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Absence of Phenotype-Genotype Correlation of Patients Expressing Mutations in the SLC4A11 Gene

Mehta, Jodhbir Singh BSc, MBBS, MRCOphth, FRCS(Ed); Hemadevi, Boomiraj MSc; Vithana, Eranga N PhD; Arunkumar, Jambulingam MD; Srinivasan, Muthaiah MD; Prajna, Venkatesh DNB, FRCOphth; Tan, Donald T MD, FRCS(Ed); Aung, Tin PhD, FRCOphth; Sundaresan, Periasamy PhD

doi: 10.1097/ICO.0b013e3181ae9038
Clinical Science

Purpose: The purposes of this study were to describe the clinical characteristics of corneal patients with mutations in the SLC4A11 gene and to determine if these characteristics could be correlated with specific genetic mutations.

Methods: A retrospective case series review was conducted. Baseline demographic data, including gender, age at diagnosis of congenital hereditary endothelial dystrophy, family history, and pedigree information, were obtained. Information from clinical examination, including intraocular pressure, ultrasonic pachymetry, best spectacle-corrected visual acuity, axial length, and slit-lamp biomicroscopic evaluation, including corneal diameter and fundus examination, were also documented from the notes. History of corneal surgery was also recorded. Hearing loss was assessed by audiometry. Genetic analysis was performed by polymerase chain reaction amplification and sequencing.

Results: Seven patients were identified. Four of the seven had associated hearing loss; all of the patients had undergone or were awaiting penetrating keratoplasty to one or both eyes. No correlation could be reached between the ocular phenotype and the gene mutation in this small sample. Individuals with the same mutation had different degrees of hearing loss within their respective families.

Conclusions: Corneal endothelial cells are more vulnerable to defects in the functional activity of SLC4A11 than cells of the striae vascularis of the inner ear. Both congenital hereditary endothelial dystrophy 2 and Harboyan syndrome have similar ocular phenotypes, ie, diffuse bilateral corneal edema present at birth or within the neonatal period; hence, audiometry must be performed to differentiate the two conditions.

From the *Singapore National Eye Centre, Singapore; †Singapore Eye Research Institute, Singapore; ‡Aravind Medical Research Foundation, Madurai, India; §Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; and ‖Cornea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India.

Received for publication July 23, 2008; revision received May 3, 2009; accepted May 5, 2009.

Drs. Mehta and Hemadevi contributed equally to this manuscript.

Reprints: Jodhbir Singh Mehta, BSc, MBBS, MRCOphth, FRCS(Ed), Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751 (e-mail:

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