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D.K. Roberts, J.E. Winters, D.D. Castells, B.A. Teitelbaum, C.C. Alexander; Krukenberg's Spindles and Pigmented Striae of the Anterior Lens Capsule: Two Highly Associated, Age and Gender Related Clinical Signs of Pigment Dispersal in a Predominantly Black Population . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2192.
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Purpose: Further investigate Krukenberg's spindles (KS) and pigmented lens striae (PLS), potential signs of age-related pigment dispersal produced by iris-lens rubbing. Methods: During a 31-month period, 5 practitioners in an urban, primary eye care setting examined consecutive patients for KS and PLS. Patients were excluded who: 1) did not have a complete eye examination including dilated fundus examination, 2) who had prior ocular trauma, uveitis, or surgery, or 3) who did not give consent. Multiple logistic regression was used to evaluate relationships among KS, PLS, and other variables including age, race, gender, refractive error, diabetes, and hypertension. Results: 3,142 (2,644 Blacks, 303 Whites, 121 Hispanics, 54 Asians, 27 other) met the inclusion criteria. KS were present in 59 subjects (53/54, right/left eyes), comprised of 52 Blacks (2.0%), 5 Whites (1.7%), and 2 Hispanics (1.7%). PLS were present in 57 subjects (50/51 right/left eyes), comprised of 53 Blacks (2.0%), 3 Whites (1.0%), and 1 Asian (1.9%). KS and PLS were coexistent in 20 subjects, there were KS only in 33, and PLS only in 30. KS were bilateral in 49 (83%) subjects, and PLS in 44 (77%). Mean age +SD (range) of the inclusion group was 39.6 +22.7 yrs (7-96). Mean age of KS subjects was 63.0 +14.7 yrs (24-88). Mean age of PLS subjects was 66.5 +10.1 yrs (33-88). Mean refractive error of KS right eyes was +0.50 +2.44D (-6.50 to +5.50). Mean refractive error of PLS right eyes was +1.39 +1.50D (-6.50 to +7.25). Controlling for age, PLS were highly predictive (OR=31.4, 95% CI=15.8 to 62.4, P<0.0001) of KS. Controlling for age and refractive error, KS were highly predictive (OR=33.0, 95% CI=16.2 to 67.2, P<0.0001) of PLS. Ignoring PLS status, age (in decades) (OR=1.62, 95% CI=1.40 to 1.88, P<0.0001) and female gender (OR=2.29, 95% CI=1.11 to 4.73, P=0.026) were significantly associated with KS. Ignoring KS status, age (OR=1.68, 95% CI=1.41 to 2.0, P<0.0001), female gender (OR=2.24, 95% CI=1.04 to 4.86, P=0.04), and increasing hyperopic refractive error (D) (OR=1.28, 95% CI=1.12 to 1.46, P=0.0003) were significantly associated with PLS. Analysis of the Blacks only gave similar results. Conclusions: KS and PLS were strongly associated in this group. The likelihood of KS and PLS increased with age and with female gender. Hyperopic refractive error was a predictor of PLS but not KS. This information has value in the process to understand age-related pigment dispersal and if it may be influential to IOP to at least some degree in certain patients.
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