Purpose: Diabetes mellitus and systemic hypertension are frequently reported as ischemic causes of sixth nerve palsy/-paresis, but there are few rigorous studies to support these associations. We conducted a populatio...Purpose: Diabetes mellitus and systemic hypertension are frequently reported as ischemic causes of sixth nerve palsy/-paresis, but there are few rigorous studies to support these associations. We conducted a population-based case-control study to determine the presence and magnitude of any association of preexisting diabetes mellitus and systemic hypertension with isolated sixth nerve palsy. Design: Retrospective population-based case-control study. Participants and Controls: Participants were patients with new onset of neurologically isolated sixth nerve palsy or paresis (n=76) in Olmsted County, Minnesota, from January 1, 1978, to December 31, 1992. Controls (n=76) were selected from the same general population and were matched for age, gender, and length of medical follow-up. Methods: Using the Rochester Epidemiology Project medical records linkage system, which captures virtually all medical care provided to residents of Olmsted County, Minnesota, we identified all incident cases of neurologically isolated sixth nerve palsy/paresis (n=76) among county residents between the given dates. An equal number (n=76) of controls were randomly selected from the general population. We reviewed the entire medical record of each case and control, using stringent predetermined criteria to define the presence of diabetes mellitus and systemic hypertension. We compared the prevalence of diabetes and systemic hypertension between cases and controls by use of chi-square tests, and we calculated odds ratios (OR)with 95%confidence intervals (CI). MainOutcome Measures: Presence or absence of diabetes mellitus and systemic hypertension. Results: Diabetes mellitus occurred more frequently in cases (23.7%) than in controls (5.3%; P=0.001; OR, 5.59; 95%CI, 1.79-17.42). Systemic hypertension occurred with similar frequency in cases (51.3%) and controls (39.5%; P=0.14; OR, 1.62; 95%CI, 0.85-3.08). Coexistent diabetes mellitus and hypertension were more common in cases (18.4%) than in controls (2.6%; P=0.002; OR, 8.36; 95%CI, 1.83-38.18). Conclusions: We conclude that there is a 6-fold increase in odds of having diabetes in cases of sixth nerve palsy over controls, whereas systemic hypertension does not seem to be associated with increased odds. In contrast, there is an 8-fold increased odds of having coexistent diabetes and hypertension in cases of sixth nerve palsy over controls. The much-cited association of systemic hypertension alone with sixth nerve palsy may be coincidental.展开更多
Purpose: To determine changes in the central endothelium and thickness of grafted corneas and the cumulative probability of developing glaucoma, of graft rejection, and of graft failure 15 years after penetrating kera...Purpose: To determine changes in the central endothelium and thickness of grafted corneas and the cumulative probability of developing glaucoma, of graft rejection, and of graft failure 15 years after penetrating keratoplasty. Design: Longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon. Methods: Regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium and measured corneal thickness using specular microscopy. The presence of glaucoma, graft rejection, and graft failure were recorded. Results: The 67 patients examined at 15 years represented 30% of the available clear grafts. Endothelial cell loss from preoperative donor levels was 71± 12% (mean± standard deviation, n=67), endothelial cell density was 872± 348 cells/mm2, and corneal thickness was 0.59± 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years, whereas corneal thickness increased (P=.001, n=55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2± 5.7% (n=54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20% , 23% , and 28% , respectively, and 6 of the 8 graft failures after 10 years resulted from late endothelial failure. Conclusions: From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.展开更多
文摘Purpose: Diabetes mellitus and systemic hypertension are frequently reported as ischemic causes of sixth nerve palsy/-paresis, but there are few rigorous studies to support these associations. We conducted a population-based case-control study to determine the presence and magnitude of any association of preexisting diabetes mellitus and systemic hypertension with isolated sixth nerve palsy. Design: Retrospective population-based case-control study. Participants and Controls: Participants were patients with new onset of neurologically isolated sixth nerve palsy or paresis (n=76) in Olmsted County, Minnesota, from January 1, 1978, to December 31, 1992. Controls (n=76) were selected from the same general population and were matched for age, gender, and length of medical follow-up. Methods: Using the Rochester Epidemiology Project medical records linkage system, which captures virtually all medical care provided to residents of Olmsted County, Minnesota, we identified all incident cases of neurologically isolated sixth nerve palsy/paresis (n=76) among county residents between the given dates. An equal number (n=76) of controls were randomly selected from the general population. We reviewed the entire medical record of each case and control, using stringent predetermined criteria to define the presence of diabetes mellitus and systemic hypertension. We compared the prevalence of diabetes and systemic hypertension between cases and controls by use of chi-square tests, and we calculated odds ratios (OR)with 95%confidence intervals (CI). MainOutcome Measures: Presence or absence of diabetes mellitus and systemic hypertension. Results: Diabetes mellitus occurred more frequently in cases (23.7%) than in controls (5.3%; P=0.001; OR, 5.59; 95%CI, 1.79-17.42). Systemic hypertension occurred with similar frequency in cases (51.3%) and controls (39.5%; P=0.14; OR, 1.62; 95%CI, 0.85-3.08). Coexistent diabetes mellitus and hypertension were more common in cases (18.4%) than in controls (2.6%; P=0.002; OR, 8.36; 95%CI, 1.83-38.18). Conclusions: We conclude that there is a 6-fold increase in odds of having diabetes in cases of sixth nerve palsy over controls, whereas systemic hypertension does not seem to be associated with increased odds. In contrast, there is an 8-fold increased odds of having coexistent diabetes and hypertension in cases of sixth nerve palsy over controls. The much-cited association of systemic hypertension alone with sixth nerve palsy may be coincidental.
文摘Purpose: To determine changes in the central endothelium and thickness of grafted corneas and the cumulative probability of developing glaucoma, of graft rejection, and of graft failure 15 years after penetrating keratoplasty. Design: Longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon. Methods: Regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium and measured corneal thickness using specular microscopy. The presence of glaucoma, graft rejection, and graft failure were recorded. Results: The 67 patients examined at 15 years represented 30% of the available clear grafts. Endothelial cell loss from preoperative donor levels was 71± 12% (mean± standard deviation, n=67), endothelial cell density was 872± 348 cells/mm2, and corneal thickness was 0.59± 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years, whereas corneal thickness increased (P=.001, n=55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2± 5.7% (n=54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20% , 23% , and 28% , respectively, and 6 of the 8 graft failures after 10 years resulted from late endothelial failure. Conclusions: From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.
