Incidence Of Ophthalmic Complications Research Articles

The U.S. Veterans Health Administration national giant cell arteritis (GCA) database cohort: incident ophthalmic complications in biopsy-negative GCA patients.

This study aimed to identify the incidence of ophthalmic complications of giant cell arteritis (GCA) among subjects with negative temporal artery biopsy (TAB) and to determine if duration of prednisone exposure relative to GCA diagnosis was associated with ophthalmic complications in TAB-negative subjects. The U.S. Veterans Health Administration (VHA) national database was queried for subjects between 1999 and 2017 with ICD-9/-10 diagnosis code for GCA, procedure code for TAB, and ICD-9/-10 diagnosis code for blindness, anterior or posterior ischemic optic neuropathy, or branch or central retinal artery occlusion. Pharmacy data regarding prednisone dispensation were collected. A Cox proportional hazard model was performed using ophthalmic complication by 1 year as the outcome variable in TAB-negative subjects, adjusting for age, TAB length, TAB laterality, and prednisone dose relative to GCA diagnosis date. Incident ophthalmic complication occurred by 1 year in 9.6% with positive TAB and in 6.2% with negative TAB. The majority of complications occurred within the first month for both groups. Compared to a reference group of prednisone initiation 0-14 days prior to GCA diagnosis, ophthalmic complications in TAB-negative subjects were significantly higher when prednisone initiation was delayed 14-28 days after GCA diagnosis. A substantial number of TAB-negative subjects accrued an incident ICD-9/-10 code for ophthalmologic complication within a year after diagnosis, most occurring within the first month. Delaying prednisone initiation 14-28 days after GCA diagnosis in TAB-negative subjects led to a 3.5-fold higher rate of ophthalmic events occurring by 1 year. Key Points • This study provides an incidence rate of ophthalmic complication by one year in biopsy-negative subjects suspected of having GCA. • Delaying prednisone initiation 14-28 days after GCA diagnosis in TAB-negative GCA subjects led to a 3.5-fold higher rate of ophthalmic events occurring by 1 year.

Chloroquine and hydroxychloroquine - safety profile of potential COVID-19 drugs from the rheumatologist's perspective.

The COVID-19 pandemic causes vital concerns due to the lack of proved, effective, and safe therapy. Chloroquine and hydroxychloroquine seem to be useful, but recently serious concerns regarding their adverse events have risen. The aim of the study was to broaden the general perspective of chloroquine and hydroxychloroquine use in COVID-19 treatment, based on an analysis of their current safety profile among patients with rheumatic diseases. The study was based on a group of 152 patients with rheumatic diseases, aged 20-78 years, treated either with chloroquine or hydroxychloroquine. Analyzed data included age, gender, comorbidities, type of drug, dosage, treatment duration, and reported adverse events. Cases of drug withdrawal related to adverse events were also recorded. The dosage was consistent in both groups: 250 mg of chloroquine or 200 mg of hydroxychloroquine daily. 77.6% of patients did not experience any adverse reactions to the treatment. Hydroxychloroquine showed better safety profile, with 10.9% of patients reporting side-ffects, compared to 28.9% in patients treated with chloroquine. The overall incidence of ophthalmic complications was 6.6%. For both drugs, no statistically significant correlation between adverse events and age, chronic heart or liver disease, or hypertension was found. Chloroquine and hydroxychloroquine at lower doses, as used in rheumatic diseases, prove to be relatively safe. Data from the literature show that high dosage as recommended in COVID-19 treatment may pose a risk of toxicity and require precise management, but prophylactic, long-term use of lower, safe doses might be a promising solution.

Fertility treatments and the risk for ophthalmic complications: a cohort study with 25-year follow-up

Objective: To investigate whether there is an association between a history of fertility treatments and future risk for long-term maternal ophthalmic complications.Study design: A population-based study compared the incidence of long-term maternal ophthalmic complications in a cohort of women with and without a prior history of fertility treatments, including in vitro fertilization (IVF) and ovulation induction (OI). Deliveries occurred between the years 1988–2013, with a mean follow-up duration of 12 years. Women with known ophthalmic diseases prior to the index pregnancy were excluded from the analysis. Ophthalmic complications were further divided to glaucoma, diabetic retinopathy, macular degeneration and retinal detachment. Kaplan–Meier survival curve was used to estimate cumulative incidence of ophthalmic complications. Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) for ophthalmic complications.Results: During the study period, 106 004 deliveries met the inclusion criteria; 4.1% (n = 4364) occurred in patients with a history of fertility treatments. Patients with a history of fertility treatments, as a group, did not have a significantly higher incidence of ophthalmic complications. However, the subgroup of patients with a history of IVF (but not OI) had a higher incidence of retinal detachment (0.3% versus 0.1%; p = 0.02). Using a Kaplan–Meier survival curve, patients following IVF had a significantly higher cumulative incidence of retinal detachment. Using Cox proportional hazards models, controlling for maternal age, obesity and parity, IVF was noted as an independent risk factor for retinal detachment (adjusted HR 3.4; 95% 1.2–9.3; p = 0.011).Conclusion: Patients following IVF treatments have a significant higher long-term risk for retinal detachment. OI treatments do not pose a risk for long-term maternal ophthalmic complications.

Obesity during pregnancy and long-term risk for ophthalmic morbidity – a population-based study with a follow-up of more than a decade

Objective: To investigate whether patients with a history of obesity during pregnancy have an increased risk for subsequent long-term ophthalmic complications, after controlling for diabetes and preeclampsia.Methods: A population-based study compared the incidence of long-term maternal ophthalmic complications in a cohort of women with and without a history of obesity during pregnancy. Deliveries occurred between the years 1988 and 2013, with a mean follow-up duration of 12 years.Results: During the study period 106 220 deliveries met the inclusion criteria; 2.2% (n = 2353) occurred in patients with a diagnosis of obesity during at least one of their pregnancies. These patients had a significantly higher incidence of ophthalmic complications in total and specifically of diabetic retinopathy. Using a Kaplan–Meier survival curve, we found that patients with a history of obesity during pregnancy had a significantly higher cumulative incidence of ophthalmic complications. Using a Cox proportional hazards model, adjusted for confounders such as maternal age, preeclampsia and diabetes mellitus, we found obesity during pregnancy remained independently associated with ophthalmic complications (adjusted HR, 2.4; 95% CI, 1.4–4.2; p = 0.003).Conclusion: Obesity during pregnancy is an independent risk factor for long-term ophthalmic complications, and specifically diabetic retinopathy.