Effect of glucagon-like peptide-1 receptor agonists in subjects with type 2 diabetes mellitus: A meta-analysis.

WHAT IS KNOWN AND OBJECTIVE: We performed a meta-analysis to evaluate the effects of glucagon-like peptide-1 receptor agonists compared to placebo on cardiovascular, kidney-related, and eye-related disease outcomes or on mortality in subjects with type 2 diabetes mellitus. METHODS: A systematic literature search up to April 2021 was performed, and 8 studies included 61,661 subjects with type 2 diabetes mellitus at the start of the study, 29,034 of them were using glucagon-like peptide-1 receptor agonists and 32,627 were given a placebo. They reported on relationships between the effects of glucagon-like peptide-1 receptor agonists compared to placebo on mortality rates, cardiovascular, renal and ophthalmic outcomes in subjects with type 2 diabetes mellitus. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of glucagon-like peptide-1 receptor agonists compared to placebo on the listed outcomes on subjects with type 2 diabetes mellitus, using the dichotomous method with a random or fixed-effect model. RESULTS: The use of glucagon-like peptide-1 receptor agonists was associated with significantly lowered all-cause mortality (OR, 0.76; 95% CI, 0.65-0.89, p < 0.001), cardiovascular deaths (OR, 0.87; 95% CI, 0.81-0.94, p < 0.001), myocardial infarctions (OR, 0.92; 95% CI, 0.85-0.98, p = 0.01), strokes (OR, 0.81; 95% CI, 0.74--0.90, p < 0.001), hospital admissions owing to heart failure (OR, 0.91; 95% CI, 0.83-1.00, p = 0.04) and renal events (OR, 0.83; 95% CI, 0.77-0.89, p < 0.001) compared to placebo in subjects with type 2 diabetes mellitus. However, glucagon-like peptide-1 receptor agonists had significantly higher ophthalmic events (OR, 1.15; 95% CI, 1.04-1.29, p = 0.009) compared to placebo in subjects with type 2 diabetes mellitus. WHAT IS NEW AND CONCLUSION: Glucagon-like peptide-1 receptor agonists may have a lower risk of all-cause mortality, cardiovascular death, myocardial infarction, stroke, hospital admission owing to heart failure and renal events compared to placebo in subjects with type 2 diabetes mellitus. However, they have significantly higher ophthalmic events compared to placebo in subjects with type 2 diabetes mellitus. Further studies are required to validate these findings.

Mortality during 6 years of follow-up in relation to visual impairment and eye disease: results from a population-based cohort study of people aged 50 years and above in Nakuru, Kenya.

OBJECTIVE: To estimate the association between (1) visual impairment (VI) and (2) eye disease and 6-year mortality risk within a cohort of elderly Kenyan people. DESIGN, SETTING AND PARTICIPANTS: The baseline of the Nakuru Posterior Segment Eye Disease Study was formed from a population-based survey of 4318 participants aged ≥50 years, enrolled in 2007-2008. Ophthalmic and anthropometric examinations were undertaken on all participants at baseline, and a questionnaire was administered, including medical and ophthalmic history. Participants were retraced in 2013-2014 for a second examination. Vital status was recorded for all participants through information from community members. Cumulative incidence of mortality, and its relationship with baseline VI and types of eye disease was estimated. Inverse probability weighting was used to adjust for non-participation. PRIMARY OUTCOME MEASURES: Cumulative incidence of mortality in relation to VI level at baseline. RESULTS: Of the baseline sample, 2170 (50%) were re-examined at follow-up and 407 (10%) were known to have died (adjusted risk of 11.9% over 6 years). Compared to those with normal vision (visual acuity (VA) ≥6/12, risk=9.7%), the 6-year mortality risk was higher among people with VI (<6/18 to ≥6/60; risk=28.3%; risk ratio (RR) 1.75, 95% CI 1.28 to 2.40) or severe VI (SVI)/blindness (<6/60; risk=34.9%; RR 1.98, 95% CI 1.04 to 3.80). These associations remained after adjustment for non-communicable disease (NCD) risk factors (mortality: RR 1.56, 95% CI 1.14 to 2.15; SVI/blind: RR 1.46, 95% CI 0.80 to 2.68). Mortality risk was also associated with presence of diabetic retinopathy at baseline (RR 3.18, 95% CI 1.98 to 5.09), cataract (RR 1.26, 95% CI 0.95 to 1.66) and presence of both cataract and VI (RR 1.57, 95% CI 1.24 to 1.98). Mortality risk was higher among people with age-related macular degeneration at baseline (with or without VI), compared with those without (RR 1.42, 95% CI 0.91 to 2.22 and RR 1.34, 95% CI 0.99 to 1.81, respectively). CONCLUSIONS: Visual acuity was related to 6-year mortality risk in this cohort of elderly Kenyan people, potentially because both VI and mortality are related to ageing and risk factors for NCD.

Occurrence and molecular composition of methicillin-resistant Staphylococcus aureus isolated from ocular surfaces of horses presented with ophthalmologic disease.

Severe infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been increasingly recognized in virtually all fields of veterinary medicine. Our objective was to study the occurrence, phylogenetic relationships and antimicrobial resistance properties of MRSA isolated from ocular surfaces of horses prior to invasive procedures. Within a 49-week sampling period, ocular swabs obtained from 46 eyes of 44 horses, including eyes with clinical signs of conjunctivitis/blepharitis, keratitis or uveitis were screened for the presence of S. aureus. As a result, seven samples were positive for S. aureus (15.2%), with six of them being classified as MRSA (13%). In addition, all isolates were resistant or showed reduced susceptibility to tetracyclines, the aminoglycosides gentamicin and kanamycin, fluoroquinolones, and the combination sulfamethoxazole/trimethoprim. Since a very close relationship between the MRSA isolates was assumed after pulsed-field gel electrophoresis employing the restriction endonuclease ApaI, whole genome sequencing (WGS) was used to shed more light on the phylogenetic relationships and the molecular composition of all MRSA isolates. Analysis of WGS data revealed closely related MRSA belonging to sequence type 398, spa type t011 and dru type dt10q, harboring an SCCmec IV element and the Staphylococcus aureus pathogenicity island SaPIbov5. Moreover, all MRSA were positive for a beta-hemolysin converting phage carrying genes of the immune evasion cluster (IEC). Since cases of eye infections due to MRSA were often associated with fatal outcomes, more research is needed with respect to the origin of MRSA isolated from ocular surfaces to implement sufficient barrier and infection control measures.

[Effects of volcanic eruptions on human health in Iceland. Review].

Volcanic eruptions are common in Iceland and have caused health problems ever since the settlement of Iceland. Here we describe volcanic activity and the effects of volcanic gases and ash on human health in Iceland. Volcanic gases expelled during eruptions can be highly toxic for humans if their concentrations are high, irritating the mucus membranes of the eyes and upper respiratory tract at lower concentrations. They can also be very irritating to the skin. Volcanic ash is also irritating for the mucus membranes of the eyes and upper respiratory tract. The smalles particles of volcanic ash can reach the alveoli of the lungs. Described are four examples of volcanic eruptions that have affected the health of Icelanders. The eruption of Laki volcanic fissure in 1783-1784 is the volcanic eruption that has caused the highest mortality and had the greatest effects on the well-being of Icelanders. Despite multiple volcanic eruptions during the last decades in Iceland mortality has been low and effects on human health have been limited, although studies on longterm effects are lacking. Studies on the effects of the Eyjafjallajökul eruption in 2010 on human health showed increased physical and mental symptoms, especially in those having respiratory disorders. The Directorate of Health in Iceland and other services have responded promptly to recurrent volcanic eruptions over the last few years and given detailed instructions on how to minimize the effects on the public health. Key words: volcanic eruptions, Iceland, volcanic ash, volcanic gases, health effects, mortality. Correspondence: Gunnar Guðmundsson, ggudmund@landspitali.is.

Impact of Visual Impairment and Eye diseases on Mortality: the Singapore Malay Eye Study (SiMES).

We investigated the relationship of visual impairment (VI) and age-related eye diseases with mortality in a prospective, population-based cohort study of 3,280 Malay adults aged 40-80 years between 2004-2006. Participants underwent a full ophthalmic examination and standardized lens and fundus photographic grading. Visual acuity was measured using logMAR chart. VI was defined as presenting (PVA) and best-corrected (BCVA) visual acuity worse than 0.30 logMAR in the better-seeing eye. Participants were linked with mortality records until 2012. During follow-up (median 7.24 years), 398 (12.2%) persons died. In Cox proportional-hazards models adjusting for relevant factors, participants with VI (PVA) had higher all-cause mortality (hazard ratio[HR], 1.57; 95% confidence interval[CI], 1.25-1.96) and cardiovascular (CVD) mortality (HR 1.75; 95% CI, 1.24-2.49) than participants without. Diabetic retinopathy (DR) was associated with increased all-cause (HR 1.70; 95% CI, 1.25-2.36) and CVD mortality (HR 1.57; 95% CI, 1.05-2.43). Retinal vein occlusion (RVO) was associated with increased CVD mortality (HR 3.14; 95% CI, 1.26-7.73). No significant associations were observed between cataract, glaucoma and age-related macular degeneration with mortality. We conclude that persons with VI were more likely to die than persons without. DR and RVO are markers of CVD mortality.

Clinical findings and survival in 56 sick neonatal New World camelids.

BACKGROUND: Information pertaining to clinical presentation and outcome of neonatal New World camelids (NWC) is limited when compared to calves and foals. HYPOTHESIS: Values of variables at admission and subsequent treatment would predict survival in sick neonatal NWC. ANIMALS: Fifty-six client-owned sick neonatal NWC presented over a 10-year period to the Purdue University Veterinary Teaching Hospital. METHODS: A retrospective study was performed. Inclusion criteria were NWC less than 30 days of age with complete medical records that presented between 2000 and 2010. RESULTS: The median age at presentation was 1 day (range 1-20). The most common diagnoses were systemic inflammatory response syndrome (50%), congenital defects (41%), ophthalmic lesions (21%), sepsis (16%), and gastrointestinal diseases (16%). Sixty-six percent of NWC survived to discharge. Clinicopathologic findings on admission were variable and not specific for disorders. Factors associated with survival were absence of choanal atresia (P = .001, OR: 55.9 [2.5-1,232]), administration of llama plasma (P = .013, OR: 4.9 [1.4-17.7]), and antimicrobial treatment with trimethoprim-sulfamethoxazole (TMS) (P = .016, OR: 6.5 [1.3-32.2]). CONCLUSIONS AND CLINICAL IMPORTANCE: The use of antibiotics, particularly TMS, and llama plasma are recommended in sick neonatal NWC. Results from this study could contribute toward defining a NWC-specific sepsis scoring system.

Ocular diseases and 10-year mortality: the Beijing Eye Study 2001/2011.

PURPOSE: To examine the relationship between major ocular diseases and mortality. METHODS: The population-based longitudinal study Beijing Eye Study was performed in 2001 and repeated in 2011. The participants underwent a detailed ophthalmic examination at baseline in 2001. RESULTS: Of 4439 subjects examined in 2001, 2695 (60.7%) subjects returned for the follow-up examination in 2011, while 379 (8.5%) subjects were dead and 1365 (30.8%) subjects were alive, however, did not agree to be re-examined. In multivariate regression analysis, mortality was significantly associated with the systemic parameters of older age (p < 0.001; Odds ratio (OR): 1.07; 95% confidence interval (CI): 1.05, 1.09), male gender (p < 0.001; OR: 0.56; 95% CI: 0.40, 0.78), lower level of education (p < 0.001; OR: 0.66; 95% CI: 0.59, 0.74) and smoking (p < 0.001; OR: 1.84; 95% CI: 1.36, 2.49) and with the ocular parameters of presence of diabetic retinopathy (p = 0.002; OR: 2.26; 95% CI: 1.34, 3.81), non-glaucomatous optic nerve damage (p = 0.001; OR: 4.90; 95% CI: 1.90, 12.7) and higher degree of nuclear cataract (p = 0.002; OR: 1.29; 95% CI: 1.10, 1.52). In that model, mortality was not significantly (all p > 0.05) associated with refractive error, cortical or subcapsular posterior cataract, intraocular pressure, best corrected visual acuity, visual field defects, prevalence of age-related macular degeneration, retinal vein occlusions, open-angle glaucoma and angle-closure glaucoma. CONCLUSIONS: After adjustment for age, gender, level of education and smoking, mortality was significantly higher in subjects with diabetic retinopathy, non-glaucomatous optic nerve damage and nuclear cataract. Other major ophthalmic parameters and disorders such as hyperopia, myopia, high myopia, pterygium, age-related macular degeneration, retinal vein occlusion, glaucoma and cortical or nuclear cataract were not significantly associated with mortality in the multivariate analysis.

The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis.

Stevens-Johnson syndrome has long been considered to resemble erythema multiforme with mucosal involvement, but is now thought to form a single disease entity with toxic epidermal necrolysis. Although Stevens-Johnson syndrome is less severe, etiology, genetic susceptibility and pathomechanism are the same for Stevens-Johnson syndrome/toxic epidermal necrolysis. The condition is mainly caused by drugs, but also by infections and probably other risk factors not yet identified. Identification of the cause is important for the individual patient and in cases of drug-induced disease withdrawal of the inducing drug(s) has an impact on the patient's prognosis. If an infectious cause is suspected, adequate anti-infective treatment is needed. Besides this, supportive management is crucial to improve the patient's state, probably more than specific immunomodulating treatments. Despite all of the therapeutic efforts, mortality is high and increases with disease severity, patients' age and underlying medical conditions. Survivors may suffer from long-term sequelae such as strictures of mucous membranes including severe eye problems.

Ophthalmic Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis and Relation to SCORTEN.

PURPOSE: To evaluate the severity of ocular involvement of patients with Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap, and to investigate the relationship of the SCORTEN (a severity-of-illness score for SJS and TEN based on a minimal set of well-defined variables calculated within 24 hours of admission) with eye disease in this patient population. DESIGN: Retrospective observational case series. METHODS: Charts of all patients admitted to the Parkland Memorial Hospital Burn Center with a preliminary diagnosis of SJS, SJS/TEN overlap, or TEN between 1998 and 2008 were reviewed. Patients were included for study if they met clinical criteria, had positive diagnostic skin biopsy, and had dermatologic and ophthalmologic consultations. Eighty-two patients with a diagnosis of SJS, SJS/TEN overlap, or TEN met inclusion criteria. Ocular manifestations were classified as mild, moderate, or severe. Admission data were used to calculate the SCORTEN. Main outcome measure was the severity of ocular involvement with respect to diagnosis and SCORTEN. RESULTS: Overall, 84% of patients had ocular involvement (71% SJS, 90% TEN, 100% SJS/TEN overlap). There was no difference in the severity of acute ocular complications among groups. While the SCORTEN value did correlate well with mortality rate (correlation coefficient 0.97, P = .005), there was no correlation between the SCORTEN value and severity of eye involvement in the acute setting. There was also no association of any individual diagnosis of SJS/overlap/TEN with the severity of eye involvement, although eye findings are more common in TEN (P = .03). CONCLUSIONS: Ocular damage in the acute setting was more frequent in patients with epidermal detachment >10% of the total body surface area. The SCORTEN value did not correlate with the severity of eye involvement in the acute setting.

The Beijing Eye Study.

PURPOSE: This review presents and summarizes the findings of the Beijing Eye Study. METHODS: The Beijing Eye Study is a population-based study which included 4439 of 5324 subjects (aged > or = 40 years) who were initially examined in 2001. The study was repeated in 2006, when 3251 (73.2% of 4439, or 61.1% of 5324) of the original subjects participated. Participants underwent a series of examinations including: refractometry; pneumotonometry; biomicroscopy assisted by slit-lamp; optical coherence tomography of the anterior segment; photography of the cornea, lens, optic disc, macula and fundus; blood sampling for laboratory tests; blood pressure measurements, and determinations of anthropomorphic parameters. They were also asked to complete a questionnaire which included questions on socioeconomic parameters, and awareness and treatment of ocular and general diseases. RESULTS: We present normative data for refractive error, anterior segment measurements, intraocular pressure and optic disc structures and their associations, frequency and causes of visual impairment, blindness and visual field defects, prevalences of trachoma, pterygia, open-angle glaucoma and angle-closure glaucoma, cortical, nuclear and posterior subcapsular cataract, age-related macular degeneration, retinal vein occlusions, diabetes mellitus and diabetic retinopathy, myelinated nerve fibres, and retinitis pigmentosa, and associated and risk factors. DISCUSSION: These data may be helpful for dealing with public health issues in China and for assessing associated and risk factors of ocular and general diseases in general.

Mortality and ocular diseases: the Beijing Eye Study.

OBJECTIVE: To examine the relationship between mortality and major ocular diseases. DESIGN: Population-based study. PARTICIPANTS: At baseline in 2001, the Beijing Eye Study examined 4439 subjects with an age of 40 years or more. The mean age was 56.2+/-10.6 years (range, 40-101 years). In 2006, all study participants were invited for a follow-up examination. METHODS: The participants underwent a detailed ophthalmic examination and answered questions regarding their socioeconomic background. Rate of mortality was determined in the follow-up survey of 2006. MAIN OUTCOME MEASURES: Factors associated with mortality. RESULTS: Of the 4439 subjects examined in the 2001, 3251 (73.2%) subjects returned for the follow-up examination, whereas 143 (3.2%) subjects had died and 1045 (23.5%) subjects were alive but did not agree to be reexamined. In binary logistic regression analysis, mortality was significantly associated with the systemic parameters of higher age (P<0.001; odds ratio [OR], 1.07), male gender (P = 0.01; OR, 0.55), lower level of education (P<0.001; OR, 0.65), smoking status (P = 0.023; OR, 1.25), and with the ocular parameters of level of diabetic-like retinopathy (P = 0.036; OR, 1.02), presence of angle-closure glaucoma (P = 0.013; OR, 3.74), and presence of nonglaucomatous optic nerve damage (P = 0.027; OR, 3.41). Presence of retinal vein occlusions was associated marginally with mortality (P = 0.059; OR, 2.59). Mortality was not significantly associated with best-corrected visual acuity (P = 0.14) in multivariate analysis, nor with age-related macular degeneration, open-angle glaucoma, trachoma, any type of cataract, visual field defects, intraocular pressure, or refractive error. CONCLUSIONS: If socioeconomic parameters, age, gender, and smoking status were taken into account, ocular parameters associated with an increased mortality were diabetic-like retinopathy, angle-closure glaucoma, and nonglaucomatous optic nerve damage. Retinal vein occlusions were marginally associated. Other major ocular disorders such as any form of cataract, open-angle glaucoma, age-related macular degeneration, trachoma, pterygia, and high myopia or high hyperopia were not significantly related to mortality.

How safe is vitamin E supplementation?

The safety of large doses of vitamin E went virtually unquestioned until the early 2000s, when several studies were published showing that consumption of vitamin E from dietary supplements increased mortality, as well as the risk of gastrointestinal cancer and heart failure. These studies prompted numerous letters to the editors of medical journals and widespread coverage in the media. Both the medical community and the general public became confused and concerned about the use of vitamin E supplements. The purpose of this article is to review the medical literature and to explain these unusual findings. First we provide an overview of the earlier literature on vitamin E. Second, we provide a critical assessment of three meta-analyses that were neutral or negative toward vitamin E supplementation. Third, we review the limitations of meta-analyses in general. Fourth, we assess the individual studies that comprised one of the three meta-analyses. Since all three meta-analyses used many of the same studies, the individual critique should further the understanding of the limitations of these meta-analyses, and the meta-analysis approach in general. Lastly, we offer some guidance for healthcare professionals to give to the general, healthy public and those with chronic conditions who are no doubt left puzzled as to what to do regarding vitamin E supplementation.

Methods for identifying long-term adverse effects of treatment in patients with eye diseases: the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study.

PURPOSE: To evaluate potential epidemiologic methods for studying long-term effects of immunosuppression on the risk of mortality and fatal malignancy, and present the methodological details of the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study. METHODS: Advantages and disadvantages of potential study designs for evaluating rare, late-occurring events are reviewed, and the SITE Cohort Study approach is presented. RESULTS: The randomized, controlled trial is the most robust method for evaluating treatment effects, but long study duration, high costs, and ethical concerns when studying toxicity limit its use in this setting. Retrospective cohort studies are potentially more cost-effective and timely, if records exist providing the desired information over sufficient follow-up time in the past. Case-control methods require extremely large sample sizes to evaluate risk associated with rare exposures, and recall bias is problematic when studying mortality. The SITE Cohort Study is a retrospective cohort study. Past use of antimetabolites, T-cell inhibitors, alkylating agents, and other immunosuppressives is ascertained from medical records of approximately 9,250 ocular inflammation patients at five tertiary centers over up to 30 years. Mortality and cause-specific mortality outcomes over approximately 100,000 person-years are ascertained using the National Death Index. Immunosuppressed and non-immunosuppressed groups of patients are compared with each other and general population mortality rates from US vital statistics. Calculated detectable differences for mortality/fatal malignancy with respect to the general population are 22%/49% for antimetabolites, 28%/62% for T-cell inhibitors, and 36%/81% for alkylating agents. CONCLUSIONS: Information from the SITE Cohort Study should clarify whether use of these immunosuppressive drugs for ocular inflammation increases the risk of mortality and fatal cancer. This epidemiologic approach may be useful for evaluating long-term risks of systemic therapies for other ocular diseases.

Adverse effects of ultraviolet radiation: a brief review.

Solar ultraviolet radiation (UVR) has always been part of the environment of man. UVB is required for the conversion of 7-deoxycholesterol to vitamin D, which is critically important in the maintenance of healthy bones and research is making clear that it has other potential roles in maintenance of human health. Exposure to UVR, whether of solar or artificial origin, also carries potential risks to human health. UVR is a known carcinogen and excessive exposure-at least to solar radiation in sunlight-increases risk of cancer of the lip, basal cell, and squamous cell carcinoma of the skin and cutaneous melanoma, particularly in fair skin populations. There is also evidence that solar UVR increases risk of several diseases of the eye, including cortical cataract, some conjunctival neoplasms, and perhaps ocular melanoma. Solar UVR may also be involved in autoimmune and viral diseases although more research is needed in these areas. Artificial UVR from tanning beds, welding torches, and other sources, may contribute to the burden of disease from UVR. This brief review will assess the human evidence for adverse health effects from solar and artificial UVR and will attempt to assign a degree of certainty to the major disease-exposure relationships based on the weight of available scientific evidence.

Age-related eye disease, visual impairment, and survival: the Beaver Dam Eye Study.

OBJECTIVE: To investigate the relationship of age-related maculopathy, cataract, glaucoma, visual impairment, and diabetic retinopathy to survival during a 14-year period. METHODS: Persons ranging in age from 43 to 84 years in the period from September 15, 1987, to May 4, 1988, participated in the baseline examination of the population-based Beaver Dam Eye Study (n = 4926). Standardized protocols, including photography, were used to determine the presence of ocular disease. Survival was followed using standardized protocols. RESULTS: As of December 31, 2002, 32% of the baseline population had died (median follow-up, 13.2 years). After adjusting for age, sex, and systemic and lifestyle factors, poorer survival was associated with cortical cataract (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.06-1.37), any cataract (HR, 1.16; 95% CI, 1.03-1.32), diabetic retinopathy (HR per 1-step increase in 4-level severity, 1.36; 95% CI, 1.14-1.63), and visual impairment (HR, 1.24; 95% CI, 1.04-1.48) and marginally associated with increasing severity of nuclear sclerosis (HR, 1.07; 95% CI, 0.99-1.16). Age-related maculopathy and glaucoma were not associated with poorer survival. Associations tended to be slightly stronger in men than women. CONCLUSIONS: Cataract, diabetic retinopathy, and visual impairment were associated with poorer survival and not explained by traditional risk factors for mortality. These ocular conditions may serve as markers for mortality in the general population.

Indicadores de salud visual en población consultante, operativo de atención oftalmológica XII región, patagonia chilena / Visual health status indicators in population consultant, operative of ophthalmological care XII region, Chilean patagonia

Objetivo: Conocer la morbilidad oftalmológica de la población consultante con el propósito de enfrentarla e identificar grupos de riesgo. Método: Se efectuó operativo oftalmológico de 9 al 13 de diciembre del 2002. 18 oftalmólogos y 14 Becados examinan 2.565 pacientes: Se confecciona base de datos especialmente diseñada. Diseño: descriptivo de corte transversal. Resultados: El motivo de consulta déficit de agudeza visual es 89 por ciento. Posesión de lentes en adultos en un 46 por ciento. El 3 por ciento fue sano. Se diagnóstico cataratas en un 16,4 por ciento de los mayores de 40 años. Se pesquisó retinopatía diabética en cualquier etapa en un 19,8 por ciento. El 23,4 por ciento con indicación de tratamiento láser. Un 3.22 por ciento tuvo diagnóstico de glaucoma. Se sospechó esta enfermedad en un 6,6 por ciento de los consultantes. El 1,75 por ciento de la población mayor de 60 años con DMRE. Se constató un 0,82 por ciento de ceguera legal. De éstos, la catarata causa un 57 por ciento. Conclusiones: Consultantes con alta tasa de diagnósticos oftalmológicos. Poco acceso al anteojo. Existe alta prevalencia de catarata y glaucoma y muy alto porcentaje de RD avanzada. Índice de ceguera y principal causa dentro de lo esperado, sin embargo, dada la muestra, este índice podría ser menor.

Necrobiotic xanthogranuloma: long-term outcome of ocular and systemic involvement.

PURPOSE: To report long-term outcomes of patients with necrobiotic xanthogranuloma, to investigate the propriety of therapeutic surgical excision or debulking, and to study tissue specimens by immunoperoxidase staining and in situ hybridization. METHODS: Medical records of all patients at the Mayo Clinic, Rochester, Minnesota, with necrobiotic xanthogranuloma between 1980 and 1997 were reviewed. A follow-up letter was sent to each patient inquiring about the current status of the lesions, the treatment regimen, and associated systemic diseases. RESULTS: The average age (+/- standard deviation) of the 15 men and 11 women was 56.8 +/- 14.8 years. Of the 26 patients, 21 (81%) had lesions of the ocular adnexa. Ulceration of the lesions occurred in 11 patients (42%). The lesions recurred after surgical removal in 11 patients (42%) and on prior incision sites from unrelated operations in three patients (12%). The average duration of follow-up from the appearance of characteristic skin lesions was 10 +/- 6.1 years. Four patients had multiple myeloma, five had a plasma cell dyscrasia, and one had a lymphoproliferative disorder during this period. Time to development of associated malignancy ranged from 8 years before the skin lesions to 11 years after the skin lesions. Overall survival was 100% at 10 years and 90% at 15 years (95% confidence limit, 0.73 to 1.00). Immunoperoxidase stains demonstrated that most histiocytes are not of Langerhans cell lineage. Monoclonal immune globulins were not identified in tissue specimens. CONCLUSION: Care of patients with necrobiotic xanthogranuloma should include avoidance of surgical removal, if possible, and lifelong follow-up to detect the development of associated malignancy.