RESUMO
Diabetic retinopathy (DR) accounts for 80% of cases of vision loss in patients with type 2 diabetes mellitus (T2DM). Interventional treatments are only indicated in advanced DR and are ineffective in some patients. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are used to attenuate T2DM-associated cardiovascular complications. We conducted the cohort study to investigate the effect of SGLT2is on DR development. Data (May 2016-December 2018) obtained from the Taiwan National Health Insurance Research Database were analyzed in this nationwide retrospective cohort study. After propensity score matching, a total of 31,764 patients receiving SGLT2is and another 31,764 patients receiving dipeptidyl peptidase 4 inhibitors (DPP4is) were included in this study. Multiple Cox proportional-hazards regression models were used to evaluate DR risk. Overall DR incidence among SGLT2i or DPP4i users was 10.9 or 15.6 per 10,000 patient-years, respectively. After covariate adjustment, DR (both early and late stage) risk was substantially lower in SGLT2i users (adjusted hazard ratio: 0.68, 95% confidence interval: 0.6-0.78) than in DPP4i users. DR risk appears to be considerably lower in SGLT2i users than in DPP4i users. Glycemic control measurement with HbA1C level was unavailable in this claim database.
Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Inibidores da Dipeptidil Peptidase IV , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Estudos de Coortes , Estudos Retrospectivos , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/induzido quimicamente , Retinopatia Diabética/complicações , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Hipoglicemiantes/efeitos adversosRESUMO
Chronic obstructive pulmonary disease (COPD) and age-related macular degeneration (AMD) are both common diseases of the elderly people. COPD induced systemic inflammation and hypoxia may have an impact on the development of AMD. This study investigated the possible association between COPD and subsequent risk of AMD. A retrospective cohort study was conducted based on the data from the National Health Insurance Research Database in Taiwan. The COPD cohort comprised 24,625 adult patients newly diagnosed during 2000-2012, whereas age-, gender-, and the year of diagnosis-matched non-COPD cohort comprised 49,250 individuals. Incident AMD was monitored to the end of 2013. A Cox proportional hazards model was applied to evaluate the risk of AMD. The COPD cohort showed 1.25 times higher AMD incidence than the non-COPD cohort (4.80 versus 3.83 per 1000 person-years, adjusted hazard ratio (HR) = 1.20 [95% confident interval (CI) = 1.10-1.32]). Stratified analyses for age, gender, and presence of comorbidity resulted in significant adjusted HRs in most subgroups. Further analysis revealed that the COPD group had an increased risk of both the exudative and non-exudative types of AMD (adjusted HRs = 1.49 [95% CI = 1.13-1.96] and 1.15 [95% CI = 1.05-1.26], respectively). COPD patients have an increased risk for AMD development. Clinicians should provide adequate care for the ocular health to these patients.
Assuntos
Degeneração Macular/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Adulto , Idoso , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , TaiwanRESUMO
The purpose of this study was to assess the effects of laser in situ keratomileusis (LASIK) on the corneal endothelium. In a prospective study, the corneal endothelium of 87 eyes (45 patients) was examined before and 1 month after LASIK. Patients were divided into two groups: people who wear contact lenses (48 eyes) and people who had never worn contact lenses (39 eyes). The corneal endothelium was analyzed for cell density, percentage of hexagonal cells, and coefficient of variation (CV) of cell size. The mean cell density and percentage of hexagonal cells was significantly higher 1 month after LASIK for all 87 eyes. However, the mean CV of cell size was not significantly different. In contact lens wearers, there was a significant increase in mean cell density and percentage of hexagonal cells, but there was no significant change in mean CV of cell size after LASIK. Among patients who had never worn contact lenses, no significant changes were noted in mean cell density, percentage of hexagonal cells, or mean CV of cell size. In this study, LASIK caused no damage to the corneal endothelium. Postoperative improvements in the mean cell density and percentage of hexagonal cells in patients who were contact lens wearers may be related to the discontinuance of contact lens use after LASIK.
Assuntos
Endotélio Corneano/patologia , Ceratomileuse Assistida por Excimer Laser In Situ , Adolescente , Adulto , Contagem de Células , Tamanho Celular , Lentes de Contato , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
A healthy 60-year-old woman presented with bilateral dry eye syndrome that was more pronounced in the right eye than in the left eye. Two patent independent supernumerary puncta and canaliculi were found in the right upper eyelid. This condition may explain the more severe dryness in her right eye. Successful punctum occlusion was accompanied by marked resolution of symptoms in both eyes.
