RESUMEN
AIM: To assess the rate of 'treatment-requiring diabetic macular oedema (DMO)' in eyes for the two years before and after cataract surgery. METHODS: Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system. INCLUSION CRITERIA: eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy. MAIN OUTCOME MEASURE: rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye. RESULTS: 4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of 'treatment-requiring DMO' increased sharply after surgery, peaking in the 3-6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0-3, 3-6, 6-9 and 9-12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01). CONCLUSIONS: This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3-6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk.
Asunto(s)
Extracción de Catarata , Catarata/complicaciones , Retinopatía Diabética/complicaciones , Registros Electrónicos de Salud , Edema Macular/etiología , Evaluación de Resultado en la Atención de Salud , Agudeza Visual , Anciano , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/terapia , Femenino , Estudios de Seguimiento , Humanos , Edema Macular/diagnóstico , Edema Macular/terapia , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Factores de Tiempo , Tomografía de Coherencia Óptica , Reino UnidoRESUMEN
AIMS: To compare the effectiveness of continuous aflibercept versus pro re nata (PRN) ranibizumab therapy for neovascular age-related macular degeneration (nAMD). METHODS: Multicentre, national electronic medical record (EMR) study on treatment naive nAMD eyes undergoing PRN ranibizumab or continuous (fixed or treat and extend (F/TE)) aflibercept from 21 UK hospitals. Anonymised data were extracted, and eyes were matched on age, gender, starting visual acuity (VA) and year of starting treatment. Primary outcome was change in vision at 1 year. RESULTS: 1884 eyes (942 eyes in each group) were included. At year 1, patients on PRN ranibizumab gained 1.6 ETDRS (Early Treatment Diabetic Retinopathy Study) letters (95% CI 0.5 to 2.7, p=0.004), while patients on F/TE aflibercept gained 6.1 letters (95% CI 5.1 to 7.1, p=2.2e-16). Change in vision at 1 year of the F/TE aflibercept group was 4.1 letters higher (95% CI 2.5 to 5.8, p=1.3e-06) compared with the PRN ranibizumab group after adjusting for age, starting VA, gender and year of starting therapy. The F/TE aflibercept group had significantly more injections compared with the PRN ranibizumab group (7.0 vs 5.8, p<2.2e-16), but required less clinic visits than the PRN ranibizumab group (10.8 vs 9.0, p<2.2e-16). Cost-effectiveness analysis showed an incremental cost-effectiveness ratio of 58 047.14 GBP/quality-adjusted life year for continuous aflibercept over PRN ranibizumab. CONCLUSION: Aflibercept achieved greater VA gains at 1 year than ranibizumab. The observed VA differences are small and likely to be related to more frequent treatment with aflibercept, suggesting that ranibizumab should also be delivered by F/TE posology.
Asunto(s)
Ranibizumab/administración & dosificación , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Agudeza Visual , Degeneración Macular Húmeda/tratamiento farmacológico , Anciano , Inhibidores de la Angiogénesis/administración & dosificación , Análisis Costo-Beneficio , Registros Electrónicos de Salud , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Receptores de Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Resultado del Tratamiento , Reino Unido , Degeneración Macular Húmeda/fisiopatologíaAsunto(s)
Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Edema Macular/tratamiento farmacológico , Oclusión de la Vena Retiniana/tratamiento farmacológico , Inhibidores de la Angiogénesis/uso terapéutico , Dexametasona/efectos adversos , Implantes de Medicamentos , Sustitución de Medicamentos , Glucocorticoides/efectos adversos , Humanos , Inyecciones Intravítreas , Edema Macular/etiología , Edema Macular/fisiopatología , Ranibizumab/uso terapéutico , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/fisiopatología , Estudios Retrospectivos , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiologíaRESUMEN
A 55-year-old woman presented to the emergency department following an episode of severe visual impairment, headache, dizziness and confusion. The patient had been taking quinine sulfate as long-term medication for leg cramps. During an episode of sleepwalking, the patient had taken an overdose of quinine sulfate. Following a thorough investigation and assessment, a diagnosis of ocular quinine toxicity was made. We present this case and highlight the risks of quinine prescription.
