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S.A. Skolik; Cox–2 Inhibitor Use in Long Term–Diabetic Patients With Clinical Arthritis and Previously Normal Retinas Appears to be Associated With New Onset Retinopathy Which Regressed Spontaneously With Cessation of the Drug . Invest. Ophthalmol. Vis. Sci. 2006;47(13):984.
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To determine if COX–2 inhibitor use in patients with long–term diabetes and co–existing arthritis and baseline absent retinopathy is associated with new onset development of diabetic retinopathy and if the cessation of the use of COX–2 inhibitors will benefit the recovery of the retina.
A group of 103 patients with clinical arthritis and long–term diabetes and normal or near normal retinas have been followed clinically for 6–127 mos (ave. 41.5). Of these patients, 40 individuals with DM (11–46 yrs, ave. 23.9) used COX–2 inhibitors. 26/40 had type–1 diabetes (11–46yrs, aver. 27.9) and 14/40 had type–2 diabetes (12–22 yrs, aver. 16.7). Within 3–6 months of initiating COX–2 inhibitors, retinopathy developed in 22/26 type–1, and 6/14 type–2 diabetics. These patients were asked to discontinue use of the COX–2 inhibitor and their clinical retinal status was observed and photographed.
Some degree of spontaneous regression occurred in 20/22 type–1, and 4/6 type–2 patients, often within 3 months. Laser and/or vitrectomy were needed in 34.1% of type–1 and 33.3% of type–2 patients for complete control of their retinopathy. Overall, 17/28 patients (60.7%) with new onset retinopathy with COX–2 inhibitor use recovered spontaneously to baseline without need of laser or surgical intervention.
There seems to exist a special group of long–term diabetic patients with co–existing clinical arthritis in whom characteristic diabetic retinopathy fails to develop, perhaps displaying a "protective factor" effect, possibly related to inflamed synovium. Various low level inflammatory factors found in synivitis, including thrombospondin have been shown to have direct effect on retinal RPE cells. Perhaps these factors bring to play an endogenous protective system whereby joint inflammation is beneficial to blocking the development of retinopathy in diabetics with clinical arthritis. Further study is indicated.
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