Association between smoking and uveitis

Temblador Barba, I.; Benítez-del-Castillo Sánchez, J.; Rodríguez Súarez, A.H.; Michán, A.

doi:10.1016/j.oftale.2022.10.003

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Temblador Barba, J. Benítez-del-Castillo Sánchez, A.H. Rodríguez Súarez, A. Michán" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Temblador Barba" "email" => array:1 [ 0 => "irenetembladorbarba@outlook.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Benítez-del-Castillo Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A.H." "apellidos" => "Rodríguez Súarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Michán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asociación entre tabaco y uveítis" ] ] "textoCompleto" => "Smoking is a major preventable cause of disease, disability and premature death. Smoking is known to be associated with a variety of diseases, including respiratory, cardiovascular, gastrointestinal, neurological and ocular diseases.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Among the latter, smoking has been shown to be a risk factor for cataracts, age-related macular degeneration, thyroid ophthalmopathy, ischemic optic neuropathy and open-angle glaucoma.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In addition, several studies have been published linking smoking to uveitis.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a>Smoking is associated with worse reduced vision and bilateral inflammation at presentation in ocular inflammatory diseases and increased risk of recurrence.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> As uveitis is an inflammatory disease resulting from an alteration of the immune system, it is feasible that smoking may contribute to its pathogenesis.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> In one published study, a history of smoking was found to be significantly associated with all anatomical subtypes of uveitis and infectious uveitis. The association was stronger in patients with intermediate uveitis and panuveitis with cystoid macular edema (CME) compared to those without CME.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> This finding on the development and progression of CME was previously described several years ago,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> and in addition a particularly strong association between smoking and infectious uveitis is also suggested in this study.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> The reason for this is not yet fully understood. The authors suggest that the pro-inflammatory components of tobacco smoke could facilitate the access of micro-organisms to intraocular tissue and also enhance the response of inflammatory cells to the damaging agent.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Despite demonstrating a strong link between smoking and uveitis, it is not proven that smoking causes or aggravates uveitis, although both scenarios are biologically plausible.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>Apart from the association between smoking and all anatomical subtypes of uveitis, several studies have found a correlation between smoking and CME in patients with intermediate uveitis and panuveitis,<a class="elsevierStyleCrossRefs" href="#bib0010">2,6</a> and that this association is also dose-dependent.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The exact mechanism by which smoking may cause macular edema is also unknown. Damage to ocular tissues occurs via ischemic and/or oxidative pathways. The detrimental effects of smoking on the vascular endothelium are widely known, and it is also known that the retinal vasculature responds abnormally to hyperoxia in smokers. Endothelial dysfunction appears to be one of the first pathological effects of smoking, and it may be that this damage leads to increased permeability of retinal blood vessels, resulting in the development of macular edema.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Age is a potential confounding variable, as younger patients are less likely to have a history of smoking, although this is changing in current times. However, after controlling for this potentially confounding variable in research papers, smoking remained a statistically significant risk factor for CME.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Similarly, it appears that uveitis manifests at an earlier age in smokers than in non-smokers, and that smoking would be associated with the degree of uveitis activity. This increases both the need for corticosteroid treatment and the incidence of cataracts and macular edema,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> in addition to the fact that smoking is implicated as a possible cause of poor response to treatment.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> It has also been reported that the relationship between smoking and uveitis is evident in both current and former smokers.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>We would like to highlight the hypothesis that smoking not only plays a role in the development of uveitis, but may also contribute to the severity of inflammation, giving rise to complications such as CME.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Although the available scientific literature is limited and more well-designed studies with larger patient samples are needed to address this issue, all studies point to the importance of recommending that patients with uveitis quit, or at least reduce, smoking.Conflict of interestsThe authors declare no conflict of interest." 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Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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