygous or homozygous for the expanded repeat allele. Furthermore, the repeat expansion showed stronger association than the most significantly associated SNP, rs613872, in TCF4, with the disease in the Australian cohort. This and haplotype analysis of both the polymorphisms suggest that considering both the polymorphisms together rather than either of the two alone would better predict susceptibility to FECD in the Australian population. This is the first study to report association of the TGC trinucleotide repeat expansion in TCF4 with advanced FECD in the Australian population.
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Affiliation(s)
- Abraham Kuot
- Department of Ophthalmology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Alex W. Hewitt
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Grant R. Snibson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Emmanuelle Souzeau
- Department of Ophthalmology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Richard Mills
- Department of Ophthalmology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jamie E. Craig
- Department of Ophthalmology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kathryn P. Burdon
- Department of Ophthalmology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Shiwani Sharma
- Department of Ophthalmology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- * E-mail:
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Urrego-Díaz JA, Frías-Ordoñez JS, Figueroa-Echandía G, Durán-Silva G. Acute corneal edema without epithelium compromise. A case report and literature review. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n3.56637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El edema de córnea es una entidad que se produce por un gran número de causas y tiene diversas formas de presentación y diferentes grados de afección. En este artículo se reporta el caso de un hombre con edema de córnea agudo sin compromiso epitelial, en el que el cuadro clínico, el examen oftalmológico y los estudios de extensión no lograron establecer su etiología. Además, se hace una revisión de la literatura disponible respecto a todas las posibles causas de edema de córnea agudo, agrupándolas en aquellas que ocasionan el edema por lesión o inflamación epitelial o estromal, por disfunción endotelial o por un aumento en la presión intraocular.
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Thomasy SM, Cortes DE, Hoehn AL, Calderon AC, Li JY, Murphy CJ. In Vivo Imaging of Corneal Endothelial Dystrophy in Boston Terriers: A Spontaneous, Canine Model for Fuchs' Endothelial Corneal Dystrophy. Invest Ophthalmol Vis Sci 2017; 57:OCT495-503. [PMID: 27454658 PMCID: PMC4968913 DOI: 10.1167/iovs.15-18885] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Boston Terriers (BTs) have a greater prevalence of corneal endothelial dystrophy (CED), in comparison to other canine breeds. Similar to Fuchs' endothelial corneal dystrophy (FECD), this condition is characterized by endothelial cell degeneration with secondary corneal edema. This study assessed corneal morphology using in vivo confocal microscopy (IVCM) and Fourier-domain optical coherence tomography (FD-OCT) in BTs with and without CED. Methods The corneas of 16 BTs with CED and 15 unaffected, age-matched BTs underwent clinical evaluation and were imaged using IVCM and FD-OCT. A two-sample t-test or Mann-Whitney rank sum test were used to statistically compare parameters between groups. Data are presented as mean ± SD or median (range). Results Mean age did not significantly differ between affected and unaffected dogs at 10.0 ± 2.0 and 10.6 ± 2.4 years, respectively (P = 0.437). Females (69%) were overrepresented among the CED-affected dogs. In CED patients, IVCM demonstrated endothelial polymegathism and pleomorphism. Corneal endothelial density was significantly less (P < 0.001) in dogs with CED (1026 ± 260 cells/mm2) versus age-matched controls (2297 ± 372 cells/mm2). Fourier-domain OCT demonstrated a significant increase (P < 0.01) in central corneal and endothelium-Descemet's complex thickness in dogs with CED versus age-matched controls at 1019 (485–1550) or 536 (464–650) μm and 32 (22–56) or 25 (15–34) μm, respectively. Conclusions Corneal endothelial dystrophy in BTs is a bilateral, adult-onset condition that shares many similarities with FECD. Thus, CED could serve as a spontaneous disease model to study the pathogenesis of and develop novel treatments for FECD.
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Affiliation(s)
- Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States
| | - Dennis E Cortes
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States
| | - Alyssa L Hoehn
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States
| | - Allison C Calderon
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States
| | - Jennifer Y Li
- Department of Ophthalmology & Vision Science, School of Medicine, University of California, Davis, California, United States
| | - Christopher J Murphy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States 2Department of Ophthalmology & Vision Science, School of Medicine, University of California, Davis, California, Uni
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Khuc E, Bainer R, Wolf M, Clay SM, Weisenberger DJ, Kemmer J, Weaver VM, Hwang DG, Chan MF. Comprehensive characterization of DNA methylation changes in Fuchs endothelial corneal dystrophy. PLoS One 2017; 12:e0175112. [PMID: 28384203 PMCID: PMC5383226 DOI: 10.1371/journal.pone.0175112] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/21/2017] [Indexed: 12/13/2022] Open
Abstract
Transparency of the human cornea is necessary for vision. Fuchs Endothelial Corneal Dystrophy (FECD) is a bilateral, heritable degeneration of the corneal endothelium, and a leading indication for corneal transplantation in developed countries. While the early onset, and rarer, form of FECD has been linked to COL8A2 mutations, the more common, late onset form of FECD has genetic mutations linked to only a minority of cases. Epigenetic modifications that occur in FECD are unknown. Here, we report on and compare the DNA methylation landscape of normal human corneal endothelial (CE) tissue and CE from FECD patients using the Illumina Infinium HumanMethylation450 (HM450) DNA methylation array. We show that DNA methylation profiles are distinct between control and FECD samples. Differentially methylated probes (10,961) were identified in the FECD samples compared with the control samples, with the majority of probes being hypermethylated in the FECD samples. Genes containing differentially methylated sites were disproportionately annotated to ontological categories involving cytoskeletal organization, ion transport, hematopoetic cell differentiation, and cellular metabolism. Our results suggest that altered DNA methylation patterns may contribute to loss of corneal transparency in FECD through a global accumulation of sporadic DNA methylation changes in genes critical to basic CE biological processes.
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Affiliation(s)
- Emily Khuc
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
| | - Russell Bainer
- Department of Surgery and Center for Bioengineering and Tissue Regeneration, University of California, San Francisco, California, United States of America
- Bay Area Physical Sciences-Oncology Program, University of California, Berkeley, California, United States of America
| | - Marie Wolf
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
| | - Selene M. Clay
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
| | - Daniel J. Weisenberger
- Department of Biochemistry and Molecular Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Jacquelyn Kemmer
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
| | - Valerie M. Weaver
- Department of Surgery and Center for Bioengineering and Tissue Regeneration, University of California, San Francisco, California, United States of America
- Bay Area Physical Sciences-Oncology Program, University of California, Berkeley, California, United States of America
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, United States of America
- Departments of Anatomy and Bioengineering and Therapeutic Sciences and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research, University of California, San Francisco, California, United States of America
| | - David G. Hwang
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
| | - Matilda F. Chan
- Department of Ophthalmology, University of California, San Francisco, California, United States of America
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
- * E-mail:
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Nielsen E. Fuchs' endothelial corneal dystrophy: pathology and treatment outcome. Acta Ophthalmol 2016. [DOI: 10.1111/aos.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Esben Nielsen
- Department of Health; Aarhus University; Aarhus Denmark
- Department of Ophthalmology; Aarhus University Hospital; Denmark
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Ali M, Raghunathan V, Li JY, Murphy CJ, Thomasy SM. Biomechanical relationships between the corneal endothelium and Descemet's membrane. Exp Eye Res 2016; 152:57-70. [PMID: 27639516 DOI: 10.1016/j.exer.2016.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/13/2016] [Indexed: 12/28/2022]
Abstract
The posterior face of the cornea consists of the corneal endothelium, a monolayer of cuboidal cells that secrete and attach to Descemet's membrane, an exaggerated basement membrane. Dysfunction of the endothelium compromises the barrier and pump functions of this layer that maintain corneal deturgesence. A large number of corneal endothelial dystrophies feature irregularities in Descemet's membrane, suggesting that cells create and respond to the biophysical signals offered by their underlying matrix. This review provides an overview of the bidirectional relationship between Descemet's membrane and the corneal endothelium. Several experimental methods have characterized a richly topographic and compliant biophysical microenvironment presented by the posterior surface of Descemet's membrane, as well as the ultrastructure and composition of the membrane as it builds during a lifetime. We highlight the signaling pathways involved in the mechanotransduction of biophysical cues that influence cell behavior. We present the specific example of Fuchs' corneal endothelial dystrophy as a condition in which a dysregulated Descemet's membrane may influence the progression of disease. Finally, we discuss some disease models and regenerative strategies that may facilitate improved treatments for corneal dystrophies.
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Affiliation(s)
- Maryam Ali
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA.
| | - VijayKrishna Raghunathan
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, TX, 77204, USA.
| | - Jennifer Y Li
- Department of Ophthalmology & Vision Science, School of Medicine, UC Davis Medical Center, Sacramento, CA, 95817, USA.
| | - Christopher J Murphy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA; Department of Ophthalmology & Vision Science, School of Medicine, UC Davis Medical Center, Sacramento, CA, 95817, USA.
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA.
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Fernández López E, Lam FC, Bruinsma M, Baydoun L, Dapena I, Melles GRJ. Fuchs endothelial corneal dystrophy: current treatment recommendations and experimental surgical options. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1024109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Weiss JS, Møller HU, Aldave AJ, Seitz B, Bredrup C, Kivelä T, Munier FL, Rapuano CJ, Nischal KK, Kim EK, Sutphin J, Busin M, Labbé A, Kenyon KR, Kinoshita S, Lisch W. IC3D classification of corneal dystrophies--edition 2. Cornea 2015; 34:117-59. [PMID: 25564336 DOI: 10.1097/ico.0000000000000307] [Citation(s) in RCA: 309] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To update the 2008 International Classification of Corneal Dystrophies (IC3D) incorporating new clinical, histopathologic, and genetic information. METHODS The IC3D reviewed worldwide peer-reviewed articles for new information on corneal dystrophies published between 2008 and 2014. Using this information, corneal dystrophy templates and anatomic classification were updated. New clinical, histopathologic, and confocal photographs were added. RESULTS On the basis of revisiting the cellular origin of corneal dystrophy, a modified anatomic classification is proposed consisting of (1) epithelial and subepithelial dystrophies, (2) epithelial-stromal TGFBI dystrophies, (3) stromal dystrophies, and (4) endothelial dystrophies. Most of the dystrophy templates are updated. The entity "Epithelial recurrent erosion dystrophies" actually includes a number of potentially distinct epithelial dystrophies (Franceschetti corneal dystrophy, Dystrophia Smolandiensis, and Dystrophia Helsinglandica) but must be differentiated from dystrophies such as TGFBI-induced dystrophies, which are also often associated with recurrent epithelial erosions. The chromosome locus of Thiel-Behnke corneal dystrophy is only located on 5q31. The entity previously designated as a variant of Thiel-Behnke corneal dystrophy on chromosome 10q24 may represent a novel corneal dystrophy. Congenital hereditary endothelial dystrophy (CHED, formerly CHED2) is most likely only an autosomal recessive disorder. The so-called autosomal dominant inherited CHED (formerly CHED1) is insufficiently distinct to continue to be considered a unique corneal dystrophy. On review of almost all of the published cases, the description appeared most similar to a type of posterior polymorphous corneal dystrophy linked to the same chromosome 20 locus (PPCD1). Confocal microscopy also has emerged as a helpful tool to reveal in vivo features of several corneal dystrophies that previously required histopathologic examination to definitively diagnose. CONCLUSIONS This revision of the IC3D classification includes an updated anatomic classification of corneal dystrophies more accurately classifying TGFBI dystrophies that affect multiple layers rather than are confined to one corneal layer. Typical histopathologic and confocal images have been added to the corneal dystrophy templates.
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Affiliation(s)
- Jayne S Weiss
- *Department of Ophthalmology, Pathology and Pharmacology, Louisiana State University Eye Center of Excellence, Louisiana State University Health Sciences Center, Louisiana State University, New Orleans, LA; †Department of Pediatric Ophthalmology, Viborg Hospital and Aarhus University Hospital, Aarhus, Denmark; ‡The Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, CA; §Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany; ¶Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway; ‖Department of Opthalmology, Helsinki University Central Hospital, Helsinki, Finland; **Jules-Gonin Eye Hospital, Lausanne, Switzerland; ††Cornea Service, Wills Eye Hospital, Philadelphia, PA; ‡‡University of Pittsburgh Medical Center Children's Eye Center, Pittsburgh, PA; §§Cornea Dystrophy Research Institute, Department of Ophthalmology, College of Medicine, Yonsei University, Seoul, Korea; ¶¶Department of Ophthalmology, University of Kansas Medical Center, Kansas City, KS; ‖‖Department of Ophthalmology, Villa Igea Hospital, Maître de Conférences des Universités Praticien Hospitalier, Forli, Italy; ***Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Institut de la Vision, Paris, France; †††Tufts University School of Medicine, Harvard Medical School, Schepens Eye Research Institute, New England Eye Center, Boston, MA; ‡‡‡Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; and §§§Department of Ophthalmology, Johannes Gutenberg University Mainz, Mainz, Germany
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