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Montero-Salinas A, Martínez-Isasi S, Fieira-Costa E, Suanzes-Hernández J, Fernández-García D, Gómez-Salgado J, Rendal-Vazquez E. Analysis of cardiovascular risk factors for the viability of cornea donors: a case-control study. BMJ Open 2023; 13:e077122. [PMID: 38154886 PMCID: PMC10759072 DOI: 10.1136/bmjopen-2023-077122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/07/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE The main objective of the study was to evaluate the influence of arterial hypertension, diabetes, dyslipidaemia, smoking, alcoholism and COPD (chronic obstructive pulmonary disease) on the viability of the extracted tissue as well as the donor. DESIGN Observational case-control study. SETTING Regional hospital in Northern Spain. PARTICIPANTS 1517 corneas were registered. INTERVENTIONS Patients' medical history was reviewed after corneal donation and evaluation. Previous medical information (age, sex and cardiovascular risk factors (CVRFs)) and data related to the donor (type of donor), the corneal tissue and its evaluation, and the viability of the implant were collected. RESULTS A total of 1517 corneas were registered and 81.5% of the donors presented at least one CVRF. In relation to the viability of the donor, it was observed that having suffered from COPD reduced the viability of the donor (no COPD: 93.8% vs COPD: 88%; OR=0.49; 95% CI: 0.28 to 0.84) while alcohol consumption increased it (drinker or ex-drinker: 95.8% vs non-drinker: 92.5%; OR=1.84; 95% CI: 1.01 to 3.33). Regarding tissue viability, decreased viability was observed in the presence of COPD (no COPD: 72.5% vs COPD: 64; OR=0.67; 95% CI: 0.47 to 0.96) and diabetes mellitus (no diabetes: 72.9% vs diabetes: 67.2%; OR=0.76; 95% CI: 0.58 to 0.99). As regards the viability of the implant, a total of 1039 corneas (68.9%) were suitable, observing decreased viability when suffering from COPD (no COPD: 69.8% vs COPD: 60.7%; OR=0.67; 95% CI: 0.47 to 0.94) and increased when having an active smoking habit (no habit: 65.3% vs habit: 74.1%; OR=1.52; 95% CI: 1.21 to 1.91). CONCLUSIONS Through this study, it can be concluded that in the absence of absolute exclusion criteria for donors, the assessment of how CVRF, alcoholism and COPD may affect the donor provides details about the quality of the tissue to be obtained.
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Affiliation(s)
- Alejandro Montero-Salinas
- Biomedical Research Institute of A Coruña (INIBIC), Universidade da Coruña, A Coruna, Spain
- Universidade da Coruña (UDC), A Coruña, Spain
| | - Santiago Martínez-Isasi
- Simulation and Intensive Care Unit of Santiago (SICRUS), Health Research Institute of Santiago, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
| | - Eva Fieira-Costa
- Biomedical Research Institute of A Coruña (INIBIC), Universidade da Coruña, A Coruna, Spain
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, Servizo Galego de Saúde (SERGAS), Coruña, Spain
| | - Jorge Suanzes-Hernández
- Biomedical Research Institute of A Coruña (INIBIC), Universidade da Coruña, A Coruna, Spain
- Research Group in Nursing and Health Care, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Daniel Fernández-García
- Nursing Health Research Group - GREIS, Department of Nursing and Physiotherapy, University of León, Leon, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, University of Huelva, Huelva, Spain
- Health and Safety Postgraduate Programme, Universidad de Especialidades Espiritu Santo, Samborondon, Ecuador
| | - Esther Rendal-Vazquez
- Biomedical Research Institute of A Coruña (INIBIC), Universidade da Coruña, A Coruna, Spain
- Unidade de Criobioloxía-Banco de Tecidos, Complexo Hospitalario Universitario A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), Coruña, Spain
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Özcan D. Effect of smoking on corneal and lens clarity: a densitometric analysis. Cutan Ocul Toxicol 2023; 42:198-203. [PMID: 37417933 DOI: 10.1080/15569527.2023.2234023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To assess the effect of chronic cigarette smoking on corneal and lens densitometry measurements using Pentacam HR and to compare the results obtained with those in non-smokers. MATERIALS AND METHODS This cross-sectional comparative study included 40 chronic-smokers and 40 age-matched healthy non-smokers between 18-40 years. After general ophthalmic examination, the Pentacam HR imaging system was used to evaluate corneal and lens densitometry measurements of smokers and non-smokers. RESULTS The mean corneal densitometry values were not statistically significantly different in all the concentric zones and layers in the eyes of the smokers and non-smokers (p > 0.05, for all). However, the mean values of zone 1, zone 2, zone 3 and average lens densitometry measurements of the smokers were statistically significantly higher compared to non-smokers (p < 0.05, for all). Additionally, significant positive correlations were detected between the number of pack-years smoked and lens densitometry measurements. CONCLUSION Lens densitometry measurements of smokers were significantly increased while corneal densitometry measurements were not significantly altered compared to non-smokers. Smoking may contribute to cataractogenesis and smoking and age-related changes may act synergistically to cataract development among smokers.
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Affiliation(s)
- Delil Özcan
- Department of Ophthalmology, Seyrantepe Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Jha A, Verma A, Priya C. Effects of chewing tobacco on corneal endothelium in patients with diabetes mellitus. Eye (Lond) 2023; 37:3392-3397. [PMID: 37072470 PMCID: PMC10630435 DOI: 10.1038/s41433-023-02515-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE To determine the impact of tobacco chewing on corneal endothelial structure in patients with diabetes mellitus (DM). METHODS Corneal endothelial parameters (endothelial cell count, ECD; coefficient of variation, CV; hexagonality, Hex, and central corneal thickness, CCT) were analysed in 1234 eyes of 1234 patients using non-contact specular microscopy (EM 4000 Tomey Nishi-Ku, Nagoya, Aichi, Japan). The study group (with a present history of tobacco chewing) comprising of 948 subjects, with 473 having DM was compared with age and gender-matched control group comprising of 286 subjects (139 having DM) with no history of tobacco use in any form. RESULTS Tobacco chewers had a significantly reduced ECD (P = 0.024) and Hex (P = 0.009) as compared with non-chewers. Similar results were noted in ECD (P = 0.004) and Hex (P = 0.005) in patients with DM. Tobacco chewers had a significantly decreased ECD values among males, HbA1C ≤ 7.5% and duration of DM ≤ 20 years, and significantly decreased Hex among those with >50 years of age, females, and duration of DM > 20 years. The CV and CCT values were comparable between the study and the control groups. Tobacco chewers showed a significant association of ECD with age, HbA1C, and duration of DM; CV with HbA1C; Hex with age and duration of DM; and CCT with gender, age, HbA1C and duration of DM. CONCLUSIONS Tobacco chewing may negatively impact corneal health, especially confounded by additional factors like age and DM. These factors must be accounted for in the pre-operative evaluation of such patients prior to any intra-ocular surgery.
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Affiliation(s)
- Ashok Jha
- Department of Ophthalmology, Military Hospital Gaya, Gaya, 823005, India.
| | - Aditya Verma
- Department of Ophthalmology and Visual Sciences, University of Louisville, 310 E Muhammad Ali Blvd, Louisville, 40202, Kentucky, USA
| | - Charima Priya
- Shree Vishveshwara Netraalaya, Gaya, Gaya, 823001, Bihar, India
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Galor A, Britten-Jones AC, Feng Y, Ferrari G, Goldblum D, Gupta PK, Merayo-Lloves J, Na KS, Naroo SA, Nichols KK, Rocha EM, Tong L, Wang MTM, Craig JP. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf 2023; 28:262-303. [PMID: 37054911 DOI: 10.1016/j.jtos.2023.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Surgical Services, Miami Veterans Administration, Miami, FL, USA.
| | - Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Yun Feng
- Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, San Raffaele Scientific Institute, Milan, Italy
| | - David Goldblum
- Pallas-Kliniken, Olten, Bern, Zurich, Switzerland; University of Basel, Basel, Switzerland
| | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA; Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo, Principality of Asturias, Spain
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eduardo M Rocha
- Department of Ophthalmology, Othorynolaringology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Karimi S, Nouri H, Mahmoudinejad-Azar S, Abtahi SH. Smoking and environmental tobacco smoke exposure: implications in ocular disorders. Cutan Ocul Toxicol 2023; 42:1-7. [PMID: 36369835 DOI: 10.1080/15569527.2022.2144874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE This article aims to gather and review the available knowledge on several implications of smoking and environmental tobacco smoke (ETS) exposure in ocular disorders and provides pathomechanistic insights where applicable. MATERIALS AND METHODS PubMed and Scopus databases were searched for relevant studies on the association of smoking and ETS exposure with various ocular disorders. Studies with different evidence levels, e.g., in-vivo, case-control, cohort, and meta-analysis, were included. RESULTS Smoking is an established, modifiable risk factor in several ocular diseases, including cataract, age-related macular degeneration, and Graves' ophthalmopathy; smokers are subject to more severe disease courses and less favorable treatment outcomes. Uveitis is twice as likely in smokers; smoking may also delay its resolution. Smoking and ETS exposure are major risk factors for diseases of other organs, with associated ocular complications as well, such as diabetes mellitus. ETS exposure is also associated with ocular surface pathologies, including dry eye syndrome. In children, early-life ETS exposure and maternal smoking during pregnancy are strongly associated with refractive errors and strabismus. Currently, available data on potential risks attributable to ETS exposure regarding ocular diseases are scarce and, in some instances, controversial. CONCLUSION In addition to smoking, ETS exposure is also a significant public health concern with possible links to several ocular diseases. However, the level of education of at-risk populations in this regard does not match the strength of the evidence.
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Affiliation(s)
- Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - Sahar Mahmoudinejad-Azar
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Vaiciuliene R, Rylskyte N, Baguzyte G, Jasinskas V. Risk factors for fluctuations in corneal endothelial cell density (Review). Exp Ther Med 2022; 23:129. [PMID: 34970352 PMCID: PMC8713183 DOI: 10.3892/etm.2021.11052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022] Open
Abstract
The cornea is a transparent, avascular and abundantly innervated tissue through which light rays are transmitted to the retina. The innermost layer of the cornea, also known as the endothelium, consists of a single layer of polygonal endothelial cells that serve an important role in preserving corneal transparency and hydration. The average corneal endothelial cell density (ECD) is the highest at birth (~3,000 cells/mm2), which then decrease to ~2,500 cells/mm2 at adulthood. These endothelial cells have limited regenerative potential and the minimum (critical) ECD required to maintain the pumping function of the endothelium is 400-500 cells/mm2. ECD < the critical value can result in decreased corneal transparency, development of corneal edema and reduced visual acuity. The condition of the corneal endothelium can be influenced by a number of factors, including systemic diseases, such as diabetes or atherosclerosis, eye diseases, such as uveitis or dry eye disease (DED) and therapeutic ophthalmological interventions. The aim of the present article is to review the impact of the most common systemic disorders (pseudoexfoliation syndrome, diabetes mellitus, cardiovascular disease), eye diseases (DED, uveitis, glaucoma, intraocular lens dislocation) and widely performed ophthalmic interventions (cataract surgery, intraocular pressure-lowering surgeries) on corneal ECD.
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Affiliation(s)
- Renata Vaiciuliene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Neda Rylskyte
- Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Gabija Baguzyte
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Vytautas Jasinskas
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
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