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Jolly JK, Rodda BM, Edwards TL, Ayton LN, Ruddle JB. Optical coherence tomography in children with inherited retinal disease. Clin Exp Optom 2024; 107:255-266. [PMID: 38252959 DOI: 10.1080/08164622.2023.2294807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Recent advances have led to therapeutic options becoming available for people with inherited retinal disease. In particular, gene therapy has been shown to hold great promise for slowing vision loss from inherited retinal disease. Recent studies suggest that gene therapy is likely to be most effective when implemented early in the disease process, making consideration of paediatric populations important. It is therefore necessary to have a comprehensive understanding of retinal imaging in children with inherited retinal diseases, in order to monitor disease progression and to determine which early retinal biomarkers may be used as outcome measures in future clinical trials. In addition, as many optometrists will review children with an inherited retinal disease, an understanding of the expected imaging outcomes can improve clinical care. This review focuses on the most common imaging modality used in research assessment of paediatric inherited retinal diseases: optical coherence tomography. Optical coherence tomography findings can be used in both the clinical and research setting. In particular, the review discusses current knowledge of optical coherence tomography findings in eight paediatric inherited retinal diseases - Stargardt disease, Bests disease, Leber's congenital amaurosis, choroideremia, RPGR related retinitis pigmentosa, Usher syndrome, X-linked retinoschisis and, Batten disease.
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Affiliation(s)
- Jasleen K Jolly
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Brent M Rodda
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, Victoria, Australia
| | - Thomas L Edwards
- Ophthalmology, Department of Surgery, The University of Melbourne, East Melbourne, Victoria, Australia
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Lauren N Ayton
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, Victoria, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, East Melbourne, Victoria, Australia
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Jonathan B Ruddle
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia
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Kiraly P, Seitz IP, Abdalla Elsayed MEA, Downes SM, Patel CK, Charbel Issa P, Birtel J, Mautone L, Dulz S, Atiskova Y, Herrmann P, Vrabič N, Jarc-Vidmar M, Hawlina M, Fischer MD. Morphological and functional parameters in X-linked retinoschisis patients-A multicentre retrospective cohort study. Front Med (Lausanne) 2024; 10:1331889. [PMID: 38351967 PMCID: PMC10864009 DOI: 10.3389/fmed.2023.1331889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction X-linked retinoschisis (XLRS) is a potential target for gene supplementation approaches. To establish potential structural and functional endpoints for clinical trials, a comprehensive understanding of the inter-eye symmetry, relationship between structural and functional parameters, and disease progression is vital. Methods In this retrospective multicentre study, 118 eyes of 59 XLRS patients with RS1 mutations were assessed. Information from center databases included: RS1 variant; age at presentation; best-corrected visual acuity (BCVA), central retinal thickness (CRT), macular volume (MV) at presentation and at the last follow up; full-field electroretinogram (ERG) findings; presence of peripheral retinoschisis and complications (vitreous hemorrhage, retinal detachment); treatment with systemic or topical carbonic anhydrase inhibitors (CAI). Results Inter-eye symmetry revealed strong correlation in CRT (r = 0.77; p < 0.0001) and moderate correlations in MV (r = 0.51, p < 0.0001) and BCVA (r = 0.49; p < 0.0001). Weak or no correlations were observed between BCVA and structural parameters (CRT, MV). Peripheral retinoschisis was observed in 40 (68%), retinal detachment in 9 (15%), and vitreous hemorrhage in 5 (8%) patients, respectively. Longitudinal examinations (mean, 4.3 years) showed no BCVA changes; however, a reduction of the CRT (p = 0.02), and MV (p = 0.01) was observed. Oral and/or topical CAI treatment did not significantly alter the CRT (p = 0.34). Discussion The XLRS phenotype demonstrates a strong CRT symmetry between the eyes within individual patients and stable BCVA over several years. BCVA exhibits a weak correlation with the morphological parameters of retinal thickness (CRT MV). In our cohort, longitudinal functional changes were not significant, likely attributed to the short average follow-up period. Furthermore, CAI treatment didn't influence both morphological and functional outcomes.
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Affiliation(s)
- Peter Kiraly
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom
| | - Immanuel P. Seitz
- Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany
| | | | - Susan M. Downes
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom
| | - Chetan K. Patel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom
| | - Johannes Birtel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Luca Mautone
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yevgeniya Atiskova
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Herrmann
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Nika Vrabič
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Marko Hawlina
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M. Dominik Fischer
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom
- Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany
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Fenner BJ, Russell JF, Drack AV, Dumitrescu AV, Sohn EH, Russell SR, Boldt HC, Affatigato LM, Hoffmann JM, Andorf JL, Stone EM, Han IC. Long-term functional and structural outcomes in X-linked retinoschisis: implications for clinical trials. Front Med (Lausanne) 2023; 10:1204095. [PMID: 37396901 PMCID: PMC10310546 DOI: 10.3389/fmed.2023.1204095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction X-linked retinoschisis (XLRS) is an inherited retinal disease (IRD) caused by pathogenic mutations in the retinoschisin gene, RS1. Affected individuals develop retinal layer separation, leading to loss of visual acuity (VA). Several XLRS gene therapy trials have been attempted but none have met their primary endpoints. An improved understanding of XLRS natural history and clinical outcomes may better inform future trials. Here, we report the long-term functional and structural outcomes of XLRS and the relevance of RS1 genotypes to the visual prognosis of affected individuals. Methods A retrospective chart review of patients with molecularly confirmed X-linked retinoschisis was performed. Functional and structural outcomes, and RS1 genotype data, were included for analysis. Results Fifty-two patients with XLRS from 33 families were included in the study. Median age at symptom onset was 5 years (range 0-49) and median follow-up was 5.7 years (range 0.1-56.8). Macular retinoschisis occurred in 103 of 104 eyes (99.0%), while peripheral retinoschisis occurred in 48 of 104 eyes (46.2%), most often in the inferotemporal quadrant (40.4%). Initial and final VA were similar (logMAR 0.498 vs. 0.521; p = 0.203). Fifty of 54 eyes (92.6%) developed detectable outer retinal loss by age 20, and 29 of 66 eyes (43.9%) had focal or diffuse outer retinal atrophy (ORA) by age 40. ORA but not central subfield thickness (CST) was associated with reduced VA. Inter-eye correlation was modest for VA (r-squared = 0.03; p = 0.08) and CST (r-squared = 0.15; p = 0.001). Carbonic anhydrase inhibitors (CAIs) improved CST (p = 0.026), but not VA (p = 0.380). Eight of 104 eyes (7.7%) had XLRS-related retinal detachment (RD), which was associated with poorer outcomes compared to eyes without RD (median final VA 0.875 vs. 0.487; p <0.0001). RS1 null genotypes had greater odds of at least moderate visual impairment at final follow-up (OR 7.81; 95% CI 2.17, 28.10; p = 0.002) which was independent of age at onset, initial CST, initial ORA, or previous RD. Discussion Overall, long-term follow-up of XLRS patients demonstrated relatively stable VA, with presenting CST, development of ORA, and null RS1 mutations associated with poorer long-term visual outcomes, indicating a clinically relevant genotype-phenotype correlation in XLRS.
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Affiliation(s)
- Beau J. Fenner
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
- Department of Medical Retina, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Jonathan F. Russell
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Arlene V. Drack
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Alina V. Dumitrescu
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Elliott H. Sohn
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Stephen R. Russell
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - H. Culver Boldt
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | | | - Jeremy M. Hoffmann
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
| | - Jeaneen L. Andorf
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
| | - Edwin M. Stone
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Ian C. Han
- Institute for Vision Research, University of Iowa, Iowa City, IA, United States
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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Liu Z, Guo J, Pan M, Xie K, Du L, Jin X, Lei B. The genetic spectrum and clinical features of X-linked juvenile retinoschisis in Central China. Ophthalmic Genet 2023; 44:262-270. [PMID: 36856325 DOI: 10.1080/13816810.2023.2182328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
PURPOSE X-linked juvenile retinoschisis (XLRS) is the most common congenital retinoschisis in rare vitreoretinopathy and causes visual disturbances. The study aimed to explore possible genetic mutations associated with XLRS and assess the clinical characteristics in Chinese families. METHODS Seventeen cases and thirty-four eyes of probands and thirty-nine cases and seventy-eight eyes of their guardians were recruited. Peripheral blood DNA was extracted and PCR-amplified for retinal disease second-generation panel sequencing to screen for mutated genes. Pathogenicity was referred to the guidelines of the American College of Medical Genetics and Genomics (ACMG). RESULTS A total of 17 male patients were included, with an average age of 9.73 years (range, 5 ~ 27 years). Clinical data indicate typical macular retinoschisis (97.06%), peripheral retinoschisis (46.67%), retinal holes (32.35%). Fifteen mutations (10 missense mutations, 4 shift mutations, and 3 nonsense mutations) of RS1 gene were identified, including 5 novel mutations. In novel mutations, amino acid conservation analysis shows W33, W50, E62, and G70 were highly conserved, and software predicts mutations to be pathogenic. SWISS-MODEL protein prediction software showed protein structural changes in proband 13. CONCLUSIONS We have identified and described five novel mutations in the RS1 gene and their corresponding clinical manifestations. These findings not only expand the range of known RS1 mutations and associated clinical phenotypes but also provide a basis for mechanistic studies and diagnosis of XLRS.
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Affiliation(s)
- Zhenhui Liu
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Ju Guo
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Meng Pan
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Kunpeng Xie
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Liping Du
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China.,Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xuemin Jin
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China.,Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bo Lei
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
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SYMPTOMATIC EARLY-ONSET X-LINKED RETINOSCHISIS: Clinical Presentation and Outcomes. Retina 2023; 43:348-355. [PMID: 36695803 DOI: 10.1097/iae.0000000000003667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To describe clinical characteristics and outcomes of children with early-onset X-linked retinoschisis. METHODS In this retrospective consecutive case series, we included children diagnosed with symptomatic X-linked retinoschisis younger than 2 years. Presenting signs, clinical characteristics, treatments, and outcomes were recorded. RESULTS Seven patients (14 eyes) with a mean age of 17.14 ± 6.28 months were included. Strabismus was the most common presenting symptom (6 of 7 patients, 86%). Clinical signs at the first diagnosis included peripheral retinoschisis in 13 eyes (13/14, 93%), of which 5 (5/13, 38%) were bullous, vitreous hemorrhage in 3 eyes (3/14, 21%), and retinal detachment in 3 eyes (3/14, 21%). The macula was involved in all eyes: It was detached in 2 eyes (2/14, 14%) and involved in the peripheral schisis in 4 eyes (4/14, 29%). In all remaining eyes, optical coherence tomography revealed foveoschisis. Six eyes (6/14, 42%) received surgery. At the last follow-up, visual acuity, when available, ranged from no light perception to 20/40, and no children had persistent retinal detachment. CONCLUSION Children with early-onset X-linked retinoschisis had severe forms. All children had peripheral retinoschisis which was often bullous and extended to the macula. Diagnosis is often clinical but handheld optical coherence tomography can be helpful in atypical forms. Complications requiring surgical management are frequent.
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Waibel AM, Stoye JM, Villavicencio-Lorini P, Hoffmann K, Obermaier C, Biskup S, Grünauer-Kloevekorn C. Specific Changes in OCT Imaging Associated with a Novel Mutation of the RS1 Gene in X-Linked Retinoschisis. Klin Monbl Augenheilkd 2022; 239:1473-1477. [PMID: 36493766 DOI: 10.1055/a-1901-1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
X-linked retinoschisis (XLRS) is a rare vitreoretinal dystrophy caused by molecular genetic changes in the RS1 gene. It usually manifests itself at a young age with symmetrical splitting within different layers of the retina and leads to a significant reduction in visual acuity. Correct diagnosis at older ages is difficult due to nonspecific changes in OCT scans. We report the morphological changes in OCT scans at different stages of life in a family with XLRS and a novel mutation in the RS1 gene. Our 78-year-old index patient presented with visual disturbances that he had experienced since his childhood. After a detailed anamnesis, complete clinical examination and measurement with SD-OCT, we performed germline genetic testing using whole blood DNA on the index patient, his clinically unaffected daughter and her clinically affected son. The OCT examination of the index patient showed nonspecific atrophic macular changes on both sides. A fundoscopy of the 8-year-old grandson showed the typical macular star pattern. The OCT scan showed the typical retinoschisis of the macula. The genetic analysis revealed the previously undescribed pathogenic variant c.487T>G; p.Trp163Gly in the RS1 gene in all 3 patients. The typical fundus image and OCT pattern, which are absent in the 78-year-old patient, are also present in childhood with the novel RS1 mutation. Our case shows that even with nonspecific changes in the OCT scans, a detailed family history can provide important information on X-linked recessive inheritance and thus for an appropriate molecular genetic diagnosis, so that rare retinal diseases can be diagnosed even at an advanced age.
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Affiliation(s)
| | | | | | - Katrin Hoffmann
- Institut für Humangenetik, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland
| | | | - Saskia Biskup
- Humangenetik, Praxis für Humangenetik Tübingen, Deutschland
| | - Claudia Grünauer-Kloevekorn
- Augenheilkunde, PraxisKlinik Augenärzte am Markt, Halle/Saale, Deutschland.,Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland
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Tondelli NN, Mencaroni BM, Lemos CMB, Rocha de Sousa J, Sandoval Barbosa GC, Gomes AMV, da Palma MM. A patient with X-linked retinoschisis and exudative retinal detachment associated with a pathogenic hemizygous variant c.304c>T in RS1. Ophthalmic Genet 2022; 43:871-875. [PMID: 36695495 DOI: 10.1080/13816810.2022.2154809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND X-linked retinoschisis (XLRS) is a rare retinal dystrophy due to pathogenic variants in the RS1 gene. The hallmark of the disease is a foveal spoke-wheel appearance. The purpose of this report is to expand the phenotypic spectrum of XLRS reporting a patient with atypical phenotype of XLRS associated with Coats-like phenotype. MATERIALS AND METHODS This is a case report of a patient diagnosed with XLRS who underwent ophthalmologic multimodal imaging and next-generation sequencing panel. RESULTS The proband is a 14-year-old male patient who presented at Instituto Suel Abujamra with a history of Coats Disease in the right eye treated with retinal laser in both eyes two years ago. His best-corrected visual acuity was count finger at 1 foot in the right eye and 20/40 in the left eye. Fundus exam showed an extensive area of exudation and retinal detachment in the right eye and cystic change at the fovea in a spoke-wheel pattern in the left eye. The next-generation sequencing panel targeting inherited retinal diseases with 236 genes found a pathogenic hemizygous variant c.304C>T (p.Arg102Trp) in RS1 that has already been reported. CONCLUSIONS The association of peripheral vascular incompetence and XLRS has already been described. Retinal exudation in the setting of XLRS is probably the result of vascular disruption and compromise. The loss of retinoschisin function that leads to foveal retinoschisis may also lead to vascular anomalies.
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Affiliation(s)
| | | | | | | | | | | | - Mariana Matioli da Palma
- Instituto Suel Abujamra, São Paulo, Brazil.,Department of Ophthalmology, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
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Wang XF, Chen FF, Zhou X, Cheng XX, Xie ZG. A novel mutation in RS1 and clinical manifestations in a Chinese twin family with congenital retinoschisis. Front Genet 2022; 13:993157. [PMID: 36212125 PMCID: PMC9538544 DOI: 10.3389/fgene.2022.993157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: We aim to analyze the clinical and genetic features in a Chinese family with congenital retinoschisis by whole-exome sequencing and comprehensive clinical examination.Methods: Six members were recruited from a Chinese family. Three of them were diagnosed as congenital retinoschisis, including two twin siblings. All subjects received a full eye examination. Whole-exome sequencing (WES) and Sanger sequencing were performed on two twin probands and all participants, respectively.Results: A novel splice site mutation RS1.c.53-1G>A was identified in a Chinese congenital retinoschisis family. The mean onset age was 16.7 ± 2.4 years old. The average BCVA in patients was 0.37 ± 0.05. A typical spoke-wheel pattern was observed in all affected eyes. OCT examination results showed fovea schisis and schisis cavities were located in the inner nuclear layer in 100% eyes (6/6). ERG b/a ratio was decreased markedly, but was still more than 1 in the four eyes that were available.Conclusion: The present study discovered a new pathogenic splice cite variant of RS1 in congenital retinoschisis, which expands the mutational spectrum. In contrast to previous research, the phenotype of patients with the same mutation within one family was highly similar. Early molecular testing is crucial for early diagnosis, clinical management, and genetic counseling of patients with congenital retinoschisis.
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Affiliation(s)
- Xiao-Fang Wang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Fei-Fei Chen
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xin Zhou
- Department of Ophthalmology, The First People’s Hospital of Kunshan Affiliated with Jiangsu University, Suzhou, China
| | - Xin-Xuan Cheng
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zheng-Gao Xie
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- *Correspondence: Zheng-Gao Xie,
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Bender C, Woo EG, Guan B, Ullah E, Feng E, Turriff A, Tumminia SJ, Sieving PA, Cukras CA, Hufnagel RB. Predominant Founder Effect among Recurrent Pathogenic Variants for an X-Linked Disorder. Genes (Basel) 2022; 13:genes13040675. [PMID: 35456481 PMCID: PMC9029724 DOI: 10.3390/genes13040675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 02/05/2023] Open
Abstract
For disorders with X-linked inheritance, variants may be transmitted through multiple generations of carrier females before an affected male is ascertained. Pathogenic RS1 variants exclusively cause X-linked retinoschisis (XLRS). While RS1 is constrained to variation, recurrent variants are frequently observed in unrelated probands. Here, we investigate recurrent pathogenic variants to determine the relative burden of mutational hotspot and founder allele events to this phenomenon. A cohort RS1 variant analysis and standardized classification, including variant enrichment in the XLRS cohort and in RS1 functional domains, were performed on 332 unrelated XLRS probands. A total of 108 unique RS1 variants were identified. A subset of 19 recurrently observed RS1 variants were evaluated in 190 probands by a haplotype analysis, using microsatellite and single nucleotide polymorphisms. Fourteen variants had at least two probands with common variant-specific haplotypes over ~1.95 centimorgans (cM) flanking RS1. Overall, 99/190 of reportedly unrelated probands had 25 distinct shared haplotypes. Examination of this XLRS cohort for common RS1 haplotypes indicates that the founder effect plays a significant role in this disorder, including variants in mutational hotspots. This improves the accuracy of clinical variant classification and may be generalizable to other X-linked disorders.
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Affiliation(s)
- Chelsea Bender
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Elizabeth Geena Woo
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Bin Guan
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Ehsan Ullah
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Eric Feng
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Amy Turriff
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Santa J. Tumminia
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Paul A. Sieving
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
- UC Davis Medical Center, Ophthalmology & Vision Sciences, University of California, Davis, CA 95817, USA
| | - Catherine A. Cukras
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Robert B. Hufnagel
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
- Correspondence:
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Guo Q, Li Y, Li J, You Y, Liu C, Chen K, Li S, Lei B. Phenotype Heterogeneity and the Association Between Visual Acuity and Outer Retinal Structure in a Cohort of Chinese X-Linked Juvenile Retinoschisis Patients. Front Genet 2022; 13:832814. [PMID: 35309139 PMCID: PMC8931683 DOI: 10.3389/fgene.2022.832814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose: X-linked juvenile retinoschisis (XLRS), caused by mutations in the RS1 gene, is an X-linked recessive inherited disease that typically involves both eyes in the first 2 decades of life. Recently, the phenotype heterogeneity of this condition has drawn increasing attention. We reported various phenotypes caused by RS1 gene mutations in eleven patients from ten Chinese families. Methods: Data on the medical history of the patients from ten Han families of central China were collected. Ophthalmic examinations including best-corrected visual acuity (BCVA), fundus photography, ultra-wide-angle sweep source optical coherence tomography (SS-OCT), and electroretinography (ERG) were performed. Adaptive optics (AO) images were acquired to evaluate the cone photoreceptor mosaic when applicable. Venous blood of the probands and their family members was collected, and DNA was subjected to sequencing based on next-generation sequencing with a custom-designed targeted gene panel PS400 for inherited retinal diseases. Validation was performed by Sanger sequencing and cosegregation. Pathogenicity was determined in accordance with the American College of Medical Genetics and Genomics (ACMG) guidelines. Results: Ten RS1 mutations, including eight missense mutations and two terminator mutations, were identified in 10 XLRS families. c.657C > A (p.C219X) was a novel mutation in this cohort. These patients showed a variety of clinical phenotypes, including fovea schisis, bullous retinoschisis, and macular or peripheral atrophy. Fifteen eyes of eight patients exhibited macular retinoschisis, and twelve eyes of seven patients exhibited peripheral retinoschisis. In addition, three patients showed asymmetrical fundus manifestations. Of importance, three patients without macular retinoschisis were misdiagnosed until genetic testing results were obtained. AO showed a decrease in cone density and loss of regularity in the cystic schisis macular of XLRS. Furthermore, the BCVA was associated with the photoreceptor inner segment and outer segment (IS/OS) thickness. Conclusion: With complicated clinical manifestations, a considerable portion of XLRS patients may present various phenotypes. It should be noted that asymmetry in fundus appearance in both eyes could lead to misdiagnosis easily. Thus, genetic testing is crucial for making a final diagnosis in those patients who are suspected of having amblyopia, bilateral or unilateral macular atrophy, or conditions presenting an asymmetric fundus appearance. In addition, the residual cone photoreceptor structure was critical for the maintenance of useful vision.
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Affiliation(s)
- Qingge Guo
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Clinical Research Center for Ocular Diseases, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Ya Li
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Clinical Research Center for Ocular Diseases, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiarui Li
- School of Medicine, People’s Hospital of Henan University, Henan University, Zhengzhou, China
| | - Ya You
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Clinical Research Center for Ocular Diseases, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Changgeng Liu
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Clinical Research Center for Ocular Diseases, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Kang Chen
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Clinical Research Center for Ocular Diseases, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuyin Li
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Clinical Research Center for Ocular Diseases, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Lei
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Clinical Research Center for Ocular Diseases, People’s Hospital of Zhengzhou University, Zhengzhou, China
- School of Medicine, People’s Hospital of Henan University, Henan University, Zhengzhou, China
- *Correspondence: Bo Lei,
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Vitreous hemorrhage in X-linked retinoschisis. Am J Ophthalmol Case Rep 2022; 25:101395. [PMID: 35198819 PMCID: PMC8841571 DOI: 10.1016/j.ajoc.2022.101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of preretinal hemorrhage from extraretinal neovascularization related to capillary non-perfused retina within a large schisis in a pediatric patient with X-linked retinoschisis (XLRS). Observations A 4-year old male with an RS1 mutation and XLRS presented with preretinal and vitreous hemorrhage in the right eye. Retinal imaging, including wide angle fluorescein angiography (FA) and optical coherence tomography (OCT), showed vitreoretinal traction on extraretinal neovascularization and capillary non-perfused retina in the schisis cavity. Laser treatment to the non-perfused retina within the schisis was successful in reducing extraretinal neovascularization. Conclusions Vitreous hemorrhage is a well-known occurrence in XLRS. Imaging using wide angle FA and OCT were helpful to determine the causes of hemorrhage in order to develop a management plan.
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Cetin GO, Cetin EN, Akyol T, Ilhan HD, Pekel G. Genotype and phenotype characteristics of X-linked retinoschisis: the first report of a Turkish population. Ophthalmic Genet 2021; 43:318-325. [PMID: 34865595 DOI: 10.1080/13816810.2021.2010772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND X-linked retinoschisis is an inherited retinal disease caused by mutations in the RS1 gene; however, a genotype-phenotype correlation regarding the mutation type or location within the RS1 gene and clinical characteristics of the patients has not been established yet. This is the first report documenting the genotypes and ophthalmological findings in a Turkish population with confirmed RS1 mutations. MATERIALS AND METHODS Fifty eyes of 25 male patients were included in the study. RS1 mutation analysis was performed by DNA sequencing. Retrospective analysis of ocular examinations and SD-OCT scans were applied. RESULTS The major mutation was c.422 G > A (p.Arg141His, exon 5) affecting 14 patients (56%) and c.531 T > G was the only non-sense mutation out of 7 pathogenic variants. At presentation; the mean age was 24.6 ± 16.2 (4-72) years, mean visual acuity (VA) was 0.61 ± 0.32 (logMAR, 0.10-1.30). Forty-six (92%) eyes had macular, 16 eyes (32%) had peripheral retinoschisis. None of the eyes had macular scar, whereas 7 eyes (14%) had macular atrophy. The most frequent location of schisis was inner nuclear layer (37.5%). The eyes with disruption of ellipsoid zone (EZ) or external limiting membrane (ELM) had worse VA (for EZ, 0.65 ± 0.25 versus 0.45 ± 0.34, logMAR, 31 versus 17 eyes, p = .013; for ELM, 0.66 ± 0.27 versus 0.45 ± 0.31, logMAR, 30 versus 18 eyes, p = .008). CONCLUSIONS Seven different pathogenic variants in the RS1 gene were identified; with c.422 G > A (p.Arg141His) as the most frequent variant and c.531 T > G as only non-sense mutation. Having EZ or ELM disruption were the significant factors affecting VA.
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Affiliation(s)
- Gokhan Ozan Cetin
- Department of Medical Genetics, Medical School of Pamukkale University, Denizli, Turkey
| | - Ebru Nevin Cetin
- Department of Ophthalmology, Medical School of Pamukkale University, Denizli, Turkey
| | - Tunahan Akyol
- Department of Ophthalmology, Medical School of Pamukkale University, Denizli, Turkey
| | - Hatice Deniz Ilhan
- Department of Ophthalmology, Medical School of Akdeniz University, Antalya, Turkey
| | - Gokhan Pekel
- Department of Ophthalmology, Medical School of Pamukkale University, Denizli, Turkey
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Kousal B, Hlavata L, Vlaskova H, Dvorakova L, Brichova M, Dubska Z, Langrova H, Vincent AL, Dudakova L, Liskova P. Clinical and Genetic Study of X-Linked Juvenile Retinoschisis in the Czech Population. Genes (Basel) 2021; 12:genes12111816. [PMID: 34828422 PMCID: PMC8623540 DOI: 10.3390/genes12111816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to identify RS1 pathogenic variants in Czech patients with X-linked retinoschisis (XLRS) and to describe the associated phenotypes, including natural history, in some cases. Twenty-one affected males from 17 families were included. The coding region of RS1 was directly sequenced and segregation of the identified mutations was performed in available family members. In total, 12 disease-causing variants within RS1 were identified; of these c.20del, c.275G>A, c.[375_379del; 386A>T], c.539C>A and c.575_576insT were novel, all predicted to be null alleles. The c.539C>A mutation occurred de novo. Three patients (aged 8, 11 and 19 years) were misdiagnosed as having intermediate uveitis and treated with systemic steroids. Repeat spectral domain optical coherence tomography examinations in four eyes documented the transition from cystoid macular lesions to macular atrophy in the fourth decade of life. Four individuals were treated with topical dorzolamide and in two of them, complete resolution of the cystic macular lesions bilaterally was achieved, while one patient was noncompliant. Rebound phenomenon after discontinuation of dorzolamide for 7 days was documented in one case. Misdiagnosis of XLRS for uveitis is not uncommon; therefore, identification of disease-causing variants is of considerable benefit to the affected individuals.
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Affiliation(s)
- Bohdan Kousal
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (B.K.); (L.H.); (H.V.); (L.D.); (L.D.)
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.B.); (Z.D.)
| | - Lucia Hlavata
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (B.K.); (L.H.); (H.V.); (L.D.); (L.D.)
| | - Hana Vlaskova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (B.K.); (L.H.); (H.V.); (L.D.); (L.D.)
| | - Lenka Dvorakova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (B.K.); (L.H.); (H.V.); (L.D.); (L.D.)
| | - Michaela Brichova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.B.); (Z.D.)
| | - Zora Dubska
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.B.); (Z.D.)
| | - Hana Langrova
- Department of Ophthalmology, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
| | - Andrea L. Vincent
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland 1142, New Zealand;
| | - Lubica Dudakova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (B.K.); (L.H.); (H.V.); (L.D.); (L.D.)
| | - Petra Liskova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (B.K.); (L.H.); (H.V.); (L.D.); (L.D.)
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.B.); (Z.D.)
- Correspondence: ; Tel.: +420-2-2496-7139
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Chen D, Zhu S. Whole-exome sequencing identifies an RS1 variant in a Chinese family with X-linked retinoschisis. Exp Ther Med 2021; 22:1406. [PMID: 34675999 PMCID: PMC8524742 DOI: 10.3892/etm.2021.10842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/09/2021] [Indexed: 11/05/2022] Open
Abstract
A notable behavioural feature of X-linked retinoschisis (XLRS) is extensive structural schisis (splitting) of the outer plexiform and inner nuclear layers of the neurosensory retina, which is partly combined with complications related to vitreous hemorrhage, macular holes and retinal detachment. The present study aimed to identify the pathogenic gene mutation in a three-generation Chinese family with XLRS by whole-exome sequencing (WES). The clinical information of a three-generation Chinese family with cases of XLRS was collected. WES was performed for the proband. A comparison with the human reference genome sequence (hg38) and bioinformatic analysis were performed to reveal putative variants and Sanger sequencing was applied to verify mutations in this family and healthy control participants. Intraretinal cystic spaces were detected by optical coherence tomography imaging. Structures of the wild-type and mutant retinoschisin 1 (RS1) protein were modelled by PyMol. Almost all patients had a history of vision loss and abnormal blue-purple colour vision; however, the phenotypes of the 4 patients were distinctly different. There was no linear correlation between phenotypic severity and age. A recurrent RS1 (Xp22.2) mutation (NM_000330: c.559C>T) was detected, resulting in the p.Q187X variant. According to the protein model, this variant is likely pathogenic. The present study was the first to report that RS1:c.559C>T induces XLRS in a three-generation Chinese pedigree, with the mutation leading to premature termination of translation of the RS1 protein. WES was able to diagnose XLRS, which has the characteristics of clinical and genetic heterogeneity.
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Affiliation(s)
- Doudou Chen
- Eye School of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, P.R. China.,Department of Ophthalmology, Ineye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610032, P.R. China.,Key Laboratory of Sichuan Province Ophthalmopathy Prevention & Cure and Visual Function Protection, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610032, P.R. China
| | - Siquan Zhu
- Eye School of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, P.R. China.,Department of Ophthalmology, Ineye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610032, P.R. China.,Key Laboratory of Sichuan Province Ophthalmopathy Prevention & Cure and Visual Function Protection, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610032, P.R. China.,Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100006, P.R. China
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