[Macular oedema due to rosiglitazone treatment in diabetes mellitus]. / Edema macular por tratamiento con rosiglitazona en diabetes mellitus.

CASE REPORT: A 61-year-old woman with type 2 diabetes mellitus for 7 years for which she was prescribed insulin therapy. Rosiglitazone (4 mg once daily) was introduced with adequate blood glucose control. One month later, she presented with complaints of systemic oedema and loss of vision. Fundoscopy showed bilateral macular oedema. A systemic study demonstrated peripheral oedema. Rosiglitazone was stopped and she was managed conservatively with a rapid resolution of the oedemas and at fundus examination there was no decrease in the macular oedema. DISCUSSION: This case reminds us of the importance of identifying potential toxicities of glitazone regimens. Glitazone use appears to be a cause of macular oedema, and stopping the drug may not resolve this oedema.

Edema macular por tratamiento con rosiglitazona en diabetes mellitus / Macular oedema due to rosiglitazone treatment in diabetes mellitus

Caso clínicoMujer de 61 años diabética tipo 2 de 7 años de evolución en tratamiento con insulina. Se añade rosiglitazona (4mg al día) para conseguir un control glucémico adecuado. Un mes después, la paciente presenta edema generalizado y pérdida de visión. El estudio fundoscópico mostró edema macular bilateral. En la exploración sistémica destacaban edemas periféricos. La rosiglitazona fue suspendida y la paciente fue tratada de forma conservadora, con resolución rápida de los edemas periféricos pero no de los maculares.DiscusiónEste caso nos indica la importancia de identificar los efectos secundarios de las glitazonas. El tratamiento con glitazonas puede causar edema macular que podría permanecer aun después de su supresión(AU)

Case reportA 61-year-old woman with type 2 diabetes mellitus for 7 years for which she was prescribed insulin therapy. Rosiglitazone (4mg once daily) was introduced with adequate blood glucose control. One month later, she presented with complaints of systemic oedema and loss of vision. Fundoscopy showed bilateral macular oedema. A systemic study demonstrated peripheral oedema. Rosiglitazone was stopped and she was managed conservatively with a rapid resolution of the oedemas and at fundus examination there was no decrease in the macular oedema.DiscussionThis case reminds us of the importance of identifying potential toxicities of glitazone regimens. Glitazone use appears to be a cause of macular oedema, and stopping the drug may not resolve this oedema(AU)

[Erythropoietin concentrations in the vitreous body from patients with proliferative diabetic retinopathy]. / Concentración de eritropoyetina en el vítreo de pacientes con retinopatía diabética proliferante.

OBJECTIVE: To measure erythropoietin (Epo) levels in the vitreous body from patients with proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Undiluted vitreous samples were obtained from 44 patients who had not undergone prior vitreous or intraocular surgery. Patients were divided into two groups: A (n= 24) patients with PDR and B (n= 20) patients with retinal detachment, preretinal macular membranes and macular holes. Epo was determined using radioimmunoassay. RESULTS: Epo vitreous concentration in group A was 512 mU/mL (range 120-880) and in group B was 25.1 mU/mL (range 5.2-201) (p< 0.001). CONCLUSIONS: These results show that the concentration of Epo in the vitreous body was significantly higher in patients with PDR than in the control group.

[Clinically significant diabetic macular edema: systemic risk factors]. / Edema macular diabético clínicamente significativo: factores sistémicos de riesgo.

OBJECTIVE: We examined the influence of non-ophthalmic parameters as risk factors of clinically significant macular edema (CSME). METHODS: The authors reviewed clinical records of all clinically significant macular edema between 1995 and 2005. The association between the presence of CSME and HgbA1c, onset and duration of diabetes, blood pressure, body mass index, lipid status, sex, tobacco smoking and urinary albumin excretion was evaluated. RESULTS: 208 eyes met the study criteria. Patients ranged in age from 14 to 82 years (mean, 66 years) and had 8 to 64 years (mean, 47.5 years) of history of diabetes. Significant risk factors for CSME were older age, high levels of HgbA1c, high values of blood pressure, tobacco smoking, high cholesterol and LDL-cholesterol and high levels of proteinuria and microalbuminuria. CONCLUSION: Independent on the type of diabetes, patients with long standing diabetes have a high risk to develop diabetic maculopathy, but other closely-related risk factors are hypertension, hyperglycemia, lipids, tobacco smoking and renal status.

Concentración de eritropoyetina en el vítreo de pacientes con retinopatía diabética proliferante / Erythropoietin concentrations in the vitreous body from patients with proliferative diabetic retinopathy

Objetivo: Determinar los niveles de eritropoyetina (Epo) en el vítreo de pacientes con retinopatía diabética proliferante (RDP). Material y método: Mediante vitrectomía vía pars plana, se recogieron muestras no diluidas de vítreo de 44 pacientes sin antecedentes de cirugía vítrea o intraocular previa, que fueron divididos en dos grupos: A (n=24) pacientes con RDP y B (n=20) pacientes con desprendimiento de retina, membrana premacular y agujero macular. La concentración de Epo se determinó mediante radioinmunoensayo. Resultados: La concentración vítrea de Epo en el grupo A fue 512 mU/mL (rango 120-880) y en el grupo B fue 25,1 mU/ml (rango 5,2-201) (p< 0,001). Conclusiones: Estos resultados demuestran que la concentración vítrea de Epo está más elevada en los pacientes con RDP en comparación con el grupo control

Objective: To measure erythropoietin (Epo) levels in the vitreous body from patients with proliferative diabetic retinopathy (PDR). Patients and methods: Undiluted vitreous samples were obtained from 44 patients who had not undergone prior vitreous or intraocular surgery. Patients were divided into two groups: A (n= 24) patients with PDR and B (n= 20) patients with retinal detachment, preretinal macular membranes and macular holes. Epo was determined using radioimmunoassay. Results: Epo vitreous concentration in group A was 512 mU/mL (range 120-880) and in group B was 25.1 mU/mL (range 5.2-201) (p< 0.001). Conclusions: These results show that the concentration of Epo in the vitreous body was significantly higher in patients with PDR than in the control group (Arch Soc Esp Oftalmol 2008; 83: 169-172)

Edema macular diabético clínicamente significativo: factores sistémicos de riesgo / Clinically significant diabetic macular edema: systemic risk factors

Objetivo: Estudiar los factores de riesgo sistémico del edema macular clínicamente significativo(EMCS) en una población de diabéticos. Método: Se revisaron las historias clínicas de los pacientes diabéticos diagnosticados de edemamacular clínicamente significativo entre 1995 y2005. Se evaluó la asociación entre EMCS yHgbA1c, comienzo y duración de la diabetes, hipertensión arterial, índice masa corporal, nivel de lípidos, sexo, fumar y excreción urinaria de albúmina. Resultados: 208 ojos fueron considerados con los criterios del estudio. Los pacientes tenían un rango de edad entre 15 y 82 años (media, 66 años) y tenían entre 8 y 64 años (media, 47,5 años) de historia de diabetes. Factores de riesgo significativos para desarrollar EMCS fueron edad avanzada, cifras elevadas de HgbA1c, hipertensión arterial, fumar, valores elevados de colesterol y LDL-colesterol y niveles elevados de proteinuria y microalbuminuria. Conclusiones: Independientemente del tipo de diabetes, los pacientes con diabetes mellitus de larga evolución tienen un elevado riesgo de desarrollar maculopatía diabética, pero otros factores de riesgo asociados son la hipertensión, la hiperglucemia, los lípidos, el tabaquismo y el estado renal

Objective: We examined the influence of non-ophthalmic parameters as risk factors of clinically significant macular edema (CSME). Methods: The authors reviewed clinical records of all clinically significant macular edema between1995 and 2005. The association between the presence of CSME and HgbA1c, onset and duration of diabetes, blood pressure, body mass index, lipid status, sex, tobacco smoking and urinary albumin excretion was evaluated. Results: 208 eyes met the study criteria. Patients ranged in age from 14 to 82 years (mean, 66 years)and had 8 to 64 years (mean, 47.5 years) of history of diabetes. Significant risk factors for CSME were older age, high levels of HgbA1c, high values of blood pressure, tobacco smoking, high cholesterol and LDL-cholesterol and high levels of proteinuria and microalbuminuria. Conclusion: Independent on the type of diabetes, patients with long standing diabetes have a high riskto develop diabetic maculopathy, but other closely related risk factors are hypertension, hyperglycemia, lipids, tobacco smoking and renal status