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2016 ; 16
(1
): 158
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New histopathologic and ultrastructural findings in Reis-Bücklers corneal
dystrophy caused by the Arg124Leu mutation of TGFBI gene
#MMPMID27590038
Qiu WY
; Zheng LB
; Pan F
; Wang BB
; Yao YF
BMC Ophthalmol
2016[Sep]; 16
(1
): 158
PMID27590038
show ga
BACKGROUND: Reis-Bücklers corneal dystrophy (RBCD) was consistently reported as a
corneal dystrophy only affected Bowman's layer and superficial corneal stroma,
and superficial keratectomy was a recommendation surgery for treatment in
literatures. The study reported new histopathological and ultrastructural
findings in RBCD caused by the Arg124Leu mutation of transforming growth factor
induced (TGFBI) gene in a four-generation Chinese pedigree. METHODS: Subjects
including eight patients and seven unaffected family members received slit-lamp
biomicroscopy and photography. DNA was obtained from all subjects, and exons 4
and 11 to 14 of TGFBI gene were analyzed by polymerase chain reaction and the
products were sequenced. Anterior segment optical coherence tomography (AS OCT)
and in vivo confocal microscopy were conducted for ten eyes of five patients.
Based on the results of AS OCT and in vivo confocal microscopy, deep anterior
lamellar keratoplasty (DLKP) using cryopreserved donor cornea was applied for
four eyes of four patients. Four lamellar dystrophic corneal buttons were studied
by light and transmission electron microscopy, and TGFBI immunohistochemistry.
RESULTS: Eight patients had typical clinical manifestations of RBCD presenting
recurrent painful corneal erosion starting in their early first decades, along
with age-dependent progressive geographic corneal opacities. TGFBI sequencing
revealed a heterozygous mutation, Arg124Leu in all eight patients. Anterior
segment optical coherence tomography and in vivo confocal microscopy showed the
dystrophic deposits involved not only in subepithelial and superficial stroma,
but also in mid- or posterior stroma in four examined advanced eyes. Light
microscopy showed Bowman's layer was absent, replaced by abnormal deposits stain
bright red with Masson's trichrome. In superficial cornea, the deposits stacked
and produced three to five continuous bands parallel to the corneal collagen
lamellae. In mid- to posterior stroma, numerous granular or dot- like aggregates
were heavily scattered, and most of them presented around the nuclei of stromal
keratocytes. Transmission electron microscopy revealed the multiple
electron-dense rod-shaped deposits aggregated and formed a characteristic pattern
of three to five continuous bands in superficial cornea, which were similar to
those seen under light microscopy. In mid- to posterior stroma, clusters of
rod-shaped bodies were scattered extracellular or intracellular of the stromal
keratocytes between the stromal lamellae suggesting the close relationship
between mutated proteins and keratocyte. CONCLUSIONS: The study offer evidences
indicating DLKP is a viable treatment option for advanced RBCD to avoid
recurrence, and the mutated TGFBIp in dystrophic corneas are of keratocytes
origin.