A prospective observational study on the risk of contrast-induced nephropathy among patients undergoing fundus fluorescein angiography

@#OBJECTIVE: To determine the incidence of contrast-induced nephropathy (CIN) among patients undergoing fundus fluorescein angiography (FFA) METHODS: One hundred fifty-nine (159) patients from the Ophthalmology out-patient department were enrolled in this prospective, observational study. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were measured within 7 days before and 48 to 72 hours after FFA. Subjects were stratified into low-, intermediate-, and high-risk groups for developing CIN according to baseline eGFR. CIN was defined by an increase in SCr by more than 25% or by 0.5 mg/dL within 72 hours of intravascular administration of contrast media. The incidence of CIN, changes in SCr levels, and changes in eGFR were analyzed. RESULTS: Of the 144 subjects who completed the study, 106 (73.6%) were females, 105 (72.9 %) were diabetics, and 57 (39.6%) had elevated baseline SCr. Four (4 or 2.8%) patients developed CIN after FFA, all of whom had normal baseline SCr and were stratified as low-risks. Overall, there were no significant changes in the means of SCr (1.18 ± 0.56 vs 1.16 ± 0.52, p = 0.13) and eGFR (64.53 ± 26.05 vs 64.94 ± 24.88, p = 0.64) before and after FFA. In the low-risk group, the means of SCr and eGFR remained unchanged after FFA (p = 0.06 and p = 0.15, respectively). In the intermediate-risk group, no significant change was appreciated in SCr levels (p = 0.07) however a significant improvement in eGFR (p = 0.006) was seen. Interestingly, a significant decrease in SCr levels (p = 0.004) as well as a significant improvement in eGFR (p = 0.02) was noted after FFA in the high-risk group. CONCLUSION: The incidence of CIN among patients undergoing FFA in our cohort was 2.8%. There was no prolonged or serious worsening of renal function based on SCr and eGFR before and after FFA overall, and among low-, moderate-, and high-risk groups.

Short wavelength automated perimetry and peripapillary retinal nerve fiber layer in early diabetes

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To investigate the significance of short wavelength automated perimetry (SWAP) in detecting retinal functional impairment in early diabetic patients without retinopathy and with mild non-proliferative diabetic retinopathy (NPDR). <br /><br /> <strong>METHODS:</strong> This is a prospective, cross-sectional study of 37 eyes of early diabetics which were divided into 2 groups: no DR with 18 subjects and mild NPDR with 19. All subjects underwent HBA1C, SWAP, peripapillary RNFL thickness measurement and fundus photo. Visual field indices: MD and PSD as well as average RNFL thickness were compared among the 2 groups. Correlation of MD with RNFL thickness and HBA1C were also analyzed. <br /><br /> <strong>RESULTS:</strong> There was no statistically significant difference in the MD (-4.46 ± 3.03 vs -2.94 ± 2.21; p=0.09), PSD (3.08 ± 1.28 vs 2.69 ± 0.47; p=0.23) and average peripapillary RNFL thickness (98.47 ± 6.89 vs 98.72 ± 11.01; p=0.93) among early diabetics with mild NPDR and no signs of DR. There is no correlation between MD and RNFL thickness in the no DR group (R2=0.017) and the mild DR group (R2=0.000). There was a weak correlation between MD and HBA1C in the no DR group (R2=0.137), while no correlation was seen in the mild NPDR group (R2=0.000). <br /><br /> <strong>CONCLUSION:</strong> SWAP does not appear to be a sensitive measure of worsening retinopathy in older individuals with early diabetes. The usefulness of SWAP and peripapillary RNFL thickness in the early stages of retinopathy are inconclusive.</p>

Glycemic control and changes in macular thickness after phacoemulsification in diabetics

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To correlate glycemic control, as expressed by HbA1c levels, to the change in macular thickness in diabetic patients who undergo phacoemulsification.</p> <p style="text-align: justify;"><strong>METHODS:</strong> This was a prospective cohort study done at the Cataract and Medical Retina Clinics of the University of the Philippines Department of Ophthalmology and Visual Sciences (UP-DOVS), Sentro Oftalmologico Jose Rizal (SOJR) of the Philippine General Hospital, University of the Philippines - Manila. Participants included 15 diabetic patients with mature cataracts that warranted lens extraction surgery via phacoemulsification by a senior resident of the UP-DOVS. Participants were screened using pre-determined inclusion and exclusion criteria. Pre-operative best corrected visual acuity (BCVA) was obtained for both eyes using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Pre-operative central macular thickness (CMT) was measured using the Cirrus Ocular Coherence Tomography (OCT) machine. Patients then underwent monocular phacoemulsification by their respective surgeons and instilled antibiotic and steroid drops as instructed. One month after surgery, BCVA and post-operative CMTwere measured. Blood was extracted and sent for determination of glycosylated hemoglobin (HbA1c) levels. Ttest was done to compare the mean CMT and BCVA at baseline and at 1 month after phacoemulsification in the study and control eyes. T-test was also used to compare the mean change in CMT in the study and control eyes. Simple correlation between HbA1c and CMT, as well as CMT and BCVA, was done using Pearson's R.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> Neither mean baseline nor mean post-operative CMT between study and control eyes were statistically different  and p=0.1562). There was a statistically significant greater mean CMT in the study eye group (p=0.004). There was a mean change in CMT of 16.7 ± 18.5 ?m, and 1.8 ± 8.8 ?m in the group of control eyes (p=0.011). Mean HbA1c was 8.19%. No positive correlation was established between HbA1c and mean CMT in both study eyes (r=-0.312) and control eyes (r=-0.289). No correlation was established between BCVA and CMT (r=0.426).</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> In diabetics, eyes that undergo phacoemulsification gain a significant change in CMT but this may not necessarily result in macular edema and may not parallel the severity of diabetic retinopathy. We were not able to demonstrate correlation between CMT and HbA1c levels or CMT and BCVA.</p>

Psychological profile of patients with central serous retinopathy

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the psychological profile of Filipino patients diagnosed with central serous retinopathy (CSR).<br /><strong>METHODOLOGY:</strong> Patients seen at the Philippine General Hospital and diagnosed with CSR were included in the study after undergoing an eye evaluation. They completed a data collection form and the Minnesota Multiphasic Personality Inventory (MMPI) questionnaire that was administered by a psychologist. The results of the MMPI were analyzed against an available normative scale. The socio-demographic data and patients' psychological profile were determined.<br /><strong>RESULTS:</strong> The study population (N=12) included 10 males (83%) and 2 females (17%), with a mean age of 38 ± 8.58 years. Eighty three percent (83%) of the patients lived at home with their families. All (100%) had some formal education; 58% attended or completed high school. The majority (75%) worked in non-professional roles (cooks, drivers, seaman, salesman) and 25% were not working. Most (67%) had no other medical illnesses. In the MMPI, the CSR patients showed tendencies to schizophrenia (84%), hysteria (83%), depression (75%), psychopathic deviate (67%), and hypochondriasis (58%).<br /><strong>CONCLUSION:</strong> The socio-demographic data confirmed that CSR is an ailment largely affecting middle-aged men. The sample population of Filipino CSR patients have the tendency to demonstrate schizophrenia (84%), hysteria (83%), depression (75%), and psychopathic deviate (67%), and 33% showed type A personality.</p>