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Details about other KC related genes screened in this study To further insure the significance of the identified ZNF469 mutations, we also screened other genes related to KC in patients who carry the ZNF469 mutations. The following search strategy was used to screen studies that reported gene mutations related to KC in the Pubmed database: (keratoconus[Title/Abstract]) AND ((gene[Title/Abstract]) OR mutation[Title/Abstract]). In all, thirty-one genes related to KC were involved: dedicator of cytokinesis 9 (DOCK9)[1], collagen type V alpha 1 chain (COL5A1), lysyl oxidase(LOX), calpastatin (CAST), fibronectin type III domain containing 3B (FNDC3B), transforming growth factor beta induced(TGFBI), RAB3 GTPase activating protein catalytic subunit 1(RAB3GAP1), multiple PDZ domain crumbs cell polarity complex component (MPDZ-NF1B), zinc finger E-box binding homeobox 1 (ZEB1), superoxide dismutase 1(SOD1), interleukin 1 alpha(IL1A), interleukin 1 beta (IL1B), collagen type IV alpha 4 chain(COL4A4), visual system homeobox 1(VSX1), microRNA 184 (MIR-184)[2], secreted protein acidic and cysteine rich (SPARC), metallopeptidase inhibitor 3 (TIMP3)[3], RAD51 recombinase (RAD51)[4], transferring(TF)[5], DNA ligase 3 (LIG3)[6], flap structure-specific endonuclease 1 (FEN1)[7],solute carrier family 4 member 11 (SLC4A11), interleukin 1 receptor antagonist (IL1RN)[8], platelet derived growth factor receptor alpha(PDGFRA), tripartite motif containing 29(TRIM29)[9], DNA polymerase gamma, catalytic subunit (POLG), X-ray repair cross complementing 1 (XRCC1), nei like DNA glycosylase 1 (NEIL1), poly(ADP-ribose) polymerase-1(PARP-1) [10], serine/threonine kinase 24(STK24), transforming growth factor beta-1-like(TGFβ1)[11]. All involved genes were screened by next-generation sequencing technology, and further identified using Sanger sequencing technology. Only one DOCK9 mutation( c.1940C>T)) was detected, whose SIFT score was 0. Reference 1. Karolak JA, Rydzanicz M, Ginter-Matuszewska B, Pitarque JA, Molinari A, et al. Variant c.2262A> C in DOCK9 Leads to Exon Skipping in Keratoconus Family. Invest Ophthalmol Vis Sci. 2015 ; 56(13):7687-90 2. Bykhovskaya Y, Margines B, Rabinowitz YS. Genetics in Keratoconus: where are we? Eye Vis (Lond). 2016; 27;3:16 3. De Bonis P, Laborante A, Pizzicoli C, Stallone R, Barbano R, et al. Mutational screening of VSX1, SPARC, SOD1, LOX, and TIMP3 in keratoconus. Mol Vis. 2011;17:2482-94 4. Synowiec E, Wojcik KA, Izdebska J, Binczyk E, Blasiak J,et al. Polymorphisms of the homologous recombination gene RAD51 in keratoconus and Fuchs endothelial corneal dystrophy. Dis Markers. 2013;35(5):353-62 5. Wójcik KA, Synowiec E, Jiménez-García MP, Kaminska A, Polakowski P, et al. JP.Polymorphism of the transferrin gene in eye diseases: keratoconus and Fuchs endothelial corneal dystrophy. Biomed Res Int. 2013;2013:247438 6. Synowiec E, Wojcik KA, Izdebska 2, Binczyk E, Szaflik J, et al. Polymorphism of the LIG3 gene in keratoconus and Fuchs endothelial corneal dystrophy. Cell Mol Biol (Noisy-le-grand). 2015; 61(1):56-63 7. Wojcik KA, Synowiec E, Polakowski P, Głowacki S, Izdebska J, et al. Polymorphism of the flap endonuclease 1 gene in keratoconus and Fuchs endothelial corneal dystrophy. Int J Mol Sci. 2014 ;15(8):14786-802 8. Nowak DM, Karolak JA, Kubiak J, Gut M, Pitarque JA, et al. Substitution at IL1RN and deletion at SLC4A11 segregating with phenotype in familial keratoconus. Invest Ophthalmol Vis Sci. 2013; 54(3):2207-15 9. Mishra A, Yazar S, Hewitt AW, Mountain JA, Ang W, et al. Genetic variants near PDGFRA are associated with corneal curvature in Australians. Invest Ophthalmol Vis Sci. 2012;53(11):7131-6. 10. Wojcik KA, Synowiec E, Sobierajczyk K, Izdebska J, Blasiak J, et al. Polymorphism of the DNA base excision repair genes in keratoconus. Int J Mol Sci. 2014 ;15(11):19682-99 11. Karolak JA, Rydzanicz M, Ginter-Matuszewska B, Pitarque JA, Molinari A, et al. M.Molecular Screening of Keratoconus Susceptibility Sequence Variants in VSX1, TGFBI, DOCK9, STK24, and IPO5 Genes in Polish Patients and Novel TGFBI Variant Identification. Invest Ophthalmol Vis Sci. 2015 ;56(13):7687-90