OBJECTIVE:To determine whether adults with type 2 diabetes mellitus (T2DM) using cetirizine, ibuprofen, or prednisone have a reduced incidence of diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). DESIGN:Retrospective propensity score-matched cohort study. PARTICIPANTS:Adults with T2DM and documented eye-care in the TriNetX US Collaborative Network who had two documented uses of cetirizine, ibuprofen, prednisone, fenofibrate, or gabapentin between January 1, 2005, and March 1, 2025. METHODS:Each drug cohort was 1:1 propensity score-matched on 44 covariates against non-users; fenofibrate served as a positive control, and gabapentin served as both a negative control and an active comparator. Residual confounding was assessed using eight ophthalmic negative-control outcomes (NCOs) and E-values. Nine sensitivity analyses tested comparison to users of gabapentin, alternative outcome windows, a new-user design, glycemic strata, matching for drug indication, and exposure duration. MAIN OUTCOME MEASURES:Incident DME and PDR within 3 years of the index date. RESULTS:Matched-pair counts ranged from 18,762 to 86,846. Cetirizine was associated with reduced DME (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.51-0.74) and PDR (HR, 0.59; 95% CI, 0.46-0.77); ibuprofen with reduced DME (HR, 0.63; 95% CI, 0.56-0.69) and PDR (HR, 0.48; 95% CI, 0.41-0.56); and prednisone with reduced DME (HR, 0.46; 95% CI, 0.41-0.52) and PDR (HR, 0.36; 95% CI, 0.30-0.43). Fenofibrate showed associations of similar magnitude (DME HR, 0.57; 95% CI, 0.48-0.68; PDR HR, 0.59; 95% CI, 0.45-0.77); gabapentin showed no association (DME HR, 0.95; 95% CI, 0.88-1.02; PDR HR, 1.04; 95% CI, 0.93-1.15). Point E-values for the investigational drugs ranged from 2.57 to 4.97 (lower 95% CI bound, 1.93 to 4.06). The NCO panel was near null for cetirizine and ibuprofen and showed mild protective bias for prednisone and fenofibrate. Findings persisted across the nine sensitivity analyses. CONCLUSIONS:Cetirizine, ibuprofen, and prednisone were associated with reduced incidence of DME and PDR in adults with T2DM, with effect sizes comparable to those of the fenofibrate positive control. These findings support prospective evaluation of anti-inflammatory medications for the prevention of vision-threatening diabetic retinopathy.
Orr, Samantha Drs.; Pereira, Austin; Jiang, Shangjun; Golding, John Mr.; Choudhry, Netan Drs.; Kalevar, Ananda; Janetos, Timothy M.; Goldstein, Debra A.Editor(s): Agarwal, Anita Author Information
The purpose of this paper is to review recent advances in vitreoretinal surgery with a particular focus on new techniques of intraoperative visualization and new instrumentation for tissue manipulation. Advances in vitreoretinal surgical visualization include 3-D viewing systems, intraoperative OCT, and ocular endoscopy. Advances in tissue manipulation include hypersonic vitrectomy, and vitrectomy probes with improved cut rates, dual bore infusion, and shorter shafts for pediatric cases. There are many ongoing advancements in intraoperative visualization and tissue manipulation for vitreoretinal surgeries. As these techniques continue to be developed and tested, patients will ultimately benefit from the improved intraoperative visualization, decision-making, and surgical outcomes.
Purpose: Routine use of face masks for patients and physicians during intravitreal anti-vascular endothelial growth factor (VEGF) injections has increased with the emergence of the coronavirus disease 2019 pandemic. This study evaluates the impact of universal face mask use on rates and outcomes of post-injection endophthalmitis (PIE). Design: Retrospective, multicenter, comparative cohort study. Participants: Eyes receiving intravitreal anti-VEGF injections from October 1, 2019, to July 31, 2020, at 12 centers. Methods: Cases were divided into a "no face mask" group if no face masks were worn by the physician or patient during intravitreal injections or a "universal face mask" group if face masks were worn by the physician, ancillary staff, and patient during intravitreal injections. Main Outcome Measures: Rate of endophthalmitis, microbial spectrum, and visual acuity (VA). Results: Of 505 968 intravitreal injections administered in 110 547 eyes, 85 of 294 514 (0.0289%; 1 in 3464 injections) cases of presumed endophthalmitis occurred in the "no face mask" group, and 45 of 211 454 (0.0213%; 1 in 4699) cases occurred in the "universal face mask" group (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.51-1.18; P = 0.097). In the "no face mask" group, there were 27 cases (0.0092%; 1 in 10 908 injections) of culture-positive endophthalmitis compared with 9 cases (0.004%; 1 in 23 494) in the "universal face mask" group (OR, 0.46; 95% CI, 0.22-0.99; P = 0.041). Three cases of oral flora-associated endophthalmitis occurred in the "no face mask" group (0.001%; 1 in 98 171 injections) compared with 1 (0.0005%; 1 in 211 454) in the "universal face mask" group (P = 0.645). Patients presented a mean (range) 4.9 (1-30) days after the causative injection, and mean logarithm of the minimum angle of resolution (logMAR) VA at endophthalmitis presentation was 2.04 (similar to 20/2200) for "no face mask" group compared with 1.65 (similar to 20/900) for the "universal face mask" group (P = 0.022), although no difference was observed 3 months after treatment (P = 0.764). Conclusions: In a large, multicenter, retrospective study, physician and patient face mask use during intravitreal anti-VEGF injections did not alter the risk of presumed acute-onset bacterial endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Three months after presentation, there was no difference in VA between the groups. (C) 2021 by the American Academy of Ophthalmology
PURPOSE:To evaluate the refractive outcomes of sutureless intrascleral fixation of intraocular lens with pars plana vitrectomy. METHOD:A retrospective, consecutive cohort from multiple surgeons of a single center. Primary outcomes included spherical equivalent (SEQ) and change in SEQ (ΔSEQ) from preoperative intraocular lens power calculations. Secondary outcomes included refractive outcomes of fixation at 1.5 mm, 2 mm, and 2.5 mm posterior to the limbus. RESULTS:In total, 84 eyes of 80 patients were included. Preoperative logarithm of the minimum angle of resolution visual acuity was 1.21 ± 0.68 (20/320). The mean follow-up time was 2.33 ± 1.36 years. At 3 months, SEQ was -0.50 ± 1.59 D and ΔSEQ was 0.58 ± 1.49 D. At 1 year, SEQ was -0.55 ± 1.32 D and ΔSEQ was 0.39 ± 1.42 D. At the last follow-up, logarithm of the minimum angle of resolution visual acuity was 0.34 ± 0.34 (20/40), SEQ was -0.51 ± 1.44 D, and ΔSEQ was 0.57 ± 1.27 D. There was no difference between SEQ or ΔSEQ throughout follow-up (P = 0.97 and P = 0.96, respectively). At fixation distances more posterior to the limbus, mean ΔSEQ was more hyperopic at 3 months, 1-year, and the last follow-up (P = 0.02, P = 0.01, and P = 0.006, respectively). CONCLUSION:Refractive outcomes for sutureless intrascleral fixation of intraocular lens with pars plana vitrectomy were favorable and showed stability postoperatively. These results may aid surgeons achieve better desired refractive outcomes for this technique.
