Diabetic retinopathy should not be a contraindication to thrombolytic therapy for acute myocardial infarction: review of ocular hemorrhage incidence and location in the GUSTO-I trial. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries.
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OBJECTIVES: This study sought to evaluate the incidence of ocular hemorrhage in patients with and without diabetes after thrombolytic therapy for acute myocardial infarction. BACKGROUND: Ocular hemorrhage after thrombolysis has been reported rarely. However, there is concern that the risk is increased in patients with diabetes. In fact, diabetic hemorrhagic retinopathy has been identified as a contraindication to thrombolytic therapy without clear evidence that these patients have an increased risk for ocular hemorrhage. METHODS: We identified all suspected ocular hemorrhages from bleeding complications reported in patients enrolled in the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-I trial. Additional information was collected on a one-page data form. We compared the incidence and location of ocular hemorrhages in patients with and without diabetes. RESULTS: There were 40,899 patients (99.7%) with information about diabetic history and ocular bleeding. Twelve patients (0.03%) had an ocular hemorrhage. Intraocular hemorrhage was confirmed in only one patient. There were 6,011 patients (15%) with diabetes, of whom only 1 had an ocular hemorrhage (eyelid hematoma after a documented fall). The upper 95% confidence intervals for the incidence of intraocular hemorrhage in patients with and without diabetes were 0.05% and 0.006%, respectively. CONCLUSIONS: Ocular hemorrhage and, more important, intraocular hemorrhage after thrombolytic therapy for acute myocardial infarction is extremely uncommon. The calculated upper 95% confidence interval for the incidence of intraocular hemorrhage in patients with diabetes was only 0.05%. We conclude that diabetic retinopathy should not be considered a contraindication to thrombolysis in patients with an acute myocardial infarction. (+info)
Adverse ocular reactions following transfusions--United States, 1997-1998.
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On December 23, 1997, the Portland region of the American Red Cross (ARC) notified the Oregon Health Division about a cluster of adverse ocular reactions among six patients who had received out-patient red blood cell (RBC) transfusions at a hospital in Washington; all patients experienced severe bilateral conjunctival erythema within 24 hours of transfusion. Since the initial report, 106 similar reactions in 74 patients in 14 states (Alabama, California, Connecticut, Maine, Michigan, Minnesota, Montana, Oklahoma, Oregon, Pennsylvania, Texas, Utah, Washington, and Wisconsin) have been identified. This report summarizes the preliminary findings from three of these states about the ongoing investigation of these reactions. (+info)
Acute hemorrhagic conjunctivitis--St. Croix, U.S. Virgin Islands, September-October 1998.
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Hurricane Georges struck the U.S. Virgin Islands on September 21, 1998. Immediately thereafter, health authorities on St. Croix (1998 population: approximately 50,000) became aware of increased numbers of cases of conjunctivitis. During September, one of the two public health clinics on the island recorded 88 cases of conjunctivitis, compared with three cases during August. Cases were characterized by periorbital swelling, excessive lacrimation, conjunctival redness with occasional hemorrhages, and foreign-body sensation in the eye. No severe sequelae were reported. Local ophthalmologists considered the symptoms characteristic of viral acute hemorrhagic conjunctivitis (AHC). This report describes the initial findings of an ongoing clinical, epidemiologic, and laboratory investigation of this outbreak. (+info)