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Tsui JC, Willett K, Cohen JB, Yu Y, VanderBeek BL. Erythropoiesis-Stimulating Agents and the Risk of Vision-Threatening Diabetic Retinopathy. Ophthalmic Epidemiol 2024; 31:249-257. [PMID: 37427852 PMCID: PMC10776797 DOI: 10.1080/09286586.2023.2235001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Animal studies have suggested that Erythropoiesis-Stimulating Agents (ESAs) may increase vascular endothelial growth factor (VEGF)-related retinopathies, but this effect is unclear in humans. This study evaluates the risk of vision-threatening diabetic retinopathy (VTDR), defined as either diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR), in patients exposed to an ESA. METHODS Two analyses were performed. First, a retrospective matched-cohort study was designed using a de-identified commercial and Medicare Advantage medical claims database. The ESA cohort of non-proliferative diabetic retinopathy patients who were new users of an ESA from 2000 to 2022 was matched to controls up to a 3:1 ratio. Exclusion criteria included less than 2 years in the plan, history of VTDR or history of other retinopathy. Multivariable Cox proportional hazards regression with inverse proportional treatment weighting (IPTW) was used to assess the hazard of developing VTDR, DME, and PDR. The second analysis was a self-controlled case series (SCCS) evaluating the incidence rate ratios (IRR) of VTDR during 30-day periods before and after initiating an ESA. RESULTS After inclusion of 1502 ESA-exposed patients compared with 2656 controls, IPTW-adjusted hazard ratios found the ESA cohort had an increased hazard of progressing to VTDR (HR = 3.0 95%CI:2.3-3.8;p < .001) and DME (HR = 3.4,95%CI:2.6-4.4,p < .001), but not PDR (HR = 1.0,95%CI:0.5-2.3,p = .95). Similar results were found within the SCCS which demonstrated higher IRRs for VTDR (IRRs = 1.09-1.18;p < .001) and DME (IRRs = 1.16-1.18;p < .001), but not increased IRRs in PDR (IRR = 0.92-0.97,p = .02-0.39). CONCLUSION ESAs are associated with higher risks for VTDR and DME, but not PDR. Those studying ESAs as adjunctive therapy for DR should be cautious of possible unintended effects.
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Affiliation(s)
- Jonathan C. Tsui
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Keirnan Willett
- Kittner Eye Center, Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, USA
| | - Jordana B. Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
| | - Yinxi Yu
- Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Brian L. VanderBeek
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Loukovaara S, Haukka J. Incidence of diabetic macular oedema shows geographical regional differences in Finland-An epidemiological study. Acta Ophthalmol 2024; 102:e409-e411. [PMID: 38158781 DOI: 10.1111/aos.16620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Sirpa Loukovaara
- Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Eriksson MI, Hietala K, Summanen P, Harjutsalo V, Putaala J, Ylinen A, Hägg-Holmberg S, Groop PH, Thorn LM. Stroke incidence increases with diabetic retinopathy severity and macular edema in type 1 diabetes. Cardiovasc Diabetol 2024; 23:136. [PMID: 38664827 PMCID: PMC11046873 DOI: 10.1186/s12933-024-02235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND As the retina is suggested to mirror the brain, we hypothesized that diabetic retinopathy and macular edema are indicative of stroke risk in type 1 diabetes and sought to assess this association in individuals with type 1 diabetes. METHODS We included 1,268 adult FinnDiane Study participants with type 1 diabetes (age 38.7 ± 11.8 years, 51.7% men vs. 48.3% women, and 31.5% had diabetic kidney disease), data on baseline diabetic retinopathy severity, and first stroke during our observational follow-up. Retinopathy was graded by the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, and macular edema as clinically significant (CSME) or not. Strokes identified from registries were confirmed from medical files. Adjusted hazard ratios (HR) for stroke by retinopathy severity and CSME were calculated by Cox models adjusted for clinical confounders, including diabetic kidney disease. RESULTS During median 18.0 (14.1-19.3) follow-up years, 130 strokes (96 ischemic, 34 hemorrhagic) occurred. With no-very mild (ETDRS 10-20) retinopathy as reference, the adjusted HR for stroke was 1.79 (95%CI 1.02-3.15) in non-proliferative (ETDRS 35-53), and 1.69 (1.02-2.82) in proliferative (ETDRS 61-85) retinopathy. Corresponding adjusted HR for ischemic stroke was 1.68 (0.91-3.10) in non-proliferative and 1.35 (0.77-2.36) in proliferative retinopathy. The adjusted HR for hemorrhagic stroke was 2.84 (0.66-12.28) in non-proliferative and 4.31 (1.16-16.10) in proliferative retinopathy. CSME did not increase HR for any stroke type after adjustment for clinical confounders (data not shown). CONCLUSIONS Stroke incidence increases with the severity of diabetic retinopathy independently of comorbid conditions, including diabetic kidney disease.
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Affiliation(s)
- Marika I Eriksson
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki Haartmaninkatu 8, Helsinki, FIN-00290, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Kustaa Hietala
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Paula Summanen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anni Ylinen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki Haartmaninkatu 8, Helsinki, FIN-00290, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Stefanie Hägg-Holmberg
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki Haartmaninkatu 8, Helsinki, FIN-00290, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki Haartmaninkatu 8, Helsinki, FIN-00290, Finland.
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki Haartmaninkatu 8, Helsinki, FIN-00290, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Tungsattayathitthan U, Jenjanya S, Choopong P, Sanphan W, Tesavibul N, Boonsopon S. Prevalence, clinical characteristics, and independent predictors of uveitic macular edema in an Asian population: a retrospective cohort study. BMC Ophthalmol 2024; 24:181. [PMID: 38649909 PMCID: PMC11036638 DOI: 10.1186/s12886-024-03447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND To determine the prevalence, clinical characteristics, and independent predictors of uveitic macular edema (UME) in patients with intermediate, posterior and panuveitis. METHODS We retrospectively reviewed the records of patients with intermediate, posterior, and panuveitis who underwent macular assessment using optical coherence tomography between January 2015 and February 2020. The prevalence of UME and clinical characteristics of the patients were described. Predictors of UME were identified using multivariate regression analysis. RESULTS A total of 349 patients were included. The mean age was 41 years, female: male ratio was 1.3:1. The prevalence of UME was 51.9%. UME was found in 33.9%, 56.9%, and 54.1% of the intermediate, posterior, and panuveitis cases, respectively. Among patients with UME, 47% had infectious uveitis, 32.6% had idiopathic uveitis, and 20.4% had immune-mediated uveitis. Diffuse macular edema was the most frequently observed pattern (36.5%). Multivariate analysis showed that factors independently associated with UME included age at uveitis onset (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00-1.03, P = 0.036), PU and panuveitis compared with intermediate uveitis (aOR 2.09, 95% CI 1.14-3.86, P = 0.018), and infectious uveitis compared with noninfectious uveitis (aOR 2.13, 95% CI 1.34-3.37, P = 0.001). CONCLUSIONS Increasing age at uveitis onset, posterior/panuveitis, and infectious etiology are predictive factors for UME in patients with intermediate, posterior and panuveitis.
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Affiliation(s)
- Usanee Tungsattayathitthan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Sukanda Jenjanya
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Wilawan Sanphan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, 10700, Bangkoknoi, Bangkok, Thailand.
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Finger CTM, Maliska G, Novello SB. Macular edema after surgery to treat rhegmatogenous retinal detachment: 1-year follow-up, incidence, and associated risk factors. Arq Bras Oftalmol 2024; 87:e2022. [PMID: 38656020 DOI: 10.5935/0004-2749.2022-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 08/07/2023] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To clarify the postoperative incidence of macular edema in patients undergoing surgery to repair rhegmatogenous retinal detachment and identify the associated risk factors. METHODS In this prospective, observational study, 79 patients who underwent surgery to correct rhegmatogenous retinal detachment using pars plana vitrectomy with silicone oil injection were analyzed. Patients were followed up postoperatively at 7, 30, 90, 180, and 365 days. At each visit, optical coherence tomography was performed to assess the presence or absence of macular edema. were analyzed as possible risk factors for macular edema: age, sex, macular status (attached or detached), presence of vitreoretinal proliferation, history of previous intraocular surgery, reported time of symptoms suggestive of rhegmatogenous retinal detachment up to the date of surgery, and the surgical modality performed. RESULTS The 1-year macular edema prevalence rate was 26.6%. In the adjusted analysis, older patients had a higher risk of macular edema, and each 1-year increase in age increased the risk of macular edema by 6% (95% confidence interval = 1.00-1.12). The macular status, vitreoretinal proliferation, the surgical technique used, prior intraocular surgery, and the intraocular lens status were not identified as risk factors. However, the incidence of macular edema increased up to 180 days after surgery, peaking at 10.6%, and then decreased until 365 days after surgery. CONCLUSION Macular edema was a common complication after surgery to treat rhegmatogenous retinal detachment, with its incidence peaking between 30 and 180 days after surgery. Age was an important risk factor for macular edema in this cohort.
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Affiliation(s)
| | - Gabriela Maliska
- Department of Ophthalmology, Hospital Regional de São José, São José, SC, Brazil
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Ishibashi R, Inaba Y, Koshizaka M, Takatsuna Y, Tatsumi T, Shiko Y, Kashiwagi Y, Maezawa Y, Kawasaki Y, Kawakami E, Yamamoto S, Yokote K. Sodium-glucose co-transporter 2 inhibitor therapy reduces the administration frequency of anti-vascular endothelial growth factor agents in patients with diabetic macular oedema with a history of anti-vascular endothelial growth factor agent use: A cohort study using the Japanese health insurance claims database. Diabetes Obes Metab 2024; 26:1510-1518. [PMID: 38240052 DOI: 10.1111/dom.15454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 03/05/2024]
Abstract
AIM We assessed the effectiveness of sodium-glucose co-transporter 2 inhibitors (SGLT2is) in reducing the administration frequency of anti-vascular endothelial growth factor (VEGF) agents in patients with diabetic macular oedema (DMO) using a health insurance claims database. MATERIALS AND METHODS This retrospective cohort study analysed health insurance claims data covering 11 million Japanese patients between 2005 and 2019. We analysed the frequency and duration of intravitreal injection of anti-VEGF agents after initiating SGLT2is or other antidiabetic drugs. RESULTS Among 2412 matched patients with DMO, the incidence rates of anti-VEGF agent injections were 230.1 per 1000 person-year in SGLT2i users and 228.4 times per 1000 person-year in non-users, respectively, and the risk ratio for events was unchanged in both groups. Sub-analysis of each baseline characteristic of the patients showed that SGLT2is were particularly effective in patients with a history of anti-VEGF agent use [p = .027, hazard ratio (HR): 0.44, 95% confidence interval (CI): 0.22-0.91]. SGLT2is reduced the risk for the first (p = .023, HR: 0.45, 95% CI: 0.22-0.91) and second (p = .021, HR: 0.39, 95% CI: 0.17-0.89) anti-VEGF agent injections. CONCLUSIONS There was no difference in the risk ratio for the addition of anti-VEGF therapy between the two treatment groups. However, the use of SGLT2is reduced the frequency of anti-VEGF agent administration in patients with DMO requiring anti-VEGF therapy. Therefore, SGLT2i therapy may be a novel, non-invasive, low-cost adjunctive therapy for DMO requiring anti-VEGF therapy.
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Affiliation(s)
- Ryoichi Ishibashi
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Kimitsu Chuo Hospital, Kisarazu, Japan
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yosuke Inaba
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Masaya Koshizaka
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Yoko Takatsuna
- Department of Ophthalmology, Chiba Rosai Hospital, Ichihara, Japan
- Department of Ophthalmology and Vision Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoaki Tatsumi
- Department of Ophthalmology and Vision Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yusuke Kashiwagi
- Department of Artificial Intelligence Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Eiryo Kawakami
- Department of Artificial Intelligence Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Vision Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
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Liu Y, Zhu Q, Jiang P, Yang Y, Wang M, Liang H, Peng Q, Zhang Q. Bibliometric and visualized analysis of DME from 2012 to 2022. Medicine (Baltimore) 2024; 103:e37347. [PMID: 38552080 PMCID: PMC10977560 DOI: 10.1097/md.0000000000037347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/02/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Diabetic macular edema (DME) is the main cause of irreversible vision loss in patients with diabetes mellitus (DM), resulting in a certain burden to patients and society. With the increasing incidence of DME, more and more researchers are focusing on it. METHODS The papers related to DME between 2012 and 2022 from the Web of Science core Collection were searched in this study. Based on CiteSpace and VOS viewer, these publications were analyzed in terms of spatiotemporal distribution, author distribution, subject classification, topic distribution, and citations. RESULTS A total of 5165 publications on DME were included. The results showed that the research on DME is on a steady growth trend. The country with the highest number of published documents was the US. Wong Tien Yin from Tsinghua University was the author with the most published articles. The journal of Retina, the Journal of Retinal and Vitreous Diseases had a large number of publications. The article "Mechanisms of macular edema: Beyond the surface" was the highly cited literature and "Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema" had the highest co-citation frequency. The treatment, diagnosis, pathogenesis, as well as etiology and epidemiological investigation of DME, have been the current research direction. Deep learning has been widely used in the medical field for its strong feature representation ability. CONCLUSIONS The study revealed the important authoritative literature, journals, institutions, scholars, countries, research hotspots, and development trends in in the field of DME. This indicates that communication and cooperation between disciplines, universities, and countries are crucial. It can advance research in DME and even ophthalmology.
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Affiliation(s)
- Yi Liu
- Department of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Qiuyan Zhu
- Clinical Laboratory Department, Longgang Sixth People’s Hospital, Shenzhen, China
| | - Pengfei Jiang
- Ophthalmology Department, Quzhou Hospital of Zhejiang Medical and Health Group, Quzhou, China
| | - Yang Yang
- Department of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Mingyun Wang
- Department of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Hao Liang
- Department of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Qinghua Peng
- Department of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Qiuyan Zhang
- Department of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
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Vidal-Oliver L, Mataix Boronat J, Palacios Pozo E, López-Prats MJ, Desco Esteban MC. Long-term complications according to silicone oil type. A single center cohort study. Eur J Ophthalmol 2024; 34:541-548. [PMID: 37671421 DOI: 10.1177/11206721231200034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE To study the incidence of macular edema (ME), ocular hypertension (OHT), emulsification and migration to the anterior chamber (AC) of silicone oil (SO) in patients after complex retina surgery, stratified by SO type. METHODS Retrospective, cohort study. Patients who underwent retina surgery with SO injection and extraction in our center were included. We compared the complication rates of ME, OHT, emulsification and migration to the AS according to SO type (1300cSt, 5700cSt and heavy SO). Data on age, sex, emulsification time, duration of the tamponade, previous retina surgeries and diagnosis were also gathered and included in a multivariate analysis. RESULTS We included 163 patients (mean age of 64.8 years; mean duration of the tamponade: 11 months). Rates of emulsification, ME, OHT and SO migration to the AC were similar in all groups (p = 0.998, 0.668, 0.915 and 0.360). ME was the most frequent complication (33.3-47.8%), which resolved after SO extraction in 77.6% of cases. The majority of cases with OHT persisted (61.7%). Emulsification was related to younger age (OR 0.94) and longer duration of the tamponade (OR 1.04). The odds of SO migration to the AC increased with emulsification (OR 2.78), recurrent retinal detachment (OR 0.99) and aphakia (OR 4.05). CONCLUSIONS We propose SO extraction as the preferred treatment for ME during SO tamponade. SO extraction should be performed sooner in younger patients to avoid emulsification. In selected patients, we suggest a longer duration of the tamponade up to 11 months with a reasonable safety profile, regardless of the SO type.
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Affiliation(s)
| | | | | | | | - M Carmen Desco Esteban
- Fundación Oftalmología Médica de la Comunidad Valenciana, Valencia, Spain
- Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
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Lin W, Li D, Wen L, Moonasar N, Wang Y, Lin Z. Aspirin intake is not associated with diabetic retinopathy and diabetic macular edema: A report from the Fushun diabetic retinopathy cohort study. Indian J Ophthalmol 2024; 72:S298-S302. [PMID: 38271427 DOI: 10.4103/ijo.ijo_2932_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE We aimed to study the effects of aspirin intake for diabetic retinopathy (DR) and diabetic macular edema (DME) in a cohort from northeastern China. METHODS Participants in the Fushun Diabetic Retinopathy Cohort Study were enrolled between July 2012 and May 2013. Fundus photographs of six fields were graded according to the modified Airlie House Classification system. The prevalence, incidence, progression, and regression of DR, as well as the prevalence/incidence of DME, were evaluated at baseline and during follow-up examinations after at least 1 year. RESULTS In total, 1370 patients were enrolled in the study, and 270 (19.7%) were taking aspirin. The prevalence of any DR in participants with and without aspirin intake was 47.4% and 44.9%, respectively (P = 0.46). The incidence of any DR in patients with and without aspirin intake was 9.2% and 8.3%, respectively (P = 0.74). In univariate regression, there was no association between aspirin intake and the prevalence of any DR and DME (odds ratios (OR), 95% confidence intervals (CI): 0.93, 0.68-1.27 and 1.22, 0.79-1.88, respectively). Aspirin intake was not significantly associated with the prevalence and incidence of DME (OR, 95% CI: 1.22, 0.79-1.88 and 1.79, 0.62-5.17, respectively). Furthermore, aspirin intake was not significantly associated with DR progression or regression (OR, 95% CI: 1.04, 0.66-1.66 and 0.75, 0.52-1.09, respectively). CONCLUSION Aspirin intake was not associated with the prevalence and incidence of any DR or DME in a northeastern Chinese population. Neither progression nor regression of DR revealed a significant association with aspirin intake.
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Affiliation(s)
- Wei Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dong Li
- Fushun Eye Hospital, Liaoning, China
| | - Liang Wen
- Fushun Eye Hospital, Liaoning, China
| | | | - Yu Wang
- Fushun Eye Hospital, Liaoning, China
| | - Zhong Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Parimi V, Elsner AE, Gast TJ, Chen Z, Baskaran K, Alhamami MA, Litvin TV, Ozawa GY, Cuadros JA. Clinically significant macular edema in an underserved population: Association with demographic factors and hemoglobin A1c. Optom Vis Sci 2024; 101:25-36. [PMID: 38350055 DOI: 10.1097/opx.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
SIGNIFICANCE Suspected clinically significant macular edema (SCSME) from exudates differed among ethnic groups in our underserved population. African American and Asian subjects had higher prevalence than Hispanics and non-Hispanic Caucasians, from the same clinics. Men had higher prevalence than women. Highly elevated blood glucose was frequent and associated with SCSME. PURPOSE We investigated the association between the presence of SCSME from exudates and hemoglobin A1c (HbA1c), as well as demographic factors such as age, sex, and ethnic group. Our population was underserved diabetic patients from the same geographic locations. Ethnic groups were White Hispanic, non-Hispanic Caucasian, African American, and Asian, with a high proportion of underrepresented minorities. METHODS In a diabetic retinopathy screening study at four community clinics in Alameda County, California, nonmydriatic 45° color fundus images were collected from underserved diabetic subjects following the EyePACS imaging protocol. Images were analyzed for SCSME from exudates by two certified graders. Logistic regression assessed the association between SCSME from exudates and age, sex, ethnic group, and HbA1c. RESULTS Of 1997 subjects, 147 (7.36%) had SCSME from exudates. The mean ± standard deviation age was 53.4 ± 10.5 years. The mean ± standard deviation HbA1c level was 8.26 ± 2.04. Logistic regression analysis indicated a significant association between presence of SCSME from exudates and HbA1c levels (p<0.001), sex (p=0.027), and ethnicity (p=0.030). African Americans (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.06 to 2.50; p=0.025) and Asians (OR, 1.63; 95% CI, 1.05 to 2.54; p=0.029) had a higher risk than Hispanics. After adjusting for ethnicity, sex, and age, the odds of developing SCSME from exudates increased by 26.5% with every 1% increase in HbA1c level (OR, 1.26; 95% CI, 1.18 to 1.36; p<0.001). CONCLUSIONS In our underserved population, many diabetic patients had very high HbA1c values. Ethnic background (African American > Asians > Hispanics), sex (male > female), and HbA1c level were strong indicators for identifying who is at increased risk of developing SCSME from exudates.
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Affiliation(s)
- Vamsi Parimi
- Indiana University School of Optometry, Bloomington, Indiana
| | | | | | - Zhongxue Chen
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | | | - Mastour A Alhamami
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Taras V Litvin
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
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Gurnani B, Kaur K. Re: Dot et al.: Incidence of retinal detachment, macular edema, and ocular hypertension after neodymium:yttrium-aluminum-garnet capsulotomy: a population-based nationwide study-The French YAG 2 Study (Ophthalmology. 2022;130:478-487). Ophthalmology 2023; 130:e43. [PMID: 37737811 DOI: 10.1016/j.ophtha.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Bharat Gurnani
- Ocular Surface and Refractive Services, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Janaki Kund, Chitrakoot, Madhya Pradesh, India.
| | - Kirandeep Kaur
- Ocular Surface and Refractive Services, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Janaki Kund, Chitrakoot, Madhya Pradesh, India
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12
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Ahmad KT, Chauhan MZ, Soliman MK, Elhusseiny AM, Yang YC, Sallam AB. Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study. Graefes Arch Clin Exp Ophthalmol 2023; 261:3511-3520. [PMID: 37347245 DOI: 10.1007/s00417-023-06120-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/07/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE To analyze the impact of axial length (AL) on the visual outcome and rate of perioperative complications in phacoemulsification surgery. DESIGN Retrospective clinical database study. METHODS Cataract surgery data of 217,556 eyes was extracted from the electronic medical records of 8 ophthalmic centers in the United Kingdom from July 2003 to March 2015. A total of 88,774 eyes without ocular co-pathologies were grouped eyes according to AL (mm): short AL (< 22), average AL (22-26; reference group), and long AL (> 26). MAIN OUTCOMES AND MEASURES We analyzed visual acuity (VA) outcomes at 4 weeks, 4-12 weeks, and 12-24 weeks postoperatively, as well as the incidence of posterior capsular rupture (PCR), torn iris (TI), cystoid macular edema (CME), and retinal detachment (RD). RESULTS Mean pre-operative VA (logMAR) was the worst in eyes with long AL compared to average and short AL eyes (VA 0.59 vs. 0.58 and 0.56; p < 0.001). However, post-operative VA at 4-12 weeks was slightly better in the long AL group (0.14 in short and average AL; 0.12 in long AL, p < 0.001). We observed an increased odds of TI in the short AL group (OR 2.09, 95% CI 1.60-2.75). There was increased risk of RD in long AL eyes (p < 0.001). However, PCR and CME rates were not different. CONCLUSION In the absence of any coexisting ocular pathology, AL alone did not have an impact on VA improvement or the risk of encountering PCR or CME. The risk of TI was greater in the short AL group, and the risk of RD was higher in the long AL group.
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Affiliation(s)
- Kinza T Ahmad
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Muhammad Z Chauhan
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Mohamed K Soliman
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelrahman M Elhusseiny
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Yit C Yang
- Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA.
- Department of Ophthalmology, Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom.
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13
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Yu AJ, Masalkhi M, Brown R, Chen B, Chhablani J. Racial and Ethnic Distribution in Diabetic Macular Edema Clinical Trials in the United States (2002-2021). Ophthalmol Retina 2023; 7:1035-1041. [PMID: 37479084 DOI: 10.1016/j.oret.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/29/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Diabetic macular edema (DME), the leading cause of vision loss among patients with diabetes mellitus, disproportionately affects Black and Hispanic patients. Currently, non-White racial and ethnic subgroups are frequently underrepresented in clinical trials, limiting the application of results to the most pertinent patient populations. Thus, we aimed to characterize the trajectory of racial reporting as well as changes and disparities in racial and ethnic distribution among participants of DME clinical trials. DESIGN This is a cross-sectional retrospective study. SUBJECTS Patients enrolled in United States (US)-based clinical trials for DME. METHODS We examined the racial and ethnic demographic distribution of participants in clinical trials related to DME across a 20-year period from 2002 to 2021. Clinical trials were screened from ClinicalTrials.gov for DME, US trial location, study completion, and > 50 patient enrollment. Descriptive statistics, proportions, odds ratios (ORs), and chi-square tests were reported and compared with 2021 US Census demographic data and diagnosed patients with diabetes demographic data. MAIN OUTCOME MEASURES Change in racial reporting and race/ethnicity across 2 decades and comparison of racial/ethnic distribution with 2021 US Census demographics and diagnosed patients with diabetes. RESULTS There was an increase in race reporting from January 2002 to December 2011 (8 trials [40%]) versus January 2012 to December 2021 (20 trials [87%]; OR, 10.00; 95% confidence interval [CI], 2.21-45.16; P = 0.0032). Across the 2 decades, the proportion of Asian patients enrolled increased from 2.4% to 8.0% (OR, 3.47; 95% CI, 2.64-4.56; P < 0.0001). Similarly, the proportion of enrolled Hispanic patients increased from 13.4% to 19.5% (OR, 1.56; 95% CI, 1.37-1.78; P < 0.0001). Compared with diabetes prevalence, many minority groups are underrepresented in the total enrollment of DME clinical trial patients (Black [z = -18.51, P < 0.001]; Asian [z = -5.11, P < 0.0001]; Hispanic [chi-square = 274.7, df = 1, P < 0.0001]). CONCLUSIONS In the past 2 decades, there has been a trend of increased racial reporting and minority patient enrollment in DME clinical trials. However, Black, Asian, and Hispanic patients remain significantly underrepresented among the DME clinical trial patient population based on diabetes prevalence. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Amy J Yu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Richard Brown
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brian Chen
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Wykrota AA, Abdin AD, Munteanu C, Löw U, Seitz B. Incidence and treatment approach of intraocular pressure elevation after various types of local steroids for retinal diseases. Graefes Arch Clin Exp Ophthalmol 2023; 261:3569-3579. [PMID: 37432451 PMCID: PMC10667145 DOI: 10.1007/s00417-023-06163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE For the treatment of macular edema, in addition to the use of antivascular endothelial growth factors, steroids are also used intravitreally and sub-Tenon. Side effects include among others cataract formation and elevation of intraocular pressure (IOP). The aim of this retrospective study was to elicit the IOP elevation after administration of various steroidal medication, the time of onset, and the efficacy of the administered IOP-lowering therapies. METHODS We included 428 eyes with a postoperative (n = 136), diabetic (n = 148), uveitic macular edema (n = 61), and macular edema after retinal vein occlusion (n = 83). These patients were treated with one or more diverse steroidal agents once or multiple times. These drugs included: triamcinolone acetonide (TMC) as intravitreal injection (TMC IVI) or sub-Tenon (TMC ST), as well as dexamethasone (DXM) and fluocinolone acetonide (FA) intravitreally. An increase of IOP of ≥ 25 mmHg was designated as pathological. A steroid response in anamnesis, the time of onset of IOP rise from the first administration, and the therapy administered were documented. RESULTS Of 428 eyes, 168 eyes (39.3%) had IOP elevation up to a mean of 29.7 (SD ± 5.6) mmHg, which occurred at a median of 5.5 months. Steroids most frequently leading to rise of IOP included DXM (39.1% of all eyes receiving that drug), TMC IVI (47.6%), TMC ST combined with DXM (51.5%), DXM with FA (56.8%), and TMC IVI with DXM (57.4%). A Kaplan-Meier analysis and the Log Rank test showed a significant difference (p < 0.001). IOP rise was treated as follows: 119 conservatively (70.8%), and 21 surgically (12.5%, cyclophotocoagulation 8.3%, filtering surgery 1.8%, in 4 the steroidal drug implant was removed 2.4%), and 28 eyes received no therapy (16.7%). Sufficient IOP regulation was achieved in 82 eyes (68.9%) with topical therapy. In 37 eyes (31.1%) with persistently elevated intraocular pressure, topical therapy had to be continued over the follow-up of 20 ± 7 months. CONCLUSIONS IOP increases after any type of steroid application are not rare. Results of our study let us suspect that especially therapy with intravitreal dexamethasone, either as a monotherapy or in combination with another steroid, tends to increase IOP more than other steroids. Regular IOP checks are necessary after each steroid administration, with possible initiation of long-term conservative and/or surgical therapy if necessary.
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Affiliation(s)
- Agata Anna Wykrota
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany.
| | - Alaa Din Abdin
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Cristian Munteanu
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Ursula Löw
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
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15
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Abdelaal A, Eltaras MM, Katamesh BE, Serhan HA, Farahat RA, Badr H, Abdelazeem B. The prevalence and presentation patterns of microcystic macular oedema: a systematic review and meta-analysis of 2128 glaucomatous eyes. Eye (Lond) 2023; 37:3322-3333. [PMID: 37072471 PMCID: PMC10630304 DOI: 10.1038/s41433-023-02524-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/06/2023] [Accepted: 04/04/2023] [Indexed: 04/20/2023] Open
Abstract
We conducted this research to determine the prevalence rate and presentation patterns with microcystic macular oedema (MMO) in glaucoma patients. The protocol was pre-registered on PROSPERO ( CRD42022316367 ). PubMed, Scopus, Web of Science, EMBASE, ProQuest, EBSCOHost, CENTRAL, clinicaltrials.gov, and Google Scholar were searched for articles reporting MMO in glaucoma patients. The primary outcome was the prevalence of MMO, while secondary outcomes included the comparison between MMO and non-MMO in terms of patients' characteristics (age, gender), glaucoma stage, and ocular parameters (axial length (AL), intraocular pressure, mean deviation, spherical equivalent). Data are reported as mean difference (MD) or log odds ratio (logOR) along with their corresponding 95% confidence intervals (CI) for continuous and dichotomous outcomes, respectively. The quality of included studies was assessed using the NIH tool, and the certainty of evidence was assessed using GRADE framework. Ten studies (2128 eyes) were included, revealing an overall prevalence rate of MMO of 8% (95%CI: 5-12%). When compared to non-MMO group, MMO was associated with lower age (MD = -5.91; 95%CI: -6.02: -5.20), greater risk of advanced glaucoma stage (LogOR=1.41; 95%CI: 0.72: 2.09), and lower mean deviation of the visual field (MD = -5.00; 95%CI: -7.01: -2.99). No significant difference was noted between both groups in terms of gender, axial length, or spherical equivalent. Three studies had good quality while seven had poor quality. MMO is a prevalent observation in glaucoma patients and is associated with patients' age and stage of the disease. However, the certainty of evidence remains very low.
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Affiliation(s)
- Abdelaziz Abdelaal
- Tanta Research Team, Tanta, El-Gharbia, Egypt.
- Harvard Medical School, Boston, MA, USA.
- Master of Medical Sciences in Clinical Investigation (MMSCI), Harvard Medical School, Boston, MA, USA.
- Tanta University Hospitals, Tanta, Gharbia Governorate, Egypt.
| | - Mennatullah Mohamed Eltaras
- Tanta Research Team, Tanta, El-Gharbia, Egypt
- Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Basant E Katamesh
- Tanta Research Team, Tanta, El-Gharbia, Egypt
- Tanta University Hospitals, Tanta, Gharbia Governorate, Egypt
- Research Scholar, Mayo Clinic, Rochester, USA
| | - Hashem Abu Serhan
- Tanta Research Team, Tanta, El-Gharbia, Egypt
- Department of Ophthalmology, Hamad Medical Corporations, Doha, Qatar
| | - Ramadan Abdelmoez Farahat
- Tanta Research Team, Tanta, El-Gharbia, Egypt
- Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Helmy Badr
- Tanta Research Team, Tanta, El-Gharbia, Egypt
- Tanta University Hospitals, Tanta, Gharbia Governorate, Egypt
| | - Basel Abdelazeem
- Tanta Research Team, Tanta, El-Gharbia, Egypt
- McLaren Health Care, Flint, MI, 48532, USA
- Michigan State University, East Lansing, MI, 48824, USA
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Gill ZS, Marin AI, Caldwell AS, Mehta N, Grove N, Seibold LK, Puente MA, De Carlo Forest TE, Oliver SCN, Patnaik JL, Manoharan N. Limited English Proficiency Is Associated With Diabetic Retinopathy in Patients Presenting for Cataract Surgery. Transl Vis Sci Technol 2023; 12:4. [PMID: 37796496 PMCID: PMC10561792 DOI: 10.1167/tvst.12.10.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Purpose To investigate the relationship between limited English proficiency (LEP) and diabetic retinopathy (DR) in patients presenting for cataract surgery. Methods This is a retrospective observational study of patients who underwent cataract surgery between January 2014 and February 2020. Patients who self-identified as needing or preferring an interpreter were defined as having LEP. Differences in demographics, characteristics, and outcomes including history of type 2 diabetes (T2DM), DR, preoperative best corrected visual acuity (BCVA), macular edema, and anti-vascular endothelial growth factor injections were analyzed. Statistical comparisons were assessed using logistic regression with generalized estimating equations. Results We included 13,590 eyes. Of these, 868 (6.4%) were from LEP patients. Patients with LEP were more likely to be Hispanic (P < 0.001), female sex (P = 0.008), or older age (P = 0.003) and have worse mean BCVA at presentation (P < 0.001). Patients with LEP had a significantly higher rate of T2DM (P < 0.001), macular edema (P = 0.033), and DR (18.1% vs. 5.8%, P < 0.001). Findings remained significant when controlling for age, sex, race/ethnicity, and type of health insurance. Patients with LEP and DR were more likely to have had later stages of DR (P = 0.023). Conclusions Patients with LEP presenting for cataract surgery had a higher rate of DR and associated complications compared to patients with English proficiency. Further studies are needed to understand how language disparities influence health and what measures could be taken to improve healthcare in this vulnerable population. Translational Relevance Our study highlights healthcare disparities within ophthalmology and emphasizes the importance of advocating for improved healthcare delivery for patients with LEP.
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Affiliation(s)
- Zafar S. Gill
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A. Itzam Marin
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne Strong Caldwell
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nihaal Mehta
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nathan Grove
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Leonard K. Seibold
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael A. Puente
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Scott C. N. Oliver
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer L. Patnaik
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Niranjan Manoharan
- Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Sesmero-Garcia C, Serrador M, Revenga M, Gonzalez-Lopez JJ. An Update on the Epidemiology of Uveitis in an Urban Setting in Northern Madrid, Spain. Ocul Immunol Inflamm 2023; 31:1623-1628. [PMID: 35793514 DOI: 10.1080/09273948.2022.2089900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To describe the incidence, prevalence and etiologies of uveitis in Madrid, Spain. METHODS A retrospective cross-sectional study was performed in a single hospital. All consecutive cases of uveitis that attended the Hospital during year 2019 were included. Mean incidence and prevalence were calculated. RESULTS Three hundred and one cases were included. Of these, 127 were incident. This represents an incidence of 21.24 new cases per 100,000 persons/year, and a prevalence was 50.43 cases per 100,000 persons. Mean age was 56.89 ± 18.78 years, and 159 were women (52.8%). Sixty-two cases were infectious (20.6%). Age (p = .005), initial visual acuity (p = .001) and cystoid macular oedema (CMO; p = .010) were found to be independent predictors of the final best corrected visual acuity (BCVA) in patients with uveitis. CONCLUSIONS Uveitis affects approximately 1 in 1800 persons in northern Madrid. Younger age, better initial visual acuities and the presence of CMO predicted better final BCVA.
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Affiliation(s)
| | - Mercedes Serrador
- Surgery Department, Universidad de Alcalá School of Medicine, Madrid, Spain
- Ophthalmology Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain
| | - Marcelino Revenga
- Medicine Department, Universidad de Alcalá School of Medicine, Madrid, Spain
- Rheumatology Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain
| | - Julio J Gonzalez-Lopez
- Surgery Department, Universidad de Alcalá School of Medicine, Madrid, Spain
- Ophthalmology Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain
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18
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Iftikhar M, Dun C, Schein OD, Lum F, Woreta F. Cystoid Macular Edema after Cataract Surgery in the United States: IRIS® Registry (Intelligent Research in Sight) Analysis. Ophthalmology 2023; 130:1005-1014. [PMID: 37302490 DOI: 10.1016/j.ophtha.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023] Open
Abstract
PURPOSE To determine the incidence, risk factors, and visual outcomes of cystoid macular edema (CME) after cataract surgery in the United States. DESIGN Retrospective, longitudinal, case-control study. PARTICIPANTS Patients aged ≥ 18 years who underwent phacoemulsification cataract surgery. METHODS The American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) was used to analyze patients who underwent cataract surgery between 2016 and 2019. Patients who received a diagnosis of CME within 90 days after cataract surgery were classified as cases, and the rest were classified as controls. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with the development of CME as well as poor visual outcome (defined as a best-recorded visual acuity worse than 20/40 Snellen equivalent at postoperative month 12). MAIN OUTCOME MEASURES Incidence, demographics, baseline characteristics, and visual outcomes. RESULTS Of 3.1 million cataract surgeries performed during the study period, CME was diagnosed in 25 595 eyes (0.8%), with an average onset of 6 weeks. Patients with CME were more likely to be male, to be aged < 65 years, to be Black, and to have preexisting diabetic retinopathy. Patients with CME were more likely to have a poor visual outcome (OR, 1.75; 95% CI, 1.66-1.84; P < 0.001), with a mean best-recorded visual acuity of 20/30 at postoperative month 12 (compared with 20/25 for those without CME; P < 0.001). Other factors associated with a poor visual outcome included smoking, Medicaid insurance, non-White race, and baseline ocular comorbidities such as macular degeneration and retinal vein occlusion. CONCLUSIONS Although the incidence of CME after cataract surgery is low and most eyes achieve a visual acuity of 20/40 or better, there are significant outcome disparities that warrant further exploration. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oliver D Schein
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Zaini MA, Mohd Zain A, Din NM, Mustapha M, Sidi H. The psychological status of patients with delayed intravitreal injection for treatment of diabetic macular edema due to the COVID-19 pandemic. PLoS One 2023; 18:e0290260. [PMID: 37624864 PMCID: PMC10456183 DOI: 10.1371/journal.pone.0290260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Since the enforcement of the Movement Control Order (MCO) to contain the spread of COVID -19 infection in Malaysia, most clinic appointments have been rescheduled and procedures and surgeries postponed to a later date. Clinic appointments including intravitreal endothelial growth factor (anti-VEGF) treatment for patients with diabetic macular edema (DME) were also no exception to the postponement. This measure takes a psychological toll on patients because of the overwhelming concern for their eye condition. This study was conducted to assess the psychological status of DME patients with delayed anti-VEGF treatment during the pandemic. METHODS A cross-sectional study was conducted from September 2020 to March 2021 in Ophthalmology Clinic Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia (HCTM UKM). Subjects diagnosed with center-involved DME aged between 20 to 80 years who experienced delayed anti-VEGF injection were recruited. Level of depression, anxiety and stress were assessed using DASS-21 questionnaire. Statistical analysis using non-parametric tests were performed to determine the relationship between the DASS-21 score and duration of last injection, in those whose vision was affected by delayed injection and the relationship to the impact of COVID-19 pandemic. Statistical significance was denoted as p < 0.05. RESULTS A total of 86 respondents with median age of 69 years old participated in this study. Most respondents were Malays (n = 47,54.7%) males (n = 51, 59.3%), had education up to secondary level (n = 37, 43%), unemployed (n = 78, 90.7%), married (n = 72, 83.7%) and living with their family (n = 82, 95.3%). The number of intravitreal injections received was at least three times among the respondents (n = 81, 94.2%). More than half of the respondents (n = 46, 53.5%) had been postponed for more than 12 weeks and felt that their vision was affected after delayed intravitreal injection (n = 47, 54.7%). Most of the subjects did not experience depression, anxiety, or stress. However, there was a significant level of stress scores among those with delayed injection of 9 to 12 weeks (p = 0.004), and significant anxiety (p = 0.029) and stress (p = 0.014) scores found in subjects with vision affected due to delayed treatment. CONCLUSION The level of anxiety and stress can be significant in DME patients who experienced delay in intravitreal anti-VEGF treatment. Assessment of psychosocial impacts is important to identify early mental health issues potentially leading to the onset of psychiatry illness, thus early intervention is indispensable.
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Affiliation(s)
- Mohamad Azlan Zaini
- Department of Ophthalmology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ayesha Mohd Zain
- Department of Ophthalmology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Norshamsiah Md. Din
- Department of Ophthalmology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mushawiahti Mustapha
- Department of Ophthalmology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hatta Sidi
- Department of Psychiatry, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
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20
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Rathinavelu J, Sarvepalli SM, Bailey B, D'Alessio D, Hadziahmetovic M. The Impact of Pregnancy on Diabetic Retinopathy: A Single-Site Study of Clinical Risk Factors. Ophthalmic Res 2023; 66:1169-1180. [PMID: 37573783 PMCID: PMC10614555 DOI: 10.1159/000533416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION This study aimed to provide information on modifiable and non-modifiable risk factors for the progression and development of diabetic retinopathy (DR) and diabetic macular edema (DME). This retrospective chart review case-control study was designed to provide perspective on clinical variables. METHODS Single-center study analysis was completed with chart review, identifying 50 patients (100 eyes) ultimately included in the final analysis. Included patients were women with type 1 or 2 diabetes that entered prenatal care and had a delivery from January 2010 to December 2022. The primary outcome measure was clinical variables between progression and no progression groups. Data were analyzed via χ2 analysis and independent samples t test when appropriate. Significantly different variables were further analyzed by binary logistic regression. RESULTS The DR progression group had significantly higher prepregnancy HbA1c levels (9.9) when compared to the no progression group (8.5, p value 0.028). DR progression group also had higher rates (51.9%) of full-term births. The DME progression group had significantly higher rates of type 2 diabetics (100%) compared to the no progression group (30.9%, p value 0.029). Hypertension treatment before (81.8%; p value 0.008) pregnancy was also more common in the DME progression group. Intravitreal injections were more common in patients with visual acuity deterioration (26.7%, p value 0.046). The average number of fetal complications was significantly higher in the visual acuity non-worsening group (1.1) compared to the progression group (0.5, p value 0.04). These variables were not statistically significant after entry into multivariate analysis. DISCUSSION Severity and treatment of retinopathy before pregnancy, type of diabetes, and blood pressure control are all significant factors affecting the progression and development of severe ocular complications in pregnancy.
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Affiliation(s)
- Jay Rathinavelu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Swara M Sarvepalli
- Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA,
| | - Beth Bailey
- Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | - David D'Alessio
- Department of Endocrinology, Duke University, Durham, North Carolina, USA
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21
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Lundeen EA, Burke-Conte Z, Rein DB, Wittenborn JS, Saaddine J, Lee AY, Flaxman AD. Prevalence of Diabetic Retinopathy in the US in 2021. JAMA Ophthalmol 2023; 141:747-754. [PMID: 37318810 PMCID: PMC10273133 DOI: 10.1001/jamaophthalmol.2023.2289] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/17/2023] [Indexed: 06/16/2023]
Abstract
Importance Diabetic retinopathy (DR) is a common microvascular complication of diabetes and a leading cause of blindness among working-age adults in the US. Objective To update estimates of DR and vision-threatening diabetic retinopathy (VTDR) prevalence by demographic factors and US county and state. Data Sources The study team included data from the National Health and Nutrition Examination Survey (2005 to 2008 and 2017 to March 2020), Medicare fee-for-service claims (2018), IBM MarketScan commercial insurance claims (2016), population-based studies of adult eye disease (2001 to 2016), 2 studies of diabetes in youth (2021 and 2023), and a previously published analysis of diabetes by county (2012). The study team used population estimates from the US Census Bureau. Study Selection The study team included relevant data from the US Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System. Data Extraction and Synthesis Using bayesian meta-regression methods, the study team estimated the prevalence of DR and VTDR stratified by age, a nondifferentiated sex and gender measure, race, ethnicity, and US county and state. Main Outcomes and Measures The study team defined individuals with diabetes as those who had a hemoglobin A1c level at 6.5% or more, took insulin, or reported ever having been told by a physician or health care professional that they have diabetes. The study team defined DR as any retinopathy in the presence of diabetes, including nonproliferative retinopathy (mild, moderate, or severe), proliferative retinopathy, or macular edema. The study team defined VTDR as having, in the presence of diabetes, severe nonproliferative retinopathy, proliferative retinopathy, panretinal photocoagulation scars, or macular edema. Results This study used data from nationally representative and local population-based studies that represent the populations in which they were conducted. For 2021, the study team estimated 9.60 million people (95% uncertainty interval [UI], 7.90-11.55) living with DR, corresponding to a prevalence rate of 26.43% (95% UI, 21.95-31.60) among people with diabetes. The study team estimated 1.84 million people (95% UI, 1.41-2.40) living with VTDR, corresponding to a prevalence rate of 5.06% (95% UI, 3.90-6.57) among people with diabetes. Prevalence of DR and VTDR varied by demographic characteristics and geography. Conclusions and Relevance US prevalence of diabetes-related eye disease remains high. These updated estimates on the burden and geographic distribution of diabetes-related eye disease can be used to inform the allocation of public health resources and interventions to communities and populations at highest risk.
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Affiliation(s)
- Elizabeth A. Lundeen
- US Centers for Disease Control and Prevention, Division of Diabetes Translation, Vision Health Initiative, Atlanta, Georgia
| | - Zeb Burke-Conte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | - Jinan Saaddine
- US Centers for Disease Control and Prevention, Division of Diabetes Translation, Vision Health Initiative, Atlanta, Georgia
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Abraham D. Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
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22
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Teo MAL, Bloch E, Muniraju R, Ursell P. Intraoperative subconjunctival steroid reduces the incidence of pseudophakic macular oedema: a cohort study of 20,066 consecutive phacoemulsification surgeries. Eye (Lond) 2023; 37:2077-2081. [PMID: 36273040 PMCID: PMC10333298 DOI: 10.1038/s41433-022-02290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/23/2022] [Accepted: 10/10/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES Pseudophakic macular oedema remains the most common sight-threatening complication following cataract surgery. This study aims to assess the effect of intraoperative subconjunctival steroids on the rate of pseudophakic cystoid macular oedema. METHODS A retrospective, observational database study of 20 066 consecutive phacoemulsification surgeries. The incidence of pseudophakic cystoid macular oedema was compared in eyes that did and did not receive intraoperative subconjunctival steroid injection during routine cataract surgery. RESULTS Intraoperative subconjunctival injection of dexamethasone or betamethasone sodium phosphate significantly reduced the odds of developing pseudophakic cystoid macular oedema across the cohort (odds ratio: 0.67; 95% confidence interval: 0.46-0.98, p = 0.039). The effect of subconjunctival steroids on pseudophakic macular oedema remained independently associated on multivariate logistic regression analysis (p = 0.028). CONCLUSION This study demonstrates that administration of intraoperative subconjunctival steroid injection is associated with a reduced incidence of pseudophakic cystoid macular oedema in routine, uncomplicated cataract surgery.
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Affiliation(s)
| | - Edward Bloch
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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23
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Krstevska B, Mishevska SJ, Nakova VV, Bitoska I, Guceva NL, Ahmeti I, Markovic S, Todorova B, Mladenovska I. Assessment of Prevalence and Risk Factors for Diabetic Retinopathy in Patients with Type 1 and Type 2 Diabetes Examined at a Tertiary Care. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:23-30. [PMID: 37453120 DOI: 10.2478/prilozi-2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and the leading cause of visual impairment and blindness. The aim of the study was to estimate and compare the prevalence of DR and to determine an association between DR and systemic risk factors in hospitalized type 1 (DMT1) and type 2 (DMT2) diabetic patients. Material and methods: We analyzed 260 patients with diabetes, 43 with DMT1 and 217 with DMT2. The following data were collected: age, gender, type and duration of diabetes, glycemic control, blood pressure, estimated glomerular filtration rate, ophthalmologic examinations and routine biochemical parameters. Results: Out of the total number of 260 patients, 77 (29.6%) had non-proliferative DR (NPDR), 21 (8.1%) had proliferative DR (PDR), 29 (11.1%) had diabetic macular edema (DME), and 69 (23.5%) had diabetic cataracts. Forty-three (16.5%) patients were previously diagnosed with DMT1 and 217 (83.5%) with DMT2. The duration of diabetes was not significantly longer in DMT1 (12.8±11.2 years) in comparison to DMT2 (11.07±8.1 years). The prevalence of NPDR and PDR did not differ statistically in either groups. DME was more prevalent in DMT2 than in DMT1 (P<0.05). Diabetic cataract was found in 26.7% vs. 6.7% of patients with DMT2 and DMT1, respectively (p<0.01). The duration of diabetes significantly correlated with NPDR and PDR in DMT1 (r=o.31, p<0.05; r=0.55, p<0.001, respectively). In DMT2, significant correlations were found between the duration of diabetes and cataract, NPDR, PDR and DME (r=0.31, p<0.001; r=0.43 p<0.01, r=0.16 p<0.05 and r=0.20 p<0.01, respectively). Fasting plasma glucose (FPG) significantly correlated with PDR (r=0.258, p<0.05), while HbA1c with DME (r= 0.15 p<0.05). Conclusion: The duration of diabetes and hyperglycemia were associated with DR in both types of diabetes.
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Affiliation(s)
- Brankica Krstevska
- 1Internal Medicine Center "Srce"
- 2Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Sasha Jovanovska Mishevska
- 2Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
- 3University Clinic of Endocrinology, diabetes and metabolic disorders, Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Valentina Velkoska Nakova
- 4Clinical Hospital - Stip, RN Macedonia
- 5Faculty of Medical Science, Goce Delcev University in Stip, RN Macedonia
| | - Iskra Bitoska
- 2Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
- 3University Clinic of Endocrinology, diabetes and metabolic disorders, Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Nevenka Laban Guceva
- 3University Clinic of Endocrinology, diabetes and metabolic disorders, Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
- 5Faculty of Medical Science, Goce Delcev University in Stip, RN Macedonia
| | - Irfan Ahmeti
- 2Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
- 3University Clinic of Endocrinology, diabetes and metabolic disorders, Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Snezana Markovic
- 2Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
- 3University Clinic of Endocrinology, diabetes and metabolic disorders, Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Biljana Todorova
- 2Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
- 3University Clinic of Endocrinology, diabetes and metabolic disorders, Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Ivana Mladenovska
- 2Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
- 3University Clinic of Endocrinology, diabetes and metabolic disorders, Medical Faculty, Ss. Cyril and Methodius University in Skopje, RN Macedonia
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24
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Wang L, Jin L, Wang W, Gong X, Li Y, Li W, Liang X, Huang W, Liu Y. Association of renal function with diabetic retinopathy and macular oedema among Chinese patients with type 2 diabetes mellitus. Eye (Lond) 2023; 37:1538-1544. [PMID: 35864160 PMCID: PMC10219992 DOI: 10.1038/s41433-022-02173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate the associations of renal function with diabetic retinopathy (DR) and diabetic macular oedema (DMO) in diabetic patients. METHODS A total of 1877 diabetic participants aged 30 to 80 years were consecutively recruited between October 2017 and April 2019. The presence of DR, vision-threatening DR (VTDR) and DMO were graded using seven-field fundus photographs. Renal function was defined as normal, mildly impaired or indicative of chronic kidney disease (CKD) based on different estimated glomerular filtration rates (GFR). RESULTS In the multivariable logistic regression model, decreased GFR was associated with the presence of any DR only in the presence of microalbuminuria (OR = 2.40 for mildly impaired and 3.37 for CKD, all P < 0.05), while an impaired GFR was an independent risk factor for VTDR regardless of microalbuminuria status (all P < 0.05). The risks of any DR (OR = 1.74 for quartile 2 and 3.09 for quartile 4) and VTDR (OR = 3.27 for quartile 2 and 6.41 for quartile 4) increased gradually along with microalbuminuria quartile (all P < 0.05). CKD (OR = 3.07, P = 0.012) and high microalbuminuria (OR = 3.22 for quartile 3 and 5.25 for quartile 4, all P < 0.05) were independent DMO risk factors. CONCLUSIONS AND RELEVANCE There is a strong association between GFR and VTDR, whereas the association between GFR and any DR was significant only under the premise of microalbuminuria. High microalbuminuria and CKD were significantly associated with DMO.
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Affiliation(s)
- Lanhua Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Xia Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yuting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
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Tarasewicz D, Karter AJ, Pimentel N, Moffet HH, Thai KK, Schlessinger D, Sofrygin O, Melles RB. Development and Validation of a Diabetic Retinopathy Risk Stratification Algorithm. Diabetes Care 2023; 46:1068-1075. [PMID: 36930723 PMCID: PMC10257789 DOI: 10.2337/dc22-1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/23/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Although diabetic retinopathy is a leading cause of blindness worldwide, diabetes-related blindness can be prevented through effective screening, detection, and treatment of disease. The study goal was to develop risk stratification algorithms for the onset of retinal complications of diabetes, including proliferative diabetic retinopathy, referable retinopathy, and macular edema. RESEARCH DESIGN AND METHODS Retrospective cohort analysis of patients from the Kaiser Permanente Northern California Diabetes Registry who had no evidence of diabetic retinopathy at a baseline diabetic retinopathy screening during 2008-2020 was performed. Machine learning and logistic regression prediction models for onset of proliferative diabetic retinopathy, diabetic macular edema, and referable retinopathy detected through routine screening were trained and internally validated. Model performance was assessed using area under the curve (AUC) metrics. RESULTS The study cohort (N = 276,794) was 51.9% male and 42.1% White. Mean (±SD) age at baseline was 60.0 (±13.1) years. A machine learning XGBoost algorithm was effective in identifying patients who developed proliferative diabetic retinopathy (AUC 0.86; 95% CI, 0.86-0.87), diabetic macular edema (AUC 0.76; 95% CI, 0.75-0.77), and referable retinopathy (AUC 0.78; 95% CI, 0.78-0.79). Similar results were found using a simpler nine-covariate logistic regression model: proliferative diabetic retinopathy (AUC 0.82; 95% CI, 0.80-0.83), diabetic macular edema (AUC 0.73; 95% CI, 0.72-0.74), and referable retinopathy (AUC 0.75; 95% CI, 0.75-0.76). CONCLUSIONS Relatively simple logistic regression models using nine readily available clinical variables can be used to rank order patients for onset of diabetic eye disease and thereby more efficiently prioritize and target screening for at risk patients.
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Affiliation(s)
| | | | - Noel Pimentel
- Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Khanh K. Thai
- Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Oleg Sofrygin
- Division of Research, Kaiser Permanente, Oakland, CA
| | - Ronald B. Melles
- Department of Ophthalmology, The Permanente Medical Group, Oakland, CA
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26
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Gärdin J, Johansson B. Incidence of unplanned visits after cataract surgery in two large cohorts with different anti-inflammatory treatment protocols. Acta Ophthalmol 2023; 101:310-318. [PMID: 36200168 DOI: 10.1111/aos.15265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare incidences and reasons for unplanned extra visits after phacoemulsification surgery in two unselected clinical populations with different postoperative treatment protocols. DESIGN Retrospective cohort study. METHODS We reviewed medical records of 1000 patients that underwent cataract surgery at two adjacent clinics in Sweden. At each clinic, 500 consecutive surgeries were included. Preoperatively recorded comorbidities were registered. One clinic used a non-steroidal anti-inflammatory drug (NSAID) in combination with steroids as postoperative treatment, the other used steroids in monotherapy. Main outcome was the number of patients that returned within 6 months after surgery for at least one unplanned visit. Reasons for unplanned visits were secondary outcomes. RESULTS Among patients receiving combined treatment 84 cases (16.8%) returned for at least 1 extra visit, compared with 63 cases (12.6%) in the group treated with steroids only (RR = 1.33 [95% CI 0.99-1.80, p = 0.061]). No significant differences were found regarding any underlying reasons for the visits, including cystoid macular oedema (CME). We found increased risks for CME in patients with diabetes mellitus (RR = 3.83 [95% CI 1.18-12.41, p = 0.016]) and patients with epiretinal membrane (ERM) (RR = 10.76 [95% CI 3.14-36.89, p < 0.0001]). CONCLUSIONS Postoperative anti-inflammatory treatment with NSAID in combination with steroids did not reduce need for unplanned postoperative visits or incidence of visually disturbing CME after cataract surgery compared with steroids alone. Patient groups with elevated risks for CME are of interest in future research regarding benefits and optimal use of NSAID treatment after cataract surgery.
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Grants
- 2020 Anders & Solveig Bergman Foundation, Linköping, Research
- 2019 Karin Sandqvist Foundation, Stockholm, Travel
- RÖ-937430 County council of Östergötland, Linköping, Research
- SC-2018-00231-41 County council of Östergötland, Linköping, Research
- SC-2017-00202-37 County council of Östergötland, Linköping, Research
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Affiliation(s)
- Jan Gärdin
- Department of Ophthalmology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Björn Johansson
- Department of Ophthalmology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Lundeen EA, Kim M, Rein DB, Wittenborn JS, Saaddine J, Ehrlich JR, Holliday CS. Trends in the Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Commercially Insured Adults Aged <65 Years. Diabetes Care 2023; 46:687-696. [PMID: 36637915 PMCID: PMC10928529 DOI: 10.2337/dc22-1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Examine the 10-year trend in the prevalence and treatment of diabetic macular edema (DME) and vision-threatening diabetic retinopathy (VTDR) among commercially insured adults with diabetes. RESEARCH DESIGN AND METHODS We analyzed the 10-year trend (2009-2018) in health care claims for adults aged 18-64 years using the IBM MarketScan Database, a national convenience sample of employer-sponsored health insurance. We included patients continuously enrolled in commercial fee-for-service health insurance for 24 months who had a diabetes ICD-9/10-CM code on one or more inpatient or two or more different-day outpatient claims in the index year or previous calendar year. We used diagnosis and procedure codes to calculate the annual prevalence of patients with one or more claims for 1) any DME, 2) either DME or VTDR, and 3) antivascular endothelial growth factor (anti-VEGF) injections and laser photocoagulation treatment, stratified by any DME, VTDR with DME, and VTDR without DME. We calculated the average annual percent change (AAPC). RESULTS From 2009 to 2018, there was an increase in the annual prevalence of patients with DME or VTDR (2.1% to 3.4%; AAPC 7.5%; P < 0.001) and any DME (0.7% to 2.6%; AAPC 19.8%; P < 0.001). There were sex differences in the annual prevalence of DME or VTDR and any DME, with men having a higher prevalence than women. Annual claims for anti-VEGF injections increased among patients with any DME (327%) and VTDR with DME (206%); laser photocoagulation decreased among patients with any DME (-68%), VTDR with DME (-54%), and VTDR without DME (-62%). CONCLUSIONS Annual claims for DME or VTDR and anti-VEGF injections increased whereas those for laser photocoagulation decreased among commercially insured adults with diabetes.
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Affiliation(s)
- Elizabeth A Lundeen
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Minchul Kim
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL
| | - David B Rein
- National Opinion Research Center at the University of Chicago, Atlanta, GA
| | - John S Wittenborn
- National Opinion Research Center at the University of Chicago, Atlanta, GA
| | - Jinan Saaddine
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences and Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Christopher S Holliday
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Malone JI, Gao X, Lorenzi GM, Raskin P, White NH, Hainsworth DP, Das A, Tamborlane W, Wallia A, Aiello LP, Bebu I. Retinopathy During the First 5 Years of Type 1 Diabetes and Subsequent Risk of Advanced Retinopathy. Diabetes Care 2023; 46:680-686. [PMID: 36511796 PMCID: PMC10090905 DOI: 10.2337/dc22-1711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine whether individuals with type 1 diabetes (T1D) who develop any retinopathy at any time prior to 5 years of diabetes duration have an increased subsequent risk for further progression of retinopathy or onset of proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME), diabetes-related retinal photocoagulation, or anti-vascular endothelial growth factor injections. Additionally, to determine the influence of HbA1c and other risk factors in these individuals. RESEARCH DESIGN AND METHODS Diabetic retinopathy (DR) was assessed longitudinally using standardized stereoscopic seven-field fundus photography at time intervals of 6 months to 4 years. Early-onset DR (EDR) was defined as onset prior to 5 years of T1D duration. Cox models assessed the associations of EDR with subsequent risk of outcomes. RESULTS In unadjusted models, individuals with EDR (n = 484) had an increased subsequent risk of PDR (hazard ratio [HR] 1.51 [95% CI 1.12, 2.02], P = 0.006), CSME (HR 1.44 [1.10, 1.88], P = 0.008), and diabetes-related retinal photocoagulation (HR 1.48 [1.12, 1.96], P = 0.006) compared with individuals without EDR (n = 369). These associations remained significant when adjusted for HbA1c, but only the association with PDR remained significant after adjustment for age, duration of T1D, HbA1c, sex, systolic/diastolic blood pressure, pulse, use of ACE inhibitors, albumin excretion rate, and estimated glomerular filtration rate (HR 1.47 [95% CI 1.04, 2.06], P = 0.028). CONCLUSIONS These data suggest that individuals with any sign of retinopathy within the first 5 years of T1D onset may be at higher risk of long-term development of advanced DR, especially PDR. Identification of early-onset DR may influence prognosis and help guide therapeutic management to reduce the risk of future visual loss in these individuals.
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Affiliation(s)
| | - Xiaoyu Gao
- Biostatistics Center, The George Washington University, Rockville, MD
| | - Gayle M. Lorenzi
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Philip Raskin
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Neil H. White
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | | | - Arup Das
- University of New Mexico, Albuquerque, NM
| | | | - Amisha Wallia
- Department of Medicine, Northwestern University, Chicago, IL
| | - Lloyd P. Aiello
- Department of Ophthalmology, Joslin Diabetes Center, Boston, MA
| | - Ionut Bebu
- Biostatistics Center, The George Washington University, Rockville, MD
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Jia H, Luo H, Wu Z, Meng X, Zhang L, Hu W, Yu K, Chen R, Sun X. Residential greenness exposure and decreased prevalence of diabetic retinopathy: A nationwide analysis in China. Environ Res 2023; 221:115302. [PMID: 36642124 DOI: 10.1016/j.envres.2023.115302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Diabetic retinopathy (DR) is a leading cause of vision impairment and blindness among diabetics. We aimed to explore whether long-term exposure to residential greenness was beneficial to DR. RESEARCH DESIGN AND METHODS We used data from a large-scale, cross-sectional screening survey conducted in 129 cities of 27 provincial regions of China from 2018 to 2021 among patients with diabetes. We measured residential greenness exposure as the 3-year average of annual maximum Normalized Difference Vegetation Index (NDVI) at a spatial resolution of 250 m. DR was assessed by ophthalmologists based on fundus photographs. The primary outcome was DR, and secondary outcome included DR severity status (i.e., nonproliferative and proliferative), hallmarks of retinal lesions and macular oedema. RESULTS A total of 484,380 adult participants with diabetes were included in the current analysis, and 15.7% of them were diagnosed with DR. NDVI was inversely and linearly associated with DR prevalence, and an increment of 0.1 NDVI was associated with a 10% (9%-10%) decrease in DR prevalence. Significant and inverse associations were further found for nonproliferative and proliferative DR, hallmarks of lesions and macular oedema. The association between greenness and DR was stronger among participants who were older, obese, lived in the south, had longer duration of diabetes or did not take antidiabetic medications. CONCLUSIONS This large-scale nationwide study provides the first-hand epidemiological evidence on the associations of residential greenness with DR. Our findings highlight the importance of residential greenness in alleviating DR risk especially in an era of aging and urbanization.
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Affiliation(s)
- Huixun Jia
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China; Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Huihuan Luo
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Zhenyu Wu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China.
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Lina Zhang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Weiting Hu
- Shanghai Phoebus Medical Co. Ltd., Shanghai, China
| | - Kexin Yu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China.
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China.
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30
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Tarasewicz D, Conell C, Gilliam LK, Melles RB. Quantification of risk factors for diabetic retinopathy progression. Acta Diabetol 2023; 60:363-369. [PMID: 36527502 DOI: 10.1007/s00592-022-02007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
AIMS To determine the importance of blood sugar control, blood pressure, and other key systemic factors on the risk of progression from no retinopathy to various stages of diabetic retinopathy. METHODS Restrospective cohort analysis of patients (N = 99, 280) in the Kaiser Permanente Northern California healthcare system with a baseline retina photographic screening showing no evidence of retinopathy and a minimum follow-up surveillance period of 3 years from 2008 to 2019. We gathered longitudinal data on diabetic retinopathy progression provided by subsequent screening fundus photographs and data captured in the electronic medical record over a mean surveillance of 7.3 ± 2.2 (mean ± SD) years. Progression from an initial state of no diabetic retinopathy to any of four outcomes was determined: (1) any incident retinopathy, (2) referable (moderate or worse) retinopathy, (3) diabetic macular edema, and (4) proliferative diabetic retinopathy. Multiple predictors, including age, race, gender, glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), cholesterol, chronic renal disease, and type of diabetes were investigated. RESULTS Among modifiable risk factors, the average HbA1c had the strongest impact on the progression of diabetic retinopathy, followed by average SBP control and total cholesterol. Patients with an average HbA1c of 10.0% or greater (≥ 97 mmol/mol) had a risk ratio of 5.72 (95% CI 5.44-6.02) for progression to any retinopathy, 18.84 (95% CI 17.25-20.57) for referable retinopathy, 22.85 (95% CI 18.87-27.68) for diabetic macular edema, and 25.96 (95% CI 18.75-36.93) for proliferative diabetic retinopathy compared to those with an average HbA1c of 7.0% (53 mmol/mol) or less. Non-white patients generally had a higher risk of progression to all forms of diabetic retinopathy, while Asian patients were less likely to develop diabetic macular edema (HR 0.76, 95% CI 0.66-0.87). CONCLUSIONS We confirm the critical importance of glucose control as measured by HbA1c on the risk of development of diabetic retinopathy.
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Affiliation(s)
- Dariusz Tarasewicz
- The Permanente Medical Group, Department of Ophthalmology, Oakland, CA, USA
| | - Carol Conell
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Lisa K Gilliam
- The Permanente Medical Group, Department of Endocrinology, Oakland, CA, USA
| | - Ronald B Melles
- The Permanente Medical Group, Department of Ophthalmology, Oakland, CA, USA.
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31
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Rachmilevich A, Yanculovich N, Hazan I, Tsumi E, Liberty IF. Glycemic control and macular edema in patients undergoing cataract surgery. Prim Care Diabetes 2023; 17:55-59. [PMID: 36599797 DOI: 10.1016/j.pcd.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/12/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023]
Abstract
AIMS Cataract, the most common cause of blindness, has higher prevalence among patients with diabetes mellitus. About 20% of cataract surgeries are performed on patients with diabetes. One of the complications of cataract surgery is pseudophakic cystoid macular edema (CME). This study examined whether patients' glycemic control (as indicated by HbA1c level before cataract surgery) is associated with CME incidence within one year post-surgery. METHODS We conducted a retrospective cohort study of 1285 diabetes patients over age 18 who underwent cataract surgery between January 2015 and January 2020. Data were obtained from medical records reporting glycated hemoglobin (HbA1c) level prior to surgery and post-operative CME with intraocular anti-vascular endothelial growth factor injections. RESULTS The patients with CME complications were younger, with longer duration diabetes, and higher percentages of type 1 diabetes and diabetic retinopathy. The main variables influencing risk of post-operative CME were found to be diabetic retinopathy and HbA1c level. Multivariate analysis revealed that HbA1c is an independent risk for post-operative CME with a relative risk of 2.01 when HBa1c is above 7 c (95% CI, 1.10-3.67). CONCLUSION The study demonstrates that pre-cataract surgery diabetes control, measured by HbA1c level, is an independent risk factor for developing post-surgery CME.
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Affiliation(s)
- Amit Rachmilevich
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B 635, Beer-Sheva 8410501, Israel.
| | - Noam Yanculovich
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B 635, Beer-Sheva 8410501, Israel; Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O.B. 635, Beer-Sheva 8410501, Israel.
| | - Itai Hazan
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B 635, Beer-Sheva 8410501, Israel; Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 635, Beer-Sheva 8410501, Israel.
| | - Erez Tsumi
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B 635, Beer-Sheva 8410501, Israel; Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O.B. 635, Beer-Sheva 8410501, Israel.
| | - Idit F Liberty
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B 635, Beer-Sheva 8410501, Israel; Diabetes Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O.B. 635, Beer-Sheva 8410501, Israel.
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32
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Visco DM. Comparison of postcataract surgery anti-inflammatory regimens on the incidence of cystoid macular edema, iritis, pain, and photophobia. J Cataract Refract Surg 2023; 49:44-49. [PMID: 35862832 DOI: 10.1097/j.jcrs.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/19/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare postcataract surgery anti-inflammatory regimens of intracanalicular dexamethasone insert and topical bromfenac on the incidence of cystoid macular edema (CME), iritis, pain, and photophobia. SETTING Eyes of York Cataract & Laser Center, York, Pennsylvania. DESIGN Retrospective chart review. METHODS Case records of 647 consecutive patients (1001 eyes) who underwent cataract surgery and received dexamethasone intracanalicular insert 0.4 mg (Group 1; 482 eyes) or topical nonsteroidal anti-inflammatory drug (NSAID) (bromfenac 0.075% 2 times a day) for 4 weeks postoperatively (Group 2; 519 eyes) were included. Both groups received intracameral moxifloxacin and phenylephrine/ketorolac. Patients with prior CME, vitreomacular traction, combined cataract/glaucoma surgery, and medication protocols different from those examined in this study were excluded. RESULTS Compared with the dexamethasone insert group, the topical NSAID group had a significantly lower incidence of CME (0.4% [2/519] vs 3.9% [19/482], P < .001) and photophobia (1.9% [10/519] vs 4.8% [23/482], P = .012). The incidence of breakthrough iritis (3.5% [18/519] vs 5.6% [27/482], P = .104) and pain also trended lower (4.0% [21/519] vs 5.4% [26/482], P = .314) in the topical NSAID group. CONCLUSIONS Topical NSAIDs were found to be more effective in controlling CME, pain, iritis, and photophobia after cataract surgery compared with the intracanalicular dexamethasone insert in the presence of intracameral phenylephrine/ketorolac.
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Affiliation(s)
- Denise M Visco
- From the Eyes of York Cataract & Laser Center, York, Pennsylvania
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Barreto J, Chaves F, Fernandes VHR, Jesus DCD, Nascimento MA, Lira RPC, Nadruz W, Arieta C, Sposito AC. Proteinuria in early referral to spectral domain optical coherence tomography for macular edema detection in type 2 diabetes individuals: results from the Brazilian diabetes study. Curr Med Res Opin 2022; 38:2141-2148. [PMID: 36190762 DOI: 10.1080/03007995.2022.2131302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Measurement of retinal thickness by optical coherence tomography (OCT) shows higher diagnostic accuracy for diabetic macular edema (DME) than fundus photography alone. The expanding gap between the rising number of type 2 diabetes (T2D) individuals and the availability of OCT devices demands a targeted selection of individuals at higher risk of DME who would benefit the most from early referral. We sought to appraise if proteinuria should be considered in a targeted referral of T2D individuals to OCT examination. METHODS This study was a cross-sectional analysis of 576 consecutive patients enrolled in the Brazilian Diabetes Study between June/2016 and December/2021 who underwent OCT exam and urinalysis to assess ME and proteinuria status, respectively. Differences in the prevalence of DME between proteinuria groups and across a range of diabetic retinopathy (DR) stages were evaluated. RESULTS Among 1134 eyes included in this analysis, the prevalence of proteinuria was 22% and 18.2% of eyes had DME. Proteinuria was related to an increased prevalence of DME (13.2% vs 38.7% for control vs proteinuria, respectively; p < .001), with an OR of 4.08 [95% confidence interval (CI): 2.50-6.64, p < .001), after adjustment for covariates. Proteinuria was independently related to DME also among eyes with non-apparent DR [OR: 2.82; 95%CI: 1.34-5.93; p = .003] and non-proliferative DR (OR of 5.94, 95%CI 2.13-16.62, p < .001). Fundus photography spotted only half of the DME cases detected by OCT. CONCLUSION In T2D individuals, early referral to OCT examination should be pursued for all individuals with concurrent proteinuria. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04949152.
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Affiliation(s)
- Joaquim Barreto
- Laboratory of Atherosclerosis and Vascular Biology (Aterolab), Cardiology Division, University of Campinas (Unicamp), Sao Paulo, Brazil
| | - Fernando Chaves
- Division of Ophthalmology, Clinics Hospital, Unicamp, Sao Paulo, Brazil
| | | | - Daniel Campos de Jesus
- Laboratory of Atherosclerosis and Vascular Biology (Aterolab), Cardiology Division, University of Campinas (Unicamp), Sao Paulo, Brazil
| | | | - Rodrigo P C Lira
- Division of Ophthalmology, Clinics Hospital, Unicamp, Sao Paulo, Brazil
- Division of Ophthalmology, Federal University of Pernambuco, Recife, Brazil
| | - Wilson Nadruz
- Division of Cardiology, Clinics Hospital, Unicamp, Sao Paulo, Brazil
| | - Carlos Arieta
- Division of Ophthalmology, Clinics Hospital, Unicamp, Sao Paulo, Brazil
| | - Andrei C Sposito
- Laboratory of Atherosclerosis and Vascular Biology (Aterolab), Cardiology Division, University of Campinas (Unicamp), Sao Paulo, Brazil
- Division of Cardiology, Clinics Hospital, Unicamp, Sao Paulo, Brazil
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Wang FY, Kang EYC, Liu CH, Ng CY, Shao SC, Lai ECC, Wu WC, Huang YY, Chen KJ, Lai CC, Hwang YS. Diabetic Patients With Rosacea Increase the Risks of Diabetic Macular Edema, Dry Eye Disease, Glaucoma, and Cataract. Asia Pac J Ophthalmol (Phila) 2022; 11:505-513. [PMID: 36417674 DOI: 10.1097/apo.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Inflammation plays a role in diabetic eye diseases, but the association between rosacea and eye diseases in patients with diabetes remains unknown. DESIGN This retrospective cohort study used claims data from the National Health Insurance Research Database in Taiwan to investigate the association between rosacea and eye diseases in patients with diabetes. MATERIALS AND METHODS Taiwanese patients diagnosed as having diabetes mellitus between January 1, 1997, and December 31, 2013, and using any hypoglycemic agents were included and divided into rosacea and nonrosacea groups. After applying 1:20 sex and age matching and exclusion criteria, 1:4 propensity score matching (PSM) was conducted to balance the covariate distribution between the groups. The risk of time-to-event outcome between rosacea and nonrosacea groups in the PSM cohort was compared using the Fine and Gray subdistribution hazard model. RESULTS A total of 4096 patients with rosacea and 16,384 patients without rosacea were included in the analysis. During a mean follow-up period of 5 years, diabetic patients with rosacea had significantly higher risks of diabetic macular edema [subdistribution hazard ratio (SHR): 1.31, 95% confidence interval (CI): 1.05-1.63], glaucoma with medical treatment (SHR: 1.11, 95% CI: 1.01-1.21), dry eye disease (SHR: 1.55, 95% CI: 1.38-1.75), and cataract surgery (SHR: 1.13, 95% CI: 1.02-1.25) compared with diabetic patients without rosacea. A cumulative incidence analysis performed up to 14 years after the index date revealed that the risks of developing ocular diseases consistently increased over time. No significant differences in diabetic retinopathy, age-related macular degeneration, retinal vascular occlusion, ischemic optic neuropathy, optic neuritis, uveitis, or retinal detachment were identified according to rosacea diagnosis. However, we observed significant associations between rosacea and psoriasis, irritable bowel syndrome, anxiety, and major depressive disorder among patients with diabetes. CONCLUSIONS Rosacea is associated with diabetic macular edema, glaucoma, dry eye disease, and cataract development in diabetic patients, as well as increased risks of psoriasis, irritable bowel syndrome, anxiety, and depression in diabetic patients.
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Affiliation(s)
- Fang-Ying Wang
- Department of Biomedical Engineering, College of Medicine, College of Engineering, National Taiwan University, Taipei, Taiwan
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Eugene Yu-Chuan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hao Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chau Yee Ng
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chi Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yi-You Huang
- Department of Biomedical Engineering, College of Medicine, College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Kuan-Jen Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yih-Shiou Hwang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen, China
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
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Antonio-Aguirre B, Swenor B, Canner JK, Singh MS. Risk of Cystoid Macular Edema after Cataract Surgery in Retinitis Pigmentosa: An Analysis of United States Claims from 2010 to 2018. Ophthalmol Retina 2022; 6:906-913. [PMID: 35513237 DOI: 10.1016/j.oret.2022.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Cataract surgery is commonly performed to improve vision in patients with retinitis pigmentosa (RP). However, the risk of postoperative cystoid macular edema (CME) in RP remains unclear. Here, we leveraged a large multiyear claims database to estimate the risk of CME after cataract surgery in patients with and without RP. DESIGN Retrospective multicenter cohort. SUBJECTS Patients aged 18 to 65 years who underwent single-phase cataract surgery between January 1, 2020, and December 31, 2018. Identified using the IBM MarketScan claims database. METHODS We evaluated the baseline characteristics and outcomes and estimated the hazard ratio (HR) using a multivariable mixed-effects approach. The eyes of patients with RP were categorized as group R1, and those without diagnoses of RP by the time of surgery were categorized as group R0. MAIN OUTCOME MEASURES Incident postoperative CME in the same eye that underwent cataract extraction within 12 months of the procedure. RESULTS We included 468 123 patients and 615 645 eyes. This included 124 eyes with RP (R1) and 615 521 without RP (R0). The mean ages were 50.5 ± 9.8 years in R1 and 57.9 ± 6.1 years in R0. The cumulative incidence of CME at 12 months was 5.8% (95% confidence interval [CI] 1.2%-10.3%) in R1, and it was 1.1% (95% CI 1.1%-1.2%) in R0. On average, CME was reported in R1 subjects 3.9 weeks later than in R0 subjects (95% CI 2.04-6.5 weeks; P <0.001). The subjects in R1 had 4.83 (95% CI 2.13-10.93, P <0.001) times the risk of CME compared to the subjects in R0. A stratified analysis showed that epiretinal membrane (ERM) decreased the risk of CME in R1 (HR 0.12 [95% CI 0.48-0.97; P = 0.004]) but increased it in R0 (HR, 4.32 [95% CI 3.13-5.95; P <0.001]). CONCLUSIONS The cataract surgery-related risk of CME among patients with RP may be >4 times that among people without RP. Men and individuals aged 18 to 34 and 55 to 65 years may be at the greatest risk, whereas ERM may lower the risk. Further study is warranted to stratify the risk by RP genotype and phenotype and illuminate the natural history, angiographic features, and functional consequences of postoperative CME.
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Affiliation(s)
- Bani Antonio-Aguirre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Bonnielin Swenor
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland; Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Mandeep S Singh
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland; Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland.
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36
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Li Z, Deng X, Zhou L, Lu T, Lan Y, Jin C. Nomogram-based prediction of clinically significant macular edema in diabetes mellitus patients. Acta Diabetol 2022; 59:1179-1188. [PMID: 35739321 DOI: 10.1007/s00592-022-01901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/27/2022] [Indexed: 11/01/2022]
Abstract
AIMS The aim of the study was to construct and validate a risk nomogram for clinically significant macular edema (CSME) prediction in diabetes mellitus (DM) patients using systemic variables. METHODS In this retrospective study, DM inpatients who underwent routine diabetic retinopathy screening were recruited and divided into training and validation sets according to their admission date. Ninety-three demographic and systemic variables were collected. The least absolute shrinkage and selection operator was used to select the predictive variables from the training set. The selected variables were used to construct the CSME prediction nomogram. Internal and external validations were performed. The C-index, calibration curve and decision curve analysis (DCA) were reported. RESULTS A total of 349 patients were divided into the training set (240, 68.77%) and the validation set (109, 31.23%). The presence of diabetic peripheral neuropathy (DPN) symptoms, uric acid, use of insulin only or not for treatment, insulin dosage, urinary protein grade and disease duration were chosen for the nomogram. The C-index of the prediction nomogram was 0.896, 0.878 and 0.837 in the training set, internal validation and external validation, respectively. The calibration curves of the nomogram showed good agreement between the predicted and actual outcomes. DCA demonstrated that the nomogram was clinically useful. CONCLUSIONS A nomogram with good performance for predicting CSME using systemic variables was developed. It suggested that DPN symptoms and renal function may be crucial risk factors for CSME. Moreover, this nomogram may be a convenient tool for non-ophthalmic specialists to rapidly recognize CSME in patients and to transfer them to ophthalmologists for early diagnosis and treatment.
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Affiliation(s)
- Zijing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, 510060, China
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510020, China
| | - Xiaowen Deng
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510020, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Tu Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Yuqing Lan
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510020, China.
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, 510060, China.
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Pappot N, Do NC, Vestgaard M, Ásbjörnsdóttir B, Hajari JN, Lund‐Andersen H, Holmager P, Damm P, Ringholm L, Mathiesen ER. Prevalence and severity of diabetic retinopathy in pregnant women with diabetes-time to individualize photo screening frequency. Diabet Med 2022; 39:e14819. [PMID: 35188688 PMCID: PMC9303564 DOI: 10.1111/dme.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/21/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate the prevalence and severity of diabetic retinopathy including macular oedema in pregnant women with diabetes and to identify women in whom the frequency of retinal screening can be reduced to minimize the burden of health care visits. METHODS A cohort study of 348 women with pre-existing diabetes were routinely screened with retinal photo in early (12 weeks) and late pregnancy (27 weeks). Diabetic retinopathy was classified in five stages in accordance with National Danish Guidelines based on the eye with the highest retinopathy level. Sight-threatening retinopathy was defined as the presence of proliferative retinopathy and/or clinically significant macular oedema (CSMO). RESULTS Retinopathy was present in 52% (116/223) vs. 14% (17/125), with sight-threatening retinopathy in 16% (35/223) vs. 6% (7/125) of women with type 1 and type 2, respectively. Women without retinopathy in early and late pregnancy were characterized by shorter diabetes duration (p < 0.0001 and p = 0.008) and predominance of type 2 diabetes. Amongst the 50% (175/348) of the cohort having no retinopathy in early pregnancy and HbA1c<53 mmol/mol (7.0%), none developed sight-threatening retinopathy and 94% (165/175) remained without any retinopathy during pregnancy. Development of sight-threatening retinopathy was mainly observed in women with retinopathy in early pregnancy. Treatment for sight-threatening retinopathy was given to a minority (2.7 and 2.4%, respectively). CONCLUSION Good glycaemic control and no retinopathy was seen in a large proportion of women in early pregnancy and none of these women developed sight-threatening retinopathy. The frequency of retinal screening can probably be safely reduced during pregnancy in these women.
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Affiliation(s)
- Nina Pappot
- Center for Pregnant Women with DiabetesRigshospitaletCopenhagenDenmark
- Department of Endocrinology and MetabolismRigshospitaletCopenhagenDenmark
| | - Nicoline Callesen Do
- Center for Pregnant Women with DiabetesRigshospitaletCopenhagenDenmark
- Department of Endocrinology and MetabolismRigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | | | | | - Javad Nouri Hajari
- Department of OphthalmologyRigshospitalet‐Glostrup HospitalCopenhagenDenmark
| | | | - Pernille Holmager
- Center for Pregnant Women with DiabetesRigshospitaletCopenhagenDenmark
- Department of Endocrinology and MetabolismRigshospitaletCopenhagenDenmark
| | - Peter Damm
- Center for Pregnant Women with DiabetesRigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of ObstetricsRigshospitaletCopenhagenDenmark
| | - Lene Ringholm
- Center for Pregnant Women with DiabetesRigshospitaletCopenhagenDenmark
- Department of Endocrinology and MetabolismRigshospitaletCopenhagenDenmark
| | - Elisabeth Reinhardt Mathiesen
- Center for Pregnant Women with DiabetesRigshospitaletCopenhagenDenmark
- Department of Endocrinology and MetabolismRigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Woon PY, Chien JY, Wang JH, Chou YY, Lin MC, Huang SP. Prevalence and associated relating factors in patients with hereditary retinal dystrophy: a nationwide population-based study in Taiwan. BMJ Open 2022; 12:e054111. [PMID: 35396285 PMCID: PMC8995947 DOI: 10.1136/bmjopen-2021-054111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the prevalence, incidence and relating factors that are associated with hereditary retinal dystrophy (HRD) in Taiwan from 2000 to 2013. DESIGN, SETTING AND PARTICIPANTS This is a nationwide, population-based, retrospective case-control study using National Health Insurance Database. Study groups are patients with HRD as case group; age-matched patients without any diagnosis of HRD as control group. We enrolled 2418 study subjects, of which 403 were HRD patients. Important relating factors such as hypertension, diabetes, coronary artery disease, autoimmune disease, cancer, liver cirrhosis, chronic kidney disease, stroke, hyperlipidaemia, asthma, depression and dementia are also included. EXPOSURE Patients diagnosed with HRD were retrieved from National Health Insurance Database. MAIN OUTCOMES AND MEASURES OR calculated between the relating factors and HRD for objects and stratified by age and sex group between 2000 and 2013. RESULTS Four hundred and three patients were included in the study group and 2015 in the control group. The incidence of HRD was 3.29/100 000, and the prevalence of HRD was 40.5/100 000 persons. The tendency of study group to have more cataract, cystoid macula oedema (CME) as compared with the control group. Among the subgroup with comorbidities, the relating factors such as hypertension, diabetes and chronic kidney disease was significantly higher among HRD patients with age 55 and above. CONCLUSIONS 74% of the diagnosed HRD are retinitis pigmentosa. Population-based data suggested an increased incidence of cataract in younger patients, whereas older HRD patients are more susceptible to develop CME. Further work is needed to elucidate the mechanism between these ophthalmological disorders and HRD.
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Affiliation(s)
- Peng Yeong Woon
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
| | - Jia-Ying Chien
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Medical Center, Hualien, Taiwan
| | - Yu-Yau Chou
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Lin
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shun-Ping Huang
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Department of Ophthalmology, Taichung Tzu Chi Hospital, Taichung, Taiwan
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Zarranz-Ventura J, Nguyen V, Creuzot-Garcher C, Verbraak F, O Toole L, Invernizzi A, Viola F, Squirrel D, Barthelmes D, Gillies MC. INTERNATIONAL IMPACT OF THE COVID-19 PANDEMIC LOCKDOWN ON INTRAVITREAL THERAPY OUTCOMES: Fight Retinal Blindness Registry. Retina 2022; 42:616-627. [PMID: 34907129 DOI: 10.1097/iae.0000000000003368] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the impact of the COVID-19 pandemic lockdowns on the outcomes of eyes treated for neovascular age-related macular degeneration, diabetic macular edema, and retinal vein occlusion in eight countries. METHODS A multicenter international database study of 5,782 eyes (4,708 patients) receiving intravitreal antivascular endothelial growth factor injections before, during, and after national lockdowns. The baseline visit was defined as the last visit within 3 months before lockdown, and prelockdown and postlockdown periods were defined as 6 months before and after the lockdown date. RESULTS Eyes with neovascular age-related macular degeneration (n = 4,649) lost vision in all countries in proportion to the reduced number of injections. The mean visual acuity change postlockdown ranged from -0.4 to -3.8 logarithm of the minimum angle of resolution letters, and the median number of injections/visits decreased from 4-5/4-7 to 2-4/2-4 postlockdown. The diabetic macular edema (n = 654) and retinal vein occlusion (n = 479) eyes' mean visual acuity change ranged from -2.8 to +1.7 letters and -1.6 to +0.1 letters, and the median number of injections/visits decreased from 2.5-5/4-6 to 1-3/2-4 and from 3-5.5/4-5 to 1-3.5/2-3.5, respectively. The 6-month dropout rates postlockdown were 20% for neovascular age-related macular degeneration, 27% for diabetic macular edema, and 28% for retinal vein occlusion. CONCLUSION This international study provides estimates of the impact of COVID-19 pandemic lockdown on intravitreal therapy and suggests that prioritizing neovascular age-related macular degeneration eyes seems appropriate.
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Affiliation(s)
- Javier Zarranz-Ventura
- Institut Clínic of Ophthalmology (ICOF), Hospital Clínic, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Vuong Nguyen
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Frank Verbraak
- Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | | | - Alessandro Invernizzi
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia
- Eye Clínic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesco Viola
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - David Squirrel
- Department of Ophthalmology, Greenlane Clinical Centre and District Health Board, Auckland, New Zealand; and
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Mark C Gillies
- Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia
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Lei C, Zhang Y, Zhang M. The association between different hypoglycemic regimens and postoperative diabetic macular edema after vitrectomy in the Japanese patients with proliferative diabetic retinopathy. Front Endocrinol (Lausanne) 2022; 13:764254. [PMID: 35937830 PMCID: PMC9355608 DOI: 10.3389/fendo.2022.764254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To study the association between different hypoglycemic regimens and postoperative diabetic macular edema (DME). METHODS A secondary analysis based on a retrospective cohort study. RESULTS In this secondary analysis, 124 eyes from patients with proliferative diabetic retinopathy (PDR) who underwent pars plana vitrectomy (PPV) between January 2008 and September 2012 were included. We found that compared with oral hypoglycemic medication, oral hypoglycemic medication plus insulin treatment revealed an insignificant relationship with postoperative DME (odds ratio [OR]=0.8, 95% confidence interval [CI]: 0.12-5.21, P=0.8167), only insulin treatment revealed a significant association with postoperative DME (OR=0.10, 95% CI: 0.01-0.84, P=0.0337) after adjusted age, sex. After adjusted age, sex, diabetes mellitus (DM) duration, glycosylated hemoglobin (HbA1c), the results did not have obvious changes (OR=0.61, 95% CI: 0.09-4.26, P=0.6187; OR=0.07, 95% CI: 0.01-0.65, P=0.0197). Furthermore, after adjusted age, sex, DM duration, HbA1c, hypertension, intraoperative retinal photocoagulation, vitreous hemorrhage, macular detachment, fibrovascular membrane, intraocular lens implantation and microincision vitrectomy surgery, the results were consistent (OR=0.66, 95% CI: 0.05-9.49, P=0.7621; OR=0.06, 95% CI: 0.00-0.81, P=0.0342). The same trend was observed in these adjusted models as well (p for trend was 0.0254, 0.0141, and 0.0311, respectively). CONCLUSION In conclusion, our results of the secondary analysis should be interpreted as a significant association between insulin treatment and reduced risks of postoperative DME in Japanese PDR patients with PPV surgery, compared with oral medications. Well glycemic control with longstanding insulin therapy may be beneficial to reduce the risks of postoperative DME in PDR patients. Our investigation calls for large-scale and long-term prospective clinical studies for a full evaluation of the exact role of insulin in the progression of postoperative DME.
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Affiliation(s)
- Chunyan Lei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Meixia Zhang,
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Shimokawa S, Murakami Y, Fujiwara K, Funatsu J, Nakatake S, Koyanagi Y, Akiyama M, Yoshida N, Takeda A, Ikeda Y, Sonoda KH. RECURRENCE RATE OF CYSTOID MACULAR EDEMA WITH TOPICAL DORZOLAMIDE TREATMENT AND ITS RISK FACTORS IN RETINITIS PIGMENTOSA. Retina 2022; 42:168-173. [PMID: 34393209 DOI: 10.1097/iae.0000000000003286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the rate of the recurrence of cystoid macular edema (CME) secondary to retinitis pigmentosa (RP) after the initiation of topical dorzolamide and the recurrence risk factors. METHODS We retrospectively analyzed the data of RP patients at Kyushu University Hospital. We included patients who showed a treatment response to 1.0% topical dorzolamide. The day of treatment initiation was set as the baseline. Topical dorzolamide treatment was continued during the follow-up. The recurrence of CME (defined as a >20% increase in central subfield thickness compared to previous visit, or a central subfield thickness value that exceed baseline value) was evaluated at each follow-up visit. Risk factors for RP-CME recurrence were analyzed by Cox proportional hazards modeling. A Kaplan-Meier survival analysis was used to evaluate the time to recurrent RP-CME. RESULTS Forty RP-CME patients showed a treatment response to topical dorzolamide. During the mean 3.9-year follow-up, 14 patients exhibited recurrence; its rate was 15.6%, 34.7%, and 48.7% at 1, 3, and 5 years, respectively. A high baseline central subfield thickness was significantly associated with recurrent (hazard ratio 1.11, 95% CI: 1.05-1.18, P = 0.0004). CONCLUSION The recurrence rate of RP-CME increased with time. A high baseline central subfield thickness value was a risk factor for recurrence.
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Affiliation(s)
- Shotaro Shimokawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Murakami
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kohta Fujiwara
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Funatsu
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunji Nakatake
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshito Koyanagi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masato Akiyama
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Yoshida
- Department of Clinical Research Center, Faculty of Medicine, University of Saga, Saga, Japan; and
| | - Atsunobu Takeda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Ikeda
- Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Su YC, Shao SC, Lai ECC, Lee CN, Hung MJ, Lai CC, Hsu SM, Hung JH. Risk of diabetic macular oedema with sodium-glucose cotransporter-2 inhibitors in type 2 diabetes patients: A multi-institutional cohort study in Taiwan. Diabetes Obes Metab 2021; 23:2067-2076. [PMID: 34047442 DOI: 10.1111/dom.14445] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 12/19/2022]
Abstract
AIMS To investigate the risk of diabetic macular oedema (DMO) associated with the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS We conducted a retrospective cohort study by analysing a large multi-institutional electronic medical records database in Taiwan. We included adult patients with T2DM without DMO newly receiving either SGLT2 inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RAs) during the period 2016 to 2018. We used propensity scores with inverse probability of treatment weighting to generate comparable groups. The study outcome was incident DMO, determined by clinical diagnosis during outpatient visits or admissions. We followed patients from the index date to either DMO occurrence, last clinical visit, patient death, or December 31, 2020. We performed Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of DMO. RESULTS We included 9986 new users of SGLT2 inhibitors (mean [SD] age 59.6 (12.1) years, median [interquartile range {IQR}] glycated haemoglobin [HbA1c] 70 (61-81)mmol/mol, estimated glomerular filtration rate [eGFR] 89.1 [71.4-108.7] mL/min/1.73 m2 and urine albumin-creatinine ratio [UACR] 26.1 [9.7-117.6] mg/g) and 1067 new users of GLP-1RAs (mean [SD] age 58.4 (41.5) years, median [IQR] HbA1c 73 [64-84] mmol/mol, eGFR 91.6 [68.6-114.0] mL/min/1.73 m2 and UACR 37.6 [11.1-153.2] mg/g) with similar baseline characteristics. Lower DMO risks were observed among patients newly receiving SGLT2 inhibitors (7.9/1000 person-years), compared to those receiving GLP-1RAs (10.7/1000 person-years) with an HR of 0.75 (95% CI 0.64-0.88). CONCLUSIONS Our findings suggest use of SGLT2 inhibitors was associated with lower risk of DMO in T2DM patients in clinical practice, compared to use of GLP-1RAs. Future studies are necessary to confirm this observation.
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Affiliation(s)
- Yu-Chen Su
- Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chaw-Ning Lee
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Jui Hung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jia-Horung Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Busch C, Katzmann JL, Jochmann C, Unterlauft JD, Vollhardt D, Wiedemann P, Laufs U, Rehak M. General health of patients with diabetic macular edema-The LIPSIA study. PLoS One 2021; 16:e0252321. [PMID: 34115786 PMCID: PMC8195383 DOI: 10.1371/journal.pone.0252321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Cardiovascular risk factors such as hypertension or dyslipidemia can influence the incidence and progression of diabetic retinopathy (DR) and diabetic macular edema (DME). The aim of this study is to describe the comorbidities in patients with DME. Methods Prospective, monocentric observational study. Patients presenting for the treatment of DME received laboratory and clinical examinations including 24-hour blood pressure measurement. Results Seventy-five consecutive patients were included in the study. The mean age was 61.0 ± 14.5 years, and 83% had type 2 diabetes. The mean body mass index (BMI) was 32.8 ± 6.0 kg/m2. Overweight (BMI ≥ 25 kg/m2) was present in 92% of all patients. HbA1c values were > 7.0% in 57%. Although 87% of the patients already received antihypertensive therapy, the blood pressure (BP) of 82% was still above the recommended target values of systolic < 140 mmHg and diastolic < 80 mmHg. An insufficient nocturnal fall of the systolic BP (< 10%, non-dipping or reverse dipping) was observed in 62%. In 83% of the patients the glomerular filtration rate was ≤ 90 ml/min/1.73m2. Despite 65% of the cohort already receiving lipid-lowering therapy, LDL cholesterol was above the target value of 1.4 mmol/l in 93%. All patients had at least one cardiovascular risk factor in addition to diabetes (overweight, hypertension, insufficient nocturnal BP fall, dyslipidemia, or renal dysfunction) and 86% had ≥ 3 risk factors. Conclusion DME patients are characterized by highly prevalent cardiovascular risk factors that are poorly controlled. These comorbidities reduce the prognosis and negatively influence existing DR and DME. The data reveal an important opportunity for improving patient care by interaction of the ophthalmologist with the general practitioner and internal specialists for the detection and treatment of these conditions.
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Affiliation(s)
- Catharina Busch
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | | | - Claudia Jochmann
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | | | - Daniela Vollhardt
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Peter Wiedemann
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
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Pacella F, Bongiovanni G, Malvasi M, Trovato Battagliola E, Pistone A, Scalinci SZ, Basili S, La Torre G, Pacella E. Impact of cardiovascular risk factors on incidence and severity of Retinal Vein Occlusion. Clin Ter 2021; 171:e534-e538. [PMID: 33151253 DOI: 10.7417/ct.2020.2269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Retinal Vein Occlusion (RVO) is a thrombotic process affecting retinal veins. The purpose of this research is to study demographic characteristics and prevalence of cardiovascular comorbidities among subjects affected by RVO. In addition, authors explore the role of each variable in determining occlusion type and severity. SUBJECTS, MATERIALS AND METHODS This was a prospective observational study recruiting subjects affected by RVO and secondary macular edema. Exclusion criteria included pre-existing macular edema, recent ocular surgery (<6 months), pregnancy, diagnosis other than RVO, diabetes mellitus type I, any systemic pathology that significantly reduced life expectancy. Each participant was studied through a comprehensive medical history, cardiovascular assessment, blood testing, ocular exam, and macular OCT imaging. RESULTS A total of 145 eyes, 145 participants, thereof 80 males (55%) and 65 females. (45%) Mean age: 62.5 ± 14.3 SD. 61 eyes (42%) were affected by CRVO and 84 eyes (58%) by BRVO. No statistically significant differences were noted between genders. Hypertension was very prevalent (63%). Dyslipidemia was more associated with BRVO (p = 0.044). Subjects with hypertension had a mean central macular thickness (CMT) of 643 µm against a mean of 489 µm of those without hypertension. (p < 0.05). No other variable was associated with macular edema severity. CONCLUSIONS Older age and hypertension are strong risk factors for RVO. Dyslipidemia was strongly associated with BRVO. (p=0.044) Hypertension was not only associated with RVO incidence, but also with its severity. In fact, hypertensive subjects had significantly worse macular edema.
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Rosenblatt TR, Vail D, Saroj N, Boucher N, Moshfeghi DM, Moshfeghi AA. Increasing Incidence and Prevalence of Common Retinal Diseases in Retina Practices Across the United States. Ophthalmic Surg Lasers Imaging Retina 2021; 52:29-36. [PMID: 33471912 DOI: 10.3928/23258160-20201223-06] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE To provide an updated estimate of incidence and prevalence of the foremost retinal diseases in the U.S. PATIENTS AND METHODS Retrospective study of the Vestrum Health Database evaluating eyes with diagnoses of wet or dry age-related macular degeneration (AMD), diabetic macular edema (DME), diabetic retinopathy (DR), branch or central retinal vein occlusion (BRVO; CRVO) from January 2014 to December 2019 across 58 retina practices. RESULTS Of the 3,086,791 eyes examined, 490,881 (15.9%) had dry AMD, 294,041 (9.5%) wet AMD, 270,703 (8.8%) DME, 254,690 (8.3%) DR without DME, 73,617 (2.4%) BRVO, and 50,670 (1.6%) CRVO. Dry AMD had the highest incidence. These diseases comprised 61.0% of total prevalence and 54.3% of incidence among patients at the retina practices analyzed. CONCLUSIONS Based on a diverse database, these diseases comprised the majority of U.S. retina practice cases, with increasing annual incidences. AMD is the most common diagnosis, then diabetic eye disease. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:29-36.].
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Kawali AA, Mohan A, Mehta R, Mahendradas P, Srinivasan S, Shetty B. Anti-vascular endothelial growth factor in the treatment of macular edema in epidemic retinitis. Indian J Ophthalmol 2020; 68:1912-1915. [PMID: 32823413 PMCID: PMC7690540 DOI: 10.4103/ijo.ijo_439_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/04/2020] [Accepted: 05/09/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To study efficacy of anti-vascular endothelial growth factor (anti-VEGF) in resolution of macular edema in epidemic retinitis (ER). METHODS In this retrospective, comparative study, patients diagnosed as ER with central macular thickness (CMT) ≥ 600 μm on SD-OCT at presentation were studied. Eyes which did not receive intravitreal anti-VEGF formed group A and eyes receiving additional anti-VEGF formed group B. Eyes receiving anti-VEGF monotherapy were studied separately. Cases with subsequent OCT scans with interval of more than 20 days and cases without OCT scan at the resolution were excluded. Treatment details, visual outcome, and days to resolution of macular edema were studied. RESULTS Mean CMT in group A (n = 8) was 820.1 μm (range 607-1004 μm) and in Group B (n = 4) was 756.0 μm (range 603-1000 μm). Macular edema resolved in 34.8 days (range: 16-65) and 39.0 days (range: 21-45) in group A and B, respectively. Two eyes with anti-VEGF monotherapy recovered in 45 and 18 days, respectively. Mean corrected distance visual acuity (CDVA) at presentation in group A was 19.1 (range: 0-61) ETDRS letters and in group B was 14.3 (range: 0-35) ETDRS letters. Mean CDVA improved to 65.7 (range: 0-85) and 50.8 (range: 20-76) ETDRS letters in group A and B, respectively. Anti-VEGF monotherapy eyes improved from 35 and 46 ETDRS letters to 70 and 85 ETDRS letters, respectively. CONCLUSION Additional anti-VEGF therapy has no added advantage in speed of resolution of macular edema due to ER. A randomized controlled trial with steroids sparing "anti-VEGF monotherapy" may verify our observations.
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Affiliation(s)
- Ankush A Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ashwin Mohan
- Retina, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ruchir Mehta
- Retina, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sanjay Srinivasan
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Bhujang Shetty
- General Ophthalmology, Narayana Nethralaya, Bengaluru, Karnataka, India
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Fajnkuchen F, Delyfer MN, Conrath J, Baillif S, Mrejen S, Srour M, Bellamy JP, Dupas B, Lecleire-Collet A, Meillon C, Bonicel P, Hobeika M, Giocanti-Aurégan A. Expectations and fears of patients with diabetes and macular edema treated by intravitreal injections. Acta Diabetol 2020; 57:1081-1091. [PMID: 32274583 DOI: 10.1007/s00592-020-01513-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/06/2020] [Indexed: 01/19/2023]
Abstract
AIMS Clinical outcomes of diabetic macular edema (DME) have been widely described, but data on diabetic retinopathy perceptions by diabetes patients are limited. The aim of this survey was to explore the lived experience, knowledge, fears and expectations about disease, and treatment in patients with diabetes and macular edema treated with intravitreal injections (IVTI) and to characterize patient profiles. METHODS Cross-sectional survey including a preliminary qualitative phase (20 patients with DME, treated or treatment-naive, 5 female and 15 male, age 36-74 years) followed by a quantitative survey (116 patients treated with IVTI for DME). Data ASKIA Analyze (version 5.3.3.5) was used for descriptive statistics, and R software (version 3.4.1) for multiple correspondence analysis. RESULTS The qualitative phase identified the wording used by patients and information helpful to propose modalities of response in the quantitative phase. In the quantitative survey (116 patients, mean age 66.6 years), most patients were treated with anti-vascular endothelial growth factor. Overall, 71.9% reported that the disease negatively affected their daily activities and 33.1% considered that regular visits to the ophthalmologist were disrupting their life. Treatment expectations differed significantly between patients in terms of disease experience (visit and injection schedules), fears and feelings, and relationship with physicians, allowing three patient profiles to be identified: "Worried" patients (n = 45) felt isolated and were worried about the need for repeated treatment and possible side effects. They were mainly active men aged < 60 with type I diabetes (T1D) and DME diagnosed for > 2 years; "Curious" patients (n = 21) experienced insufficient support and requested more information on their disease and existing treatments. They were mainly single women aged 60-69 years; "Passive" patients (n = 50) felt sufficiently informed by their ophthalmologist and were not concerned by DME. They were older (mean age: 70 years) and mainly type 2 diabetic men. CONCLUSIONS Patients with diabetes and macular edema treated with IVTI form a heterogeneous group regarding fears and expectations. Different patient profiles were identified and need to be confirmed in larger studies. A better understanding of psychological profiles may optimize compliance of diabetic patients.
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Affiliation(s)
- Franck Fajnkuchen
- Ophthalmology Department, Hôpital Avicenne and University Paris 13, Bobigny, Paris, France
- Centre d'Imagerie et de Laser, 11 rue Antoine Bourdelle, 75015, Paris, France
| | - Marie-Noëlle Delyfer
- Department of Ophthalmology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - John Conrath
- Centre Monticelli Paradis d'Ophtalmologie, Marseille, France
| | | | - Sarah Mrejen
- Centre d'Imagerie et de Laser, 11 rue Antoine Bourdelle, 75015, Paris, France
- Department of Ophthalmology, XV-XX Ophthalmology National Hospital Center, Paris, France
| | - Mayer Srour
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, Créteil, France
| | | | - Benedicte Dupas
- Ophthalmology Department, Hôpital Lariboisière, Université Paris 7, Paris, France
| | | | - Cyril Meillon
- Department of Ophthalmology, University Hospital, Dijon, France
| | - Pierre Bonicel
- Department of Ophthalmology, Orléans Hospital, Orléans, France
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Parravano M, Costanzo E, Querques G. Profile of non-responder and late responder patients treated for diabetic macular edema: systemic and ocular factors. Acta Diabetol 2020; 57:911-921. [PMID: 32114642 DOI: 10.1007/s00592-020-01496-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/04/2020] [Indexed: 12/12/2022]
Abstract
Diabetic macular edema (DME) treatment represents a challenge for the ophthalmologists, and several aspects of real treatment expectancy are still being discussed and not yet fully elucidated. A univocal definition of responsiveness to treatment has not been reached. How the clinicians can evaluate the therapeutic success? The evaluation of systemic and ocular factors should help in this complex management. The age influences the long-term outcomes, and the role of glycemic control is confounded by contrasting correlations between hemoglobin glycated A1c and DME. Long-term treatment success is influenced by baseline best-corrected visual acuity (BCVA), central macular thickness (CMT) and early BCVA response. Also baseline diabetic retinopathy severity scale score is useful to evaluate the chances of improvement before and during treatments. The time-switching was influenced by early BCVA response, however considering a delayed response in a percentage of patients. Several structural optical coherence tomography (OCT) findings could predict long-term success, as the presence of serous retinal detachment, hyperreflective retinal spots, the disruption of external limiting membrane and ellipsoid zone, the disorganization of inner retinal layers and continued increase in CMT were considered predictors of poor response to treatment. Foveal avascular zone enlargement, high number of microaneurysms (Mas), lower vessel density (VD) in deep capillary plexus and lower parafoveal VD in superficial capillary plexus were considered as OCT angiography biomarkers of poor responsiveness. The aim of this review is to report the factors that could influence the response to treatment of DME patients.
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Affiliation(s)
| | | | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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Rossi T, Panozzo G, Della Mura G, Giannarelli D, Ferrari D, Alessio G, Palmisano C, Telani S, Ripandelli G. Diabetes and diabetic retinopathy in patients undergoing cataract surgery: a prevalence study-DiCat study report #2. Acta Diabetol 2020; 57:645-650. [PMID: 31912329 DOI: 10.1007/s00592-019-01466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To report on the prevalence of diabetes, diabetic macula oedema (DME) and retinopathy and their respective grading in a large cohort of patients undergoing cataract surgery. METHODS Data on previous diagnosis of diabetes, fasting glucose, glycated haemoglobin, presence and type of retinopathy and other maculopathy of 3657 patients over 55 years of age undergoing cataract surgery in 13 centres scattered throughout Italy were analysed. RESULTS A total of 20.4% of patients were known diabetics and 27.9% of diabetics showed signs of retinopathy. Haemoglobin A1C was higher than 48 mmol/L (6.5%) in 32% of diabetics and 2.4% non-diabetics. Fasting blood glucose level was higher than 120 mg/dL in 4.3% non-diabetics and 50% diabetics. Duration of diabetes did not significantly correlate with either fasting glucose or glycated haemoglobin, while higher grades of diabetic retinopathy were significantly more prevalent as duration of disease increased. DME was present in almost 40% of diabetics and 22% of patients showed non-diabetic maculopathy. DISCUSSION Diabetic retinopathy and DME worsen after cataract extraction thus complicating long-term prognosis and requiring expensive injective therapy. Since unknown diabetics represent 2-4% of the many million cataract candidates and even known diabetics show poor metabolic control and high rates of DME, preoperative medical testing and accurate retinopathy screening may prove both ethically necessary and cost-effective.
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Affiliation(s)
- Tommaso Rossi
- IRCCS Ospedale Policlinico San Martino IRCCS - UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy.
| | - Giacomo Panozzo
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Giulia Della Mura
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Diana Giannarelli
- Department of Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Ferrari
- IRCCS Ospedale Policlinico San Martino IRCCS - UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy
| | | | | | - Serena Telani
- IRCCS Ospedale Policlinico San Martino IRCCS - UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy
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Tessier M, Meillon C, Creuzot-Garcher C, Bron AM, Nguyen P. Efficacy and follow-up of anti-VEGF injections in diabetic macular edema in real-life practice at the Dijon university medical centre through the Save Sight Registries. J Fr Ophtalmol 2020; 43:618-625. [PMID: 32473741 DOI: 10.1016/j.jfo.2019.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/18/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (IVT) in diabetic macular edema (DME) in real-life practice using the Save Sight Registries (SSR). MATERIAL AND METHODS We conducted an observational, single-centre, retrospective study in the department of ophthalmology of the Dijon University Hospital. We included treatment-naive patients who presented with DME between January 2016 and December 2017. Demographic and clinical data, follow-up visits, and treatments administered were entered into the SSR, an international online ophthalmic registry. Primary endpoints were the change in best-corrected visual acuity (BCVA) and central subfield thickness (CST) from baseline to 12 and 24 months. RESULTS Fifty-eight eyes of 43 patients with a mean [standard deviation (SD)] age of 67.1 [9.5] years were included. Forty-one eyes completed 12 months of follow-up, and 17 eyes completed 24 months of follow up. Median [SD] baseline BCVA was 56.1 [22.9] ETDRS letters and the median [95% confidence interval (95% CI)] baseline CST was 447.9 [161.0] micrometers (μm). Median [95% CI] improvement in BCVA from baseline to months 12 and 24 were respectively, +5.6 [+0.5; +10.7] ETDRS letters and +7.7 [-2.8; +18.2] ETDRS letters. The median [95% CI] decrease in CST from baseline to months 12 and 24 were respectively, -110.9 [-154.5; -67.3] μm and -125.5 [-198.0; -53.0] μm. CONCLUSION Our clinical practice can be evaluated easily with the SSR system. In real life, anti-VEGF IVT are an effective treatment for DME, which result in improved BCVA and decreased CST.
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Affiliation(s)
- M Tessier
- Service d'ophtalmologie, CHU de Dijon, Dijon, France.
| | - C Meillon
- Service d'ophtalmologie, CHU de Dijon, Dijon, France
| | - C Creuzot-Garcher
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRA, 6265 CNRS, Université Bourgogne Franche-Comté, Dijon, France
| | - A M Bron
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRA, 6265 CNRS, Université Bourgogne Franche-Comté, Dijon, France
| | - P Nguyen
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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