Congenital stromal corneal dystrophy: Difference between revisions

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{{Infobox medical condition (new)
{{Short description|A rare genetic eye disorder affecting the cornea}}
| name            = Congenital stromal corneal dystrophy
| synonyms        =  '''Witschel dystrophy'''
| image          = Congenital stromal corneal dystrophy.jpg
| caption        = The cornea is particularly opaque in the anterior stroma by slit-lamp biomicroscopy
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[[File:Congenital stromal dystrophy 2.jpg|thumb|Congenital stromal dystrophy. Transmission electron microscopy of the corneal stroma showing normal collagen lamellae separated by abnormal randomly distributed collagen filaments in an electron-lucent extracellular matrix.]]
'''Congenital stromal corneal dystrophy''' (CSCD), is an extremely rare, [[autosome|autosomal]] [[dominance (genetics)|dominant]] form of [[corneal dystrophy]].<ref name=audcscd>{{Cite journal| last1 = Bredrup | first1 = C.| last2 = Knappskog | first2 = P. M.| last3 = Majewski | first3 = J.| last4 = Rødahl | first4 = E.| last5 = Boman | first5 = H.| title = Congenital stromal dystrophy of the cornea caused by a mutation in the decorin gene| journal = Invest Ophthalmol Vis Sci| date = February 2005| volume = 46| issue = 2| pages = 420&ndash;426| pmid = 15671264| doi = 10.1167/iovs.04-0804| url = http://www.iovs.org/cgi/content/full/46/2/420| format = Free full text}}
</ref> Only 4 families have been reported to have the disease by 2009.<!--


--><ref name="pmid19236704">{{cite journal |author=Klintworth GK |title=Corneal dystrophies |journal=[[Orphanet J Rare Dis]] |volume=4 |issue= |pages=7 |year=2009 |pmid=19236704 |pmc=2695576 |doi=10.1186/1750-1172-4-7 |url=http://www.ojrd.com/content/4//7}}</ref><!--
'''Congenital stromal corneal dystrophy''' (CSCD) is a rare [[genetic disorder]] that affects the [[cornea]], the transparent front part of the [[eye]]. This condition is characterized by the presence of cloudy, opalescent spots in the corneal stroma, which can lead to visual impairment. CSCD is present at birth and is typically inherited in an [[autosomal dominant]] pattern.


--> The main features of the disease are numerous opaque flaky or feathery areas of clouding in the stroma that multiply with age and eventually preclude visibility of the endothelium. Strabismus or primary open angle [[glaucoma]] was noted in some of the patients. Thickness of the cornea stays the same, Descemet's membrane and endothelium are relatively unaffected, but the fibrills of collagen that constitute stromal lamellae are reduced in diameter and lamellae themselves are packed significantly more tightly.
==Pathophysiology==
The cornea is composed of several layers, including the epithelium, stroma, and endothelium. In congenital stromal corneal dystrophy, the primary abnormality occurs in the [[corneal stroma]], which is the thick, transparent middle layer of the cornea. The stroma is responsible for maintaining the cornea's shape and clarity. In CSCD, abnormal deposits of [[collagen]] and other substances accumulate in the stroma, leading to the characteristic cloudiness and opalescence.


==Genetics==
==Genetics==
CSCD is caused by mutations in the [[DCN]] gene, which encodes the protein decorin. Decorin is involved in the regulation of collagen fibril formation and organization in the corneal stroma. Mutations in the DCN gene disrupt normal decorin function, leading to the abnormal deposition of collagen and other matrix components in the cornea.


CSCD is associated with a mutation in the gene DCN that encodes the protein [[decorin]], located at [[chromosome]] [[chromosome 12|12q22]].<ref name=audcscd/> The disorder is inherited in an autosomal dominant manner,<ref name=audcscd/> which indicates that the defective gene responsible for a disorder is located on an [[autosome]] (chromosome 12 is an autosome), and only one copy of the gene is sufficient to cause the disorder, when inherited from a parent who has the disorder.
==Clinical Features==
Individuals with congenital stromal corneal dystrophy typically present with:
* Bilateral corneal clouding present at birth or in early childhood
* Opalescent spots in the corneal stroma
* Progressive visual impairment
* Photophobia (sensitivity to light)
 
The severity of visual impairment can vary, with some individuals experiencing significant vision loss, while others may have only mild symptoms.


==Diagnosis==
==Diagnosis==
{{Empty section|date=July 2017}}
The diagnosis of CSCD is based on clinical examination and family history. Key diagnostic features include:
 
* Slit-lamp examination revealing opalescent spots in the corneal stroma
==Treatment==
* Family history consistent with autosomal dominant inheritance
{{Empty section|date=July 2017}}
* Genetic testing to identify mutations in the DCN gene


==References==
==Management==
{{Reflist}}
There is currently no cure for congenital stromal corneal dystrophy. Management focuses on alleviating symptoms and improving vision. Treatment options may include:
* [[Corrective lenses]] to improve visual acuity
* [[Phototherapeutic keratectomy]] (PTK) to remove superficial corneal opacities
* [[Corneal transplantation]] in severe cases where vision is significantly impaired


== External links ==
==Prognosis==
{{Medical resources
The prognosis for individuals with CSCD varies depending on the severity of the condition. While some individuals may maintain relatively good vision with appropriate management, others may experience progressive vision loss. Regular follow-up with an [[ophthalmologist]] is essential to monitor the condition and adjust treatment as needed.
|  DiseasesDB    =
|  ICD10          = H18.5
|  ICD9          =
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|  OMIM          = 610048
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|  MeshID        =
|  Orphanet      = 101068
}}
*[https://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=csc-dys  GeneReviews/NCBI/NIH/UW entry on Congenital Stromal Corneal Dystrophy]


{{Human corneal dystrophy}}
==Related pages==
{{Scleroprotein disease}}
* [[Corneal dystrophy]]
* [[Genetic disorders]]
* [[Ophthalmology]]


{{DEFAULTSORT:Congenital Stromal Corneal Dystrophy}}
[[Category:Genetic disorders]]
[[Category:Disorders of sclera and cornea]]
[[Category:Ophthalmology]]
[[Category:Rare diseases]]
[[Category:Corneal dystrophies]]
[[Category:Autosomal dominant disorders]]
{{dictionary-stub1}}

Revision as of 19:25, 22 March 2025

A rare genetic eye disorder affecting the cornea


Congenital stromal corneal dystrophy (CSCD) is a rare genetic disorder that affects the cornea, the transparent front part of the eye. This condition is characterized by the presence of cloudy, opalescent spots in the corneal stroma, which can lead to visual impairment. CSCD is present at birth and is typically inherited in an autosomal dominant pattern.

Pathophysiology

The cornea is composed of several layers, including the epithelium, stroma, and endothelium. In congenital stromal corneal dystrophy, the primary abnormality occurs in the corneal stroma, which is the thick, transparent middle layer of the cornea. The stroma is responsible for maintaining the cornea's shape and clarity. In CSCD, abnormal deposits of collagen and other substances accumulate in the stroma, leading to the characteristic cloudiness and opalescence.

Genetics

CSCD is caused by mutations in the DCN gene, which encodes the protein decorin. Decorin is involved in the regulation of collagen fibril formation and organization in the corneal stroma. Mutations in the DCN gene disrupt normal decorin function, leading to the abnormal deposition of collagen and other matrix components in the cornea.

Clinical Features

Individuals with congenital stromal corneal dystrophy typically present with:

  • Bilateral corneal clouding present at birth or in early childhood
  • Opalescent spots in the corneal stroma
  • Progressive visual impairment
  • Photophobia (sensitivity to light)

The severity of visual impairment can vary, with some individuals experiencing significant vision loss, while others may have only mild symptoms.

Diagnosis

The diagnosis of CSCD is based on clinical examination and family history. Key diagnostic features include:

  • Slit-lamp examination revealing opalescent spots in the corneal stroma
  • Family history consistent with autosomal dominant inheritance
  • Genetic testing to identify mutations in the DCN gene

Management

There is currently no cure for congenital stromal corneal dystrophy. Management focuses on alleviating symptoms and improving vision. Treatment options may include:

Prognosis

The prognosis for individuals with CSCD varies depending on the severity of the condition. While some individuals may maintain relatively good vision with appropriate management, others may experience progressive vision loss. Regular follow-up with an ophthalmologist is essential to monitor the condition and adjust treatment as needed.

Related pages