The Ross Eye Institute

Exfoliation Syndrome is an age-related systemic condition characterized by large aggregated fibrillar material deposition in the anterior eye tissues. This aggregate formation and deposition on the aqueous humor outflow pathway are significant risk factors for developing Exfoliation Glaucoma (XFG). XFG is a multifactorial late-onset disease that shares common features of neurodegenerative diseases, such as increased protein aggregation, impaired protein degradation, and oxidative and cellular stress. XFG patients display decreased mitochondrial membrane potential and mitochondrial DNA deletions. Here, using Tenon Capsule Fibroblasts (TFs) from patients without glaucoma (No Glaucoma, NG) and XFG patients, we found that XFG TFs have impaired mitochondrial bioenergetics and increased reactive oxygen species accumulation. These defects are associated with mitochondrial abnormalities as XFG TFs exhibit smaller mitochondria that contain dysmorphic cristae, with increased mitochondrial localization to lysosomes and slowed mitophagic flux. Mitochondrial dysfunction in the XFG TFs was associated with hyperdynamic microtubules, decreased acetylated tubulin, and increased HDAC6 activity. Treatment of XFG TFs with a mitophagy inducer, Urolithin A (UA), and a mitochondrial biogenesis inducer, Nicotinamide Ribose (NR), improved mitochondrial bioenergetics and reduced ROS accumulation. Our results demonstrate that XFG TFs have abnormal mitochondria and suggest that mitophagy inducers may represent a potential class of therapeutics for reversing mitochondrial dysfunction in XFG patients.

Introduction Refractive error is one of the most common causes of visual impairment in the world, negatively affecting a patient's quality of life, economic opportunities and more. Although numerous studies have explored the impact of severe ocular allergies on refractive error, there is limited research on how relatively mild forms of ocular allergies may affect vision. This study aims to assess the impact of allergic conjunctivitis, a milder and more common ocular allergy, on the development and progression of refractive error in the pediatric population. Methods This was a retrospective study that reviewed the records (2015-2018) of 198 established pediatric patients from the Ross Eye Institute: 90 with a new diagnosis of allergic conjunctivitis, and 108 age- and sex-matched controls. All refractions were performed by a single board-certified and fellowship-trained pediatric ophthalmologist utilizing retinoscopy, the gold standard for measuring refractive error in the pediatric population. T-tests were used to analyze continuous variables, and chi-square tests were used for categorical variables. Linear regression was used to identify factors associated with refractive error. Results The average age of the patient population was 9.7 years, with 42% males. Children with allergic conjunctivitis were found to have a significantly higher incidence of cylindrical refractive error compared to controls (56% vs 34%, p < 0.001), with increased cylindrical power (1.20 ± 0.07 D vs 0.80 ± 0.08 D; p < 0.001), but no difference in spherical equivalent (-0.83 ± 0.27 vs -0.66 ± 0.21, p = 0.64). Additionally, compared to the refraction obtained one year prior to the diagnosis of allergic conjunctivitis, patients were found to have a greater increase in cylindrical power compared to controls (0.13 ± 0.04 D vs 0.01 ± 0.02 D, p = 0.007), with no significant difference in the type of cylindrical refractive error. Conclusions Our study demonstrates that allergic conjunctivitis may prognosticate the development and progression of cylindrical refractive error in children.

To report a case of acute noncardiogenic pulmonary edema (NCPE) after administration of acetazolamide post routine cataract surgery.

30 minutes after administration of oral acetazolamide, the patient experienced abdominal pain, nausea, vomiting, diarrhea, and diaphoresis. The patient was taken to the emergency room where she was found to have pulmonary edema. After life threatening respiratory failure resulting in prolonged intubation, the patient was eventually discharged from the hospital.

NCPE is a rare but severe adverse effect of acetazolamide and should be considered when prescribing such agents.