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Abad S, Badelon I, Martin A, Héran F, Héron E, Mouriaux F, Zmuda M, Ducasse A, Vicaut E, Dhôte R. Étude multicentrique nationale des patients atteints du syndrome d’inflammation orbitaire idiopathique : cohorte SIOI. Caractéristiques des patients à l’inclusion. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Errera MH, Levinson RD, Fardeau C, Thomas D, Cohen D, Navarro A, Héron E, Paques M, Pavesio C, Sahel JA, Westcott MC, Gaudric A, LeHoang P, Bodaghi B. Late posterior segment relapses in a series of Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2015; 93:e509-10. [PMID: 25604241 DOI: 10.1111/aos.12640] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mora P, Ghirardini S, Héron E, Sedira N, Olcelli F, Gandolfi S, Sahel JA, Errera MH. Ocular tuberculosis: experience of an Italian and French cohort. Acta Ophthalmol 2015; 93:e403-e404. [PMID: 25488026 DOI: 10.1111/aos.12602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jachiet M, Flageul B, Deroux A, Le Quellec A, Maurier F, Cordoliani F, Godmer P, Abasq C, Astudillo L, Belenotti P, Bessis D, Bigot A, Doutre MS, Ebbo M, Guichard I, Hachulla E, Héron E, Jeudy G, Jourde-Chiche N, Jullien D, Lavigne C, Machet L, Macher MA, Martel C, Melboucy-Belkhir S, Morice C, Petit A, Simorre B, Zenone T, Bouillet L, Bagot M, Frémeaux-Bacchi V, Guillevin L, Mouthon L, Dupin N, Aractingi S, Terrier B. The clinical spectrum and therapeutic management of hypocomplementemic urticarial vasculitis: data from a French nationwide study of fifty-seven patients. Arthritis Rheumatol 2015; 67:527-34. [PMID: 25385679 DOI: 10.1002/art.38956] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 11/06/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Hypocomplementemic urticarial vasculitis (HUV) is an uncommon vasculitis of unknown etiology that is rarely described in the literature. We undertook this study to analyze the clinical spectrum and the therapeutic management of patients with HUV. METHODS We conducted a French nationwide retrospective study that included 57 patients with chronic urticaria, histologic leukocytoclastic vasculitis, and hypocomplementemia. We assessed clinical and laboratory data and evaluated the patients' cutaneous and immunologic responses to therapy. We evaluated treatment efficacy by measuring the time to treatment failure. RESULTS Urticarial lesions were typically more pruritic than painful and were associated with angioedema in 51% of patients, purpura in 35%, and livedo reticularis in 14%. Extracutaneous manifestations included constitutional symptoms (in 56% of patients) as well as musculoskeletal involvement (in 82%), ocular involvement (in 56%), pulmonary involvement (in 19%), gastrointestinal involvement (in 18%), and kidney involvement (in 14%). Patients with HUV typically presented with low C1q levels and normal C1 inhibitor levels, in association with anti-C1q antibodies in 55% of patients. Hydroxychloroquine or colchicine seemed to be as effective as corticosteroids as first-line therapy. In patients with relapsing and/or refractory disease, rates of cutaneous and immunologic response to therapy seemed to be higher with conventional immunosuppressive agents, in particular, azathioprine, mycophenolate mofetil, or cyclophosphamide, while a rituximab-based regimen tended to have higher efficacy. Finally, a cutaneous response to therapy was strongly associated with an immunologic response to therapy. CONCLUSION HUV represents an uncommon systemic and relapsing vasculitis with various manifestations, mainly, musculoskeletal and ocular involvement associated with anti-C1q antibodies, which were found in approximately half of the patients. The best strategy for treating HUV has yet to be defined.
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Héron E, Touhami S, Arzouk N, Mantout F, Benrabah R. PRES syndrome sous everolimus après transplantation rénale. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sedira N, Errera MH, Rossignol I, Parize P, Charlier-Woerther C, Lortholary O, Héron E. Syphilis oculaire : huit cas en huitans ! Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feldman-Billard S, Sedira N, Boelle PY, Poisson F, Héron E. High prevalence of undiagnosed diabetes and high risk for diabetes using HbA1c criteria in middle-aged patients undergoing cataract surgery. DIABETES & METABOLISM 2013; 39:271-5. [PMID: 23628550 DOI: 10.1016/j.diabet.2012.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022]
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Zmuda M, Tiev KP, Knoeri J, Héron E. Successful use of infliximab therapy in sight-threatening corticosteroid-resistant Vogt-Koyanagi-Harada disease. Ocul Immunol Inflamm 2013; 21:310-6. [PMID: 23617262 DOI: 10.3109/09273948.2013.775312] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report an experience with infliximab in severe corticosteroid-resistant Vogt-Koyanagi-Harada (VKH) disease. DESIGN Interventional case series. METHODS The medical records of 2 adult patients were reviewed. RESULTS Both patients had a visual acuity reduced to hand motion perception bilaterally after 1 month of high-dose corticosteroid therapy, due to multiple exudative retinal detachment involving the fovea. Visual acuity and OCT findings improved immediately after the first infliximab infusion, retinal detachments fully resolved after 1 month and visual acuity returned to normal within 6 months. Despite a negative pretreatment screening, one patient developed multivisceral tuberculosis, which led to infliximab discontinuation after the 7th infusion and was cured by a 9-month ambulatory antibiotic regimen. The other patient received 11 well-tolerated infliximab infusions. Respectively, 9 and 4 months after infliximab discontinuation both patients had normal vision and OCT findings. CONCLUSION Infliximab showed tremendous therapeutic efficacy in sight-threatening corticosteroid-resistant VKH disease.
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Errera MH, Goldschmidt P, Batellier L, Degorge S, Héron E, Laroche L, Sahel JA, Westcott M, Chaumeil C. Findings in Detection ofHerpesviridaeby Polymerase Chain Reaction and Intraocular Antibody Production in a Case Series of Anterior Uveitis. Ocul Immunol Inflamm 2013; 21:61-8. [DOI: 10.3109/09273948.2012.730653] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Héron E, Zmuda M, Knoeri J, Tiev KP. Évolution à long terme de deux cas d’uvéite sévère corticorésistante de Harada traités par infliximab. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Errera MH, Goldschmidt P, Batellier L, Degorge S, Héron E, Laroche L, Sahel JA, Westcott M, Chaumeil C. Real-time polymerase chain reaction and intraocular antibody production for the diagnosis of viral versus toxoplasmic infectious posterior uveitis. Graefes Arch Clin Exp Ophthalmol 2011; 249:1837-46. [PMID: 21732111 DOI: 10.1007/s00417-011-1724-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 04/21/2011] [Accepted: 05/21/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The aim of this work was to determine the diagnostic performance of real-time polymerase chain reaction (RT-PCR) and to assess intraocular specific antibody secretion (Goldmann-Witmer coefficient) on samples from patients with signs of posterior uveitis presumably of infectious origin and to target the use of these two biologic tests in the diagnostic of Toxoplasma/viral Herpesviridae posterior uveitis by the consideration of clinical behavior and delay of intraocular sampling. METHODS Aqueous humour and/or vitreous fluid were collected from patients suspected of having posterior uveitis of infectious origin at presentation (140 samples). The diagnosis was confirmed by quantification of antibodies with the Goldmann-Witmer coefficient (GWC) and for detection of Herpesviridae and Toxoplasma gondii genomes with RT-PCR. Forty-one patients had final diagnosis of uveitis of non-Toxoplasma/non-viral origin and 35 among them constituted the control group. The main outcome measures were sensitivity, specificity, and positive and negative predictive values (PPV and NPV). RESULTS When pre-intraocular testing indication was compared with final diagnosis, GWC was a more sensitive and specific method than RT-PCR, and was successful in detecting T. gondii, especially if the patient is immunocompetent and the testing is carried out later in the disease course, up to 15 months. For viral Herpesviridae uveitis, the sensitivity and PPV of PCR evaluation was higher than detected with GWC with respectively 46% compared with 20% for sensitivity and 85% versus 60% for PPV. In either viral retinitis or toxoplasmosis infection, RT-PCR results were positive from 24 h, although GWC was not significant until 1 week after the onset of signs. In toxoplasmosis patients, positive RT-PCR results were statistically correlated with the chorioretinitis area (more than three disc areas; p = 0.002), with the age older than 50 (p = 0.0034) and with a clinical anterior inflammation (Tyndall ≥1/2+) and panuveitis; (p = 0.0001). CONCLUSIONS For the diagnosis of viral or toxoplasmosis-associated intraocular inflammation, the usefulness of laboratory diagnosis tools (RT-PCR and GWC) depends on parameters other than the sensitivity of the tests. Certain patient characteristics such as the age of the patients, immune status, duration since the onset of symptoms, retinitis area, predominant site and extent of inflammation within the eye should orientate the rational for the choice of laboratory testing in analysis of intraocular fluids.
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Wautier MP, Héron E, Picot J, Colin Y, Hermine O, Wautier JL. Red blood cell phosphatidylserine exposure is responsible for increased erythrocyte adhesion to endothelium in central retinal vein occlusion. J Thromb Haemost 2011; 9:1049-55. [PMID: 21362128 DOI: 10.1111/j.1538-7836.2011.04251.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Retinal vein occlusion (RVO) is a common cause of permanent loss of vision. The pathophysiology is uncertain, although enhanced erythrocyte aggregation and blood hyperviscosity have been observed. Increased red blood cell (RBC) adhesion has been associated with vascular complications in several diseases, such as sickle cell anemia, diabetes mellitus or polycythemia vera. OBJECTIVES To measure RBC adhesion to endothelial cells in RVO and to explore the molecular basis of the adhesion process. PATIENTS AND METHODS We assessed RBC adhesion to endothelial cells and adhesion molecule expression among 32 patients with RVO. Patients with disease known to alter RBC adhesion were excluded (n = 8), and further investigation was conducted in 20 patients with central retinal vein occlusion (CRVO) and four patients with retinal artery occlusion (RAO), compared with 25 normal subjects. RESULTS Under static conditions, adhesion of CRVO RBC was increased (135 ± 7 × 10(2) mm(-2)) compared with RAO RBC (63 ± 5 × 10(2) mm(-2)) (P < 0.01) and normal control RBC (37 ± 3 × 10(2) mm(-2)) (P < 0.001). Under flow conditions, CRVO RBC adhered in greater numbers than normal RBC (P < 0.001). Phosphatidylserine (PS) expression on CRVO RBC was 2.4-fold higher than controls and correlated with RBC adhesion (P = 0.001). In static conditions, specific antibodies against PS receptor and annexin V inhibited RBC adhesion. In flow conditions, the inhibitory effect was in the same range with antibodies but was 2-fold higher with annexin V. CONCLUSION Increased CRVO RBC adhesion is mediated by PS RBC and endothelial PS receptor. This phenomenon may be one of the factors responsible for CRVO.
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Feldman-Billard S, Massin P, Meas T, Guillausseau PJ, Héron E. Hypoglycemia-induced blood pressure elevation in patients with diabetes. ACTA ACUST UNITED AC 2010; 170:829-31. [PMID: 20458093 DOI: 10.1001/archinternmed.2010.98] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Mantout-Mihoubi F, Maalouly G, Feldman-Billard S, Benrabah R, Héron E. Neuropathie optique ischémique antérieure aiguë non artéritique du sujet âgé : étude de 49 cas. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mateo-Montoya A, Bonnel S, Wolff B, Héron E, Sahel JA. White dots in the eye fundus revealing Hodgkin's lymphoma. Eye (Lond) 2009; 24:934-7. [DOI: 10.1038/eye.2009.188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Feldman-Billard S, Héron E. Tolérance systémique des corticoïdes en ophtalmologie : influence de la voie d’administration. J Fr Ophtalmol 2008; 31:1026-36. [DOI: 10.1016/s0181-5512(08)74751-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sedira N, Lanternier F, Rossignol I, Benrabah R, Lortholary O, Héron E. Tuberculome cérébral révélé par une uvéite. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Héron E, Marzac C, Feldman-Billard S, Girmens JF, Paques M, Delarue R, Piette JC, Casadevall N, Hermine O. Endogenous Erythroid Colony Formation in Patients with Retinal Vein Occlusion. Ophthalmology 2007; 114:2155-61. [DOI: 10.1016/j.ophtha.2007.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 08/02/2007] [Accepted: 08/09/2007] [Indexed: 10/22/2022] Open
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Girmens JF, Scheer S, Héron E, Sahel JA, Tournier-Lasserve E, Paques M. Familial central retinal vein occlusion. Eye (Lond) 2006; 22:308-10. [PMID: 17173011 DOI: 10.1038/sj.eye.6702672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM To report four cases of central retinal vein occlusion (CRVO) in a French family. PATIENTS AND METHODS Ophthalmological examination and medical work-up of seven members of the family. RESULTS There were four cases of CRVO in two consecutive generations. Three of them had CRVO in both eyes. Arterial hypertension was present in two, associated to glaucoma in one. Medical work-up did not reveal additional risk factors. CONCLUSIONS We report a case of familial clustering of CRVO. Our cases combined to other cases reported in the literature provide arguments for the existence in some subjects of a genetic predisposition of CRVO. Additional case series are however needed to confirm this hypothesis.
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Chatel MA, Bourcier T, Borderie V, Laroche L, Héron E. Des dépôts lipidiques dans la cornée. Rev Med Interne 2006; 27:881-2. [PMID: 16777269 DOI: 10.1016/j.revmed.2006.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 04/05/2006] [Indexed: 11/19/2022]
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Feldman-Billard S, Du Pasquier-Fediaevsky L, Héron E. Hyperglycemia after repeated periocular dexamethasone injections in patients with diabetes. Ophthalmology 2006; 113:1720-3. [PMID: 17011953 DOI: 10.1016/j.ophtha.2006.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 03/24/2006] [Accepted: 05/17/2006] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To assess the hyperglycemic effect of 3 consecutive daily periocular steroid injections in patients with diabetes. DESIGN Retrospective observational study in a national eye center. PARTICIPANTS Twenty-five hospitalized patients with type 2 diabetes who received a subconjunctival (n = 11) or a peribulbar injection (n = 14) with 4 mg dexamethasone disodium phosphate once a day for 3 consecutive days for ocular conditions. METHODS Baseline patient characteristics were recorded as well as serial blood glucose measurements and hypoglycemic interventions, both performed according to a written protocol. MAIN OUTCOME MEASURES Serial blood glucose measurements and hypoglycemic interventions. RESULTS Each ocular injection with dexamethasone was followed around 6 hours later by an increase of blood glucose up to a median doubling from baseline (+100% increase) followed by falls until the next injection, toward a median 13% increase from baseline before the next ocular injection. Older age (P<0.05), duration of diabetes (P = 0.01), and microangiopathy or macroangiopathy (P = 0.01) were associated with higher blood glucose rises. Using a 14-mmol/l threshold for intervention, the probability of requiring additional hypoglycemic treatment during ocular steroid therapy in patients with HbA1c >7.5% and up to 7.5% was 100% and 60%, respectively. CONCLUSIONS Periocular injections with dexamethasone in patients with type 2 diabetes induce a marked hyperglycemic effect, similar to that observed during intravenous pulse methylprednisolone.
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Héron E, Augustin P, Cervera P, Girmens JF, Généreau T, Lortholary O, Cabane J. Systemic nocardiosis mimicking an ocular relapse of giant-cell arteritis. Rheumatology (Oxford) 2006; 45:641-3. [PMID: 16531438 DOI: 10.1093/rheumatology/kel064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bourcier T, Chibane S, Boutboul S, Abitbol M, Borderie V, Laroche L, Héron E. Des opacités cornéennes. Rev Med Interne 2005; 26:518-9. [PMID: 15936482 DOI: 10.1016/j.revmed.2004.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2004] [Accepted: 11/09/2004] [Indexed: 11/18/2022]
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Feldman-Billard S, Lissak B, Kassaei R, Benrabah R, Héron E. Short-term tolerance of pulse methylprednisolone therapy in patients with diabetes mellitus. Ophthalmology 2005; 112:511-5. [PMID: 15745783 DOI: 10.1016/j.ophtha.2004.10.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Accepted: 09/23/2004] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess the short-term tolerance of pulse methylprednisolone in patients with diabetes. DESIGN Retrospective study in a national eye center. PARTICIPANTS Eighty patients with type 2 diabetes, half of them also treated for hypertension, who received 3-day pulse methylprednisolone between January 1999 and December 2002 for eye disorders and were monitored according to a written protocol. MAIN OUTCOME MEASURE Potentially serious side effects, serial blood glucose measurements, and hypoglycemic interventions during pulse therapy. RESULTS Each pulse induced about 10 hours later a mean 2-fold peak increase of blood glucose. According to a 14-mmol/l (250 mg/dl) threshold glucose level for intervention, rapid insulin was required in 27 of 27 (100%) and 24 of 53 (45%) patients with glycosylated hemoglobin levels higher than 8% and up to 8%, respectively. In the latter group, patients older than 70 years had a 3-fold increased risk of requiring insulin. Significant side effects were systolic and/or diastolic blood pressure elevation > or = 180/110 mmHg (n = 6), ketosis without acidosis (n = 5), silent myocardial ischemia (n = 1), and disorientation (n = 1). All side effects were transient or controlled successfully by medical intervention. No infectious complication occurred during the treatment period. CONCLUSIONS Pulse methylprednisolone is globally well tolerated in diabetic patients, but requires strict blood glucose and clinical monitoring.
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