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Letters to Editor
26 (
4
); 313-314
doi:
10.4103/0971-4065.179304

Secret in the eyes - fish eye disease

Department of Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
Department of Ophthalmology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India

Address for correspondence: Dr. V. K. Ingle, Department of Medicine, AIIMS Bhopal, Saket Nagar, Bhopal - 462 024, Madhya Pradesh, India. E-mail: vaibhav.genmed@aiimsbhopal.edu.in

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Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Sir,

In response to “Co-existence of classic familial lecithin-cholesterol acyltransferase deficiency and fish eye disease in the same family”,[1] we would like to report a case of Fish eye disease.

A 42-year-old male was referred for physician consultation for low high-density lipoprotein (HDL) cholesterol levels. It was found that patient had persistently low HDL cholesterol (<10 mg/dl) and persistently high serum triglycerides (>200 mg/dl) on multiple occasions.

The patient was nonobese, nonsmoker, and had no other addictions. He had no history of premature cardiovascular events or renal failure in the family. Patient's fasting blood sugars, renal function tests, and urine analysis were normal.

This mystery of persistent hypoalphalipoproteinemia was solved when it was noticed that patient had bilateral corneal opacities [Figure 1]. Ophthalmologic evaluation revealed corneal opacities involving all the layers of the cornea with maximum density near the limbus, without any impairment of vision.

Corneal opacities
Figure 1
Corneal opacities

Persistent hypoalphalipoproteinemia with characteristic corneal opacities led to the provisional diagnosis of fish eye disease. Plasma lecithin- cholesterol acyltransferase (LCAT) activity performed at Pacific Biomarkers, USA, was normal. Genetic studies could not be performed because of economic non-viability. Family members had no dyslipidemia or corneal opacities.

Fish eye disease is a rare disease with only about thirty case reports.[2] Fish eye disease or partial LCAT deficiency was named after the appearance of cornea similar to that of boiled fish.[3] There is a partial deficiency of alpha-LCAT activity (present in HDL) while beta-LCAT activity is preserved.[4]

In contrast to total LCAT deficiency, fish eye disease patients have no anemia or renal failure. There is no risk for premature coronary artery disease.[5]

The patient was reassured and advised to follow-up with ophthalmologists at regular intervals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , , . Co-existence of classic familial lecithin-cholesterol acyl transferase deficiency and fish eye disease in the same family. Indian J Nephrol. 2015;25:362-5.
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  2. National Library of Medicine (US) . Genetics Home Reference [Internet]. Bethesda (MD): The Library; Fish eye disease; Available from: http://www.ghr.nlm.nih.gov/condition/fish-eye-disease
    [Google Scholar]
  3. , , . Fish-eye disease. A new familial condition with massive corneal opacities and dyslipoproteinaemia. Lancet. 1979;2:922-4.
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  4. , . Familial LCAT deficiency and fish-eye disease. J Inherit Metab Dis. 1988;11(Suppl 1):45-56.
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  5. , , , , , , . Functional lecithin: Cholesterol acyltransferase is not required for efficient atheroprotection in humans. Circulation. 2009;120:628-35.
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