Unusual manifestations of x-linked retinoschisis: clinical profile and diagnostic evaluation.

PURPOSE: To describe the unusual clinical manifestations and diagnostic evaluation of X-linked retinoschisis (XLR). DESIGN: Prospective, observational case series. METHODS: Eight patients with subnormal vision seeking treatment at a tertiary eye care center were evaluated clinically by optical coherence tomography (OCT) and electroretinography (ERG) in this prospective, noncomparative case series. Mutational screening was performed for the retinoschisin gene (RS1) by direct deoxyribonucleic acid (DNA) sequencing. The primary outcome measures were the clinical fundus findings and genetic results. RESULTS: The mean patient age was 16.4 years (range, two to 33 years). Family history was positive in seven patients. Four demonstrated atypical fundus findings of XLR bilaterally. Atypical features included macular dragging and distortion (seven eyes, five patients), macular pigmentary changes or scarring (five eyes; three patients), and bilateral exudative detachments (one patient). One patient had macular dragging and pigmentary changes bilaterally. ERG aided diagnosis in five patients: selective B-wave suppression was observed in all. OCT demonstrated typical retinal schitic cavities universally, including the eyes with macular dragging and scarring. Genetic studies confirmed the clinical diagnosis in all patients; two revealed novel mutations. CONCLUSIONS: We identified unusual presentations of XLR with the help of ERG, OCT, family screening, and genetic analysis; OCT seems to be a consistent diagnostic aid across the clinical spectrum of XLR.

Genetic variations in the hotspot region of RS1 gene in Indian patients with juvenile X-linked retinoschisis.

PURPOSE: X-linked juvenile retinoschisis (XLRS) is the leading cause of macular degeneration in males. This condition is caused by mutations in the RS1 gene and is, characterized by schisis within the retina. The purpose of this study was to identify the mutations in the RS1 gene associated with XLRS in an Indian cohort. METHODS: The coding region of RS1 was analyzed for mutations by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) and restriction fragment length polymorphism (RFLP) analysis in six unrelated subjects clinically diagnosed as having XLRS and in their available family members. Direct sequencing was performed for all samples that displayed an electrophoretic mobility shift in SSCP gel. RESULTS: Mutation analysis of RS1 gene revealed five mutations in exon 6 like c.574C>T, c.583A>G, c.608C>T, c.617G>A, and c.637C>T, respectively, among them four missense mutations, one nonsense mutation, and two novel sequence variations. These mutations were found in individuals who exhibited clinical features of bilateral foveal and peripheral retinoschisis consistent with XLRS. The mutations were absent in the 100 age matched control samples analyzed. CONCLUSIONS: This is the first report of mutations in RS1 to be associated with XLRS in the Indian population. The identified genetic variations, phenotype and genotype correlations were consistent with other studies. Identification of the causative mutation in patients with XLRS is helpful in confirming the diagnosis and in counseling of family members.

Association of VEGF and eNOS gene polymorphisms in type 2 diabetic retinopathy.

PURPOSE: Vascular endothelial growth factor (VEGF) is a major mediator of angiogenesis, and nitric oxide (NO) is an upstream and downstream regulator of VEGF mediated angiogenesis. VEGF and NO have been suggested to play an important role in the pathogenesis of microvascular complications in diabetic retinopathy (DR). The objective of this study was to examine the genetic variations of the VEGF and eNOS gene and assess their possible relationship to DR in type 2 diabetic patients in the Indian population. METHODS: In this study, 210 unrelated patients were enrolled and categorized into two study groups: a DR group, consisting of patients with proliferative diabetic retinopathy, and a diabetic without retinopathy (DWR) group comprised of patients with type 2 diabetes of more than 15 years duration who showed no signs of DR or had fewer than five dots or blot hemorrhages. Association of the genetic polymorphisms in the promoter and 5' UTR region of VEGF and the intron4 region of eNOS were studied. Total genomic DNA was isolated from peripheral blood leukocytes. PCR-RFLP analysis was performed for all samples to evaluate the genotypes. The distributions of the genotypes were compared using the chi2 test. Haplotype estimation and multiple logistic regression analysis were carried out to analyze the significance of polymorphisms. RESULTS: We investigated four reported polymorphisms in the VEGF (5' UTR, promoter) and one reported polymorphism (intron 4) in the eNOS gene in Type 2 diabetes patients with (n=120) and without (n=90) retinopathy. The genotype distribution of the C(-7)T, T(-1498)C, and C(-634)G polymorphisms of VEGF differed significantly between patients with DR and DWR (p=0.001, p=0.0001, and p=0.021, respectively). Allele C in the -1498 region (p=0.0001) and T in -7 region (p=0.002) were also found to be significantly increased in patients with retinopathy. Calculated odds ratios (OR) for three heterozygous genotypes of C(-7)T, T(-1498)C, and C(-634)G regions were 4.17 (95% CI: 1.90-9.18, p=0.0001), 4.37 (95% CI: 2.44-7.84, p=0.0001), and 2.33 (95% CI: 1.24-4.36, p=0.008), respectively, and was found to be significantly higher in the DR group when compared with the DWR group. Multiple logistic regression analysis revealed that the nongenetic parameters, age (p=0.024) and duration of diabetes (p=0.009), and the genetic parameters, like VEGF C(-7)T (p=0.002) and T(-1498)C (p=0.001) polymorphisms, were significantly associated with DR. The frequencies of haplotype consisting of the majority of alleles in VEGF were found to be significantly associated with DR. The genotype distribution of eNOS did not differ significantly between the two study groups, and therefore the eNOS intron 4 polymorphism was considered to be less significant. CONCLUSIONS: This is the first study to report VEGF and eNOS gene polymorphisms in patients with DR in the Indian population. The data suggest that the polymorphisms in the 5' UTR and promoter region of VEGF could be regarded as a major genetic risk factor for DR.