The aim of this study was to determine the prevalence and progression of diabetic retinopathy (DR) with hyperglycemic disorders during pregnancy (HDPs) in Japan between 2013 and 2018 using two cohorts. The patients with HDPs were classified as those with pre-existing DM (pexD), gestational DM (GDM), and overt DM (ODM). Cohort 1 was obtained from the health claims database whose diseases were classified by the International Classification of Diseases-10. Cohort 2 was derived from a retrospective, multicenter analysis of the medical records of 225 patients from 10 ophthalmological institutions. In Cohort 1, there were 5268 patients with an HDP prevalence of 8.4%. Among them, 73 of 1139 patients had pexD (6.4%) and 61 of 4129 patients with GDM (1.5%) had DR; the overall prevalence of DR was 2.5%. In Cohort 2, 36 of 225 patients (16.0%) had DR, and 149 patients were followed at the early and late stages of pregnancy. Moreover, 10 of the 102 patients with pexD (9.8%) and two of five patients with ODM (40.0%) had a progression of DR. In conclusion, the prevalence and progression of DR in patients with pexD is lower than previously reported. More attention should be given to pexD and ODM.
Purpose To compare the therapeutic effects of anti-vascular endothelial growth factor (anti-VEGF) agents in eyes with macular edema associated with branch retinal vein occlusion (BRVO-ME) with glaucoma to those without glaucoma. Patients and Methods This retrospective study was conducted using the medical records of Mie University Hospital from 2013 to 2017. Patients were recruited if they had received anti-VEGF agents for BRVO-ME treatment and included 30 patients (30 eyes) without glaucoma (G[-] group) and 27 patients (27 eyes) with glaucoma (G[+] group). The central retinal thickness (CRT) and best-corrected visual acuity (BCVA) at 3 months after a single injection of anti-VEGF agents were compared between the two groups. Results Before treatment, the mean±standard deviation of the CRT was 514.2±117.3 μm for the G[-] group, which was not significantly different from that for the G[+] group (533.4±171.4 μm). The CRT in the G[-] and G[+] groups significantly reduced to 321.1±114.6 μm and 347.8±134.7 μm, respectively, at 1 month after the injection and to 360.4±159.5 μm and 352.4±151.9 μm, respectively, at 3 months after the injection ( P <0.01 for each group). The difference in the degree of CRT reduction between the two groups was not significant. Before treatment, the BCVA was 0.42±0.32 logMAR units in the G[-] group and 0.57±0.33 logMAR units in the G[+] group, showing no significant difference. The BCVA in the G[-] and G[+] groups improved significantly to 0.27±0.26 logMAR units and 0.34±0.42 logMAR units, respectively, at 1 month, and to 0.18±0.20 logMAR units and 0.39±0.34 logMAR units, respectively, at 3 months ( P <0.01). The BCVA in the G[-] group was significantly better than that in the G[+] group at 3 months ( P =0.02). Conclusion The therapeutic response of anti-VEGF agents for BRVO-ME is affected by the presence of glaucoma.
Background Takayasu’s arteritis (TA) is a rare complication associated with inflammatory bowel disease (IBD). TA is a granulomatous systemic vasculitis of uncertain aetiology affecting large arteries, predominantly the aorta and its main branches, leading to stenotic and expansible lesions. The estimated prevalence of coexisting of TA in patients with ulcerative colitis (UC) is 0.3%, and that in patients with Crohn’s disease (CD) is 0.1%. Anti-tumour necrosis factor-α (TNF-α) agents are used to treat both TA and IBD, although some patients with IBD paradoxically develop TA during treatment with anti-TNF-α agents. However, data regarding the incidence and clinical features of TA in such cases are lacking. This study was performed to clarify the prevalence, risk factors, and clinical features of TA that develops paradoxically during treatment with anti-TNF-α agents in patients with IBD. Methods Consecutive patients with IBD who were regularly seen at our centre, a tertiary IBD centre in Japan, from 2000 to 2019 were included in this retrospective single-centre study. We evaluated the prevalence of TA according to the presence or absence of treatment with anti-TNF-α agents and the patients’ clinical manifestations. Results Of 1846 patients with UC and 1249 patients with CD, 7 (0.23%) patients with UC developed TA. The prevalence of TA in patients treated with anti-TNF-α agents was significantly higher (4/254, 1.6%) than that in patients without anti-TNF-α agent treatment (3/1592, 0.19%) (p=0.0087, Fisher’s exact test). Among four patients with UC who paradoxically developed TA during treatment with anti-TNF-α agents, three (75%) received infliximab, one (25%) received adalimumab, and one (25%) received golimumab. One was male and three (75%) were female. The median interval from starting treatment with anti-TNF-α agents to diagnosis of TA was 49.0 (34–63) months. All patients had pancolitis as well as persistent active colitis resistant to anti-TNF-α antibody treatment. The treatments for TA administered after anti-TNF-α therapy were as follows: Two (50%) patients discontinued anti-TNF-α agent therapy, three (75%) were treated with prednisolone, and one (25%) received tocilizumab. No patient required an operation for TA. Conclusion To our knowledge, this is the first study to show the prevalence and clinical features of TA in patients with IBD following administration of anti-TNF-α agent therapy. Although TA is a rare complication, our results suggest that it can develop as paradoxical reaction following administration of anti-TNF-α agents.
Background Current consensus statements recommend at least 3–6 months of preconception steroid-free remission for women with inflammatory bowel disease, as determined by experts. However, little data is available on the appropriate preconception remission period in women with ulcerative colitis (UC). We explored the effect of the preconception steroid-free remission period on disease activity during pregnancy and birth outcomes in women with UC. Methods Data were obtained from a retrospective chart review of 141 consecutive pregnant women with UC at our inflammatory bowel disease centre and a related clinic from 2000–2020. Women who were diagnosed with UC more than 6 months before conception and who were judged to have been accurately assessed for disease activity during the 6-month preconception period and at each trimester during pregnancy were included. We categorized the women into four subgroups according to their preconception steroid-free remission periods (≥6 months, 3–6 months, <3 months, and active disease at conception) and compared the disease activity during pregnancy and adverse birth outcomes in the four subgroups. Multivariable logistic regression of risk factors of disease activity during pregnancy and adverse birth outcomes was performed. Results The rate of active disease during pregnancy was 63% in the ≥6 months preconception steroid-free remission group, 50% in the 3–6 months preconception steroid-free remission group, 71% in the <3 months preconception steroid-free remission group, and 93% in the active disease at conception group. The rates of active disease during pregnancy were significantly lower in all the preconception steroid-free remission groups than in the active disease at conception group. In the multivariate analysis, independent predictors of disease activity during pregnancy were a preconception steroid-free remission period of ≥6 months [adjusted odds ratio (aOR), 0.13; p<0.001], 3–6 months (aOR, 0.09; p<0.001), and <3 months (aOR, 0.17; p<0.05) compared with active disease at conception after adjustment for age and smoking. Active disease at conception was also an independent predictor of disease activity during pregnancy (aOR, 8.13; p<0.001) compared with remission at conception. The neonatal birthweight tended to decrease as the length of preconception steroid-free remission period decreased. Preterm birth, low birth weight, and small for gestational age were more common in the <3 months and active disease at conception groups (p>0.05). Conclusion The largest risk factor for disease activity during pregnancy appears to be active disease at conception. A shorter preconception steroid-free remission period than the recommended 3–6 months might reduce the risk of disease activity during pregnancy.
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