Efectividad de la dorzolamida en el tratamiento del edema quístico macular poscirugía de catarata / Effectiveness of dorzolamide in the treatment of cystoid macular edema after cataract surgery

Objetivo: Evaluar la efectividad del tratamiento combinado con dorzolamida tópica en pacientes con edema quístico macular poscirugía de catarata. Métodos: Se realizó un estudio experimental en pacientes atendidos en el Servicio de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el año 2018. Se definió el grupo de casos (dorzolamida y tratamiento convencional) y el grupo control (tratamiento convencional), los cuales se evaluaron en la consulta inicial y al mes de tratamiento. Resultados: La edad media fue de 60,73 ± 11,25 años. Predominó el sexo femenino (53,33 por ciento), el ojo afectado derecho (60,00 por ciento), el tiempo posquirúrgico ≤ 3 meses (63,33 por ciento), sin factores de riesgo asociados (56,67 por ciento). El edema sin alteraciones asociadas fue más frecuente (80,00 por ciento). La media del grosor macular disminuyó en ambos grupos (de 529,27 ± 183,58 a 349,93 ± 221,35 en los casos y de 498,87 ± 213,26 a 373,53 ± 215,51 en los controles). Resultó mayor la variación en el grupo de casos (179,33 p= 0,008). La agudeza visual aumentó en ambos grupos. Se observó un porcentaje mayor de ojos que mejoraron la visión en el grupo de casos (52,38 por ciento). La mejoría de la agudeza visual se relacionó con la recuperación del grosor macular. Conclusiones: En los casos con edema quístico macular poscirugía de catarata, en los que está indicado el tratamiento tópico con antinflamatorios, la combinación con dorzolamida resulta efectiva para la reducción del grosor macular y la mejoría de la agudeza visual corregida(AU)

ABSTRACT Objective: Evaluate the effectiveness of a treatment combined with topical dorzolamide in patients with cystoid macular edema after cataract surgery. Methods: An experimental study was conducted of patients attending the Vitreous-Retina Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology in the year 2018. The sample was divided into a case group (dorzolamide and conventional treatment) and a control group (conventional treatment), and evaluated at the initial consultation and after one month of treatment. Results: Mean age was 60.73 ± 11.25 years. A predominance was found of the female sex (53.33 percent), affected right eye (60.00 percent), postsurgical time ≤ 3 months (63.33 percent), and no associated risk factors (56.67 percent). Edema without associated alterations was more common (80.00 percent). Mean macular thickness decreased in both groups (from 529.27 ± 183.58 to 349.93 ± 221.35 in cases and from 498.87 ± 213.26 to 373.53 ± 215.51 in controls). Variation was greater in the case group (179.33 p= 0.008). Visual acuity increased in both groups. A higher percentage of eyes with improved vision was found in the case group (52.38 percent). Visual acuity improvement was related to macular thickness recovery. Conclusions: In cases of cystoid macular edema after cataract surgery with indication of topical treatment with anti-inflammatories, the combination with dorzolamide is effective to reduce macular thickness and improve corrected visual acuity(AU)

Incidence of clinical and subclinical macular edema in patients submitted to phacoemulsification in a university health service

INTRODUCTION: The incidence of cystoid macular edema (CME) after cataract surgery varies substantially and depending on the diagnostic method used. In addition, other factors that influence the incidence of CME are the technique of surgery and the associated comorbidities. OBJECTIVE: The aim of the present study was to evaluate the incidence of EMC after uncomplicated phacoemulsification surgery, using the spectral domain optical coherence tomography (OCT). METHODS: The incidence of subclinical and clinical CME was evaluated in 14 patients who underwent uncomplicated phacoemulsification surgery, using OCT before the surgical procedure and after seven and 28 days after it. The volunteers could not use a prostaglandin analogue or present any retinopathy that compromised visual acuity. RESULTS: The incidence of clinically significant CME was 6.4%, however retinal thickening by OCT was observed in all patients in the fourth postoperative week. Regarding gender and laterality, the percentages were similar. CONCLUSION: In this study, we obtained a low incidence of EMC in patients assisted at this center, corroborating multicenter studies.

Retinopatía diabética y edema macular diabético: prevalencia en una población de atención primaria de Antofagasta / Diabetic retinopathy and diabetic macular edema: prevalence in a family health care center of Antofagasta

INTRODUCCIÓN: La Retinopatía Diabética (RD) es una complicación microangiopática de la diabetes y una de las principales causas de ceguera a nivel mundial. La principal complicación de la RD es el edema macular diabético (EMD). El objetivo de este trabajo es determinar la prevalencia de RD y sus subtipos, así como de EMD en una población de pacientes diabéticos de la atención primaria (APS) de Antofagasta. MATERIALES Y MÉTODOS: Estudio descriptivo de corte transversal realizado en una población de 380 pacientes diabéticos diagnosticados y tratados en siete centros de APS de Antofagasta sometidos a control anual de tamizaje de RD mediante retinografía. Se analizó sexo, edad, presencia de RD y subtipos y EMD. RESULTADOS: Se encontró prevalencia de RD de 19.21%. Dentro de este grupo la mayoría (60.27%) fueron hombres y el rango de edad predominante fue 40-64 años con 60.27%. El subtipo más frecuente fue la RD no proliferativa moderada con 45.21% y la prevalencia de EMD fue de 1.84%. CONCLUSIONES: La RD es una complicación prevalente y prevenible, por lo que es necesario mejorar los programas de control metabólico y métodos de screening. Este estudio aporta nuevos datos a la escasa literatura nacional sobre el tema.

INTRODUCTION: Diabetic retinopathy (DR) is a diabetic microangiopatic complication and the leading cause of blindness worldwide. The principal complication of DR is diabetic macular edema (DME). The objective of this study is to determine the prevalence of DR and their subtypes, as well as DME in a primary health care (PC) diabetic population of Antofagasta. ;ATERIAL AND METHODS: This is a transversal descriptive study carried out in a population of 380 diabetic patients diagnosed and treated in Antofagasta's seven PC centers, who underwent an anual retinography for DR screening. The factors analyzed were sex, age, presence of RD and their subtypes, and DME. RESULTS: We found a RD prevalence of 19.21%. In this group, the majority were men and the age group of 40-64 years showed the highest prevalence. The more frequent subtype (45.21%) was moderate non-proliferative DR, and the prevalence of DME was 1.84%. CONCLUSIONS: RD is a prevalent and preventable complication, and metabolic control programs and screening methods must be improved. This study contributes new data to the scarse national literature of this topic.

Early diagnosis of diabetic retinopathy in primary care / Diagnóstico temprano de retinopatía diabética en el primer nivel de atención

Objective: To evaluate the impact of a strategy for early detection of diabetic retinopathy in patients with type 2 diabetes mellitus (DMT2) in Quintana Roo, México. Methods: Study transversal, observational, prospective, analytical, eight primary care units from Mexican Social Security Institute in the northern delegation of the State of Quintana Roo, Mexico were included. A program for early detection of diabetic retinopathy (DR) in adult 376,169 was designed. Were diagnosed 683 cases of type 2 diabetes, in 105 patients randomized was conducted to direct ophthalmoscopy were subjected to a secondary hospital were assigned. Will determine the degree of diabetic retinopathy and macular edema was performed. Results: In population were 55.2% female, mean age 48+11.1 years, 23.8 % had some degree of DR, 28.0% with mild non- proliferative diabetic retinopathy 48.0 % moderate 16.0% and severe and 8.0% showed proliferative diabetic retinopathy. Those over age 30 are 2.8 times more risk of developing DR, OR= 2.8; 95%CI: 0.42-18.0, and OR= 1.7; 95%CI: 1.02-2.95 women. Conclusions: The implementation of programs aimed at the early detection of debilitating conditions such as diabetic retinopathy health impact beneficiaries, effective links between primary care systems and provide second level positive health outcomes for patient diseases.

Objetivo: Evaluar el impacto de una estrategia para la detección temprana de Retinopatía Diabética en pacientes con Diabetes Mellitus tipo 2 (DM2) en Quintana Roo. Métodos: Estudio Transversal, observacional, prospectivo, analítico. En Ocho unidades de primer nivel de atención de la delegación Norte del Estado de Quintana Roo, México del Instituto Mexicano del Seguro Social. Se diseñó un programa de detección oportuna de retinopatía diabética en 376,169 adultos, se realizó el diagnóstico de 683 casos de DM2, de forma aleatoria se asignaron 105 pacientes a quienes se les practicó oftalmoscopia directa en un hospital de segundo nivel. Se realizó la determinación del grado de retinopatía diabética y edema macular. Resultados: En la muestra predominaron las mujeres: 55.2%, edad promedio de 48+11.1 años, el 23.8% presentó algún grado de DR, 28.0% con retinopatía diabética no proliferativa leve (DRnPL), 48.0% moderada (DRnPM), 16.0% Severa (DRnPS) y el 8.0% presento Retinopatía diabética proliferativa (DRP). Los mayores de 30 años tuvieron 2.8 veces más riesgo de desarrollar DR, OR 2.8; IC95%: 0.42-18.0 al igual que las mujeres OR= 1.7; IC95%: 1.02-2.95. Conclusiones: La realización de programas dirigidos a la detección oportuna de enfermedades incapacitantes como la retinopatía diabética tienen impacto en la salud de los derechohabientes, la vinculación efectiva entre los sistemas de atención primaria y segundo nivel ofrecen resultados favorables para la salud de los pacientes.

Prevalencia de retinopatía diabética y edema macular en población diabética del CESFAM Cordillera Andina de Los Andes / Prevalence of diabetic retinopathy and macular edema in the diabetic population of the Cordillera Andina de Los Andes family health center (CESFAM)

Introducción: La retinopatía diabética (RD) es una microangiopatía progresiva a nivel retinal que aparece como complicación de la diabetes y es una delas principales causas de ceguera en el mundo. En los diabéticos la principal causa de pérdida visual es el edema macular diabético (EMD). Presentamos un trabajo cuyo objetivo es describir la prevalencia de RD y subtipos y EMD en una población de pacientes diabéticos en un centro de atención primaria del país. Materiales y métodos: Estudio transversal descriptivo realizado en un grupo de 468 pacientes diabéticos del CESFAM Cordillera Andina de Los Andes, sometidos a examen anual de fondo de ojo. Los parámetros analizados en este estudio fueron: sexo, edad, años de diagnóstico de diabetes mellitus(DM), presencia de RD y subtipos y EMD. Resultados: Se encontró una prevalencia de RD de 24,78 por ciento. El grupo etario entre los 50-70 años presentó la mayor prevalencia de RD mientras que el 51,7 por ciento de pacientes con RD tenía 10 o más años de diagnóstico de DM2. El subtipo más frecuente fue la RD no proliferativa (RDNP) leve(37,1 por ciento). La prevalencia de EMD fue 3,8 por ciento. Conclusiones: Se aportan nuevos datos a la escasa literatura nacional disponible, destacando la medición de prevalencia de EMD.

Introduction: Diabetic retinopathy (DR) is a progressive microangiopathy at the retinal level which appears as a complication of diabetes and is a major cause of blindness in the world. In diabetics, the leading cause of visual loss is diabetic macular edema (DME). We present a study which aims to determine the prevalence of DR and subtypes and DME in a population of diabetic patients in a primary care center of the country. Materials and Methods: Transversal descriptive study carried out in a group of 468 diabetic patients of Cordillera Andina from Los Andes Family Health Center (CESFAM), who underwent an annual fundoscopy. The factors analyzed in this study were: sex, age, years of diagnosis of diabetes, presence of DR and subtypes and DME. Results: We found a prevalence of DR of 24.78 percent. The most frequent subtype was mild non-proliferative diabetic retinopathy (NPDR) (37.1 percent). The age group between 50-70 years old showed the biggest prevalence, while 51.7 percent of patients with DR had ten or more years of diagnosis of diabetes. DME prevalence was 3.8 percent. Conclusions: This study provides new data to add to the limited available national literature, highlighting the prevalence of DME measurement.

Comportamiento del edema macular en el Servicio de Retina del Hospital Doctor Salvador Allende de la Habana / Macular edema behavior in the Retina Service at Doctor Salvador Allende Hospital in Havana

El edema macular, provocado por múltiples causas, constituye un problema importante de salud ocular. Se realizó la presente investigación en 96 ojos de 150 pacientes que acudieron al Servicio de Retina del Hospital Dr Salvador Allende entre enero y diciembre de 2008. Se incluyeron todos los casos con diagnóstico confirmado de edema macular difuso que quisieron participar en la investigación, a los que se les realizó examen bajo midriasis con oftalmoscopía indirecta, biomicroscopía en lámpara de hendidura con lente aéreo de 90 dioptrías, angiografía fluoresceínica y la tomografía óptica coherente. Se determinó la prevalencia del edema macular y su comportamiento socio-demográfico y clínico-epidemiológico. Se identificaron los factores de riesgo y las causas más frecuentes que lo originaron. Se concluyó que el edema macular predominó en el sexo femenino y en pacientes de 61 años en adelante. Los principales factores de riesgo identificados fueron la diabetes mellitus y las cirugías oculares previas. El edema macular diabético fue la causa vascular más frecuente. Entre las inflamatorias, las secundarias a cirugía de catarata y entre las distrofias, la retinosis pigmentaria.

Macular Edema, caused by multiple causes, is an important eye health problem. This research was performed in 96 eyes of 150 patients that came to the Retina Service at Dr Salvador Allende Hospital, between January and December 2008. It was included all cases with confirmed diagnosis of diffuse macular edema who wanted to participate in the investigation, to those that carried out under mydriasis using indirect ophthalmoscope, biomicroscopy in slit-lamp with air lens of 90 diopters, fluorescein angiography and optical coherence tomography. The prevalence of macular edema and its socio-demographic and clinical epidemiology behavior was determined. It was identified risk factors and common causes that originated it. It was concluded that macular edema was predominant in females and in patients aged 61 and older. The main risk factors identified were diabetes mellitus and previous ocular surgeries. Diabetic macular edema was the most common vascular cause. Among the inflammatory, secondary to cataract surgery and between dystrophy, retinitis pigmentosa.

Diabetic retinopathy, visual impairment and ocular status among patients with diabetes mellitus in Yemen: A hospital-based study.

Background: We present a series of patients with diabetes mellitus (DM) who attended an eye hospital in Sana, Yemen during 2004. Aim: To determine the magnitude and risk factors of diabetic retinopathy (DR). Design: Cross-sectional study. Materials and Methods: Ophthalmologists assessed vision, ocular pressure, ocular media and posterior segment to note ocular manifestations among patients with DM. DR was graded by using bio-microscope and Volk lens. The prevalence and 95% confidence interval of ocular complications of DM were calculated. Risk factors of DR like age, sex, duration of diabetes and hypertension were evaluated. Statistical Analysis: Univariate and multivariate analysis. Results: Our series comprised 350 patients suffering from DM. The duration of diabetes was ≥15 years in 101 (29%) patients. Physician was treating 108 DM patients with insulin. The prevalence of DR was 55% (95% CI 49.6–60.1). The proportions of background diabetic retinopathy (BDR), preproliferative diabetic retinopathy (PPDR), proliferative diabetic retinopathy (PDR) and diabetic macular edema were 20%, 13%, 17% and 22% respectively. The prevalence of blindness among DM patients was 16%. The prevalence of cataract and glaucoma was 34.3% and 8.6%. Duration of DM was the predictor of DR. One-fifth of the patients had sight-threatening DR and needed laser treatment. Conclusions: DR was of public health magnitude among our patients. An organized approach is recommended to address DR in the study area.

Epidemiologia e diferenças regionais da retinopatia diabética em Pernambuco, Brasil / Epidemiology and regional differences of diabetic retinopathy in Pernambuco, Brazil

OBJETIVOS: Avaliar os dados de freqüência e estadiamento da retinopatia diabética em Pernambuco, Brasil, comparando a região metropolitana com cidades do interior do estado. MÉTODOS: Os prontuários de 2.223 pacientes diabéticos (1.568 mulheres e 655 homens; idade média de 58,4 ± 12,0 anos; duração média do diabetes de 8,1 ± 6,3 anos), que fizeram parte de um programa de triagem para retinopatia diabética na Fundação Altino Ventura entre os meses de junho de 2004 e junho de 2005, foram revistos quanto à presença de retinopatia. Os pacientes foram divididos em dois grupos quanto à origem: grupo I, pacientes residentes em Recife e região metropolitana; grupo II, pacientes residentes no interior do estado de Pernambuco. RESULTADOS: No grupo I, 477 (24,2 por cento) pacientes apresentavam retinopatia diabética ao passo que no grupo II, 89 (39,4 por cento) pacientes (p<0,0001). A freqüência de retinopatia diabética proliferativa, edema macular, hemorragia vítrea e descolamento tracional de retina foi maior entre os pacientes do grupo II com significância estatística (p<0,05). CONCLUSÕES: Pacientes oriundos do interior do estado de Pernambuco apresentam maior prevalência de retinopatia diabética bem como de formas avançadas da doença em relação aos pacientes da região metropolitana quando atendidos na Campanha de Diabetes. Medidas de implantação de telemedicina ou descentralização das unidades são sugeridas para melhorar a qualidade da triagem de diabéticos residentes no interior do estado.

PURPOSE: To evaluate the prevalence and severity of diabetic retinopathy among patients cared for in a screening program in Pernambuco, Brazil, comparing regional differences between urban and rural zones. METHODS: The charts of 2,223 diabetic patients (1,568 females and 655 males; mean age 59.3 ± 12.0 years; mean duration of diabetes 8.1 ± 6.3 years) that took part in a screening program for diabetic retinopathy at Altino Ventura Foundation from June 2004 to June 2005 were reviewed for the presence of the disease. Patients were divided into two groups: group I, patients living in Recife and the metropolitan area; group II, patients living in the interior of Pernambuco state. RESULTS: In group I, 477 (24.2 percent) patients had diabetic retinophathy, while in group II, 89 (39.4 percent) patients (p<0.0001). The frequency of proliferative diabetic retinophathy, macular edema, vitreous hemorrhage and retinal detachment was higher in group II patients (p<0.05). CONCLUSIONS: Patients living in the interior of Pernambuco state have a higher incidence of diabetic retinophathy and the advanced forms than patients living in Recife and the metropolitan area when examined in a screening program for diabetic retinopathy at the Altino Ventura Foundation. Telemedicine and descentralization actions are recommended for improvement of screening quality in patients living in the interior of Pernambuco state.

Fotocoagulacion laser verde en edemas maculares: un estudio retrospectivo: Fundacion Oftalmologica Colombiana Medellin 1987-1988 / Photocoagulation with laser in macular edema: a retrospective study: Fundacion Oftalmologica Colombiana Medellin 1987-1988

Se evaluaron las historias de 37 pacientes (50) ojos, con diagnostico de edema macular tratados con Laser de Argon en la Fundacion Oftalmologica Colombiana, entre agosto de 1987 y agosto de 1988. El objetivo principal del estudio fue determinar la eficacia del tratamiento en dicha institucion y establecer unos patrones basico de su aplicación. Se realizo el tratamiento con Laser verde Argon, de acuerdo con el patron angiografico y/o clínico por medio de tres patrones: "grid: o rejilla (62%), focal (22%) y en "C" (16%) rodeando el area comprometida y evitando el haz papilomacular. En algunos casos se hizo combinacion de estos metodos. Hubo mejoria de la agudeza visual, determinada en una cartilla de optotipos de Snellen, en 25 ojos (50%), no hubo variación en 20 ojos (40%), y empeoro en 5 ojos (10%). Haciendo un analisis estadistico para datos independientes apareados (prueba de T pareada), se encontro significancia estadistica a un nivel del 99% (p= 0.000795), con una confiabilidad del 70%. No hubo una correlación definida entre el tipo de patron del tratamiento y la mejoria en la agudeza visual, pero si con el tipo de patologia de base del edema macular