title: Brittle cornea syndrome: recognition, molecular diagnosis and management.
abstract: Brittle cornea syndrome (BCS) is an autosomal recessive disorder characterised by extreme corneal thinning and fragility. Corneal rupture can therefore occur either spontaneously or following minimal trauma in affected patients. Two genes, ZNF469 and PRDM5, have now been identified, in which causative pathogenic mutations collectively account for the condition in nearly all patients with BCS ascertained to date. Therefore, effective molecular diagnosis is now available for affected patients, and those at risk of being heterozygous carriers for BCS. We have previously identified mutations in ZNF469 in 14 families (in addition to 6 reported by others in the literature), and in PRDM5 in 8 families (with 1 further family now published by others). Clinical features include extreme corneal thinning with rupture, high myopia, blue sclerae, deafness of mixed aetiology with hypercompliant tympanic membranes, and variable skeletal manifestations. Corneal rupture may be the presenting feature of BCS, and it is possible that this may be incorrectly attributed to non-accidental injury. Mainstays of management include the prevention of ocular rupture by provision of protective polycarbonate spectacles, careful monitoring of visual and auditory function, and assessment for skeletal complications such as developmental dysplasia of the hip. Effective management depends upon appropriate identification of affected individuals, which may be challenging given the phenotypic overlap of BCS with other connective tissue disorders.
authors: Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK. graeme.black@manchester.ac.uk.
authors: Emma M M
authors: EM
authors: Burkitt Wright
authors: Louise F
authors: LF
authors: Porter
authors: Helen L
authors: HL
authors: Spencer
authors: Jill
authors: J
authors: Clayton-Smith
authors: Leon
authors: L
authors: Au
authors: Francis L
authors: FL
authors: Munier
authors: Sarah
authors: S
authors: Smithson
authors: Mohnish
authors: M
authors: Suri
authors: Marianne
authors: M
authors: Rohrbach
authors: Forbes D C
authors: FD
authors: Manson
authors: Graeme C M
authors: GC
authors: Black
mesh_terms: D000293:Adolescent; D004268:DNA-Binding Proteins / Q000235:genetics; D004535:Ehlers-Danlos Syndrome / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000628:therapy; D005124:Eye Abnormalities; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000151:congenital; D009154:Mutation; D012868:Skin Abnormalities; D014157:Transcription Factors / Q000235:genetics
chemical_list: D004268:DNA-Binding Proteins; C487762:PRDM5 protein, human; D014157:Transcription Factors; C530065:ZNF469 protein, human
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