June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Ocular Phenotype and Therapeutic Interventions in the Ectodermal Dysplasia Keratitis-Ichthyosis-Deafness Syndrome
Author Affiliations & Notes
  • David Armstrong
    Department of Ophthalmology, Royal Victoria Hospital, Belfast, United Kingdom
  • Maeve Lagan
    Department of Ophthalmology, Royal Victoria Hospital, Belfast, United Kingdom
  • Janet Sinton
    Department of Ophthalmology, Altnagelvin Area Hospital, Londonderry, United Kingdom
  • Stephen Kaye
    St Paul's Eye Unit, Royal Liverpool Hospital, Liverpool, United Kingdom
  • Colin Willoughby
    Centre for Vision and Vascular Science, Royal Victoria Hospital, Belfast, United Kingdom
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 3873. doi:
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      David Armstrong, Maeve Lagan, Janet Sinton, Stephen Kaye, Colin Willoughby; Ocular Phenotype and Therapeutic Interventions in the Ectodermal Dysplasia Keratitis-Ichthyosis-Deafness Syndrome. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3873.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: The purpose of the study was to report the ocular manifestations, the clinical course, and the therapeutic management of four patients with KID syndrome who had a molecular diagnosis.

Methods: Four patients with KID syndrome (KID ; MIM148210) from across the UK were recruited for a general and ocular examination and GJB2 (Cx26) mutational analysis. The ocular assessment included best corrected visual acuity, slit lamp bio-microscopy and ocular surface assessment. Mutational analysis of the coding region of GJB2 (Cx26) was performed by bidirectional Sanger sequencing. Specific therapeutic interventions using oral ketaconazole were performed in 2 patients supplemented with sub-conjunctival bevacizumab injection in one patient.One patient received both sub conjunctival and intracorneal bevacizumab.

Results: All four affected individuals had the characteristic systemic features of KID syndrome. Main ophthalmic features were vascularising keratopathy, ocular surface disease, hyperkeratotic lid lesions, recurrent epithelial defects and corneal stromal scarring. Each patient was found to have missense mutation in KID syndrome, which results in substitution of aspartic acid with asparagine at codon 50 (p.D50N). In one patient, multiple surgical procedures, including superficial keratectomies and lamellar keratoplasty, failed to prevent severe visual loss. In contrast, oral therapy with ketaconzole stabilised the corneal and skin disease in two other patients with KID syndrome. The patient who underwent intracorneal bevacizumab injection showed a marked reduction in corneal vascularisation following a single application.

Conclusions: KID syndrome is a rare ectodermal dysplasia caused by heterozygous mutations in GJB2 (Cx26) with a severe, progressive vascularising keratopathy. It has been suggested that oral ketoconazole therapy may play a role in the prevention of KID syndrome associated corneal disease, in contrast to surgical procedures which have a high failure rate. Oral ketaconazole therapy offers benefit in stabilising the corneal and skin disease and further studies in a larger series of patients is warranted. The role of sub-conjunctival bevacizumab has not been established, however the intracorneal injection of bevacizumab appears to have localised benefit with decreased corneal vascularisation in one patient.

Keywords: 609 neovascularization • 526 eyelid • 573 keratitis  
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