1
|
Soh YQ, Kocaba V, Weiss JS, Jurkunas UV, Kinoshita S, Aldave AJ, Mehta JS. Corneal dystrophies. Nat Rev Dis Primers 2020; 6:46. [PMID: 32528047 DOI: 10.1038/s41572-020-0178-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 12/21/2022]
Abstract
Corneal dystrophies are broadly defined as inherited disorders that affect any layer of the cornea and are usually progressive, bilateral conditions that do not have systemic effects. The 2015 International Classification of Corneal Dystrophies classifies corneal dystrophies into four classes: epithelial and subepithelial dystrophies, epithelial-stromal TGFBI dystrophies, stromal dystrophies and endothelial dystrophies. Whereas some corneal dystrophies may result in few or mild symptoms and morbidity throughout a patient's lifetime, others may progress and eventually result in substantial visual and ocular disturbances that require medical or surgical intervention. Corneal transplantation, either with full-thickness or partial-thickness donor tissue, may be indicated for patients with advanced corneal dystrophies. Although corneal transplantation techniques have improved considerably over the past two decades, these surgeries are still associated with postoperative risks of disease recurrence, graft failure and other complications that may result in blindness. In addition, a global shortage of cadaveric corneal graft tissue critically limits accessibility to corneal transplantation in some parts of the world. Ongoing advances in gene therapy, regenerative therapy and cell augmentation therapy may eventually result in the development of alternative, novel treatments for corneal dystrophies, which may substantially improve the quality of life of patients with these disorders.
Collapse
Affiliation(s)
- Yu Qiang Soh
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore.,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Viridiana Kocaba
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands
| | - Jayne S Weiss
- Department of Ophthalmology, Pathology and Pharmacology, Louisiana State University, School of Medicine, New Orleans, USA
| | - Ula V Jurkunas
- Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Schepens Eye Research Institute, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Anthony J Aldave
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore. .,Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore. .,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore.
| |
Collapse
|
2
|
Can E, Kan E, Akgün Hİ. Clinical features and in-vivo confocal microscopic imaging of fleck corneal dystrophy. Semin Ophthalmol 2013; 28:239-41. [PMID: 23627401 DOI: 10.3109/08820538.2012.760629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the value of in-vivo confocal microscopy (CM) in the diagnosis of Fleck corneal dystrophy. METHODS Case report and literature review. After complete eye examination of the patient, in-vivo CM was performed. The morphologies of the corneal layers were evaluated by in-vivo CM. RESULTS Slit-lamp examination revealed bilateral gray-white, oval or round discrete opacities in the stroma. Confocal microscopy showed hyper-reflective opacities in enlarged and unremarkable keratocyte nuclei throughout the stroma. The surface epithelium, subbasal nerves, and endothelium showed normal morphology. CONCLUSION The diagnosis of rare corneal dystrophies such as Fleck corneal dystrophy should sometimes be made only after performing in-vivo confocal microscopy.
Collapse
Affiliation(s)
- Ertuğrul Can
- Ondokuz Mayıs University, School of Medicine, Department of Ophthalmology, Samsun, Turkey.
| | | | | |
Collapse
|
3
|
Abstract
PURPOSE To report the outcome of laser in situ keratomileusis (LASIK) in a patient with Fleck corneal dystrophy. METHODS Case report and literature review. RESULTS A 48-year-old Taiwanese man presented in November 2005, 6 years after bilateral myopic LASIK. He complained of loss of uncorrected distance visual acuity that was worse in the left eye. The patient did not report glare, halos, or other visual aberrations. Preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 OU, with a manifest refraction of -14 D OU. In November 2005, uncorrected visual acuity (UCVA) was 20/40 OD and 20/50 OS, and BSCVA was 20/25 in each eye with a manifest refraction of -1.00 sphere OD and -1.75 -1.25 x 115 OS. Slit-lamp examination was remarkable for several subtle, small, gray corneal opacities present throughout the corneal stroma. Confocal microscopy revealed refractile bodies within swollen keratocytes and normal surrounding stromal mileu. The clinical and confocal appearance was consistent with Fleck corneal dystrophy. CONCLUSION In this patient with Fleck corneal dystrophy, corneal clarity and BSCVA were maintained 6 years after bilateral myopic LASIK, suggesting that LASIK does not stimulate visually significant exacerbation of Fleck corneal dystrophy.
Collapse
|
4
|
Abstract
PURPOSE To describe corneal opacities of a new type and distribution in a small family. METHODS Family members were interviewed and examined to establish a pedigree and to detect any corneal abnormalities. RESULTS Two family members presented with corneal opacities. Both had, in the very peripheral cornea, flat, greyish, rounded opacities, 20-200 microm in diameter, on the Descemet's membrane. In addition, the mother had the same type of opacities over the central cornea just inside the Bowman's layer. The remaining parts of the corneas were clear. Vision was unaffected and the opacities caused no discomfort. There was no other corneal pathology. The subjects' general health was good. CONCLUSIONS To our knowledge, these types and distribution of corneal opacities have not been described previously. Although the mode of inheritance at this point is uncertain, we believe the changes are of a dystrophic nature.
Collapse
Affiliation(s)
- Per Fagerholm
- Department of Ophthalmology, Linköping University Hospital, Linköping, Sweden.
| | | | | |
Collapse
|
5
|
Li S, Tiab L, Jiao X, Munier FL, Zografos L, Frueh BE, Sergeev Y, Smith J, Rubin B, Meallet MA, Forster RK, Hejtmancik JF, Schorderet DF. Mutations in PIP5K3 are associated with François-Neetens mouchetée fleck corneal dystrophy. Am J Hum Genet 2005; 77:54-63. [PMID: 15902656 PMCID: PMC1226194 DOI: 10.1086/431346] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Accepted: 04/25/2005] [Indexed: 11/03/2022] Open
Abstract
François-Neetens fleck corneal dystrophy (CFD) is a rare, autosomal dominant corneal dystrophy characterized by numerous small white flecks scattered in all layers of the stroma. Linkage analysis localized CFD to a 24-cM (18-Mb) interval of chromosome 2q35 flanked by D2S2289 and D2S126 and containing PIP5K3. PIP5K3 is a member of the phosphoinositide 3-kinase family and regulates the sorting and traffic of peripheral endosomes that contain lysosomally directed fluid phase cargo, by controlling the morphogenesis and function of multivesicular bodies. Sequencing analysis disclosed missense, frameshift, and/or protein-truncating mutations in 8 of 10 families with CFD that were studied, including 2256delA, 2274delCT, 2709C-->T (R851X), 3120C-->T (Q988X), IVS19-1G-->C, 3246G-->T (E1030X), 3270C-->T (R1038X), and 3466A-->G (K1103R). The histological and clinical characteristics of patients with CFD are consistent with biochemical studies of PIP5K3 that indicate a role in endosomal sorting.
Collapse
Affiliation(s)
- Shouling Li
- Ophthalmic Genetics and Clinical Services Branch, National Eye Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Jiao X, Munier FL, Schorderet DF, Zografos L, Smith J, Rubin B, Hejtmancik JF. Genetic linkage of Francois-Neetens fleck (mouchetée) corneal dystrophy to chromosome 2q35. Hum Genet 2003; 112:593-9. [PMID: 12607114 DOI: 10.1007/s00439-002-0905-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2002] [Accepted: 12/11/2002] [Indexed: 10/25/2022]
Abstract
Francois-Neetens fleck (mouchetée) corneal dystrophy is an autosomal dominant corneal dystrophy characterized by scattered small white flecks occurring at all levels of the corneal stroma. We report linkage of the CFD locus to D2S2289 (Z(max)=4.46, theta=0), D2S325 (Z(max)=3.28, theta=0), D2S317 (Z(max)=3.1, theta=0), D2S143 (Z(max)=3.8, theta=0.03), and D2S2382 (Z(max)=5.0, theta=0) on chromosome 2q35. Multipoint analysis confirmed linkage to the region between D2S117 and D2S126 with a maximum multipoint lod score of 5.0 located midway between D2S2289 and D2S325. Analysis of CFD in these same families assuming a 90% penetrance increased the maximum lod score to 6.28 at D2S157.
Collapse
Affiliation(s)
- Xiaodong Jiao
- Ophthalmic Genetics and Clinical Services Branch, National Eye Institute, Bethesda, Maryland 20892-1860, USA
| | | | | | | | | | | | | |
Collapse
|
7
|
Holopainen JM, Moilanen JAO, Tervo TMT. In vivo confocal microscopy of Fleck dystrophy and pre-Descemet's membrane corneal dystrophy. Cornea 2003; 22:160-3. [PMID: 12605053 DOI: 10.1097/00003226-200303000-00016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the value of in vivo confocal microscopy (CM) in the diagnosis of Fleck dystrophy and pre-Descemet's membrane corneal dystrophy. METHODS Case report of two patients. Standard slit-lamp and ophthalmic examination and in vivo CM were performed on both patients. The thickness of the cornea and the morphology of the corneal epithelium, stroma, endothelium, and subbasal nerves were evaluated by confocal microscopy. RESULTS Biomicroscopy revealed bilateral, fine, dust-, and flour-like opacities in the corneal stroma for the Fleck dystrophy patient. In the pre-Descemet's membrane corneal dystrophy patient, biomicroscopy showed opacities larger than those in the first patient. Both patients were then examined by in vivo CM. Confocal microscopy of the Fleck dystrophy showed intracellular deposits throughout the stroma. In pre-Descemet's membrane corneal dystrophy, however, these and the extracellular deposits were observed immediately anterior to Descemet's membrane. The thicknesses of the corneas were 560 and 650 microm for Fleck and pre-Descemet's membrane corneal dystrophy, respectively. The surface epithelium, subbasal nerves, and endothelium showed normal morphology in both patients. CONCLUSION In vivo CM is a valuable tool in diagnosing rare corneal dystrophies when the final diagnosis is difficult to obtain with conventional methods.
Collapse
Affiliation(s)
- Juha M Holopainen
- Department of Ophthalmology, University of Helsinki, PO Box 220, 00029 HUS, Finland.
| | | | | |
Collapse
|