Efectividad del moxifloxacino intracameral profiláctico para reducir la endoftalmitis posterior a cirugía de cataratas en población chilena

Background: Endophthalmitis is a serious infectious complication of cataract surgery, which may lead to vision loss. Aim: To evaluate the effectiveness of intracameral moxifloxacin in reducing endophthalmitis after cataract surgery in Chilean patients. Material and Methods: We reviewed all phacoemulsification surgeries performed between 2012 and 2020 at a public hospital. The use of intraoperative intracameral moxifloxacin and possible surgical complications were recorded. In patients with postoperative endophthalmitis, we reviewed their risk factors and clinical characteristics. Results: In the study, 22,869 phacoemulsification surgeries were registered, with an annual average of 2,541. The use of prophylactic intracameral moxifloxacin started progressively in 2014. In 2018 it was used in 88% of the surgeries. Fifteen eyes evolved with postoperative endophthalmitis, but none of these surgeries used intracameral moxifloxacin. Five and seven cases occurred in 2012 and 2013, respectively. There was a trend favoring moxifloxacin use, as a preventive measure for endophthalmitis, but the difference between groups was not significant (p = 0.56). In the group with endophthalmitis, 33.3% of the eyes were from patients with type 2 diabetes mellitus, in 13.3% there was rupture of the posterior capsule and 60% of the eyes corresponded to female patients. Since 2018 there is no record of endophthalmitis after cataract surgery performed in this center. Conclusions: Intracameral moxifloxacin showed a tendency to reduce the frequency of endophthalmitis after phacoemulsification surgery, but a longer observation period is required to reach statistical significance, due to the low frequency of this complication.

Exactitud de tamizaje de retinopatía diabética: inteligencia artificial versus tecnólogos médicos entrenados / Accuracy of artificial intelligence compared to trained medical technologists in diabetic retinopathy screening

Background: The early detection of retinopathy among diabetics is of utmost importance. Aim: To estimate the diagnostic accuracy of two diabetic retinopathy (DR) screening strategies currently used in the Chilean public health system. Material and Methods: Cross-sectional observational study of 371 diabetic patients aged 61 ± 14 years (61% women) who underwent DR screening at a public Hospital between July 1 and August 31, 2019. The mydriatic retinal photographs of all participants were classified using artificial intelligence software (DART) and trained medical technologists, independently. The precision of both strategies was compared with the reference standard, namely the evaluation of the fundus by an ophthalmologist with a slit lamp. Participants with severe non-proliferative DR or worse were considered as positive cases. The ophthalmologist was blind to the results of the screening tests. Results: Twenty four percent of participants had DR, including 34 (9.2%) who had sight threatening DR in at least one eye. The sensitivity and specificity of DART were 100% (95% confidence intervals (CI): 90-100%) and 55,4% (95% CI: 50-61%), respectively. Medical technologists had a sensitivity of 97,1% (95% CI: 85-100%) and a specificity of 91,7% (95% CI: 88-94%). The only case missed by medical technologists was a patient with unilateral panphotocoagulated DR. Conclusions: Both strategies had a similar sensitivity to detect cases of sight-threatening DR. However, the specificity of DART was significantly lower compared to medical technologists, which would greatly increase the burden on the health system, a very important aspect to consider in a screening strategy.

Tamizaje en el diagnóstico y prevalencia de retinopatía diabética en atención primaria / Coverage of a screening program and prevalence of diabetic retinopathy in primary care

Background: Diabetic retinopathy is the first cause of blindness during working years. Aim: Provide knowledge of screening coverage, prevalence and level of diabetic retinopathy in patients that belong to the Cardiovascular Health Program in primary care. Material and Methods: Analysis of retinographies performed to 9076 diabetic patients aged 61 ± 13 years (61% women) adscribed to a Cardiovascular Health program in primary care centers of South-East Metropolitan Santiago. The examination was carried out by the evaluation of retinographies by trained optometrists. Results: The coverage of the screening program was 21%. The prevalence of sight threatening diabetic retinopathy was 3,1%. The prevalence of these entities was 45% higher in people aged between 18 and 44 years than in older people. Their prevalence in urban communities was 32% higher than in rural locations. Conclusions: The coverage of the screening program is low. Diabetic patients aged 18 to 44 years and those coming from urban communities have a higher prevalence of severe non-proliferative and proliferative diabetic retinopathy.

Tratamiento con ablación multifocal para presbicie asociada a hipermetropía / Multifocal corneal ablation for presbyopia

Objetivos: Evaluar resultados clínicos y complicaciones en pacientes sometidos a lasik con ablación multifocal para tratar la presbicia. Material y Método: En forma prospectiva seleccionamos 38 ojos en 19 pacientes con presbicia e hipermetropía hasta +3.0 D y astigmatismo hasta +1.0 D sin patologías ocular ni cirugía previa. El análisis wavefront fue realizado con el aberrómetroVISX Wavescan® y el tratamiento con el VISX Star S4 IR excimer laser. El perfil de ablación fue el CustomVue™Multifocal Ablation que produce una zona óptica central para visión intermedia y cerca y una periférica para lejos. Los resultados fueron evaluados según seguridad, eficacia, predictibilidad, estabilidad, complicaciones y cambios en las aberraciones de alto orden. Resultados: La edad promedio fue de 52 años. El Equivalente Esférico preoperatorio fue +2.00 D +/- 0.56 D. El seguimiento fue de 6 meses. El Equivalente Esférico postoperatorio fue de -0.25 +/-0.56 D. No se observaron complicaciones. Hubo una pérdida de la mejor agudeza visual para lejos de 1 línea en el 12.5 por ciento de los ojos. En términos de eficacia el 75 por ciento de los pacientes alcanzan > 20/20 y el 100 por ciento > 20/40 sin corrección para lejos. Para cerca sin corrección 100 por ciento de los pacientes obtienen > J5, 88 por ciento obtiene > J3 y un 50 por ciento > J1. 62.5 por ciento de los pacientes alcanzaron > 20/25 para lejos y > J3 para cerca. Conclusión: El tratamiento con Lasik CustomVue™ Multifocal Ablation para pacientes hipermétropes con presbicie es un procedimiento seguro y produce un alto grado de satisfación debido a la independencia a los lentes. Un seguimiento más prolongado es necesario para evaluar nuestros buenos resultados.

Purpose: To evaluate outcomes and complications in patients who underwent multifocal corneal ablation to treat presbyopia. Methods: In a prospective way we selected 38 eyes of 19 patients with presbyopia and hyperopia up to +3.0 D and astigmatism up to +1.0 D. Patients with ocular pathology or with previous ocular surgery were excluded. The wavefront analysis was performed with the VISX Wavescan® aberrometer, and the treatment with the VISX Star S4 IR excimer laser. The ablation profile was CustomVue™ Multifocal Ablation, that produces a central zone for intermediate and near vision and a periferic zone for distance vision. The clinical outcomes were evaluated based in standards terms of safety, efficacy, predictability, stability, complications and changes in higher order aberrations. Results: The average age was 52 years. The mean of the preoperative spherical equivalent was + 2.00 D +/- 0.56 D. The follow up was up to 6 months. The mean of postoperative spherical equivalet was -0.25 +/-0.56, that was relatively stable after the first 6 postoperative months and no complication was observed. 12.5 percent of the eyes lost 1 line of BSCVA for distance vision. No subjects had change in BSCVA for near vision at the end of follow up. In terms of efficacy, 75 percent of subjects achieved 20/20 or better UCVA for distance and 100 percent achieved 20/40 or better UCVA. For near vision 100 percent of subjects achieved J5 or better vision at the end of follow up, 88 percent achieved > J3 and 50 percent > J1. 62.5 percent of subjects achieved both 20/25 or better vision for distance and J3 or better for near vision. Conclusion: The treatment with Lasik CustomVue™ ultifocal Ablation for hyperopic patients with presbyopia is a safe procedure and procedure a high rate of satisfaction due to spectacles independency. A longer follow up is necessary to evaluate ours good outcomes.

Anillos intracorneales en el manejo de las ectasias cornéales primarias / Intrastromal corneal rings in the treatment of eyes with primary corneal ectasia

Objetivo: Evaluar la seguridad, eficacia y complicaciones asociadas al implante de Anillos Intracorneales de Ferrara en el tratamiento de pacientes portadores de ectasia corneal primaria. Material y Métodos: Catorce pacientes portadores de queratocono bilateral o degeneración corneal pelúcida con intolerancia a lentes de contacto fueron evaluados en este estudio. Dieciséis ojos fueron implantados. Se realizó topografía corneal de elevación y paquimetría ultrasónica en todos los ojos para identificar el vértice del cono y la profundidad a la cual se debían implantar los anillos. Resultados: El seguimiento promedio fue de 19 meses. En 3 casos, los semianillos debieron ser explantados en el postoperatorio por extrusión de uno de ellos debido a una implantación muy superficial. En todos los ojos operados se demostró una reducción en el equivalente esférico y el astigmatismo con una significativa mejoría en la agudeza visual no corregida. Ningún ojo perdió líneas de la mejor agudeza visual corregida. Conclusiones: Los anillos intraestromales de Ferrara reducen la curvatura corneal y normalizan la córnea central en ojos con queratocomo. La implantación de los anillos de Ferrara es un procedimiento seguro para ser considerado en pacientes portadores de queratectasias primarias con intolerancia al uso de lentes de contacto, particularmente en aquellos cuya única alternativa es el trasplante de córnea.