Abstract
Abstract: :
Purpose: There exist a special group of diabetics with co–existing arthritis who appear to have innate resistance to the development of diabetic retinopathy. However, in this group, use of COX2 inhibitors appears to blunt this "protective effect" and allow the expression/development of diabetic retinopathy, which can improve with cessation of the use of the COX2 inhibitors.Methods:We compare the retinal appearance for the presence of retinal disease in two groups of patients. Group One consisted of 114 patients, age 31–96 (average 67.2 yrs) who have had diabetes for 10–63 years (average 23.7 years) and some form of arthritis; and Group Two, age and diabetes duration matched with no history of arthritis. All patients underwent careful biomicroscopy and indirect ophthalmoscopy by a retinal specialist with photographic documentation of the retinal appearance to detect evidence of DR. A subpopulation of patients in Group One was identified who had taken or were taking COX2 inhibitors and the level and progression of retinopathy in this subgroup was studied. Results:90.3%(103/114) of patients in Group Two displayed either severe non–proliferative and/or proliferative disease as compared to 1.7%(2/114) of patients in Group One. Some patients in Group One did develop milder forms of retinopathy, 9.6%(11/114), however, 9/11 of these patients (81.8%) had recently been taking a COX2 inhibitor. With cessation of COX2 use, 5/9 (55.5%) had partial or complete recovery to pre–COX2 use retinal appearance within 6 months. Of the patients in Group One who took COX2 inhibitors (3mos–4years) 11/15 (73.3%) appeared to display loss of the protective effect and at least while taking the COX2 inhibitor developed retinal vascular abnormalities Conclusion:COX2 inhibitor use in arthritic–diabetics may interfere with the potential presence of a "protective factor" and be associated with breakthrough development of retinopathy.
Keywords: diabetic retinopathy • diabetes • retinal neovascularization