Phenotype-genotype correlation of patients with congenital cataracts and hair anomalies

Hair anomalies represent a common associated symptom of congenital cataracts. Early diagnosis is crucial for treatment and predicting prognosis. However, the insidious and nonspecific nature of the symptoms in young children makes diagnosis challenging, often necessitating tools such as whole-exome sequencing (WES) for accurate assessment. This study aims to propose a simple and expedient approach to guide clinical management by analyzing phenotype-genotype correlations.

A prospective cohort study was conducted among participants who underwent clinical examinations and WES between 2021 and 2023. Bioinformatic analysis was performed. In total, 170 unrelated congenital cataract probands were tested. The suspected pathogenic variants were validated through Sanger sequencing in both the probands and available family members. Correlation analyses were then performed, integrating clinical characteristics, cataract phenotype, and genotype data.

Nine probands presented with both cataracts and hair anomalies. Potential pathogenic variants were detected in all patients with hair anomalies, including a novel variant in LSS. Phenotype-genotype analysis supports the classification of patients into two groups: hypotrichosis 14 and ichthyosis follicularis with atrichia and photophobia syndrome 2, based on the cataract phenotype, severity of the hair anomalies, and the presence of corneal pannus. These patients should be monitored closely for the development and progression of glaucoma and corneal lesions.

We identified nine probands with hair anomalies in our large cohort of congenital cataract probands. Using WES and comprehensive clinical examinations, we established definitive diagnoses, broadened the phenotype and genotype, and proposed phenotype-genotype correlations.