Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde / Color retinography as a means of screening for diabetic retinopathy in the tertiary hospital of Unified Health System

RESUMO Objetivo Avaliar o impacto da triagem de retinopatia diabética de paciente diabéticos realizada com retinografia colorida. Métodos Estudo retrospectivo, de caráter descritivo, avaliando laudos de retinografias realizadas desde a implementação do protocolo da triagem de retinopatia diabética de paciente diabéticos acompanhados no Ambulatório de Endocrinologia de um hospital terciário do Sistema Único de Saúde, de maio de 2018 até maio de 2020. Resultados Realizaram retinografia 727 pacientes diabéticos, que tinham entre 14 e 91 anos, sendo a maioria com 60 anos ou mais (53,2%), do sexo feminino (68%) e brancos (87,6%). Não apresentavam retinopatia diabética 467 (64,2%) pacientes, 125 (17,2%) tinham retinopatia diabética não proliferativa, 37 (5,1%) retinopatia diabética não proliferativa grave e/ou suspeita de edema macular, 65 (8,9%) retinopatia diabética proliferativa, 21 (2,9%) suspeita de outras patologias, e as imagens de 12 (1,7%) pacientes eram insatisfatórias. Foram considerados de alto risco (aqueles com retinopatia diabética não proliferativa grave e/ou edema macular, retinopatia diabética proliferativa ou imagem insatisfatória) 114 (15,68%) pacientes. Conclusão O rastreio de retinopatia diabética com retinografia colorida possibilitou a detecção de pacientes diabéticos de alto risco que necessitavam atendimento com brevidade, permitindo o acesso deles à consulta oftalmológica e diminuindo a morbidade da doença relacionada ao tratamento tardio. Os demais foram encaminhados à Atenção Primária para regulamentação, por meio do Sistema de Regulação.

ABSTRACT Objective To evaluate the impact of diabetic retinopathy (DR) screening using color retinography in diabetic patients. Methods Retrospective descriptive study, evaluating reports of all retinographs performed since the implementation of the protocol for screening for diabetic retinopathy in diabetic patients followed up at the endocrinology outpatient clinic of a tertiary hospital of the Unified Health System, from May 2018 to May 2020. Results 727 diabetic with age range from 14 to 91 years old, the majority being 60 years old or older (53.2%), female (68%) and white (87.6%), patients underwent retinography. Of the patients, 467 (64.2%) did not have DR, 125 (17.2%) had non-proliferative DR, 37 (5.1%) had severe non-proliferative DR and/or suspected macular edema, 65 (8.9%) had proliferative DR, 21 (2.9%) had suspicion signs of other pathologies and 12 (1.7%) had unsatisfactory images. A total of 114 (15.68%) patients were considered at high risk (those with severe non-proliferative NP and/or EM, proliferative DR or poor image) and were referred for comprehensive ophthalmic evaluation. Conclusion The screening of RD with color retinography enabled the detection of high-risk diabetic patients who needed assistance sooner and enabled their access to ophthalmologic consultation, which decreased disease morbidity. The others were referred to primary care for regulation through the Regulation System (SISREG).

Prevalência e fatores de risco para retinopatia diabética em pacientes diabéticos atendidos por demanda espontânea: um estudo transversal / Prevalence and risk factors of diabetic retinopathy in patients with diabetes seen by unscheduled demand: a cross-sectional study

RESUMO Objetivo: Estimar a prevalência da retinopatia diabética em pacientes diabéticos de uma capital brasileira e correlacioná-la com fatores de risco presentes na população estudada. Métodos: Estudo observacional transversal, realizado a partir do relatório de atendimentos prestados em mutirão ocorrido em 2018. O relatório foi preenchido pelos médicos oftalmologistas durante a campanha, com informações referentes a sexo do paciente, idade, classificação do diabetes mellitus, tempo de doença, uso de insulina, índice de massa corporal, hábitos de vida (tabagismo e atividade física) e história de hipertensão arterial sistêmica, dislipidemia, infarto agudo do miocárdio e acidente vascular cerebral, além de exame clínico oftalmológico realizado na ação. Resultados: Dentre os 219 participantes do estudo, a prevalência da retinopatia diabética foi de 31,96%. As variáveis que se apresentaram como fator de risco com significância estatística foram sexo masculino, idade de 51 a 70 anos, mais de 10 anos de diabetes mellitus, insulinoterapia, índice de massa corporal ≥40kg/m2 e história prévia de infarto agudo do miocárdio. Atividade física mostrou-se como fator protetor significativo. Conclusão: Estudos populacionais ao longo dos anos comprovaram a variabilidade geográfica na prevalência da retinopatia diabética justificada pela diferente exposição aos fatores de risco. Dentro de tal conjuntura, ressalta-se o quão fundamental é o conhecimento das características regionais, de modo a orientar as políticas de saúde pública, permitindo atuar com impacto na redução das estatísticas de cegueira evitável.

ABSTRACT Objective: To estimate the prevalence of diabetic retinopathy in patients with diabetes, from a Brazilian capital city, and to correlate with the risk factors present in the studied population. Methods: A cross-sectional observational study, based on the report of care provided by a campaign, in 2018. The report was filled out by ophthalmologists during the joint effort, with information on patient's gender, age, classification of diabetes mellitus, duration of illness, use of insulin, body mass index, lifestyle (smoking and physical activity), history of hypertension, dyslipidemia, myocardial infarction, stroke, and the clinical ophthalmic examination. Results: Among the 219 study participants, the prevalence of diabetic retinopathy was 31.96%. The variables considered risk factors with statistical significance were male sex, age 51-70 years, diabetes mellitus for over 10 years, insulin therapy, body mass index ≥40 kg/m2, and previous history of myocardial infarction. The physical activity proved to be a significant protective factor. Conclusion: Over the years, population studies have proven the geographical variability in prevalence of diabetic retinopathy justified by different exposure to risk factors. Therefore, knowledge of regional characteristics is crucial and emphasized in the text, since it can guide public health policies, aiming to have an impact on reduction of preventable blindness statistics.

Sensibilidad al contraste en un grupo de diabéticos mexicanos / Contrast sensitivity in a group of Mexican diabetics

RESUMEN Objetivo: Comparar la sensibilidad al contraste evaluada en un grupo de mexicanos con diabetes mellitus contra uno sin diabetes como control. Métodos: Un total de 31 voluntarios, 14 participantes con DM con un tiempo de diagnóstico entre 2 y 20 años (sin retinopatía diabética), y 17 en el grupo control iniciaron el estudio; 4 diabéticos y 5 no diabéticos fueron excluidos por no cumplir con los criterios de inclusión. Por lo tanto, los datos analizados fueron de un grupo de 10 diabéticos (52 ± 10 años) y otro de 12 no diabéticos (52 ± 6 años). Se evaluó la sensibilidad al contraste con la cartilla Vector Vision CSV1000E a una distancia de 2,5 metros con una iluminación de 85 cd/m2. Resultados: Un mayor porcentaje de ojos diabéticos alcanzaron un mejor umbral de contraste en 3, 6 y 18 ciclos por grado en comparación con el grupo control. En 12 ciclos por grado solamente en los umbrales 1 y 5. Conclusiones: La sensibilidad al contraste de la población mexicana con diabetes mellitus presenta mejor percepción de contraste en las frecuencias evaluadas que el grupo control(AU)

ABSTRACT Objective: Compare contrast sensitivity as measured in a group of Mexican diabetes mellitus patients versus a control non-diabetic group. Methods: A group of 31 volunteers, 14 participants with DM with a diagnosis time between 2 and 20 years (without diabetic retinopathy), and 17 in the control group started the study; 4 diabetics and 5 non-diabetics were excluded because they did not meet the inclusion criteria. Therefore, the data analyzed were from a group of 10 diabetics (52 ± 10 years) and another of 12 non-diabetics (52 ± 6 years). Contrast sensitivity was evaluated with a Vector Vision CSV1000E chart at a distance of 2.5 meters and a luminance of 85 cd/m2. Results: A higher percentage of diabetic eyes reached a better contrast threshold at 3, 6 and 18 cycles per degree in comparison with the control group. At 12 cycles per degree only at thresholds 1 and 5. Conclusions: Contrast sensitivity in the Mexican population with diabetes mellitus displays better contrast perception at the frequencies evaluated than the control group(AU)

Rol del diagnóstico de enfermería en el tratamiento láser de la retinopatía diabética / The Role of the Nursing Diagnosis during Laser Treatment of Diabetic Retinopathy

Introducción: La retinopatía diabética es una de las causas más frecuentes de ceguera legal. El tratamiento láser induce la regresión de la retinopatía diabética. Objetivo: Describir el rol del diagnóstico de enfermería en el tratamiento láser de la retinopatía diabética proliferativa. Métodos: Estudio descriptivo, prospectivo en el servicio de Oftalmología del Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río, en el periodo marzo - agosto 2018. El universo estuvo constituido por 274 pacientes con retinopatía diabética proliferativa, de los cuales se seleccionó una muestra intencional de 137 de ellos. Las variables analizadas fueron: edad, sexo, tratamiento previo, tiempo de evolución de la diabetes, diagnóstico de enfermería y respuesta al tratamiento Resultados: El 100 por ciento de los pacientes estudiados tuvo un diagnóstico de enfermería de ansiedad y 66,43 por ciento pertenecieron al grupo etario de 61-70 años de edad. El 72,99 por ciento de los pacientes del sexo femenino presentó el diagnóstico de ansiedad. El 89,05 por ciento de los pacientes estudiados tenían tratamiento previo con insulina, más de 15 años de evolución de la enfermedad y una respuesta completa al tratamiento, p < 0,001 cuando se correlacionó diagnóstico de enfermería con respuesta completa y parcial. Conclusiones: El diagnóstico de enfermería unido a la educación y acompañamiento del paciente con retinopatía diabética proliferativa durante el tratamiento láser, es de suma importancia para la respuesta adecuada al tratamiento láser y para proporcionarles una mejor calidad de vida a estos pacientes(AU)

Introduction: Diabetic retinopathy is one of the most frequent causes of legal blindness. Laser treatment induces regression of diabetic retinopathy. Objective: To describe the role of nursing diagnosis in the laser treatment of proliferative diabetic retinopathy. Methods: Descriptive and prospective study carried out in the ophthalmology service of Abel Santamaría Cuadrado General Teaching Hospital of Pinar del Río, in the period from March to August 2018. The study group consisted of 274 patients with proliferative diabetic retinopathy, of which we selected an intentional sample of 137. The variables analyzed were age, sex, previous treatment, time of evolution of diabetes, nursing diagnosis, and response to treatment. Results: 100 percent of the patients studied had a nursing diagnosis of anxiety and 66.43 percent belonged to the age group of 61-70 years. 72.99 percent of female patients presented the diagnosis of anxiety. 89.05 percent of the patients studied had prior treatment with insulin, more than 15 years of disease progression, and a complete response to treatment; p < 0.001 when a nursing diagnosis was correlated with complete and partial response. Conclusions: The nursing diagnosis together with the education and accompaniment of the patient with proliferative diabetic retinopathy during laser treatment is of paramount importance for the adequate response to laser treatment and to provide a better quality of life for these patients(AU)

Óxido nítrico y estrés oxidativo en la retinopatíadiabética / Nitric oxide and oxidative stress in diabetic retinopathy

El estrés oxidativo está implicado en las complicaciones de la diabetes mellitus, como la retinopatía. En condiciones de hiperglucemia se incrementan los niveles de óxido nítrico y de anión superóxido, y se produce daño irreversible a biomoléculas. En este estudio se evaluaron los niveles urinarios y plasmáticos de nitritos, nitrotirosina en plasma eindicadores de estrés oxidativo en pacientes diabéticos tipo 1 con y sin retinopatía, procedentes de los Hospitales Gustavo Fricke, Naval y Van Buren, en Valparaíso. Se observó diferencia en los niveles de nitritos en plasma entre diabéticos con y sin retinopatía, y el grupo control (117,95±8,80 µmol/L; 77,98±32,65 µmol/L; 58,72±13,37 µmol/L; respectivamente; p<0,0001). La nitrotirosina plasmática es menor en diabéticos sin retinopatía en relación con los que presentan la complicación (0,76±1,93vs 2,20±2,44 µmol/L; p=0,0008) y es casi imperceptible en el grupo control (0,02±0,00µmol/L). Una menor actividad de las enzimas superóxidodismutasa y catalasa, así como mayor lipoperoxidación se demostró en pacientes con retinopatía. Los resultados permiten sugerir que existe una relación entre la formación e inactivación de NO con el estrés oxidativo, la retinopatía diabética y probablemente con la patogenia de esta complicación(AU)

Association between the RAGE (receptor for advanced glycation end-products) -374T/A gene polymorphism and diabetic retinopathy in T2DM

Summary Objective: Interaction between advanced glycation end-products (AGEs) and receptor for AGEs (RAGE) in cells could affect both extracellular and intracellular structure and function, which plays a pivotal role in diabetic microvascular complications. The results from previous epidemiological studies on the association between RAGE gene -374T/A polymorphism and diabetic retinopathy (DR) risk were inconsistent. Thus, we conducted this meta-analysis to summarize the possible association between RAGE -374T/A polymorphism and DR risk. Method: We searched all relevant articles on the association between RAGE -374T/A polymorphism and DR risk from PubMed, Cochrane Library, ScienceDirect, Wanfang, VIP and Chinese National Knowledge Infrastructure (CNKI) web databases up to August 2016. Odds ratio (OR) with 95% confidence interval (CI) were calculated to assess those associations. All analyses were performed using the Review Manager software. Results: Nine case-control studies, including 1,705 DR cases and 2,236 controls were enrolled, and the results showed that the A allele of RAGE -374T/A polymorphism was significantly associated with increased DR risk in dominant model (TA/AA vs. TT: OR=1.22, 95CI 1.05-1.41, p=0.006) and heterozygote model (TA vs. TT: OR=1.26, 95CI 1.07-1.47, p=0.005). The subgroup analysis by ethnicity showed that significantly increased DR risk was found in both Asian and Caucasian populations. Conclusion: This meta-analysis reveals that the A allele of RAGE -374T/A polymorphism probably increase DR risk.

Trajetória assistencial de um evento sentinela: avaliação da atenção integral ao usuário diabético no SUS a partir da Retinopatia Diabética Grave / Trajectory of a Sentinel Event Assistance: evaluation of a full diabetic user attention in SUS from Severe Diabetic Retinopathy

A prevalência das condições crônicas cresce vertiginosamente na população. Dentre elas, destaca-se o diabetes, sendo o agravo responsável por incapacidades e mortes, com elevados custos financeiros e sociais. Os muitos casos de complicações do diabetes evidencia a existência de falhas na atenção à saúde dos usuários. Diante desse contexto, se faz necessário a mudança na organização da atenção à saúde, com vistas à atenção integral, intencionando transcender a racionalidade estritamente biomédica e oferecer respostas efetivas às suas necessidades de saúde. Esse estudo se propôs a avaliar a atenção integral ao usuário diabético no município de Recife, a partir das trajetórias assistenciais dos diabéticos complicados com retinopatia diabética grave, considerada como uma complicação evitável do diabetes e, portanto, um indicador de monitoramento de emergência ou evento sentinela. Foram identificados 4 usuários com retinopatia diabética no Centro Médico, serviço de referência para o portador de diabetes, que foram entrevistados através da técnica em profundidade. As trajetórias dos usuários foram reconstruídas, sendo que os mesmos foram renomeados com termos que melhor expressam o sentimento mais explícito em cada um dos caminhos. As entrevistas foram analisadas a partir da Técnica da História de Vida, com foco nas categorias pré-estabelecidas: acesso e utilização de serviços; atendimento humanizado: vínculo, responsabilização e acolhimento; e coordenação e ordenação do cuidado. Identificaram-se fragilidades na atenção dos usuários, destacando-se ainda a quase inexistente relação entre os entrevistados e a atenção básica, o que prejudica ainda mais a garantia da assistência integral As evidências encontradas embasam a afirmativa de que os usuários diabéticos não são assistidos de forma integral, mantendo-se a assistência fragmentada e focada nas agudizações da doença. Uma atenção à saúde não adequada possibilita o surgimento de complicações evitáveis, como a retinopatia diabética e outras. Faz-se necessário uma mudança na organização da atenção à saúde do diabético, a fim de alcançar uma assistência integral e resolutiva para o mesmo, que se traduza em redução da prevalência das complicações do agravo e de seu impacto social.

The prevalence of chronic conditions grows dramatically in the population. Among them, there is diabetes, which is responsible for disability and death and also for high financial and social costs. The many cases of diabetes complications shows the failures in the health care system. In this context, is necessary a big change in the health care organization, in order to integrality care, intending to transcend the strictly biomedical rationality and offer effective answers to their health needs. This study aimed to evaluate the integral care for diabetics user in the city of Recife, from the care trajectories of complicated diabetes with severe diabetic retinopathy, regarded as a preventable complication of diabetes and therefore an emergency monitoring indicator or sentinel event. Four users were identified with diabetic retinopathy at the Medical Center, referral service for patients with diabetes, who were interviewed by the depth technique. The trajectories of the users have been rebuilt, and they were renamed with terms that best express the most explicit sense in each of the paths. The interviews were analyzed from the Technical Life Story, focusing on pre-set categories: access and use of services; humanized care: link, accountability and host; and coordination and ordering of care. We identified weaknesses in users attention, highlighting the still almost non-existent relationship between respondents and primary care, which further undermines the guarantee of comprehensive care. The evidence underpin the assertion that diabetics users are not assisted fully, keeping the fragmented and focused assistance in "exacerbations" of the disease. An attention to inadequate health enables the emergence of preventable complications, such as diabetic retinopathy and other. A change in the diabetic health care organization is necessary in order to achieve a comprehensive assistance and problem-solving for the same, which would result in reducing the prevalence of complications of this disease and its social impact.

Complicações crônicas do diabetes / Chronic diabetes complications

As complicações crônicas do diabetes mellitus (DM) são decorrentes principalmente do controle inadequado, do tempo de evolução e de fatores genéticos da doença. As complicações crônicas microvasculares englobam a nefropatia diabética, a retinopatia diabética e a neuropatia diabética. As complicações crônicas macrovasculares, como o próprio nome diz, são resultantes de alterações nos grandes vasos e causam infarto agudo do miocárdio, acidente vascular cerebral e doença vascular periférica. O risco relativo de morte devido a complicações vasculares é três vezes maior nos pacientes com DM do que na população restante com as doenças cardiovasculares (DCVs), sendo responsáveis por até 80% dos óbitos em portadores de DM. Nesses pacientes o risco de infarto agudo do miocárdio (IAM) é semelhante àquele observado em pessoas sem DM que já tiveram um IAM prévio...

The complications from chronic diabetes mellitus (DM) are resulting from inadequate control, time evolution and disease genetics factors. The chronic microvascular complications include diabetic nephropathy, diabetic retinopathy and diabetic neuropathy. The chronic microvascular complications, as name says itself, are resulting from large-vessels adjustments and it causes acute myocardial infarction, cerebrovascular accident and peripheral arterial disease as well. The relative risk of death due vascular complications is three times bigger in patients with DM than in remaining people with cardiovascular diseases (CVDs) which are responsible for until 80% of obituaries in DM carriers. In these patients, the risk of acute myocardial infarction (AMI) is similar to that observed in people who do not have DM and who had previous IAM...

Retinopatia em pacientes hipertensos e/ou diabéticos em uma unidade de saúde da família / Retinopathy in patients with hypertension and/or diabetes in a family health unit

Objetivo: Identificar a prevalência de alterações à oftalmoscopia direta em pacientes com diagnóstico de hipertensão e/ou diabetes mellitus em uma Unidade de Saúde da Família (USF). Método: Estudo individual, observacional, prioritariamente descritivo, do tipo transversal, com amostra composta por coorte de 50 pacientes hipertensos e/ou diabéticos matriculados no programa HIPERDIA de uma Unidade de Saúde Familiar (USF) do município de Ananindeua - Pará, entre os meses de setembro e novembro de 2009. Resultados: Foi realizada oftalmoscopia em 46 pacientes. Observou-se alteração à oftalmoscopia em 27 (58,7%). Ao realizar a análise específica (excluindo-se os achados de estreitamento arteriolar e ingurgitamento venoso) houve alterações em 18 (39,1%), sendo 45,5% com DM e HAS, quarenta por cento com DM e 36% com HAS. Conclusão: A elevada prevalência de alterações à oftalmoscopia encontradas no presente estudo demonstra sua eficácia como método de rastreio no contexto da atenção primária a saúde, justificando seu uso. Corrobora, ainda, a importância da atenção primária à saúde na prevenção da retinopatia hipertensiva e diabética, através do controle periódico de pacientes de alto risco vascular como a população estudada. .

Purpose: To identify the prevalence of abnormal ophthalmoscopy in patients with systemic hypertension (SH) and / or diabetes mellitus (DM) in a Family Health Unit (FHU). Method: was performed a individual study, observational, primarily descriptive and crosssectional of a sample of a cohort of 50 patients with hypertension and / or diabetic enrolled in the program HIPERDIA in a FHU of the city of Ananindeua - Para, between the months of september and november 2009. Results: ophthalmoscopy was performed in 46 patients and 27 (58.7%) had some alteration. When performing a specific analysis (excluding the findings of arteriolar narrowing and venous engorgement) were changes in 18 (39.1%), 45.5% with DM and SH, 40% with DM and 36% with SH. Conclusion: The high prevalence of the changes in ophthalmoscopy found in this study demonstrates that effectiveness as a screening method in the context of primary health care, justifying that use. corroborates also the importance of primary care in the prevention of diabetic and hypertensive retinopathy, through periodic control of patients at high vascular risk as the population studied. .

Risk factors for diabetic retinopathy in patients attending primary care settings

To identify risk factors for diabetic retinopathy [DR] among patients with diabetes attending primary care health centers and to assess level of control. Case control study. Twenty-two health centers. The medical records of patients with diabetes who were screened for retinopathy during the year 2011 were reviewed. The following were documented: age, sex, duration of diabetes, glycated hemoglobin [A1C], blood pressure [BP], lipid profile, smoking status, presence or absence of chronic kidney disease and guardian drugs [Angiotensin Converting Enzyme Inhibitors [ACEi], Angiotensin Receptor Blockers [ARBs], Statins and Aspirin] used. In addition, patients with diabetes who were screened as normal [no DR] from 4 health centers were randomly selected and their medical records were reviewed to compare the above mentioned risk factors between those with and those without DR. A total of 1,508 retinal screening forms were reviewed, 112 patients were diagnosed with DR. A total of 263 screened but had no DR were reviewed in the selected 4 health centers. In DR, uncontrolled A1C was found in 81 [72.3%] patients, high BP in 69 [61.6%] and Low Density Lipoprotein in 81 [72.3%]. There was statistically significant association between A1C >/= 53mmol/mol [P=0.000], increased diabetes duration [P=0.000], total cholesterol >/= 5.2mmol/l [P=0.008], LDL >/= 2.6mmol/l [P=0.002] and the presence of DR. There was no significant association between age, sex, BP, and triglycerides level >/= 1.7mmol/l and presence of DR. The use of statins, ARBs, fibrates and aspirin was significantly higher in patients with DR. Control of the identified modifiable risk factors is suboptimal. The burden of DR can be reduced by more intensive control of these factors through effective use of the currently available guardian drugs

Manejo de las complicaciones oftalmológicas de la Diabetes Mellitus / Management of ophthalmological complications of Diabetes Mellitus

Esta guìa contiene datos generales relacionados con la ceguera la edad en pacientes diabeticos no controlada. hay un incremento de casos por ceguera a nivel mundial que son de alta prevalencia y severidad. algunas clsificaciones de la diabetes mellitus oftalmopatìas; retinopatìa, opacidades del cristalino o cataratas, glaucoma, lesiones de la cornea, paresia o paralisis de musculos extraoculares secundario a neuropatìa. aunque existen alguna medidas de estricto control metabolico.

Short Term Visual Prognosis After Retinal Laser Photocoagulation for Diabetic Retinopathy.

To assess the outcome of laser photocoagulation treatment for diabetic retinopathy in relation to various risk factors. Method: The change in visual acuity shortly after laser photocoagulation for diabetic retinopathy was assessed in 50 eyes of 25 patients and was compared to the age of onset of diabetes, type of retinopathy, pre treatment duration of diabetes, hypertension, microalbuminuria, smoking, dyslipedemia, associated complications of diabetes and type of treatment of diabetes. Results: Visual improvement was good in young diabetics, short duration of diabetes and parents having mild diabetic retinopathy. Factors having adverse effect on prognosis were longer duration of diabetes, hypertension, dyslipedemia, nephropathy and severe diabetic retinopathy. There was no significant influence of smoking, glycemic control, type of treatment, age of onset and sex of patients on visual outcome. Conclusion: Early diagnosis of retinopathy and initiation of specific treatment by laser photocoagulation at earlier stages with proper control of risk factors viz hypertension, dyslipidemia and nephropathy lead to a favourable visual outcome.

Early visual changes in diabetic patients with no retinopathy measured by color discrimination and electroretinography

Early visual changes caused by diabetes include color vision losses and an abnormal full-field electroretinogram. The purpose of this study was to evaluate color vision in type 2 diabetic patients with no clinically detectable retinopathy using an objective psychophysical color vision test, evaluate retinal function assessed by full-field electroretinography (ffERG), and verify the agreement among the changes detected by each of these tests. Color vision was tested and ffERG was performed in 34 diabetic patients (20 males; ages 56 ± 9 years). Results were compared with those obtained from age-matched control groups. Color discrimination losses occurred in all three color-confusion axes with a higher incidence on the protan axis. The full-field electroretinographic data indicated that inner retinal components (i.e., ffERG oscillatory potentials) were more affected than outer retinal components, indicating impairment of second- and third-order retinal neurons early in the disease. Previous studies reported tritan losses as a classic color vision defect in diabetes, but our results showed that all three color-confusion axes (i.e., protan, deutan, and tritan) are compromised, at least during the very early stages of the disease, reflecting a diffuse pattern of color vision loss. The full-field electroretinographic results that showed abnormalities of the inner retina support the color vision findings...

Study on vascular endothelial growth factor and its receptor in the vitreous of diabetic rats / Estudio del factor de crecimiento endotelial vascular y su receptor en el humor vítreo de ratas diabéticas

OBJECTIVE: To investigate the vitreous level of vascular endothelial growth factor (VEGF) and kinase insert domain-containing receptor (KDR) in diabetic rats, and to explore the role of VEGF and KDR in diabetic retinopathy. METHODS: Eighty-four adult Wistar rats were randomly divided into two groups. Fifty-eight rats in group A were injected intraperitoneally with streptozotocin to induce diabetes and 20 rats in group B were injected with physiological saline. Blood glucose meter was used to detect the blood glucose level at 72 hours after injection; blood glucose level >16.67 mmol/L was considered to be successful modelling. Blood glucose level was assayed and body mass was measured on the same modelling day, one week, two weeks and four weeks after modelling. Four weeks after modelling, the vitreous was taken and the VEGF and KDR levels were detected by enzyme-linked immunosorbent assay (ELISA). The eyeballs were fixed with paraform and embedded by petrolin for haematoxylin and eosin (H & E) staining. RESULTS: Forty-two rats survived and 16 rats died in group A. No rats died in group B. The blood glucose at one week, two weeks and four weeks between the two groups had statistical differences (p < 0.05). The weight at one week and two weeks between the two groups was not different but there was statistical difference at four weeks between the two groups (p < 0.01). The ELISA results showed that the VEGF and KDR levels were 0.276 ± 0.026 ng/mL and 2.936 ± 0.295 ng/mL in group A, 0.231 ± 0.021 ng/mL and 2.394 ± 0.227 ng/mL in group B, respectively. The VEGF and KDR levels of group A were higher than those of group B (p < 0.05). CONCLUSIONS: The changes of VEGF and KDR levels in the vitreous of diabetic rats were related to the early retinopathy induced by diabetes.

OBJETIVO: Investigar el nivel vítreo del factor de crecimiento endotelial vascular (FCEV) y receptor con dominio inserto-quinasa (KDR) en ratas diabéticas, y explorar el papel de FCEV y KDR en la retinopatía diabética. MÉTODOS: Ochenta y cuatro ratas adultas Wistar fueron divididas aleatoriamente en dos grupos. A cincuenta y ocho ratas en el grupo A se les inyectó estreptozotocinapor vía intraperitonealpara inducir diabetes, mientras que a 20 ratas en el grupo B se les inyectó una solución salina fisiológica. Se usó un medidor de glucosa en sangre para detectar el nivel de glucosa en sangre a las 72 horas después de la inyección. Un nivel de glucosa en sangre > 16.67 mmol/L se consideró como un modelo exitoso. Se analizó el nivel de glucosa en sangre, y se midió la masa corporal en el mismo día del modelado, y una semana, dos semanas, y cuatro semanas después del modelado. Cuatro semanas después del modelado, se tomó el humor vítreo, y los niveles de FCEV y KDR fueron detectados mediante ensayo por inmunoabsorción ligado a enzimas (ELISA). Los globos oculares fueron fijados con para formaldehido e incrustados por petrolin para tinción (H & E) hematoxilina-eosina. RESULTADOS: Cuarenta y dos ratas sobrevivieron y 16 ratas murieron en el grupo A. Ninguna de las ratas en el grupo B murió. La glucosa en la sangre a la semana, las dos semanas, y las cuatro semanas entre los dos grupos tuvo diferencias estadísticas (p < 0.05). El peso a la semana y a las dos semanas entre los dos grupos no fue diferente, pero hubo diferencia estadística a las cuatro semanas entre los dos grupos (p < 0.01). Los resultados de ELISA mostraron que los niveles de FCEV y KDR fueron 0.276 ± 0.026 ng/mLy 2.936 ± 0.295 ng/mL en el grupo A, 0.231 ± 0.021 ng/mL y 2.394 ± 0.227 ng/mL en el grupo B, respectivamente. Los niveles de FCEV y KDR del grupo A fueron superiores a los del grupo B (p < 0.05). CONCLUSIONES: Los cambios de nivel FCEV y KDR en el humor vítreo de las ratas diabéticas estaban asociados con la retinopatía temprana inducida por diabetes.

Características clínicas y frecuencia de complicaciones crónicas en personas con diabetes mellitus tipo 2 de diagnóstico reciente / Clinical characteristics and frequency of chronic complications in people with newly diagnosed Type 2 Diabetes Mellitus

La caracterización clínica de las personas con diabetes es esencial para efectuar su evaluación de forma integral y ofrecer un tratamiento médico individualizado. Objetivo: identificar las características clínicas y la frecuencia de complicaciones crónicas en personas con Diabetes Mellitus tipo 2 de diagnóstico reciente en la provincia Granma. Métodos: se realizó un estudio transversal y descriptivo con pacientes diabéticos tipo 2 ingresados en el Centro de Atención al Diabético de Bayamo, Granma, en el período comprendido entre enero de 2011 a julio de 2012. El universo estuvo constituido por los 683 pacientes que ingresaron durante esa etapa en la institución. Representaron la muestra los 150 diabéticos tipo 2 que tenían menos de 6 meses de padecer la enfermedad. Resultados: la edad media fue de 49,2 años. Predominaron los diabéticos con antecedentes familiares de Diabetes Mellitus (60,6 por ciento), con sobrepeso y obesidad (90 por ciento) e hipertensos (62 por ciento). Al momento del diagnóstico 43 (28,7 por ciento) casos presentaron complicaciones crónicas: 9 (6 por ciento) retinopatía diabética, 16 (10,6 por ciento) polineuropatía diabética, 11 (7,3 por ciento) cardiopatía isquémica, 4 (2,6 por ciento) ictus y 13 (8,6 por ciento) enfermedad arterial periférica. A 7 pacientes se les diagnosticó más de una complicación. Conclusiones: la Diabetes Mellitus tipo 2 frecuentemente se presenta en nuestro medio en personas mayores de 45 años, con antecedentes familiares de diabetes y asociada a la obesidad y la hipertensión arterial. Las complicaciones crónicas de la diabetes están presentes en un porcentaje elevado de casos al momento del diagnóstico inicial de dicha enfermedad...

Clinical characterization of people with diabetes mellitus is essential to carry out its comprehensive evaluation and indicate an individualized medical treatment. Objective: to identify the clinical characteristics and the frequency of chronic complications in people with newly diagnosed Type 2 Diabetes Mellitus in Granma Province. Methods: a descriptive cross-sectional study was conducted in patients with Type 2 Diabetes Mellitus who were admitted to The Diabetes Care Center in Bayamo, Granma, from January 2011 to July 2012. The universe was composed of the 683 patients who were admitted to this institution during this period of time. The sample was represented by the 150 Type 2 diabetics who have been suffering from this disease for less than 6 months. Results: the mean age was 49, 2 years. The diabetics who had family antecedents of Diabetes Mellitus (60, 6 percent), the ones who were overweight and obese (90 percent) and the hypertensive ones (62 percent), predominated in the study. At the moment of the diagnosis, 43 cases (28,7 percent) presented the following chronic complications: 9 had diabetic retinopathy (6 percent), 16 had diabetic polyneuropathy (10, 6 percent), 11 had ischemic heart disease (7,3 percent), 4 suffered from stroke (2,6 percent) and 13 presented peripheral arterial disease (8,6 percent). 7 patients were diagnosed with more than one complication. Conclusions: type 2 Diabetes Mellitus frequently occurs in people over 45 years, with family antecedents of diabetes mellitus associated to obesity and hypertension. Chronic complications of diabetes are present in a high percent of cases at the moment of the initial diagnosis of the disease...

Haptoglobin2-2 phenotype is an additional risk factor of retinopathy in type 2 diabetes mellitus.

AIMS: The aim of this study was to investigate the association between haptoglobin (Hp) phenotypes and risk of the development of diabetic retinopathy (DR) in patients of type 2 diabetes mellitus. MATERIALS AND METHODS: This cross-sectional study included 45 normotensive type 2 diabetic patients (duration more than 5 years) admitted in the hospital divided into two groups (with and without DR) on the basis of fundus examination by direct ophthalmoscopy. Serum samples of all patients were subjected for Hp phenotyping by polyacrylamide gel electrophoresis. RESULTS: DR was associated significantly in diabetic patients with Hp2-2 phenotype (79.31%) than diabetic patients with Hp2-1 phenotype (43.75%) and Hp2-2 had higher odds ratio (OR) for DR in univariate analysis (OR 4.929, [95% confidence interval [CI] (1.297-18.733)], P = 0.016) and multivariate analysis (OR 7.704 [95% CI (0.887-66.945)], P = 0.064). Furthermore, Hp2-2 was associated significantly with severe forms of DR. CONCLUSION: Hp2-2 phenotype is associated with susceptibility to DR showing a graded risk relationship to the number of Hp2 alleles. Determination of Hp phenotype may be useful in the risk assessment and management of DR.

Ophthalmic findings among Jordanian patients with chronic renal failure on haemodialysis at Prince Ali Military Hospital in the south of Jordan

To characterize the ocular and peri-ocular findings in patients with chronic renal failure undergoing haemodialysis at Prince Ali Bin Al- Hussein Military Hospital. This is a descriptive study. Data were collected from patients with chronic renal failure undergoing haemodialysis from June 2012 till January 2013. The medical files were reviewed to report medical, surgical and ophthalmic history of all candidate patients. All patients underwent full ophthalmic examination on day one of recruitment. Forty-four patients [87 eyes] were reported. Mean age was 56.9 years [56.9 +/- 12.5]. Male to female ratio was 2:1. Aetiologies of chronic renal failure were: Hypertension [n=17, 39%], glomerulonephritis [n=13, 30%], and diabetes mellitus [n=10, 23%]. Some other aetiologies were also found like: Small kidney [n=4, 9%], renal stones [n=2, 5%], polycystic kidney [n=2, 5%], familial [n=2, 5%] and analgesic nephropathy [n=1, 2%]. Ocular findings were seen in 75 eyes [86%], including lid edema [n=66, 76%] conjunctival congestion [n=54, 62%], cataract [n=47, 54%], and dry eye [n=44, 51%]. Ocular and peri-ocular findings were frequent in chronic renal failure patients who were undergoing hemodialysis, which urges regular ophthalmic examination to detect and treat sight threatening complications early.

Diabetic retinopathy and its risk factors at the university hospital in Jamaica

To determine the frequency of diabetic retinopathy and its risk factors in diabetic patients attending the eye clinic at the University Hospital of the West Indies [UHWI]. This was a prospective cohort study of diabetic outpatients attending the Eye Clinic at the UHWI. Data were collected on age, gender, type of diabetes mellitus [DM], type of diabetic retinopathy, other ocular diseases, visual acuity, blood glucose and blood pressure. Statistical Package for Social Sciences [SPSS version 19.0] was used for data analysis There were 104 patients [208 eyes] recruited for this study. There were 58.6% [61/104] females [mean age 53.6 +/- 11.9 years] and 41.4% [43/104] males [mean age 61.7 +/- 12.1 years]. Type II DM was present in 68.3% [56% were females] of the patients and Type I DM was present in 31.7% [69.7% were females]. Most patients [66%] were compliant with their diabetic medications. The mean blood glucose was 11.4 +/- 5.3 mmol/L. Elevated blood pressure [>130/80] was present in 82.7% of patients. The mean visual acuity was 20/160 [logMAR 0.95 +/- 1.1]. The frequency of diabetic retinopathy was 78%; 29.5% had background retinopathy, and 50.5% of eyes had proliferative diabetic retinopathy [PDR] of which 34% had tractional retinal detachments. The odds ratio of developing PDR was 1.88 [95% confidence intervals [CI]: 1.02-3.3] for Type I DM compared to 0.74 [95% CI: 0.55-0.99] for Type II DM. PDR was more prevalent in females [Chi [2], P = 0.009] in both Type I and II DM. Jamaica has a high frequency of PDR which is more common in Type I diabetics and females. This was associated with poor glucose and blood pressure control

Chlorogenic Acid Decreases Retinal Vascular Hyperpermeability in Diabetic Rat Model

To evaluate the effect of chlorogenic acid (CGA), a polyphenol abundant in coffee, on retinal vascular leakage in the rat model of diabetic retinopathy, Sprague-Dawley rats were divided into four groups: controls, streptozotocin-induced diabetic rats, and diabetic rats treated with 10 and 20 mg/kg chlorogenic acid intraperitoneally daily for 14 days, respectively. Blood-retinal barrier (BRB) breakdown was evaluated using FITC-dextran. Vascular endothelial growth factor (VEGF) distribution and expression level was evaluated with immunohistochemistry and Western blot analysis. Expression of tight junction proteins, occludin and claudin-5, and zonula occludens protein, ZO-1 was also evaluated with immunohistochemistry and Western blot analysis. BRB breakdown and increased vascular leakage was found in diabetic rats, with increased VEGF expression and down-regulation of occludin, claudin-5, and ZO-1. CGA treatment effectively preserved the expression of occludin, and decreased VEGF levels, leading to less BRB breakdown and less vascular leakage. CGA may have a preventive role in BRB breakdown in diabetic retinopathy by preserving tight junction protein levels and low VEGF levels.

Association of Monocyte Chemoattractant Protein-1 (MCP-1) 2518A/G Polymorphism with Proliferative Diabetic Retinopathy in Korean Type 2 Diabetes

PURPOSE: Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that can increase adhesion molecule expression on monocytes and produce superoxide anions. Hyperglycemia induces MCP-1 production in vascular endothelial cells and retinal pigmented epithelial cells, and has been implicated as a causal factor in the facilitation of vascular complications in diabetes. In the present study, we evaluated the association of a single nucleotide polymorphism (SNP) in the MCP-1 gene with proliferative diabetic retinopathy (PDR) in a Korean population with type 2 diabetes. MATERIALS AND METHODS: We conducted a case-control study, which enrolled 590 subjects with type 2 diabetes, and SNP genotyping of c.2518A/G in the MCP-1 gene was performed using polymerase chain reaction followed by digestion with PvuII restriction enzyme. RESULTS: The prevalence of c.2518A/G polymorphism in diabetic patients was 13.2% (A/A), 47.1% (A/G) and 39.7% (G/G). In patients with diabetic retinopathy, the prevalence of PDR was significantly higher (p=0.009) in diabetic subjects with the c.2518A/A genotype (35.9%; n=78) compared to those with either the A/G or G/G genotype (22.3%, n=512). The prevalence of any other micro and macro-complications, including nephropathy and cerebrovascular events, were not different according to the c.2518A/G genotype. CONCLUSION: Our new genetic findings suggest that the c.2518A/A genotype in MCP-1 could be used as a susceptibility gene to predispose Koreans exhibiting type 2 diabetes for the development of PDR.