Summary Iron is necessary for life, but excess iron can be toxic to tissues. Iron is thought to damage tissues primarily by generating oxygen free radicals through the Fenton reaction. We present an overview of the evidence supporting iron's potential contribution to a broad range of eye disease using an anatomical approach. Firstly, iron can be visualized in the cornea as iron lines in the normal aging cornea as well as in diseases like keratoconus and pterygium. In the lens, we present the evidence for the role of oxidative damage in cataractogenesis. Also, we review the evidence that iron may play a role in the pathogenesis of the retinal disease age-related macular degeneration. Although currently there is no direct link between excess iron and development of optic neuropathies, ferrous iron's ability to form highly reactive oxygen species may play a role in optic nerve pathology. Lastly, we discuss recent advances in prevention and therapeutics for eye disease with antioxidants and iron chelators,.
To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes.Design: Retrospective case series review at 10 IATS sites.Participants: The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS.Methods: Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010.Main Outcome Measures: Visual acuity (VA), strabismus, adverse events (AEs), and reoperations.Results: One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1e7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00e1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (<20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (<9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P ¼ 0.037; and smaller cornea: OR, 3.95; P ¼ 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P ¼ 0.023; and smaller cornea: OR, 4.78; P ¼ 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P ¼ 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%).Conclusions: Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea. Ophthalmology 2020;127:501-510 ª 2019 by the American Academy of Ophthalmology Supplemental material available at www.aaojournal.org. MethodsThis study was approved by the institutional review board or ethics review board at all participating institutions (Mayo Clinic,
Purpose-To determine the association between tobacco smoking history and uveitis.Design-Retrospective, case-control study.Participants-564 ocular inflammation patients seen in the Proctor Foundation uveitis clinic between 2002-2009, and 564 randomly selected comprehensive eye clinic patients within the same time period.Methods-A retrospective medical record review of all cases and controls.Main Outcome Measures-A logistic regression analysis was conducted with ocular inflammation as the main outcome variable and smoking as the main predictor variable while adjusting for age, gender, race, and median income.Results-The odds of a smoker having ocular inflammation were 2.2 fold that of a patient who had never smoked (95% confidence interval [CI] 1.7-3.0, p<0.001). All anatomical subtypes of uveitis were associated with a positive smoking history, with odds ratios (OR) of 1.7 (95% CI 1.2-2.4, p=0.002) for anterior uveitis, 2.7 (95% CI 1.4-5.6, p=0.005) for intermediate uveitis, 3.2 (95% CI 1.3-7.9, p=0.014) for posterior uveitis, and 3.9 (95% CI 2.4-6.1, p<0.001) for panuveitis. In patients with panuveitis and cystoid macular edema (CME), the OR was 8.0 (95% CI 3.3-19.5, p<0.001) compared to 3.1 (95% CI 1.8-5.2, p<0.001) for those patients without CME. Patients with intermediate uveitis and CME also had a higher OR (OR 8.4, 95% CI, 2.5-28.8, p=0.001) compared to patients without CME (OR 1.5, 95% CI 0.6-3.8, p=0.342). Patients with a smoking history were at much greater odds of having infectious uveitis (OR 4.5, 95% CI 2.3-9.0, p<0.001) than noninfectious uveitis (OR 2.1, 95% CI 1.6-2.8, p<0.001), although both were associated with smoking.Conclusions-A history of smoking is significantly associated with all anatomical subtypes of uveitis and infectious uveitis. The association was greater in intermediate and panuveitis patients with CME as compared to those without CME. In view of the known risks of smoking, these findings, if replicated, would give an additional reason to recommend smoking cessation in uveitis patients.
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