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Gassel CJ, Rohrbach JM, Röck D, Bartz-Schmidt KU, Röck T. Histological findings of corneal tissue after failed phototherapeutic keratectomy in macular corneal dystrophy - a case report. BMC Ophthalmol 2022; 22:209. [PMID: 35527243 PMCID: PMC9080147 DOI: 10.1186/s12886-022-02400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/12/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Macular corneal dystrophy is a rare inherited disease of the cornea leading to deposits mainly in the stroma. Affected patients suffer from progressive loss of visual acuity which should be treated with penetrating keratoplasty. This is the first case report describing the clinical and histopathological findings of corneal tissue after failed phototherapeutic keratectomy (PTK) in a patient with macular corneal dystrophy. CASE PRESENTATION A 32-year-old man presented with visual impairment, blurred vision and increasing glare sensitivity in both eyes in 2014. All symptoms had existed for several years and had recently increased sharply. A corneal dystrophy was diagnosed and penetrating keratoplasty was recommended but the patient was hesitant to undergo surgery. In 2018, in contrast to current guidelines, a PTK was performed in both eyes in Turkey for unknown reasons. In May 2019, he presented again in our clinic. Best corrected visual acuity was markedly reduced in both eyes. Slit-lamp examination revealed multiple dense, poorly circumscribed grey-white patchy changes in the stroma accompanied by corneal opacity in both eyes. In February 2020, the patient decided to have penetrating keratoplasty performed at the University Eye Hospital in Tübingen. The explanted cornea was stained for acid mucopolysaccharides (AMP) and periodic acid-Schiff staining (PAS). The histopathological examination revealed destruction of Bowman's layer and a subepithelial fibrosis band due to the PTK previously performed. The AMP staining demonstrated blue deposits typical of macular corneal dystrophy, mainly in the stroma but also in the endothelium. Interestingly, the acidic mucopolysaccharides were found increased in the PTK-induced subepithelial fibrosis band. The postoperative course after keratoplasty was favourable with a significant increase in visual acuity and a clear graft. CONCLUSIONS This report presents the first case of a histologically evident exacerbation of macular corneal dystrophy after PTK and emphasizes the relevance of thorough pre-interventional diagnosis and patient selection to consider other therapeutic approaches, such as penetrating keratoplasty.
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Affiliation(s)
- Caroline Julia Gassel
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany
| | - Jens Martin Rohrbach
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany
| | - Daniel Röck
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany
| | - Karl Ulrich Bartz-Schmidt
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany
| | - Tobias Röck
- grid.10392.390000 0001 2190 1447Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen , Germany ,grid.10392.390000 0001 2190 1447Prof. Dr. med. Tobias Röck, Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Str. 7, 72076 Tübingen, Germany
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Hao XD, Liu YN, Hu SH, Pan XJ, Chen P. Association of macular corneal dystrophy with excessive cell senescence and apoptosis induced by the novel mutant CHST6. Exp Eye Res 2022; 214:108862. [PMID: 34826417 DOI: 10.1016/j.exer.2021.108862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
Macular corneal dystrophy (MCD) is a rare form of hereditary corneal dystrophy caused by CHST6 mutations. Owing to the genetic heterogeneity and population differences among patients with MCD, the genetic cause of MCD has not been fully elucidated, and the pathogenesis underlying the genetic mutation is still unclear. In this study, Chinese families and sporadic patients were included as subjects, and clinical and genetic analyses were performed to detect novel CHST6 mutations. In addition, the underlying pathogenic mechanisms of MCD were investigated by in vitro cell experiments. Two consanguineously married families and 10 sporadic patients with MCD were enrolled. Direct sequencing of the CHST6 gene was performed in all the patients to identify novel mutations. Wild-type and mutant overexpression cell lines were constructed to study the effects of the mutation in vitro. The expressions of endoplasmic reticulum (ER) stress markers and apoptotic factors, cell senescence, and migration levels tests were performed in different overexpression cell lines. As a result, four novel mutations (R155Afs*66, S84Cfs*17, E71G, and E71Q) and 10 previously reported mutations in the CHST6 gene were identified. Among the reported mutations, the most frequent mutations detected in the patients were L21Rfs*88 (4/14) and L21H (4/14). All the novel mutations were absent in the 50 healthy controls and were predicted to alter highly conserved amino acids across the different species and considered to be "disease causing" by function prediction. The results of the in vitro cell experiment further demonstrated that the novel homozygous frameshift mutations (S84Cfs*17 and R155Afs*66) of CHST6 detected in the consanguineously married families could lead to truncated proteins with defect functions, higher ER stress and apoptotic levels, decreased cell migration, and excessive cell senescence in corneal stromal cells, thereby affecting the normal functions of corneal stromal cells. These changes might play important roles in corneal opacity, which is characteristic of corneas with MCD. Our study extended the existing spectrum of disease-causing mutations and further elucidated the underlying pathogenic mechanisms of MCD.
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Affiliation(s)
- Xiao-Dan Hao
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
| | - Ya-Ning Liu
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao, 266071, China
| | - Shao-Hua Hu
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao, 266071, China
| | - Xiao-Jing Pan
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, China.
| | - Peng Chen
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao, 266071, China; Institute of Stem Cell Regeneration Medicine, School of Basic Medicine, Qingdao University, Qingdao, 266071, China.
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Li D, Tian L, Wang X, Chen M. Macular corneal dystrophy related to novel mutations of CHST6 in a Chinese family and clinical observation after penetrating keratoplasty. BMC Med Genomics 2021; 14:247. [PMID: 34645431 PMCID: PMC8513235 DOI: 10.1186/s12920-021-01095-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Macular corneal dystrophy (MCD) is a rare corneal stromal dystrophy with bilateral progressive vision loss. The pathogenic gene of MCD is carbohydrate sulfotransferase 6 (CHST6). Herein, we report a novel missense mutation and a rare exon deletion mutation in the CHST6 gene in a Chinese family with MCD. METHODS Genomic DNA was extracted from the peripheral blood, and next generation sequencing was used to analyse the gene sequence. The pathogenic mutations were identified in all affected family members. The proband successively received binocular penetrating keratoplasty (PKP), and the corneas were examined by histopathology and colloidal iron staining to prove the diagnosis. A long-term follow-up was made to observe the changes after PKP. RESULTS Genetic analysis demonstrated hemizygous mutations in the proband, including a novel c.520A>C (p.K174Q) missense mutation and a rarely reported exon 3 deletion mutation, which were co-segregated with the MCD phenotypes in the pedigree. The positive colloidal iron staining confirmed the diagnosis of MCD in the proband. However, the clinical phenotype and pathological manifestation of both eyes were different from each other because of complicated keratitis in the left eye. During the nine years of follow-up, visual acuity was improved significantly, and the cornea was transparent without rejection and postoperative recurrence in both eyes. CONCLUSIONS The novel hemizygous mutations were thought to contribute to the loss of CHST6 function, which induced typical clinical and pathological features of MCD. PKP was an effective treatment for MCD.
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Affiliation(s)
- Dewei Li
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 5 Yan'erdao Road, Qingdao, 266071, China
| | - Le Tian
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 5 Yan'erdao Road, Qingdao, 266071, China
| | - Xiaochuan Wang
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 5 Yan'erdao Road, Qingdao, 266071, China
| | - Min Chen
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 5 Yan'erdao Road, Qingdao, 266071, China.
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Nowińska A, Chlasta-Twardzik E, Dembski M, Wróblewska-Czajka E, Ulfik-Dembska K, Wylęgała E. Detailed corneal and genetic characteristics of a pediatric patient with macular corneal dystrophy - case report. BMC Ophthalmol 2021; 21:285. [PMID: 34301210 PMCID: PMC8299585 DOI: 10.1186/s12886-021-02041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/07/2021] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Corneal dystrophies are a group of rare, inherited disorders that are usually bilateral, symmetric, slowly progressive, and not related to environmental or systemic factors. The majority of publications present the advanced form of the disease with a typical clinical demonstration. The initial signs and symptoms of different epithelial and stromal corneal dystrophies are not specific; therefore, it is very important to establish the early characteristic corneal features of these disorders that could guide the diagnostic process. CASE PRESENTATION The main purpose of this study was to report the differential diagnosis of a pediatric patient with bilateral anterior corneal involvement suspected of corneal dystrophy. An 8-year-old male patient presented with asymptomatic, persistent, superficial, bilateral, diffuse, anterior corneal opacities. Slit lamp examination results were not specific. Despite the lack of visible stromal involvement on the slit lamp examination, corneal analysis based on confocal microscopy and optical coherence tomography revealed characteristic features of macular corneal dystrophy (MCD). The diagnosis of MCD was confirmed by CHST6 gene sequencing. The early corneal characteristic features of MCD, established based on the findings of this case report, include corneal astigmatism (not specific), diffuse corneal thinning without a pattern of corneal ectasia (specific), and characteristic features on confocal microscopy (specific), including multiple, dark, oriented striae at different corneal depths. CONCLUSIONS The clinical examination should be complemented with corneal imaging techniques, such as confocal microscopy and optical coherence tomography. In patients suspected of corneal dystrophy, genetic testing plays an important role in establishing the final diagnosis.
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Affiliation(s)
- Anna Nowińska
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. Panewnicka 65, 40-760, Katowice, Poland.
- Ophthalmology Department, Railway Hospital in Katowice, Katowice, Poland.
| | - Edyta Chlasta-Twardzik
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. Panewnicka 65, 40-760, Katowice, Poland
- Ophthalmology Department, Railway Hospital in Katowice, Katowice, Poland
| | - Michał Dembski
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. Panewnicka 65, 40-760, Katowice, Poland
- Ophthalmology Department, Railway Hospital in Katowice, Katowice, Poland
| | - Ewa Wróblewska-Czajka
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. Panewnicka 65, 40-760, Katowice, Poland
- Ophthalmology Department, Railway Hospital in Katowice, Katowice, Poland
| | - Klaudia Ulfik-Dembska
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. Panewnicka 65, 40-760, Katowice, Poland
- Ophthalmology Department, Railway Hospital in Katowice, Katowice, Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. Panewnicka 65, 40-760, Katowice, Poland
- Ophthalmology Department, Railway Hospital in Katowice, Katowice, Poland
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Singh S, Das S, Kannabiran C, Jakati S, Chaurasia S. Macular Corneal Dystrophy: An Updated Review. Curr Eye Res 2021; 46:765-770. [PMID: 33171054 DOI: 10.1080/02713683.2020.1849727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 01/11/2023]
Abstract
Macular Corneal Dystrophy is an autosomal recessive form of corneal dystrophy due to a mutation in CHST6 gene, which results in abnormal proteoglycan synthesis. There is accumulation of abnormal glycosaminoglycans in the corneal stroma and endothelium. The deposition results in progressive loss of corneal transparency and visual acuity. The histopathology shows characteristic alcian blue positive deposits. Management in the cases with visual loss requires keratoplasty either full thickness or lamellar. The decision about the ideal type of keratoplasty depends on age and pre-operative clinical features. Although prognosis after keratoplasty is good, recurrences can occur. Future research should be targeted towards gene therapy in this condition.
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Affiliation(s)
- Shalini Singh
- Cornea and Anterior Segment Services, LVPEI, Hyderabad, India
| | - Sujata Das
- Cornea and Anterior Segment Services, LVPEI, Bhubneshwar, India
| | - Chitra Kannabiran
- Kallam Anji Reddy Molecular Genetics Laboratory, Prof Brien Holden Eye Research Centre, Hyderabad, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, LVPEI, Hyderabad, India
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Safari I, Baradaran-Rafii A, Issazadeh-Navikas S, Elahi E. CHST6 mutations identified in Iranian MCD patients and CHST6 mutations reported worldwide identify targets for gene editing approaches including the CRISPR/Cas system. Int Ophthalmol 2020; 40:2223-2235. [PMID: 32472422 DOI: 10.1007/s10792-020-01401-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/25/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To identify CHST6 mutations in Iranians macular corneal dystrophy (MCD) patients and also to assess distribution of amino acids in the encoded protein that are affected by CHST6 mutations reported hitherto in various populations in order to predict gene regions that may be appropriate targets for gene editing approaches including the CRISPR/Cas system. The analysis will also reveal biologically and functionally important regions of the protein. METHODS Mutation screening of CHST6 by sequencing was performed on 21 Iranian MCD-affected probands. Previously reported MCD causing CHST6 mutations were identified by searches in NCBI. RESULTS Nineteen CHST6 mutations were found among the 21 Iranian patients, most of which were missense mutations and six of which were novel. Totally, 189 mutations among 375 MCD patients have been found worldwide, and 134 of these are missense mutations. The distribution of 88 amino acids affected by missense mutations along the length of the encoded protein was not random, and four regions of possible mutation clustering were noted. 25% of patients harbored mutations in a DNA region consisting of only 36 nucleotides. CONCLUSION Similar to most populations, CHST6 mutations among Iranians are very heterogeneous as indicated by finding 19 different mutations among 21 MCD patients. Nevertheless, identification of four potential mutation clusters identifies regions that are most suitable for gene therapy targeting by the CRISPR/Cas approach. Additionally, the mutation clusters identify regions with potential structural and/or functional importance. Consistent with this, the amino acids in these regions are well conserved among various membrane-bound sulfotransferases.
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Affiliation(s)
- Iman Safari
- School of Biology, University College of Science, University of Tehran, Enghelab Ave, Tehran, 1417614411, Iran
| | | | - Shohreh Issazadeh-Navikas
- Neuroinflammation Unit, Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Elahe Elahi
- School of Biology, University College of Science, University of Tehran, Enghelab Ave, Tehran, 1417614411, Iran.
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Shields M, Craig JE, Souzeau E, Gupta A. Bilateral phototherapeutic keratectomy for corneal macular dystrophy in an adolescent: case report and review of the literature. Ophthalmic Genet 2020; 41:368-372. [PMID: 32543930 DOI: 10.1080/13816810.2020.1776335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Phototherapeutic keratectomy (PTK) with 193-nm excimer laser is a safe and effective procedure for the treatment of superficial corneal pathology. We aimed to review the use of PTK for the treatment of corneal macular dystrophy (MCD). METHODS Case report and literature review. RESULTS A 16-year-old boy presented to an ophthalmologist with a 4-year history of reduced vision, glare and photophobia in his left eye. He was diagnosed with corneal macular dystrophy and underwent sequencing of the CHST6 gene. Left excimer PTK with mitomycin C was performed. He remained relapse free until 18 months post procedure when his visual acuity declined and the stroma appeared more "milky". He underwent a penetrating keratoplasty in his left eye 24 month following the initial PTK. CONCLUSION Phototherapeutic keratectomy is an effective means of visual restoration in patients with macular corneal dystrophy and may delay penetrating keratoplasty. Patients should be counselled regarding the high risk of recurrence. This is the first reported case of a CHST6 gene positive patient with MCD that was treated with phototherapeutic keratoplasty.
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Affiliation(s)
- Melissa Shields
- Ophthalmology, Flinders Medical Centre , Adelaide, Australia
| | - Jamie E Craig
- Ophthalmology, Flinders University, Flinders Medical Centre , Adelaide, Australia
| | - Emmanuelle Souzeau
- Ophthalmology, Flinders University, Flinders Medical Centre , Adelaide, Australia
| | - Aanchal Gupta
- Ophthalmology, The Royal Adelaide Hospital , Adelaide, Australia
- Ophthalmology, The Queen Elizabeth Hospital , Adelaide, Australia
- South Australian Institute of Ophthalmology , Adelaide, Australia
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Shetty R, Naidu JR, Nair AP, Vaidya TA, D'Souza S, Matalia H, Deshpande V, Sethu S, Ghosh A, Chakrabarty K. Distinct ocular surface soluble factor profile in human corneal dystrophies. Ocul Surf 2019; 18:237-248. [PMID: 31756391 DOI: 10.1016/j.jtos.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/30/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Corneal dystrophies (CD) are classified as rare eye diseases that results in visual impairment and requires corneal transplant in advanced stages. Ocular surface inflammatory status in different types of CD remains underexplored. Hence, we studied the levels of tear soluble factors in the tears of patients with various types of corneal dystrophies. METHODS 17 healthy subjects and 30 CD subjects (including epithelial, stromal and endothelial CD) were included in the study. Schirmer's strips were used to collect the tear fluid in all subjects. 27 soluble factors including cytokines, chemokines, soluble cell adhesion molecules and growth factors were measured in the eluted tears by multiplex ELISA or single analyte sandwich ELISA. RESULTS Percentages of subjects with detectable levels of tear soluble factors were significantly higher in CD compared to controls. Significant higher level of IL-2 was observed in both epithelial and stromal CD. IL-4, TGFβ1 and IgE were significantly higher in stromal CD. VCAM, IL-13 and Fractalkine were significantly elevated in epithelial and macular CD. IL-1α, IL-8, IL-12, ANG, Eotaxin, MCP1, RANTES, ICAM1, L-selectin and P-selectin were significantly higher in epithelial CD. TGFBIp was significantly elevated in lattice CD and endothelial CD. CONCLUSION Distinct set of the tear soluble factors were dysregulated in various types of CD. Increase in tear inflammatory factors was observed in majority of the CD subjects depending on their sub-types. This suggests a plausible role of aberrant inflammation in CD pathobiology. Hence, modulating inflammation could be a potential strategy in improving the prognosis of CD.
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Affiliation(s)
- Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, India
| | - Jagadeesh R Naidu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
| | | | - Tanuja Arun Vaidya
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, India
| | - Himanshu Matalia
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, India
| | - Vrushali Deshpande
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India; Singapore Eye Research Institute, Singapore.
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Zhang W, Kassels AC, Barrington A, Khan S, Tomatsu S, Alkadi T, Aldave A. Macular corneal dystrophy with isolated peripheral Descemet membrane deposits. Am J Ophthalmol Case Rep 2019; 16:100571. [PMID: 31799478 PMCID: PMC6881691 DOI: 10.1016/j.ajoc.2019.100571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/02/2019] [Accepted: 11/05/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Macular Corneal Dystrophy (MCD, MIM #217800) is a category 1 corneal stromal dystrophy as per the current IC3D classification. While characterized by macular stromal deposits, we report a case of MCD type II with isolated bilateral peripheral Decemet membrane opacities, describing the clinical features and results of screening the CHST6 gene and serum sulfated keratan sulfate levels. Observations A 68-year-old man with an unremarkable past medical and family history presented with bilateral progressive decrease in vision. Ocular exam revealed bilateral clear corneas with the exception of peripheral, round, gray-white discrete deposits at the level of Descemet membrane and decreased central corneal thickness in both eyes. The morphology of the corneal deposits, decreased corneal thickness and the absence of a family history were consistent with MCD, prompting screening of the CHST6 gene. Sanger sequencing followed by allele specific cloning revealed compound heterozygous CHST6 mutations in trans configuration: c.-26C > A, which created a new upstream open reading frame (uORF’), predicted to attenuate translation efficiency of the downstream main ORF; and c.803A > G (p.(Tyr268Cys)), previously associated with MCD. Serum keratan sulfate was reduced but detectable, consistent with the diagnosis of macular corneal dystrophy type II. Conclusions Although macular corneal dystrophy is classified as a corneal stromal dystrophy with endothelial involvement, we report a case of MCD with dystrophic deposits confined to the peripheral Descemet membrane, indicating that MCD may be associated with isolated endothelial involvement.
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Affiliation(s)
- Wenlin Zhang
- Stein Eye Institute, UCLA, Los Angeles, CA, 90095, USA
| | | | | | - Shaukat Khan
- Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, 19803, USA
| | - Shunji Tomatsu
- Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, 19803, USA
| | - Turad Alkadi
- Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Anthony Aldave
- Stein Eye Institute, UCLA, Los Angeles, CA, 90095, USA
- Corresponding author. Stein Eye Institute, UCLA, 200 Stein Plaza, Los Angeles, CA, 90095, USA.
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Chaurasia S, Ramappa M, Mishra DK. Clinical diversity in macular corneal dystrophy: an optical coherence tomography study. Int Ophthalmol 2019; 39:2883-2888. [PMID: 31161334 DOI: 10.1007/s10792-019-01136-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To characterise the corneal deposits of macular corneal dystrophy and correlate with high-resolution optical coherence tomography (OCT). METHODS A total of 23 eyes of 15 patients were evaluated for clinical features on slit lamp biomicroscopy, and high-resolution OCT was performed to correlate the clinical findings. The deposits were characterised based upon their location and level in the corneal layers. RESULTS Mean age was 31.5 (Range 20-67) years. The stromal deposits were restricted to central 8 mm in 9 eyes; in the rest of the 14 eyes, the deposits were seen in both central and peripheral cornea. In one patient, no such distinction could be made due to diffuse nature of the deposits throughout the cornea with sparing of 1-2 mm of the cornea internal to the limbus. The central deposits were in the anterior stromal layers, while the peripheral deposits were in the deep stromal corneal layers and non-contiguous with the anterior stromal deposits. In one patient aged 67 years, the peripheral deposits in deep corneal layers were more prominent than the central anterior stromal deposits and were associated with a significant thickening of Descemet membrane. CONCLUSIONS MCD exhibits a clinically diverse presentation as revealed on the clinical and optical coherence tomography study. Immunophenotype and genotype-phenotype correlation may further help in understanding various clinical presentations of MCD.
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Affiliation(s)
- Sunita Chaurasia
- Cornea and Anterior Segment Services, L.V. Prasad Eye Institute, L.V. Prasad Marg, Banjara Hills, Hyderabad, 500 034, India.
| | - Muralidhar Ramappa
- Cornea and Anterior Segment Services, L.V. Prasad Eye Institute, L.V. Prasad Marg, Banjara Hills, Hyderabad, 500 034, India
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Nejat F, Aghamollaei H, Pirhadi S, Jadidi K, Nejat MA. Simultaneous Presence of Macular Corneal Dystrophy and Retinitis Pigmentosa in Three Members of a Family. Iran J Med Sci 2018; 43:227-230. [PMID: 29749994 PMCID: PMC5936857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Macular corneal dystrophy (MCD) is an autosomal recessive hereditary disease. In most cases, various mutations in carbohydrate sulfotransferase 6 (CHST6) gene are the main cause of MCD. These mutations lead to a defect in keratan sulfate synthesis. Retinitis pigmentosa (RP) is another eye disorder with nyctalopia as its common symptom. It has been shown that more than 65 genes have been implicated in different forms of RP. Herein, we report on a 9-member family with 2 girls and 5 boys. Both parents, one of the girls and one of the boys had normal eye vision and another boy had keratoconus. Other children (1 girl and 2 boys) suffered from both MCD and RP. Corneal transplantation and medical supplements were used for MCD and RP during the follow-up period, respectively. Based on the family tree, it seems that the inheritance of both diseases is autosomal recessive. Based on our search of databases, there is no report on the simultaneous presence of MCD and RP. To the best of our knowledge, the present article is the first case report on this topic. Molecular genetic investigation is needed to clarify the mechanism of concurrent MCD and RP.
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Affiliation(s)
| | - Hossein Aghamollaei
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shiva Pirhadi
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Khosrow Jadidi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Nejat
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Carstens N, Williams S, Goolam S, Carmichael T, Cheung MS, Büchmann-Møller S, Sultan M, Staedtler F, Zou C, Swart P, Rice DS, Lacoste A, Paes K, Ramsay M. Novel mutation in the CHST6 gene causes macular corneal dystrophy in a black South African family. BMC Med Genet 2016; 17:47. [PMID: 27439461 PMCID: PMC4955246 DOI: 10.1186/s12881-016-0308-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 06/23/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Macular corneal dystrophy (MCD) is a rare autosomal recessive disorder that is characterized by progressive corneal opacity that starts in early childhood and ultimately progresses to blindness in early adulthood. The aim of this study was to identify the cause of MCD in a black South African family with two affected sisters. METHODS A multigenerational South African Sotho-speaking family with type I MCD was studied using whole exome sequencing. Variant filtering to identify the MCD-causal mutation included the disease inheritance pattern, variant minor allele frequency and potential functional impact. RESULTS Ophthalmologic evaluation of the cases revealed a typical MCD phenotype and none of the other family members were affected. An average of 127 713 variants per individual was identified following exome sequencing and approximately 1.2 % were not present in any of the investigated public databases. Variant filtering identified a homozygous E71Q mutation in CHST6, a known MCD-causing gene encoding corneal N-acetyl glucosamine-6-O-sulfotransferase. This E71Q mutation results in a non-conservative amino acid change in a highly conserved functional domain of the human CHST6 that is essential for enzyme activity. CONCLUSION We identified a novel E71Q mutation in CHST6 as the MCD-causal mutation in a black South African family with type I MCD. This is the first description of MCD in a black Sub-Saharan African family and therefore contributes valuable insights into the genetic aetiology of this disease, while improving genetic counselling for this and potentially other MCD families.
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Affiliation(s)
- Nadia Carstens
- />Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, 2050 Johannesburg, Gauteng South Africa
| | - Susan Williams
- />Division of Ophthalmology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saadiah Goolam
- />Division of Ophthalmology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Trevor Carmichael
- />Division of Ophthalmology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ming Sin Cheung
- />Biomarker Development, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Stine Büchmann-Møller
- />Biomarker Development, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Marc Sultan
- />Biomarker Development, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Frank Staedtler
- />Biomarker Development, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Chao Zou
- />Center for Proteomic Chemistry, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Peter Swart
- />Division of Anatomical Pathology, National Health Laboratory Services and University of the Witwatersrand, Johannesburg, South Africa
| | - Dennis S. Rice
- />Novartis Institutes for Biomedical Research, Cambridge, USA
| | - Arnaud Lacoste
- />Novartis Institutes for Biomedical Research, Cambridge, USA
| | - Kim Paes
- />Novartis Institutes for Biomedical Research, Cambridge, USA
| | - Michèle Ramsay
- />Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, 2050 Johannesburg, Gauteng South Africa
- />Division of Human Genetics, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, 2050 Johannesburg, Gauteng South Africa
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Kocluk Y, Yalniz-Akkaya Z, Burcu A, Ornek F. Corneal topography analysis of stromal corneal dystrophies. Pak J Med Sci 2015; 31:116-20. [PMID: 25878626 PMCID: PMC4386169 DOI: 10.12669/pjms.311.6292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 08/25/2014] [Accepted: 11/25/2014] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim was to compare the corneal topography and tomography parameters of macular corneal dystrophy (MCD), granular corneal dystrophy (GCD) and lattice corneal dystrophy (LCD) patients obtained by Scheimpflug imaging system. Methods: The charts, photographs and topography images of patients were reviewed retrospectively. This study included 73 eyes of 73 patients (28 MCD, 20 GCG and 25 LCD patients). Topography images were obtained by Pentacam (Oculus Optikgerate, Wetzlar, Germany). The densitometry readings at the corneal apex were used for the statistics. Results: The female to male ratio was 13/15 in MCD group, 12/8 in GCD group and 13/12 in LCD group. The mean age median age was 32, 45 and 53 years in MCD, GCD and LCD groups respectively. The groups were similar regarding the gender (p=0.861). The MCD group was significantly younger than the other two groups (p<0.001). The median (minmum-maximum) corneal densities were 100 (100-100), 68 (17-100) and 97 (34-100) Pentacam densitometry units in MCD, GCD and LCD groups respectively. The corneal density at the corneal apex was significantly higher in MCD group than in the other groups (p<0.001). The GCD and LCD groups were statistically similar in terms of density of the corneal apex (p=0.079). In MCD group, corneal thickness at the apex and at the thinnest location was significantly thinner, than in the other groups (p=.002 for thickness at apex between MCD and LCD, and p<.001 for all the remaining comparisons). In MCD group corneal volume was significantly smaller than in the other groups (p<.001 for all comparisons). Conclusion: Densitometry on Scheimpflug imaging system gives information on the density of corneal opacities.
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Affiliation(s)
- Yusuf Kocluk
- Yusuf Kocluk, MD, Ophthalmolgy Clinic, Ministry of Health, Adana Numune Training and Research Hospital, TR01076, Adana, Turkey
| | - Zuleyha Yalniz-Akkaya
- Zuleyha Yalniz-Akkaya, MD, Ophthalmolgy Clinic, Ministry of Health, Ankara Training and Research Hospital, TR06340 Ankara, Turkey
| | - Ayse Burcu
- Ayse Burcu, Associate Professor, Ophthalmolgy Clinic, Ministry of Health, Ankara Training and Research Hospital, TR06340 Ankara, Turkey
| | - Firdevs Ornek
- Firdevs Ornek, MD, Ophthalmolgy Clinic, Ministry of Health, Ankara Training and Research Hospital, TR06340 Ankara, Turkey
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