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      Lens-induced uveitis: an update

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          Abstract

          Ocular inflammation resulting from a lens pathology is rare in the absence of a cataract or lens trauma because of the lens’ immune privilege. The lens can be a source of ocular inflammation when the capsule is broken or when lens proteins leak out through an intact capsule. These uveitides are termed lens-induced uveitis (LIU) and are often associated with advanced cataracts. Cataracts are part of the normal aging process, and in today’s world, cataract surgery is a safe and affordable means of vision restoration in the developed world. In patients with neglected cataracts and in the developing world where cataract surgery rates are lower, LIU rates are higher together with the associated complications. In this literature review, we intend to equip the armamentarium of the practicing ophthalmologist with an updated knowledge on the demographic features, clinical characteristics, treatment options, and outcomes of LIU. This is to highlight the need for timely management of cataracts before the development of advanced cataracts and LIU.

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          Most cited references53

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          Orchestrated leukocyte recruitment to immune-privileged sites: absolute barriers versus educational gates.

          Complex barriers separate immune-privileged tissues from the circulation. Here, we propose that cell entry to immune-privileged sites through barriers composed of tight junction-interconnected endothelium is associated with destructive inflammation, whereas border structures comprised of fenestrated vasculature enveloped by tightly regulated epithelium serve as active and selective immune-skewing gates in the steady state. Based on emerging knowledge of the central nervous system and information from other immune-privileged sites, we propose that these sites are endowed either with absolute endothelial-based barriers and epithelial gates that enable selective and educative transfer of trafficking leukocytes or with selective epithelial gates only.
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            Antigen-presenting cells are stratified within normal human corneas and are rapidly mobilized during ex vivo viral infection.

            To define the phenotype and location of antigen-presenting cells (APCs) in normal donor human corneas, and to assess the response of APC to herpes simplex virus type 1 (HSV-1) infection. Donor human corneal tissue was analyzed by fluorescence confocal microscopy and flow cytometry to determine the phenotype and location of tissue-resident APCs. Confocal fluorescence microscopy was also utilized to investigate the response of corneal resident APCs to ex vivo infection with HSV-1. CD11c(+) dendritic cells (DCs) and CD207(+) Langerhans cells (LCs) were situated predominantly in the basal epithelium and CD68(+) macrophages in the anterior stroma of human corneas. The majority of DCs expressed major histocompatibility complex class II. Corneal resident APCs colocalized with HSV-1-infected corneal cells within 8 to 16 hours of ex vivo infection. The stratification of APCs found in human corneas is very similar to that previously reported in mice, confirming the relevance of murine models for the study of corneal APCs. Furthermore, corneal resident APCs are capable of rapidly mobilizing to the site of trauma and HSV-1 infection within the cornea.
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              Manual Small Incision Cataract Surgery: A Review.

              We aim at reviewing published peer-reviewed studies that evaluate the safety and efficacy of manual small incision cataract surgery (MSICS). Literature searches of the PubMed and the Cochrane Library databases were conducted with no date restrictions; the searches were limited to articles published in English only. All publications with at least level II and III evidence were studied and surgical techniques were analyzed. MSICS was also compared with phacoemulsification and large incision extracapsular cataract surgery (ECCE) with respect to visual outcome, surgery time, cost, intra and postoperative complications and suitability for high volume surgical practices in the developing world.The overall safety profile of MSICS was found to be excellent with intra and postoperative complication rates comparable to phacoemulsification and ECCE. Multiple studies reported the safety and efficacy of MSICS for complicated cases, such as brunescent and white cataract and cataracts associated with phacolytic and phacomorphic glaucoma. Compared to phacoemulsification MSICS was associated with lower and shorter operative times. Visual outcomes were excellent and comparable to phacoemulsification with up to 6 months follow up.The literature provides outcome analysis of a variety of different MSICS techniques. As a whole, MSICS provides excellent outcomes with a low rate of surgical and postoperative complications. Particularly in the developing world, MSICS appears to provide outcomes that are of comparable quality to phacoemulsification at a much lower cost.
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                Author and article information

                Contributors
                radgonde@gmail.com
                Journal
                Graefes Arch Clin Exp Ophthalmol
                Graefes Arch. Clin. Exp. Ophthalmol
                Graefe's Archive for Clinical and Experimental Ophthalmology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0721-832X
                1435-702X
                6 January 2020
                : 1-7
                Affiliations
                GRID grid.17788.31, ISNI 0000 0001 2221 2926, Department of Ophthalmology, , Hadassah Medical Center, ; POB 12000, 91120 Jerusalem, Israel
                Author information
                http://orcid.org/0000-0002-5730-4254
                Article
                4598
                10.1007/s00417-019-04598-3
                7223998
                31907641
                3558dc8d-c20e-4efa-bb71-cbf86a3f53b2
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 8 October 2019
                : 19 December 2019
                : 30 December 2019
                Categories
                Review Article

                Ophthalmology & Optometry
                cataract,lens-induced glaucoma,lens-induced uveitis,phacogenic uveitis

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