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Ferrette T, Lassale S, Raffort-Lareyre J, Chardavoine M, Payan J, Baillif S, Martel A. Is Floppy Eyelid Syndrome predictive of Intraoperative Floppy Iris Syndrome? A prospective and translational study. J Fr Ophtalmol 2024; 47:104293. [PMID: 39321565 DOI: 10.1016/j.jfo.2024.104293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/06/2024] [Indexed: 09/27/2024]
Abstract
INTRODUCTION Intraoperative floppy iris syndrome (IFIS) is defined as an excessive billowing of the iris during cataract surgery. Floppy eyelid syndrome is defined as an excessive hyperlaxity of the eyelids. Based in our daily experience, we suspected FES to be associated with IFIS. This association has been investigated. The goal of the study was to explore whether FES was predictive of IFIS. MATERIAL AND METHODS We conducted a prospective observational single-center study at the University Hospital of Nice. IFIS and FES were investigated in patients undergoing cataract surgery from November 2019 to May 2021. In addition, tarsus and iris samples were harvested in 2 fresh cadavers, and Verhoeff staining was used to identify elastin fibers. RESULTS We included 452 eyes (n=312 patients, 50.9% male) with a mean age of 71.7years (±11.4). IFIS was diagnosed in 88 (19.5%) patients, including 20 (4.4%) grade 1, 34 (7.5%) grade 2, and 33 (7.3%) grade 3. FES was diagnosed in 35 (7.7%) patients. PEX was found in 23 (5.1%) patients. On multivariate analysis, FES (P<0.001), pseudo exfoliation (P=0.017), intracameral dilatation (P<0.004), senior surgeons (P=0.009) and α1-ARA (P<0.001) were associated with IFIS. Elastin fibers were identified in small amounts in the tarsus samples but not in the iris samples. CONCLUSION FES is predictive of IFIS. Surgeons should be aware of this association to prevent intraoperative complications.
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Affiliation(s)
- T Ferrette
- Ophthalmology department, University Hospital of Nice, 30 Voie Romaine, 06000 Nice, France
| | - S Lassale
- Ophthalmology department, University Hospital of Nice, 30 Voie Romaine, 06000 Nice, France
| | - J Raffort-Lareyre
- Medical Biology department, University Hospital of Nice, 30 Voie Romaine, 06000 Nice, France
| | - M Chardavoine
- Ophthalmology department, University Hospital of Nice, 30 Voie Romaine, 06000 Nice, France
| | - J Payan
- Ophthalmology department, Hospital Center of Cannes, 15, avenue des Broussailles, 06400 Cannes, France
| | - S Baillif
- Ophthalmology department, University Hospital of Nice, 30 Voie Romaine, 06000 Nice, France
| | - A Martel
- Ophthalmology department, University Hospital of Nice, 30 Voie Romaine, 06000 Nice, France.
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Kuchtey RW, Insignares S, Yang TS, Kuchtey J. In Search of Mouse Models for Exfoliation Syndrome. Am J Ophthalmol 2024; 267:271-285. [PMID: 38909741 DOI: 10.1016/j.ajo.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE Exfoliation syndrome (XFS) is a systemic connective tissue disorder with elusive pathophysiology. We hypothesize that a mouse model with elastic fiber defects caused by lack of lysyl oxidase like 1 (LOXL1 encoded by Loxl1), combined with microfibril deficiency due to Fbn1 mutation (encoding fibrillin-1, Fbn1C1041G/+) will display ocular and systemic phenotypes of XFS. METHODS Loxl1-/- was crossed with Fbn1C1041G/+ to create double mutant (dbm) mice. Intraocular pressure (IOP), visual acuity (VA), electroretinogram (ERG), and biometry were characterized in 4 genotypes (wt, Fbn1C1041G/+, Loxl1-/-, dbm) at 16 weeks of age. Optic nerve (ON) area was measured by ImageJ, and axon counting was achieved by AxonJ. Deep whole-body phenotyping was performed in wt and dbm mice. Two-tailed Student t test was used for statistical analysis. RESULTS There was no difference in IOP between the 4 genotypes. VA was significantly reduced only in dbm mice. The majority of biometric parameters showed significant differences in all 3 mutant genotypes compared with wt, and dbm had exacerbated anomalies compared with single mutants. Dbm mice showed reduced retinal function and significantly enlarged ON area compared with wt. Dbm mice exhibited severe systemic phenotypes related to abnormal elastic fibers, such as pelvic organ prolapse and cardiovascular and pulmonary abnormalities. CONCLUSIONS Ocular and systemic findings in dbm mice support functional overlap between fibrillin-1 and LOXL1, 2 prominent components of exfoliation material. Although no elevated IOP or reduction of axon numbers was detected in dbm mice at 16 weeks of age, their reduced retinal function and enlarged ON area indicate early retinal ganglion cell dysfunction. Dbm mice also provide insight on the link between XFS and systemic diseases in humans.
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Affiliation(s)
- Rachel W Kuchtey
- From the Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center (R.W.K., S.I., J.K.), Nashville, Tennessee; Department of Molecular Physiology and Biophysics, Vanderbilt University (R.W.K.), Nashville, Tennessee.
| | - Samuel Insignares
- From the Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center (R.W.K., S.I., J.K.), Nashville, Tennessee
| | - Tzushan S Yang
- Division of Comparative Medicine, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center (T.S.Y.), Nashville, Tennessee, USA
| | - John Kuchtey
- From the Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center (R.W.K., S.I., J.K.), Nashville, Tennessee
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Meliante LA, Piccotti G, Tanga L, Giammaria S, Manni G, Coco G. Glaucoma, Pseudoexfoliation and Hearing Loss: A Systematic Literature Review. J Clin Med 2024; 13:1379. [PMID: 38592217 PMCID: PMC10931971 DOI: 10.3390/jcm13051379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose: To investigate the relationship between glaucoma, pseudoexfoliation and hearing loss (HL). Methods: A systematic literature search following PRISMA guidelines was conducted using the PubMed, Embase, Scopus and Cochrane databases from 1995 up to 28 August 2023. Results: Thirty studies out of the 520 records screened met the inclusion criteria and were included. Most articles (n = 20) analysed the association between pseudoexfoliation syndrome (XFS) and HL, showing XFS patients to have higher prevalence of sensorineural hearing loss (SNHL) at both speech frequencies (0.25, 0.5, 1 and 2 kHz), and higher frequencies (4 and 8 kHz) compared to controls in most cases. No significant differences in prevalence or level of HL between XFS and pseudoexfoliative glaucoma (XFG) were detected in most studies. Eight articles analysed the relationship between primary open-angle glaucoma (POAG) and HL. Overall, a positive association between the two conditions was highlighted across all studies except for two cases. Similarly, articles focusing on NTG and HL (n = 4) showed a positive association in most cases. The role of autoimmunity and, in particular, the presence of antiphosphatidylserine antibodies (APSA) in patients with NTG and HL suggested an underlying autoimmune or vascular mechanism contributing to their pathogenesis. Only one study analysed the relationship between angle-closure glaucoma (ACG) and HL, showing higher incidence of ACG in patients with SNHL compared to normal hearing controls. Conclusions: Most studies detected an association between XFS and HL as well as POAG/NTG/ACG and HL, suggesting the presence of a similar pathophysiology of neurodegeneration. However, given the strength of the association of XFS with HL, it remains unclear whether the presence of XFG is further associated with SNHL. Further research specifically targeted to assess the correlation between glaucoma, XFS and HL is warranted to provide a more comprehensive understanding of this association.
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Affiliation(s)
- Laura Antonia Meliante
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (L.A.M.); (G.P.); (G.C.)
| | - Giulia Piccotti
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (L.A.M.); (G.P.); (G.C.)
| | - Lucia Tanga
- IRCCS—Fondazione Bietti, 00184 Rome, Italy; (L.T.); (S.G.)
| | - Sara Giammaria
- IRCCS—Fondazione Bietti, 00184 Rome, Italy; (L.T.); (S.G.)
| | - Gianluca Manni
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (L.A.M.); (G.P.); (G.C.)
- IRCCS—Fondazione Bietti, 00184 Rome, Italy; (L.T.); (S.G.)
| | - Giulia Coco
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (L.A.M.); (G.P.); (G.C.)
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Patil A, Conley M, Paulson C, Pompoco C, Wallace R, Swiston C, Ritch R, Curtin K, Wirostko B. Abdominal aortic aneurysm and exfoliation syndrome: A literature review comparing single site findings. Acta Ophthalmol 2022. [DOI: 10.1111/aos.15307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Ayesha Patil
- University of Utah Health John A. Moran Eye Center Salt Lake City Utah USA
| | - Matthew Conley
- Department of Ophthalmology University of Utah School of Medicine Salt Lake City Utah USA
| | - Chase Paulson
- Department of Ophthalmology University of Utah School of Medicine Salt Lake City Utah USA
| | - Christian Pompoco
- University of Utah Health John A. Moran Eye Center Salt Lake City Utah USA
| | - Ryan Wallace
- University of Utah Health John A. Moran Eye Center Salt Lake City Utah USA
| | - Cole Swiston
- University of Utah Health John A. Moran Eye Center Salt Lake City Utah USA
| | - Robert Ritch
- New York Eye and Ear Infirmary New York City New York USA
| | - Karen Curtin
- University of Utah Health John A. Moran Eye Center Salt Lake City Utah USA
| | - Barbara Wirostko
- University of Utah Health John A. Moran Eye Center Salt Lake City Utah USA
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Huang JJ, Geduldig JE, Jacobs EB, Tai TYT, Ahmad S, Chadha N, Buxton DF, Vinod K, Wirostko BM, Kang JH, Wiggs JL, Ritch R, Pasquale LR. Head and Neck Region Dermatological Ultraviolet-Related Cancers are Associated with Exfoliation Syndrome in a Clinic-Based Population. Ophthalmol Glaucoma 2022; 5:663-671. [PMID: 35470101 PMCID: PMC9587131 DOI: 10.1016/j.ogla.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We assessed the relationship between ultraviolet (UV)-associated dermatological carcinomas (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) and exfoliation syndrome (XFS) or exfoliation glaucoma (XFG). DESIGN Case-control study. PARTICIPANTS Between 2019 and 2021, 321 participants and control subjects (XFS or XFG = 98; primary open-angle glaucoma [POAG] = 117; controls = 106; ages 50-90 years) were recruited. METHODS A cross-sectional survey assessing medical history, maximum known intraocular pressure, cup-to-disc ratio, Humphrey visual field 24-2, the propensity to tan or burn in early life, history of BCC or SCC, and XFS or XFG diagnosis. The multivariable models adjusted for age, sex, medical history, eye color, hair color, and likeliness of tanning versus burning at a young age. MAIN OUTCOME MEASURES History of diagnosed XFS or XFG. RESULTS Any history of BCC or SCC in the head and neck region was associated with a 2-fold higher risk of having XFS or XFG versus having POAG or being a control subject (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.04-3.89) in a multivariable-adjusted analysis. We observed a dose-response association in which the chance of having XFS or XFG increased by 67% per head and neck BCC or SCC occurrence (OR, 1.67; 95% CI, 1.09-2.56). When we excluded POAG participants, head and neck BCC or SCC was associated with a 2.8-fold higher risk of XFS or XFG (OR, 2.80; 95% CI, 1.12-7.02), and each additional occurrence had a 2-fold higher risk of XFS or XFG (OR, 1.97; 95% CI, 1.09-3.58). The association between head and neck region BCC or SCC and POAG compared with the control subjects was null (OR, 1.42; 95% CI, 0.58-3.48). With BCC or SCC located anywhere on the body, there was a nonsignificantly higher risk of having XFS or XFG compared with having POAG or being a control subject (OR, 1.65; 95% CI, 0.88-3.09). CONCLUSIONS Head and neck region BCCs or SCCs are associated with a higher risk of having XFS or XFG. These findings support prior evidence that head and neck UV exposure may be a risk factor for XFS.
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Affiliation(s)
- Jeff J Huang
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jack E Geduldig
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erica B Jacobs
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Tak Yee T Tai
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Sumayya Ahmad
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Douglas F Buxton
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | | | - Jae H Kang
- Channing Division of Network of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Janey L Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Robert Ritch
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; New York Eye and Ear Infirmary of Mount Sinai, New York, New York
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Shih MC, Gordis TM, Lambert PR, Nguyen SA, Meyer TA. Hearing Loss in Exfoliation Syndrome: Systematic Review and Meta-Analysis. Laryngoscope 2022; 133:1025-1035. [PMID: 36087028 DOI: 10.1002/lary.30384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine if exfoliation syndrome (XFS) is associated with hearing loss (HL) or vestibular dysfunction. DATA SOURCES PubMed, Scopus, CINAHL, and Cochrane Library through April 1, 2022. REVIEW METHODS Two reviewers independently screened abstracts, selected articles for inclusion, and extracted data. Studies included for qualitative analysis conducted audiometric, tympanometric, or vestibular evaluations on all subjects. RESULTS Twenty-one publications (1148 patients with XFS and 1212 controls) were included in the systematic review, and 16 publications (968 patients with XFS and 1147 controls) in the meta-analysis. Greater severity of HL was seen for patients with XFS compared to controls across all frequencies (odds ratio [OR] 8.8 [7.3-10.2]). Patients with XFS were more likely to have moderate to profound sensorineural HL (OR 1.8 [1.3-2.5]), and less likely to have none to mild HL (OR 0.34 [0.17-0.67]) or no HL (OR 0.37 [0.28-0.50]). Three studies found patients with XFS had lower tympanometric peaks. Two studies found that abnormal vestibular testing results could be more common for patients with XFS. CONCLUSIONS HL is associated with XFS. A sensorineural component to HL is confirmed, and mixed HL is possible. Given the high prevalence and infrequent diagnosis of XFS, the authors hypothesize that the current understandings of presbycusis might be improved by further investigation in XFS. Laryngoscope, 2022.
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Affiliation(s)
- Michael C Shih
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.,Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Tamar M Gordis
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Pompoco CJ, Curtin K, Taylor S, Paulson C, Shumway C, Conley M, Barker DJ, Swiston C, Stagg B, Ritch R, Wirostko BM. Summary of Utah Project on Exfoliation Syndrome (UPEXS): using a large database to identify systemic comorbidities. BMJ Open Ophthalmol 2021; 6:e000803. [PMID: 34765740 PMCID: PMC8552159 DOI: 10.1136/bmjophth-2021-000803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/07/2021] [Indexed: 01/15/2023] Open
Abstract
The purpose of the Utah Project on Exfoliation Syndrome (UPEXS) is to identify associations between exfoliation syndrome (XFS) and other diseases that share the commonality of abnormalities in elastin and Lysyl Oxidase-Like 1 gene regulation. The UPEXS is unique because it uses the Utah Population Database, which is linked to the Utah genealogy, that contains a compilation of large pedigrees of most families in the state of Utah that go back multiple generations (3 to ≥11). The health and medical records of these family members are linked to vital records and can be used effectively in studies focused on genetic disorders like XFS, where familial clustering of a disorder is a trend. There is increasing evidence that patients with XFS have a higher risk of certain systemic disorders that reflect the systemic tissue abnormalities of XFS. Epidemiological studies focused on patients with XFS have shown that there is an increased risk of these individuals developing other pathologies that have abnormalities in extracellular matrix metabolism and repair. UPEXS has focused on suspected comorbidities that involve abnormalities in elastin maintenance, a protein that plays a role in the makeup of the extracellular matrix. In this paper, the results from the analysis of chronic obstructive pulmonary disease, inguinal hernias, pelvic organ prolapse, obstructive sleep apnoea and atrial fibrillation are summarised along with the utility of using such a large dataset.
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Affiliation(s)
- Christian James Pompoco
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Karen Curtin
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Samuel Taylor
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Chase Paulson
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Caleb Shumway
- Department of Ophthalmology, BronxCare Hospital Center, New York, New York, USA
| | - Matt Conley
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - D James Barker
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Cole Swiston
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Brian Stagg
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
| | - Robert Ritch
- Einhorn Clinical Research, Department of New York Eye and Ear Infirmatory of Mount Sinai, New York, New York, USA
| | - Barbara M Wirostko
- Department of Ophthalmology & Visual Science, University of Utah School of Medicine, John Moran Eye Center, Salt Lake City, Utah, USA
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Detorakis ET, Bontzos G, Drakonaki EE, Spandidos DA. Changes in peri-ocular anatomy and physiology in pseudoexfoliation syndrome (Review). Exp Ther Med 2021; 21:650. [PMID: 33968180 PMCID: PMC8097227 DOI: 10.3892/etm.2021.10082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/18/2021] [Indexed: 11/05/2022] Open
Abstract
Pseudoexfoliation syndrome (PEX) is characterized by the deposition of proteinaceous material in the anterior ocular segment (resulting in ophthalmic pathologies such as glaucoma and increased risk of complications in cataract surgery), but also by several systemic manifestations. The involvement of peri-ocular tissues in PEX, including the eyelid skin, lacrimal gland, conjunctiva, orbital fat and vessels, as well as the optic nerve, has been reported by several previous studies. The peri-ocular effects of PEX include the development of eyelid laxity, conjunctival chalasis, tear film abnormalities, pronounced orbital fat atrophy in response to the administration of prostaglandin analogues in pseudoexfoliative glaucoma, deficient orbital vascular supply and biomechanical changes in both the eyeball and the optic nerve. These effects may have important clinical implications, including increased difficulty in cataract surgery, ocular surface disease and eyelid margin malpositions.
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Affiliation(s)
| | - Georgios Bontzos
- Department of Ophthalmology, Red Cross Hospital, Athens 11526, Greece
| | - Eleni E Drakonaki
- Department of Anatomy, Medical School, European University of Cyprus, Nicosia 1516, Cyprus
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion 71003, Greece
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