RESUMO
PURPOSE: To determine whether the development of nonarteritic anterior ischemic optic neuropathy (NAION) is increased after receiving cataract surgery in a large general population. DESIGN: Nationwide, population-based, retrospective cohort study. METHODS: Setting: A 12-year nationwide, population-based, retrospective cohort study including 1,025,340 beneficiaries in the 2002-2013 Korean National Health Insurance Service database. PATIENTS: We identified 40,356 patients who had undergone cataract surgery and matched non-cataract surgery controls (1:2) using estimated propensity scores in reference to age, sex, demographics, comorbidities, and co-medications. OBSERVATIONS: Kaplan-Meier curves and Cox proportional hazard models were generated to determine the risk of developing NAION in the cataract surgery group compared to the non-cataract surgery group. MAIN OUTCOME MEASURES: Effect (hazard ratio [HR]) of cataract surgery on NAION development. RESULTS: The 10-year incidence probability of NAION was 0.70% (95% confidence interval [CI], 0.55%-0.86%) in the cataract surgery group and 0.27% (95% CI, 0.25%-0.29%) in the non-cataract surgery group (P < .0001, log-rank test). The cataract surgery group had an increased risk of developing NAION compared to the non-cataract surgery group (HR = 1.80; 95% CIs, 1.46-2.21) even after adjusting for demographics, comorbidities, Charlson comorbidity index, and co-medications. CONCLUSION: Our results suggest that patients undergoing cataract surgery have an increased risk of NAION.
Assuntos
Extração de Catarata/estatística & dados numéricos , Neuropatia Óptica Isquêmica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arterite/epidemiologia , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Neuropatia Óptica Isquêmica/diagnóstico , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: To determine whether nonarteritic ischemic optic neuropathy (NAION) raises the risk of subsequent stroke in the general population. DESIGN: Population-based, retrospective cohort study. METHODS: Setting: Nationwide, population-based, retrospective cohort study. PATIENTS: Of 1 025 340 beneficiaries in the National Health Insurance Service-National Sample Cohort database (2002-2013), we included 400 952 eligible individuals in the analysis. OBSERVATIONS: To determine the effect of incident NAION on the occurrence of subsequent stroke, we used time-varying covariate Cox regression models. Model 1 included only incident NAION as a time-varying covariate. Model 2 included Model 1 and defined demographics. Model 3 included Model 2, comorbidity, co-medication, and Charlson index score. MAIN OUTCOME MEASURES: Effect (hazard ratio [HR]) of NAION on stroke development. RESULTS: Of 400 952 eligible individuals, 1125 patients developed NAION and 16 998 patients suffered from stroke. NAION was not associated with an increased risk of subsequent stroke in Model 1, with HR of 1.31 (95% confidence interval [CI], 0.89-1.92). This was consistent, after adjusting for demographics and/or confounding factors, in Model 2 (HR = 1.19, 95% CI, 0.81-1.75) and Model 3 (HR = 1.10, 95% CI, 0.75-1.62). CONCLUSIONS: Our results suggest that NAION per se is not associated with a subsequent risk of stroke in the general population.
Assuntos
Neuropatia Óptica Isquêmica/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arterite/complicações , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de RiscoRESUMO
AIMS: To compare the effects of topical diclofenac sodium with those of fluorometholone on intraocular pressure (IOP) and conjunctival inflammation after strabismus surgery. METHODS: We retrospectively analysed 60 Korean children who underwent strabismus surgery for intermittent exotropia in an institutional referral centre. Patients received topical diclofenac 0.1% or fluorometholone 0.1% after surgery for up to 4â weeks. IOP, patient discomfort, conjunctival inflammation and conjunctival injection were evaluated at 1, 2, 3 and 4â weeks after surgery. RESULTS: In the fluorometholone group, 23% showed an increase of ≥10â mmâ Hg compared to the baseline IOP within 4â weeks of surgery. The fluorometholone group showed a significant change in IOP compared to baseline (p<0.001) at all follow-up time points, whereas the diclofenac group showed no significant increase in IOP. An increased risk of IOP elevation of ≥10â mmâ Hg was observed after fluorometholone use in patients under 7â years of age. There was no significant difference in patient discomfort, conjunctival inflammation or conjunctival injection between the two groups. Conjunctival injection was more pronounced with muscle resection than with recession at 1â month after surgery. CONCLUSIONS: Postoperative topical diclofenac is an excellent substitute for steroids, particularly in young children under 7â years of age.