Ichthyosis Clinical Trial
Official title:
Prevalence of Ophthalmological Abnormalities in Children and Adults Suffering From Hereditary Ichthyosis
Presence/absence of subclinical keratoconus with corneal topographic abnormalities (skewed radial axes for forme fruste keratoconus, and inferior steepening for keratoconus suspect) on axial specular topography (TMS-4 Tomey), and elevation topographies: Pentacam (Oculus) and Orbscan (Bausch & Lomb).
Background: Hereditary ichthyosis are rare genetic diseases characterized by an abnormal
epithelial keratinization due to mutations in gene involved in skin barrier. Patients present
with scales on the whole body. Recent classification basically distinguishes syndromic from
non-syndromic forms. Ichthyoses are severe diseases with significant impact on quality of
life, due to troublesome symptoms (pruritus, pain), lack of effective therapy and
complications such as ophthalmological anomalies. Among ophthalmological abnormalities, some
are well known, such as eyelid abnormalities, including ectropion, and sicca syndrome.
Conversely, corneal abnormalities such as keratoconus are not or very partially described in
ichthyosis. The keratoconus is characterized by a corneal thickening and bulging with
progressive loss of vision that may require a corneal transplantation. Its prevalence is
0.05% in its symptomatic presentation but may reach 10% when considering subclinical
keratoconus diagnosed on basis of corneal topographies. These forme fruste keratoconus or
keratoconus suspect may remain subclinical or instead progress to severe keratoconus. Corneal
collagen crosslinking has been shown to strengthen the cornea in order to halt progressive
keratoconus, justifying the need for early screening. Keratoconus is a complex condition of
multifactorial etiology. With regards to the pathophysiology of the keratoconus, some
hypotheses incriminate the corneal epithelial differentiation that is similar to the
epidermal differentiation altered in ichthyosis. This link between both dermatological and
ophthalmological abnormalities is supported by clinical experience. It's was observed that
ichthyosis patients have frequently a subclinical keratoconus. In clinical practice,
ophthalmological abnormalities are not commonly investigated in ichthyosis patients and there
are no data on prevalence in the literature. Furthermore, there are no guidelines on
screening or therapy of ophthalmological abnormities in ichthyosis.
The purpose of this project is to demonstrate that the prevalence of subclinical keratoconus
(including forme fruste keratoconus and keratoconus suspect) is higher in ichthyosis compared
to healthy controls.
Descriptive analysis of the studied population for primary outcome: The proportion of
patients with subclinical keratoconus (including form fruste keratoconus and keratoconus
suspect) will be described in each study-group and compared between study-groups using Mac
Nemar Test.
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