American Journal of Ophthalmology最新文献

{"title":"Impact of Obstructive Sleep Apnea on Diabetic Retinopathy Progression and Systemic Complications","authors":"Ehsan Rahimy ,&nbsp;Euna B. Koo ,&nbsp;Karen M. Wai ,&nbsp;Cassie A. Ludwig ,&nbsp;Andrea L. Kossler ,&nbsp;Prithvi Mruthyunjaya","doi":"10.1016/j.ajo.2024.07.021","DOIUrl":"10.1016/j.ajo.2024.07.021","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the risk of diabetic retinopathy progression and systemic vascular events, including death, in patients with nonproliferative diabetic retinopathy (NPDR) with obstructive sleep apnea (OSA).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>Electronic chart query using TriNetX, an electronic health records network comprising data from over 124 million patients. Patients with NPDR with and without OSA were identified. Patients were excluded if they had a history of proliferative disease (proliferative diabetic retinopathy), diabetic macular edema, or prior ocular intervention (intravitreal injection, laser, or pars plana vitrectomy). Propensity score matching was performed to control for baseline demographics and comorbidities. The rate of progression to vision-threatening complications, need for ocular intervention, and systemic events was measured at 1, 3, and 5 years.</div></div><div><h3>Results</h3><div>A total of 11 931 patients in each group were analyzed after propensity score matching. There was an elevated risk of proliferative diabetic retinopathy in the OSA cohort at 1 (risk ratio [RR]: 1.34, <em>P</em> &lt; .001), 3 (RR: 1.31, <em>P</em> &lt; .001), and 5 years (RR: 1.28, <em>P</em> &lt; .001). There was an elevated risk of diabetic macular edema in the OSA group at all time points: 1 (RR: 1.31, <em>P</em> &lt; .001), 3 (RR: 1.19, <em>P</em>&lt;.001), and 5 years (RR: 1.18, <em>P</em> &lt; .001). With respect to ocular interventions, there was an increased risk of intravitreal injection in patients with OSA at 1 (RR: 1.59, <em>P</em> &lt; .001), 3 (RR: 1.58, <em>P</em> &lt; .001), and 5 years (RR: 1.54, <em>P</em> &lt; .001), and similar trends were noted with laser photocoagulation, but not vitrectomy. Regarding systemic events, patients with NPDR with OSA had a greater risk of stroke (1 year RR: 1.80, <em>P</em> &lt; .001; 3 years RR: 1.56, <em>P</em> &lt; .001; and 5 years RR: 1.49, <em>P</em> &lt; .001), myocardial infarction (1 year RR: 1.51, <em>P</em> &lt; .001; 3 years RR: 1.46, <em>P</em> &lt; .001; and 5 years RR: 1.43, <em>P</em> &lt; .001), and death (1 year RR: 1.31, <em>P</em> &lt; .001; 3 years RR: 1.19, <em>P</em> &lt; .001; and 5 years RR: 1.15, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>There is an increased rate of diabetic retinopathy progression to vision-threatening complications, need for ocular intervention, and systemic complications, including death, for patients with OSA. We emphasize the need for improved screening measures of patients with NPDR and potential OSA.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthetics in Peribulbar Block: A Meta-analysis With Trial-Sequential Analysis","authors":"Eduardo Maia Martins Pereira ,&nbsp;Patrícia Viana ,&nbsp;Rodrigo Araujo Monteiro da Silva ,&nbsp;Pedro Furlan Silott ,&nbsp;Sara Amaral","doi":"10.1016/j.ajo.2024.07.011","DOIUrl":"10.1016/j.ajo.2024.07.011","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the role of dexmedetomidine as an adjuvant to local anesthetics (LA) in enhancing the duration and quality of peribulbar blocks for ophthalmic surgeries.</div></div><div><h3>Design</h3><div>Systematic review with meta-analysis and trial sequential analysis.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE, Embase, and Cochrane for randomized controlled trials involving adult patients undergoing ophthalmic surgery under peribulbar block, comparing LA alone vs LA + dexmedetomidine. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals were computed using a random-effects model. Sensitivity and trial-sequential analyses were performed to assess inconsistencies and weight type I and II errors, and estimate the required information size of the samples for all end points.</div></div><div><h3>Results</h3><div>Sixteen randomized controlled trials (1220 patients) were included. Compared with LA alone, dexmedetomidine was associated with prolonged (1) motor block duration (MD: 65.01 minutes, <em>P</em> &lt; .001), (2) sensory block duration (MD: 81.94 minutes, <em>P</em> &lt; .001), (3) reduced intraocular pressure (MD: –2.6 mm Hg, <em>P</em> &lt; .001), and (4) decreased need for supplemental injections (RR: 0.44, <em>P</em> = .007). In addition, dexmedetomidine showed (5) longer time to analgesic request (MD: 97.15 minutes, <em>P</em> &lt; .001) and (6) increased surgeon satisfaction (RR: 1.52, <em>P</em> = .01). Sensitivity analyses and trial-sequential analyses were consistent across all end points, and the required information size was achieved for most end points, indicating that pooled analyses were reliable and sample sizes were sufficient.</div></div><div><h3>Conclusions</h3><div>Compared with LA alone, dexmedetomidine significantly prolonged sensory and motor block duration and the time to the first analgesic request; moreover, it decreased intraocular pressure and the need for supplemental injections, while increasing surgeon satisfaction.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Therapy Success in Weekly Adalimumab for Refractory Uveitis: A Retrospective Cohort Study","authors":"Timothy M. Janetos,&nbsp;Kunal Kanwar,&nbsp;Saffiya Bashey,&nbsp;Anjum Koreishi,&nbsp;Debra A. Goldstein","doi":"10.1016/j.ajo.2024.07.010","DOIUrl":"10.1016/j.ajo.2024.07.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine predictors of treatment success after dose escalation of adalimumab, including the measurement of anti-adalimumab antibodies as a predictor of success.</div></div><div><h3>Design</h3><div>Retrospective clinical cohort study.</div></div><div><h3>Methods</h3><div><em>Setting</em>: Single-center academic institution. <em>Study population</em>: Patients with noninfectious uveitis who were inadequately controlled or developed recurrent disease on every other week adalimumab and required dose escalation or therapy modification. <em>Observation procedures</em>: Patients who had anti-adalimumab antibodies checked with resultant low to intermediate levels were compared with patients who had no testing performed before adalimumab dose escalation. Of note, patients with testing and resultant high levels of anti-adalimumab antibodies were not escalated. Predictors of escalation success and utility of antibody testing before escalation were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards models. <em>Main outcome measures</em>: Treatment success defined as anterior chamber grade ≤0.5+ cell, topical corticosteroids ≤1 drop/d, oral prednisone ≤5 mg/d, resolution of macular edema, and resolution of angiographic signs of inflammation without any addition or escalation of therapy.</div></div><div><h3>Results</h3><div>A total of 24 patients had antibodies tested with low to intermediate levels (average: 32.3 ng/mL, range: 0-154 ng/mL), whereas 41 did not have antibody testing. A greater treatment success rate after escalation was observed among the “low antibody” group compared with the “no testing” group (hazard ratio: 2.63, standard error: 1.19, <em>P</em> = .031, 95% CI: 1.09-6.37). Among the entire cohort, patients with panuveitis (<em>n</em> = 14) had a lower treatment success rate compared with the reference of anterior uveitis (<em>n</em> = 26) (hazard ratio: 0.09, standard error: 0.11, <em>P</em> = .05, 95% CI: 0.01-0.99).</div></div><div><h3>Conclusions</h3><div>Patients with low anti-adalimumab antibodies had a greater treatment success than patients in whom antibodies were not checked. This suggests a utility to checking antibodies before dose escalation and that low levels of antibodies may confer a success advantage. Overall, patients with panuveitis had a lower rate of success after escalation while patients with anterior uveitis patients had a very high rate of success suggesting that certain disease characteristics may guide clinicians when determining who to escalate versus changing therapy.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}