PURPOSE: To describe the prevalence and risk factors of diabetic retinopathy in a multi-ethnic US population of whites,blacks,hispanics,and chinese. DESIGN: Cross-sectional study of 778 individuals from ages 45 to 85 ...PURPOSE: To describe the prevalence and risk factors of diabetic retinopathy in a multi-ethnic US population of whites,blacks,hispanics,and chinese. DESIGN: Cross-sectional study of 778 individuals from ages 45 to 85 years with diabetes,participating in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS: Retinal photographs were obtained with a 45° nonmydriatic digital fundus camera. Presence and severity of diabetic retinopathy were graded at a central reading center on the basis of a modification of the Airlie House classification system. All participants underwent a standardized interview,examination,and laboratory investigations. RESULTS: In this population with diabetes,the prevalence of any retinopathy was 33.2% and macular edema 9.0% . The prevalence of any diabetic retinopathy and macular edema was significantly higher in blacks (36.7% and 11.1% ) and hispanics (37.4% and 10.7% ) than in whites (24.8% and 2.7% ) and chinese (25.7% and 8.9% ) (P=.01 and P=.007,comparing racial/ethnic differences for retinopathy and macular edema,respectively). Significant independent predictors of any retinopathy were longer duration of diabetes,higher fasting serum glucose,use of diabetic oral medication or insulin,and greater waist-hip ratio. Race was not an independent predictor of any retinopathy. CONCLUSIONS: This study provides contemporary data on the prevalence of and risk factors for diabetic retinopathy among whites,blacks,hispanics,and chinese participating in the MESA.展开更多
PURPOSE: To compare the efficacy and tolerability of fixed-combination latanoprost and timolol applied in the evening with the concomitant use of the individual components. Design: Twelve-week, randomized, double-mask...PURPOSE: To compare the efficacy and tolerability of fixed-combination latanoprost and timolol applied in the evening with the concomitant use of the individual components. Design: Twelve-week, randomized, double-masked, multicenter study. Participants: Five hundred seventeen randomized patients with ocular hypertension; open-angle, pigmentary, or exfoliation glaucoma; and baseline (after washout) intraocular pressure (IOP) levels between 23 and 33 mmHg. Methods: Patients received either the fixed combination of latanoprost and timolol once daily in the evening and a placebo in the morning and evening or the unfixed combination of latanoprost once daily in the evening and timolol in the morning and evening. Study visits were at weeks 2, 6, and 12. Main Outcome Measures: The primary efficacy end point was mean change from baseline to week 12 in diurnal IOP (mean IOPs of 8 am, 12 pm, and 4 pm). The fixed combination was considered noninferior to the unfixed combination if the upper limit of the 95%confidence interval (CI) of the difference was <1.5 mmHg (analysis of covariance). Adverse events were recorded at each visit. Results: In all, 502 patients were included in intent-to-treat analyses (fixed combination, n=255; unfixed combination, n=247). For the fixed-and unfixed-combination groups, mean baseline diurnal IOP levels were 25.4 mmHg and 25.2 mmHg, respectively, and mean diurnal IOP reductions were 8.7mmHg and 9.0 mmHg (between-treatment difference, 0.3mmHg; 95%CI,-0.1 to 0.7 mmHg; P=0.15). Both treatments were well tolerated. Conclusions: The fixed combination of latanoprost and timolol administered once daily in the evening is not inferior to the unfixed combination of latanoprost once daily in the evening and timolol twice daily. The fixed combination provides an effective and well-tolerated alternative to multiple instillations.展开更多
PURPOSE: To evaluate the effect of intraocular infusion of enoxaparin,a low-molecular-weight heparin,on postoperative inflammatory response in pediatric cataract surgery. DESIGN: Prospective,comparative,consecutive in...PURPOSE: To evaluate the effect of intraocular infusion of enoxaparin,a low-molecular-weight heparin,on postoperative inflammatory response in pediatric cataract surgery. DESIGN: Prospective,comparative,consecutive interventional case series. METHODS: Seventeen consecutive eyes (11 patients) underwent pediatric cataract surgery in two tertiary medical centers. During the procedure,balanced salt solution with enoxaparin (40 mg in 500 ml) was infused into the anterior chamber. Eleven consecutive eyes (eight patients) received balanced salt solution without enoxaparin in the infusion bottle. The inflammatory response in the anterior chamber was compared between the two groups by semiquantification with slit-lamp biomicroscopy. Postoperative inflammatory complications,including fibrin formation,intraocular lens precipitates,anterior and posterior synechiae,cyclitic and pupillary membrane formation,and anterior subluxation of the intraocular lens,were also compared. The follow-up period after surgery was between 3 and 36 months (average 12.3 months). RESULTS: The number of cells and the degree of flare were minimal in the group with enoxaparin in the infusion bottle (P < .001). The total number of postoperative inflammation related complications was also lower in the enoxaparin-treated group (P=.007). All corneas remained clear,and the endothelial cell count,which was performed in two patients,did not show substantial decrease in their density or changes in shape and size. No other enoxaparin-related complications were observed. CONCLUSIONS: Infusion of enoxaparin during pediatric cataract surgery may minimize the postoperative inflammatory response and decrease the number of postoperative inflammatory related complications. Enoxaparin should also be evaluated for cataract surgery in other conditions where postoperative inflammation may be exacerbated.展开更多
Purpose: We assess the incidence of macular changes in ROP patients with retinal hemorrhages. Patients and methods: The premature group consisted of 360 children born 32 weeks gestation and/or with weight below 1500 g...Purpose: We assess the incidence of macular changes in ROP patients with retinal hemorrhages. Patients and methods: The premature group consisted of 360 children born 32 weeks gestation and/or with weight below 1500 g. We used the RetCam-120 Digital Retinal Camera to document retinal changes. Results: Of the 360 premature infants 241 (67% ) had no ROP,and 119 (33% ) had ROP. Of the preterm infants with ROP retinal hemorrhages were found in 46 (38% ) children. Of the newborns with ROP and with retinal hemorrhages,macular pigmentary changes were found in 3 (6% ) patients. Of these 3 patients,the first had prethreshold ROP,the second threshold ROP and had underwent diode laser photocoagulation,and the third patient had stage 2 ROP. In the patients with prethreshold and threshold ROP retinal hemorrhages appeared 6 weeks after birth and macular pigmentary changes were found 6 months after birth. In the patient with stage 2 ROP hemorrhages appeared 7-8 weeks after birth and macular pigmentary changes were detected 12 months after birth. Conclusions: Although macular hemorrhages almost always resorb without complications,our study allows the assumption that retinal hemorrhages may cause macular pigmentary changes in the macula,and thus may lead to deprivation amblyopia. Our results may suggest that the presence of the macular pigmentary changes may be related to the hemorrhage and not to the specific therapy or to the disease.展开更多
文摘PURPOSE: To describe the prevalence and risk factors of diabetic retinopathy in a multi-ethnic US population of whites,blacks,hispanics,and chinese. DESIGN: Cross-sectional study of 778 individuals from ages 45 to 85 years with diabetes,participating in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS: Retinal photographs were obtained with a 45° nonmydriatic digital fundus camera. Presence and severity of diabetic retinopathy were graded at a central reading center on the basis of a modification of the Airlie House classification system. All participants underwent a standardized interview,examination,and laboratory investigations. RESULTS: In this population with diabetes,the prevalence of any retinopathy was 33.2% and macular edema 9.0% . The prevalence of any diabetic retinopathy and macular edema was significantly higher in blacks (36.7% and 11.1% ) and hispanics (37.4% and 10.7% ) than in whites (24.8% and 2.7% ) and chinese (25.7% and 8.9% ) (P=.01 and P=.007,comparing racial/ethnic differences for retinopathy and macular edema,respectively). Significant independent predictors of any retinopathy were longer duration of diabetes,higher fasting serum glucose,use of diabetic oral medication or insulin,and greater waist-hip ratio. Race was not an independent predictor of any retinopathy. CONCLUSIONS: This study provides contemporary data on the prevalence of and risk factors for diabetic retinopathy among whites,blacks,hispanics,and chinese participating in the MESA.
文摘PURPOSE: To compare the efficacy and tolerability of fixed-combination latanoprost and timolol applied in the evening with the concomitant use of the individual components. Design: Twelve-week, randomized, double-masked, multicenter study. Participants: Five hundred seventeen randomized patients with ocular hypertension; open-angle, pigmentary, or exfoliation glaucoma; and baseline (after washout) intraocular pressure (IOP) levels between 23 and 33 mmHg. Methods: Patients received either the fixed combination of latanoprost and timolol once daily in the evening and a placebo in the morning and evening or the unfixed combination of latanoprost once daily in the evening and timolol in the morning and evening. Study visits were at weeks 2, 6, and 12. Main Outcome Measures: The primary efficacy end point was mean change from baseline to week 12 in diurnal IOP (mean IOPs of 8 am, 12 pm, and 4 pm). The fixed combination was considered noninferior to the unfixed combination if the upper limit of the 95%confidence interval (CI) of the difference was <1.5 mmHg (analysis of covariance). Adverse events were recorded at each visit. Results: In all, 502 patients were included in intent-to-treat analyses (fixed combination, n=255; unfixed combination, n=247). For the fixed-and unfixed-combination groups, mean baseline diurnal IOP levels were 25.4 mmHg and 25.2 mmHg, respectively, and mean diurnal IOP reductions were 8.7mmHg and 9.0 mmHg (between-treatment difference, 0.3mmHg; 95%CI,-0.1 to 0.7 mmHg; P=0.15). Both treatments were well tolerated. Conclusions: The fixed combination of latanoprost and timolol administered once daily in the evening is not inferior to the unfixed combination of latanoprost once daily in the evening and timolol twice daily. The fixed combination provides an effective and well-tolerated alternative to multiple instillations.
文摘PURPOSE: To evaluate the effect of intraocular infusion of enoxaparin,a low-molecular-weight heparin,on postoperative inflammatory response in pediatric cataract surgery. DESIGN: Prospective,comparative,consecutive interventional case series. METHODS: Seventeen consecutive eyes (11 patients) underwent pediatric cataract surgery in two tertiary medical centers. During the procedure,balanced salt solution with enoxaparin (40 mg in 500 ml) was infused into the anterior chamber. Eleven consecutive eyes (eight patients) received balanced salt solution without enoxaparin in the infusion bottle. The inflammatory response in the anterior chamber was compared between the two groups by semiquantification with slit-lamp biomicroscopy. Postoperative inflammatory complications,including fibrin formation,intraocular lens precipitates,anterior and posterior synechiae,cyclitic and pupillary membrane formation,and anterior subluxation of the intraocular lens,were also compared. The follow-up period after surgery was between 3 and 36 months (average 12.3 months). RESULTS: The number of cells and the degree of flare were minimal in the group with enoxaparin in the infusion bottle (P < .001). The total number of postoperative inflammation related complications was also lower in the enoxaparin-treated group (P=.007). All corneas remained clear,and the endothelial cell count,which was performed in two patients,did not show substantial decrease in their density or changes in shape and size. No other enoxaparin-related complications were observed. CONCLUSIONS: Infusion of enoxaparin during pediatric cataract surgery may minimize the postoperative inflammatory response and decrease the number of postoperative inflammatory related complications. Enoxaparin should also be evaluated for cataract surgery in other conditions where postoperative inflammation may be exacerbated.
文摘Purpose: We assess the incidence of macular changes in ROP patients with retinal hemorrhages. Patients and methods: The premature group consisted of 360 children born 32 weeks gestation and/or with weight below 1500 g. We used the RetCam-120 Digital Retinal Camera to document retinal changes. Results: Of the 360 premature infants 241 (67% ) had no ROP,and 119 (33% ) had ROP. Of the preterm infants with ROP retinal hemorrhages were found in 46 (38% ) children. Of the newborns with ROP and with retinal hemorrhages,macular pigmentary changes were found in 3 (6% ) patients. Of these 3 patients,the first had prethreshold ROP,the second threshold ROP and had underwent diode laser photocoagulation,and the third patient had stage 2 ROP. In the patients with prethreshold and threshold ROP retinal hemorrhages appeared 6 weeks after birth and macular pigmentary changes were found 6 months after birth. In the patient with stage 2 ROP hemorrhages appeared 7-8 weeks after birth and macular pigmentary changes were detected 12 months after birth. Conclusions: Although macular hemorrhages almost always resorb without complications,our study allows the assumption that retinal hemorrhages may cause macular pigmentary changes in the macula,and thus may lead to deprivation amblyopia. Our results may suggest that the presence of the macular pigmentary changes may be related to the hemorrhage and not to the specific therapy or to the disease.
