F.Y.EYE

628 CAN J OPHTHALMOL—VOL. 44, NO. 5, 2009

Being overweight may make you live longerAlthough obesity is unequivocally related to increased

mortality, Canadian researchers investigated the effects of being overweight but not obese. The study analyzed the National Population Health Survey, a longitudinal nation-ally representative population-health survey of Canadian adults undertaken by Statistics Canada every 2 years. The researchers used Cox proportional hazard models and specif-ically looked at the 1994/1995 data and followed through to 2006/2007, with 11 326 individuals who were surveyed be-ing included in the study. They found that there was a 73% increased risk of mortality for individuals who were under-weight, defined as a BMI <18.5 (RR = 1.73, p < 0.001), and for those who were overweight, defined as a BMI >35, there was a 36% increased risk of mortality (RR = 1.36, p < 0.05). However, for those who were overweight but not obese, de-fined as a BMI 25–29, there was a significantly decreased risk of mortality compared to individuals who were of normal weight (RR = 0.83, p < 0.05), and for those with a BMI of 30–35 the risk was similar to those with normal weight (RR 0.95, p > 0.05). The authors comment that although it seems that being overweight may increase life span, the study did not look at quality of life, which may be compromised by the potential negative health consequences of being overweight.

Orpana HM, Berthelot JM, Kaplan MS, et al. BMI and Mor-tality: Results From a National Longitudinal Study of Canadian Adults. Obesity 2009 Jun 18 [epub].

Flomax use prior to cataract surgery increases risk of postoperative adverse events

Tamsulosin (flomax) is well known to increase risks for intraoperative problems during cataract surgery, but Can-adian researchers looked at whether there was an association with increased risk of postoperative adverse events. More than 90 000 men undergoing cataract surgery between 2002 and 2007 were analyzed using a case–control retrospective cohort study with data derived from the Ontario Drug Bene-fit database, the Ontario Heath Insurance Plan database, and the Ontario Registered Persons database. To identify those individuals who had endophthalmitis, retinal detachment, or retained lens fragments, the researchers looked at phys-ician claims for 1 of 4 procedures in the 14 days following cataract surgery; vitrectomy, vitreous aspiration or injection, dislocated lens extraction, or air or fluid exchange. Of the 96 128 individuals examined in the study, 3550 (3.7%) had exposure to tamsulosin within the previous year, and 7416 (7.7%) had exposure to other alpha-blockers. The risk of a postoperative adverse event was 7.5% in patients with recent tamsulosin exposure (use within 14 days before cataract sur-gery), significantly higher than the 2.7% in those without tamsulosin exposure (adjusted odds ratio [OR] 2.33, 95% CI 1.22–4.43). However, for those individuals with exposure to tamsulosin within the past year but not within the 2 weeks before surgery there was no increased risk (7.5% vs 8.0%; adjusted OR, 0.91; 95% CI 0.54–1.54). Also, for those in-dividuals with either recent or previous exposure to other

alpha-blockers, there was no increased risk of adverse events (7.5% vs 8.0%; adjusted OR, 0.91; 95% CI 0.54–1.54 for recent exposure, and 2.9% vs 2.1%; adjusted OR, 1.08; 95% CI 0.47–2.48 for previous exposure).

Bell CM, Hatch WV, Fischer HD, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA 2009;301:1991–6.

Antibiotics reduce rate of site infection from surgical glove perforation

The risk of surgical site infection from glove perforation during surgery was investigated in a general surgery unit in Switzerland. Using a prospective observational cohort study, researchers looked at 4147 surgeries encompassing visceral, vascular, and trauma cases, for which there was a 4.5% over-all surgical site infection rate (188 of 4147 cases). There was a 200% increased risk for infection when glove perforation occurred (odds ratio [OR] 2.0, 95% CI 1.4–2.8, p < 0.001), but a multivariate analysis showed a difference in risk if antimicrobial prophylaxis was used. When patients received prophylaxis (consisting of 1.5 g of cefuroxime intravenously in conjunction with 500 mg of metronidazole phosphate for bowel surgeries), the rate of infection was not statistic-ally higher than cases where no glove perforation occurred (OR 1.3; 95% CI 0.9–1.9; p = 0.26). However, when no prophylaxis was given the risk of infection was significantly higher (OR 4.2; 95% CI 1.7–10.8; p = 0.003).

Misteli H, Weber WP, Reck S et al. Surgical glove perforation and the risk of surgical site infection. Arch Surg 2009;144:553–8.

Rate of celiac disease increasingTo determine if the prevalence of celiac disease has changed

over the last 50 years, researchers in the United States com-pared a cohort of current patients to a historical cohort. The initial cohort included 9133 young adults between 1948 and 1954, and this was compared to 2 recent cohorts of 12 768 subjects who were matched either based on similar age at time of sampling or similar birth years. All subjects had sera tested for transgluaminase and then endomysial antibodies for the diagnosis of celiac disease. From the initial cohort, 0.2% had undiagnosed celiac disease and these subjects had a higher risk of all-cause mortality than those without celiac disease (hazard ratio = 3.9; 95% CI 2.0–7.5; p < 0.001). For the recent cohorts, undiagnosed celiac disease was found in 0.9% of subjects with similar age at time of sampling, and 0.8% of subjects with similar birth years, corresponding to a 4.5 and 4-fold greater rate of undiagnosed celiac disease in the recent cohorts. Undiagnosed celiac disease also seemed to result in a higher risk of mortality.

Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology 2009;137:88–93.

F.Y.Eye presents summaries of publications and news stories of in-terest to ophthalmologists. If you have any suggestions or contribu-tions, please send them to Ian McIlraith at fyeyecolumn@yahoo.ca.