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Impact of postoperative macular comorbidity on visual outcomes after Descemet’s membrane endothelial keratoplasty: A multicenter analysis

Por: Naoya Nakagawa · Ami Igarashi · Hideaki Yokogawa · Akira Kobayashi · Tomomi Higashide · Satoru Yamagami · Takahiko Hayashi

by Naoya Nakagawa, Ami Igarashi, Hideaki Yokogawa, Akira Kobayashi, Tomomi Higashide, Satoru Yamagami, Takahiko Hayashi

The aim of this study was to identify the clinical factors associated with postoperative visual acuity following Descemet’s membrane endothelial keratoplasty (DMEK), with emphasis on the impact of macular diseases. This retrospective multicenter study included consecutive eyes that underwent DMEK between March 1, 2011, and June 30, 2022, and had available optical coherence tomography findings. Eyes with other ocular diseases causing visual loss were excluded. Overall, 77 eyes of 66 patients were included in the study. Univariable and multivariable regression analyses were performed to identify the predictors of best-corrected visual acuity (BCVA) at the final follow-up. Worse preoperative visual acuity and macular comorbidity were identified as independent predictors of poorer postoperative BCVA. Among macular pathologies, cystoid macular edema was most strongly correlated with reduced vision in the univariable analysis (β = 0.195; p = 0.016). In the subgroup analysis, worse preoperative visual acuity and macular comorbidity remained significant predictors (p 

Clinical and economic impact of cost-intensive vs non-cost-intensive antihypertensive therapies: a retrospective study using real-world data from Japan

Por: Yoshihara · H. · Maeda · N. · Tonoike · T. · Ohno · H. · Nishiuchi · S. · Igarashi · A.
Background

Hypertension is a major health challenge imposing substantial economic and health burdens worldwide. This study compared treatment outcomes and costs between cost-intensive and non-cost-intensive pharmacotherapies, defined by prescribing intervals and the type of drugs, using electronic health record (EHR) data from multiple healthcare facilities, focusing on the type of antihypertensive drug and prescribing patterns.

 Design

A retrospective cohort study. A mixed-effects Cox proportional hazards model was used to investigate the association between cardiovascular events and healthcare resource use.

 Setting

EHRs from 34 primary care facilities in Japan.

 Participants

Patients prescribed either angiotensin receptor blockers (ARBs) alone or calcium channel blockers (CCBs) alone were included.

 Results

During 6629 person-years of follow-up, 71 events were observed. Model diagnostics confirmed the proportional hazards assumption and substantial inter-clinic heterogeneity. The type of drug (ARBs or CCBs) had no statistically significant impact on the incidence of cardiovascular events (HR 0.999, 95% CI 0.603 to 1.655). Similarly, shorter prescribing intervals (less than 36 days) were not significantly associated with the outcome (HR 1.724, 95% CI 0.906 to 3.279). The mean annual medical cost per patient for the cost-intensive (ARB with short prescribing intervals) and non-cost-intensive (CCB with long prescribing intervals) groups was Japanese yen (JPY) 137 023 and JPY 85 911, respectively. Sensitivity analysis using different time windows yielded similar results, confirming the robustness of the findings.

 Conclusion

No apparent reduction in cardiovascular events associated with the use of ARBs or shorter prescribing intervals was observed despite the elevated cost caused by intensive pharmacotherapy and frequent clinic visits.
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