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Reda AM, Saad El-Din SA. Rare stromal corneal dystrophic diseases in Oman: A clinical and histopathological analysis for accurate diagnosis. Oman J Ophthalmol 2020; 13:70-75. [PMID: 32792801 PMCID: PMC7394083 DOI: 10.4103/ojo.ojo_283_2019] [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: 12/17/2019] [Revised: 01/20/2020] [Accepted: 03/27/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Corneal dystrophy (CD) encirclements a heterogeneous group of genetically determined corneal diseases. Many features still remain unknown. AIM The purpose of this study was to highlight the clinical and the histopathological aspects of rare stromal CDs and to assess the clinical and the histopathological roles in their diagnosis. PATIENTS AND METHODS This study incorporated 10 eyes of six patients, clinically diagnosed as follows: four patients with bilateral lattice stromal CD (8 eyes) and two patients, each one eye, one with macular and the other with granular-type CD. Histopathological examination with applications of many special stains was done in four eyes (4 patients) after penetrating keratoplasty. RESULTS The histopathological examination was in concordance with the clinical diagnosis of three examined corneas and revealed first eye with lattice dystrophy, second eye with macular dystrophy, and third eye with granular dystrophy. The fourth examined cornea was not that in concordance with the clinical diagnosis of lattice CD as it showed mixed stromal CD patterns of granular, macular, and lattice types. CONCLUSION Histopathological assessment of corneal dystrophy cases, subjected to keratoplasty is recommended to avoid missing cases with mixed stromal corneal dystrophy. Also, using low magnification slit lamp alone in the clinical assessment of the corneal opacity appeared to be limited mode and thus, the imaging corneal methods such confocal microscopy and high-definition optical coherence tomography are recommended for future cases especially in cases with unclassic query diagnosis.
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Affiliation(s)
- Ahmed Mohamed Reda
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Zhang T, Liu C, He J, Kang Y, Wang F, Li S. Cornea guttata associated with special phenotypic variants of granular corneal dystrophy type 2 in a Chinese family. Eur J Ophthalmol 2019; 30:469-474. [PMID: 30871369 DOI: 10.1177/1120672119832176] [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: 11/15/2022]
Abstract
PURPOSE The aim of this study was to analyze the relevant gene mutations in a Chinese family with special phenotypic variants of granular corneal dystrophy type 2 with cornea guttata. METHODS A total of 11 individuals from the affected family underwent complete ophthalmic examination. Genomic DNA was extracted from peripheral leukocytes of affected and unaffected family members. High-throughput sequencing was performed to screen for mutations in 290 genes associated with inherited ophthalmic diseases. Results were validated by bidirectional Sanger sequencing. RESULTS An Arg124His (R124H) mutation of the transforming growth factor beta-induced gene was identified in three members of the affected family: the proband (II-1), his mother (I-2), and his son (III-1). The eyes of the proband and his mother had bilateral superficial whitish ring patches with clear centers occupying their central corneas and appeared to be discoid or ring shaped. In addition, specular microscopic examination showed the presence of dark, round bodies. In vivo confocal microscopy showed some hyporeflective round images (cornea guttata), containing occasionally central highlight, in the proband, his mother, and one of his elder sisters. CONCLUSION We report, for the first time, atypical granular corneal dystrophy type 2 with cornea guttata associated with a single R124H mutation in a Chinese family. Our findings emphasize that genotyping is essential for the accurate diagnosis and classification of granular corneal dystrophy type 2.
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Affiliation(s)
- Tao Zhang
- Aier School of Ophthalmology, Central South University and Beijing Aier-Intech Eye Hospital, Beijing, P.R. China
| | - Chang Liu
- Aier School of Ophthalmology, Central South University and Beijing Aier-Intech Eye Hospital, Beijing, P.R. China
| | - Jingliang He
- Aier School of Ophthalmology, Central South University and Beijing Aier-Intech Eye Hospital, Beijing, P.R. China
| | - Yanwei Kang
- Aier School of Ophthalmology, Central South University and Beijing Aier-Intech Eye Hospital, Beijing, P.R. China
| | - Feng Wang
- Aier School of Ophthalmology, Central South University and Beijing Aier-Intech Eye Hospital, Beijing, P.R. China
| | - Shaowei Li
- Aier School of Ophthalmology, Central South University and Beijing Aier-Intech Eye Hospital, Beijing, P.R. China
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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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Abstract
The term corneal dystrophy embraces a heterogenous group of bilateral genetically determined non-inflammatory corneal diseases that are restricted to the cornea. The designation is imprecise but remains in vogue because of its clinical value. Clinically, the corneal dystrophies can be divided into three groups based on the sole or predominant anatomical location of the abnormalities. Some affect primarily the corneal epithelium and its basement membrane or Bowman layer and the superficial corneal stroma (anterior corneal dystrophies), the corneal stroma (stromal corneal dystrophies), or Descemet membrane and the corneal endothelium (posterior corneal dystrophies). Most corneal dystrophies have no systemic manifestations and present with variable shaped corneal opacities in a clear or cloudy cornea and they affect visual acuity to different degrees. Corneal dystrophies may have a simple autosomal dominant, autosomal recessive or X-linked recessive Mendelian mode of inheritance. Different corneal dystrophies are caused by mutations in the CHST6, KRT3, KRT12, PIP5K3, SLC4A11, TACSTD2, TGFBI, and UBIAD1 genes. Knowledge about the responsible genetic mutations responsible for these disorders has led to a better understanding of their basic defect and to molecular tests for their precise diagnosis. Genes for other corneal dystrophies have been mapped to specific chromosomal loci, but have not yet been identified. As clinical manifestations widely vary with the different entities, corneal dystrophies should be suspected when corneal transparency is lost or corneal opacities occur spontaneously, particularly in both corneas, and especially in the presence of a positive family history or in the offspring of consanguineous parents. Main differential diagnoses include various causes of monoclonal gammopathy, lecithin-cholesterol-acyltransferase deficiency, Fabry disease, cystinosis, tyrosine transaminase deficiency, systemic lysosomal storage diseases (mucopolysaccharidoses, lipidoses, mucolipidoses), and several skin diseases (X-linked ichthyosis, keratosis follicularis spinolosa decalvans). The management of the corneal dystrophies varies with the specific disease. Some are treated medically or with methods that excise or ablate the abnormal corneal tissue, such as deep lamellar endothelial keratoplasty (DLEK) and phototherapeutic keratectomy (PTK). Other less debilitating or asymptomatic dystrophies do not warrant treatment. The prognosis varies from minimal effect on the vision to corneal blindness, with marked phenotypic variability.
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Affiliation(s)
- Gordon K Klintworth
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA.
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Cao W, Ge H, Cui X, Zhang L, Bai J, Fu S, Liu P. Reduced penetrance in familial Avellino corneal dystrophy associated with TGFBI mutations. Mol Vis 2009; 15:70-5. [PMID: 19145249 PMCID: PMC2622714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 01/08/2009] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To characterize the clinical phenotype, histopathological features, and molecular genetic basis of an Avellino corneal dystrophy (ACD) in a Chinese family. METHODS A complete ophthalmologic examination was performed in 21 individuals (6 affected and 15 unaffected) of the four-generation family. DNA was obtained from peripheral blood leukocytes of each participant. Genetic analysis included TGFBI polymerase chain reaction (PCR) amplification and automated nucleotidic sequenceing of all 17 exons of genomic DNA. Histological analysis of corneal tissue from the proband was performed after a penetrating keratoplasty. One hundred Chinese controls were scanned for the presence of the R124H mutation by amplifying TGFBI exon 4 and then by direct sequencing of PCR products. RESULTS The proband of the pedigree had phenotypic features consistent with diagnosis of ACD. He was homozygous for the same R124H mutation in TGFBI as previously reported in Japan and European countries. In addition, 4 affected and 7 unaffected individuals carried the same variation in the heterozygous state were identified. None of the 100 control subjects was positive for this mutation. Moreover, a variable expressivity and an apparent non-penetrance were observed in the individuals with heterozygous R124H mutation in our pedigree. After excluding the missed diagnosis or a late onset, it could be interpreted as a reduced penetrance. CONCLUSIONS We reported a novel ACD family which exhibited a reduced penetrance of phenotype in northern China. This outcome supports that although the R124H mutation is one of the genetic causes of the disease, different genetic and environmental factors may influence the expressivity and the penetrance. Uncovering the mechanism may facilitate us to inhibit the occurrence of the corneal dystrophy caused by the R124H mutation in TGFBI, irrespective of the homozygous and heterozygous mutation.
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Affiliation(s)
- Wenping Cao
- Eye hospital, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Hongyan Ge
- Eye hospital, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Xiaobo Cui
- Laboratory of Medical Genetics, Harbin Medical University, Harbin, China
| | - Lu Zhang
- Eye hospital, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Jing Bai
- Laboratory of Medical Genetics, Harbin Medical University, Harbin, China
| | - Songbin Fu
- Laboratory of Medical Genetics, Harbin Medical University, Harbin, China
| | - Ping Liu
- Eye hospital, The First Affiliated Hospital, Harbin Medical University, Harbin, China
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Alavi A, Elahi E, Rahmati-Kamel M, Karimian F, Rezaei-Kanavi M. Mutation screening of TGFBI in two Iranian Avellino corneal dystrophy pedigrees. Clin Exp Ophthalmol 2008; 36:26-30. [PMID: 18290950 DOI: 10.1111/j.1442-9071.2007.01649.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Genetic analysis and phenotypic features of Avellino corneal dystrophy patients from Japan and some European countries have been published. We report for the first time the genetic analysis and phenotypic features of two Avellino corneal dystrophy pedigrees from the Middle East. METHODS Slit-lamp biomicroscope photographs of cornea were obtained, and corneal tissue sections were stained with masson-trichrome and Congo red. DNA was isolated from peripheral blood leucocytes and exons 4 and 12 of TGFBI were screened for mutations by direct sequencing. RESULTS The probands of the pedigrees had phenotypic features consistent with diagnosis of Avellino corneal dystrophy. They were homozygous for the same R124H mutation in TGFBI as previously reported in Avellino patients from Japan and European countries. Heterozygous carriers of the mutation were identified in the pedigree and shown to have symptoms of disease milder than those of the probands. CONCLUSION The finding of R124H in the Middle Eastern (Iranian) population supports the proposal that perhaps only substitution of histidine for arginine at position 124 of tumour growth factor beta induced protein results in the Avellino corneal dystrophy phenotype. As both probands were originally diagnosed with granular corneal dystrophy, and as heterozygous carriers of R124H were unaware of their disease status prior to genetic analysis, the importance of genetic analysis is emphasized.
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Affiliation(s)
- Afagh Alavi
- National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
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Vincent AL, Patel DV, McGhee CNJ. Inherited corneal disease: the evolving molecular, genetic and imaging revolution. Clin Exp Ophthalmol 2005; 33:303-16. [PMID: 15932539 DOI: 10.1111/j.1442-9071.2005.01011.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Advances in molecular genetics and in vivo ocular imaging modalities have enhanced our understanding of the corneal dystrophies. To date at least 11 genes have been identified, in which mutations manifest in corneal disease. In addition there are at least eight other loci identified to which corneal dystrophies have been linked. The information gained from the knowledge of gene function, aberrant protein production, or altered enzyme activity in the cornea, has resulted in greater knowledge of the pathophysiological mechanisms in these disorders. In vivo confocal microscopy has recently enabled microstructural study of dystrophic corneas throughout the disease course, rather than being limited to histopathological analysis of tissue removed at corneal transplantation. This perspective article summarizes the current knowledge, with emphasis on the genes, mutant proteins and resultant mechanisms that lead to manifestations of disease, along with characteristic findings with in vivo confocal microscopy.
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Affiliation(s)
- Andrea L Vincent
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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El-Ashry MF, Abd El-Aziz MM, Larkin DFP, Clarke B, Cree IA, Hardcastle AJ, Bhattacharya SS, Ebenezer ND. A clinical, histopathological, and genetic study of Avellino corneal dystrophy in British families. Br J Ophthalmol 2003; 87:839-42. [PMID: 12812879 PMCID: PMC1771747 DOI: 10.1136/bjo.87.7.839] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To establish a clinical, histopathological, and genetic diagnosis in two unrelated British families with Avellino corneal dystrophy (ACD). METHODS Genomic DNA was extracted from peripheral blood leucocytes of all members participating in the study. Exons 4 and 12 of the human transforming growth factor beta induced (BIGH3) gene were amplified by polymerase chain reaction. The mutation and polymorphism were identified by direct sequencing and restriction digest analysis. A review of the patients' clinical symptoms and signs was undertaken and a histopathological study on corneal specimen obtained from the proband of one family after keratoplasty was performed. RESULTS A heterozygous G to A transition at the second nucleotide position of codon 124 of BIGH3 gene was detected in all affected members of both families. This mutation changes an arginine residue to a histidine. The clinical diagnosis for ACD was more evident with advancing age. Histopathological study revealed granular deposits in the anterior stroma and occasional positive Congo red areas of amyloid deposition in the mid to deep stroma typical of ACD. CONCLUSIONS This is the first report of ACD families in the United Kingdom and, furthermore, of BIGH3 gene mutation in British patients with this rare type of corneal dystrophy. The results indicate that BIGH3 gene screening along with clinical and histopathological examinations is essential for the diagnosis and clinical management of corneal dystrophies.
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Affiliation(s)
- M F El-Ashry
- Department of Molecular Genetics, Institute of Ophthalmology, London EC1V 9EL, UK.
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Watanabe H, Hashida Y, Tsujikawa K, Tsujikawa M, Maeda N, Inoue Y, Yamamoto S, Tano Y. Two patterns of opacity in corneal dystrophy caused by the homozygous BIG-H3 R124H mutation. Am J Ophthalmol 2001; 132:211-6. [PMID: 11476681 DOI: 10.1016/s0002-9394(01)00962-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the opacity pattern in corneas with an Arg124His (R124H) homozygous mutation of the BIG-H3 gene. METHODS Slit-lamp examination was performed on eight patients with corneal dystrophy resulting from a genetically confirmed BIG-H3 R124H homozygous mutation. The birthplace of each patient also was determined. RESULTS Slit-lamp examination disclosed two types of opacity patterns in corneas with the BIG-H3 R124H homozygous mutation. Type I (n = 4) is a spot-like opacity present in the anterior stroma in which the lesions are confluent. Type I is the same pattern that previous reports have shown to be caused by the BIG-H3 R124H homozygous mutation. The type II corneal opacity pattern (n = 4) is a reticular opacity in the anterior stroma with round translucent spaces. Type II opacity has not been reported previously in association with any corneal dystrophy. The patients with the type I opacity do not share a common birthplace; however, interestingly, the patients with the type II opacity traced their origin to Tottori prefecture in western Japan. CONCLUSION The BIG-H3 homozygous R124H mutation induces the development of two distinct patterns of corneal opacity, the recognition of which can establish an accurate diagnosis of corneal dystrophy caused by the homozygous BIG-H3 R124H mutation independent of genetic analysis. In addition, genetic factors or circumstantial influences other than the gene responsible for the corneal dystrophy may influence the pattern of corneal opacity.
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Affiliation(s)
- H Watanabe
- Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan.
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