Observational studies have shown smoking to be a strong factor for the development of neovascular age-related macular degeneration, cataract and thyroid eye disease, perhaps as a result of a complex inflammatory process. Lin et al from the University of California, San Francisco, analyzed the role of smoking and the pathogenesis of Uveitis in a case-control study. Chart reviews of patients seen at a Uveitis click between 2002 and 2009 identified 564 who had completed the standard questionnaire, which includes a section on smoking history, and who met all the other inclusion criteria for the study. These patients were compared with an equal number of patients with no past or current history of ocular inflammation who were randomly selected from individuals seen at a comprehensive eye clinic and who also completed the standard questionnaire.

Univariate analysis showed significant differences between the 2 groups in smoking prevalence. Similar odds rations (ORs) were found for current and past smokers. Multivariate logistic regression analysis, adjusting for age, race, gender and median income, found an OR for ocular inflammation for 2.2 for smokers, past and current combined, compared with patients who had never smoked (95% confidence interval 1.7-3.0 p<.001). Additional analyses of various subpopulations of the patients showed a significant association between smoking and ocular inflammation for Caucasian, Hispanic, Asian/Pacific Islander and Indian patients but not for African Americans, Middle Easterners or Native Americans. All anatomic subtypes of uveitis - anterior, intermediate, posterior and panuvestis - were associated with smoking. This association remained significant for those with intermediate uveitis and panuveitis who also had cystoid macular edema (CME) but not for those with anterior or posterior uveitis with CME. For patients with panueveitis, the relationship with smoking existed whether or not they had CME. Patients with a history of smoking were at greater odds of having infectious uveitis than noninfectious uvetis.

This case-control study demonstrated a strong association between cigarette smoking and uvetis. Analyses suggested an especially strong association between infectious uvetis and inflammatory CME in patients with intermediate uveitis and panuveitis. The authors proposed that cigarette smoke may promote vascular inflammation related to the release of reactive oxygen species; production of these is thought to be the mechanism relating smoking to the development of macular degeneration and thyroid eye disease.

Postoperative reopening of a successfully closed macular hole (MH) is a common complication of the surgery. To prevent this from happening, an adjunctive procedure, internal limiting membrane (ILM) peeling, has been widely used in recent years. Kumagai et al From Shinjo Opthalmologic Institute, Japan, investigated the long-term incidence of MH reopening following surgery with and without ILM peeling and the factors that may cause the complication.

Included in the study were 874 eyes of 828 patients who underwent vitrectomy between October 1990 to December 2008 for an idiopathic full-thickness MH that had been closed successfully. Anatomic success was defined as both flattening of the hole and disappearance of the edges. In 512 eyes the ILM had been peeled (ILM-off group)l in 362 (ILM-on group) it had not.

During follow-up periods (range, 3-175 months; median , 49 months), reopening of the MH occurred in 2 eyes (0.39%) that had had ILM peeling and in 26 eyes , 7.2%) that had not (p<.0001). Times to reopening in the 2 ILM-off eyes were 6 and 42 months, respectively in the ILM-on group, times to reopening ranged from 1-77 months.

When the clinical data for the 26 eyes in the ILM-on group that experienced MH reopening were compared with the 336 eyes that did not, the only significant associations found were for refractive error (p=.047) and intraoperative retinal tears (p=0.15). More eyes with high myopia (defined as refractive error > - 6.0 diopters or axial length < 26.0 mm) experience reopening (5|26 [19.2%]) than did those that were not so myopic (20/336 [6.0%]).

In this study, ILM peeling significantly decreased the incidence of postoperative reopening of a successfully closed MH. The findings also suggest that myopia and intraoperative retinal tears may be related to reopening of MHs, but the pathologenesis has yet to be conclusively determined.