Are all primary retinal detachments the same? Anatomic and functional differences between phakic and pseudophakic patients.

BACKGROUND: Given differences in the pathogenic mechanisms underlying primary retinal detachment (RD) as a function of the status of the lens, the objective was to explore differences between pseudophakic and phakic patients with primary RD. METHODS: A retrospective study including 821 patients who underwent surgery for RD [491 cases of phakic and 330 of pseudophakic RD (pRD and psRD, respectively)] in our hospital between 2012 and 2020. RESULTS: The mean age was 58.24 ± 12.76 years in the pRD group and 66.87 ± 11.18 years in the psRD group (p = 0.001). There were more men in both groups (70% and 64.23% of pseudophakic and phakic patients, respectively; p = 0.07). The most common location for the RD was superior in both groups (43.94% and 51.93% of pseudophakic and phakic patients, respectively), rates of inferior and total RD were somewhat higher in the psRD group (31.82% and 13.33% in pseudophakic vs 25.25% and 11.0% in phakic patients, p = 0.001). In pseudophakic and phakic patients respectively, macular involvement in 69.09% and 62.73% of cases (p = 0.067). Proliferative vitreoretinopathy was significantly more common in the psRD group (7.88% vs 3.6% in phakic patients, p = 0.01).The rate of final anatomic reattachment differed markedly between groups, with a higher rate in phakic (94.03%) than pseudophakic (87.27%) patients (p = 0.001). CONCLUSIONS: The specific pathogenic mechanism involved in psRD seems to be responsible for worse evolution characteristics which are associated with poorer final anatomic and functional outcomes in pseudophakic patients.

Albuminuria as a biomarker of severity in diabetic retinopathy and in the response to intravitreal treatment in diabetic macular edema.

PURPOSE: Diabetic macular edema (DME) presents a suboptimal response to antiangiogenic treatment in approximately 30% of patients. We analyzed the relationship between renal function and response to antiangiogenic therapy in patients with DME. METHODS: A total of 367 patients were collected and distributed into three main groups: uncomplicated diabetic retinopathy (DR) group (n = 97), proliferative diabetic retinopathy (PDR) group (n = 94) and DME group (n = 175). Likewise, patients with DME were divided into two groups: responders to antiangiogenic drugs (n = 96) and non-responders to antiangiogenic drugs (n = 79). Age, type of diabetes, arterial hypertension (AHT), creatinine, HbA1c, albuminuria and glomerular filtration rate were analyzed. In the statistical analysis, chi-square test and t student were used to compare each group. The relationship between albuminuria and response to treatment in the DME group was studied with a binary logistic regression model, estimating odds ratio and their confidence intervals. RESULTS: There are differences between the three main groups in terms of the presence or not of albuminuria. The presence of albuminuria is greater in the group of patients with more severe DR (PDR and DME), compared to the uncomplicated DR group (p < 0.009). In the logistic regression analysis model, a positive relationship was found and the odds ratio for the albuminuria variable and is 2.78 (CI: 1.42-5.36). CONCLUSIONS: The presence of albuminuria is associated with a higher degree of DR and worse response to antiangiogenic therapy in patients with DME in our series. Multidisciplinary teams would be necessary to reduce albuminuria and thus optimize the treatment of patients with DME.

Dacryocystitis: Systematic Approach to Diagnosis and Therapy.

The objective of this paper is to review the main findings of the largest studies on the etiopathogenesis and microbiology of the development of dacryocystitis and to formulate clinical and surgical guidelines based on said studies and on our experience at Cruces Hospital, the Basque Country, Spain. The most common sign of this entity is the distal nasolacrimal duct obstruction, and this should be treated to prevent clinical relapse. The time when surgery should be indicated mainly depends on the clinical signs and symptoms, age and general status of a patient. Given the germs isolated in cases of dacryocystitis, antibiotic therapy against Gram positive (S. aureus, S. pneumoniae, S. epidermidis) and Gram negative bacteria (H. influenzae, P. aeruginosa) should be administered, orally in adults and intravenously in pediatric patients, prior to surgery. Gentamicin and amoxicillin-clavulanic acid have been found to be effective against the bacteria commonly implicated in the etiopathogenesis of this entity.

Study on the effectiveness of antibiotic prophylaxis in external dacryocystorhinostomy: a review of 697 cases.

PURPOSE: To evaluate the prophylactic use of antibiotics in external dacryocystorhinostomy for the prevention of postoperative complications. METHODS: This study included 697 patients diagnosed with distal nasolacrimal duct obstruction and who were operated on by the same surgeon. Direct culture of the lacrimal sac content was carried out. Data were collected regarding clinical signs and symptoms, use of intraoperative antibiotics, results of culture samples obtained during surgery, and antibiogram analysis. Also, the postoperative period was analyzed with regard to the presence of postoperative complications. RESULTS: Out of 697 patients, 536 were women. The mean age at surgery was 67.0 ± 13.3 years. Prior to surgery, 19.5%, 18.5%, 11%, and 17.8% of patients showed recurrent conjunctivitis, mucocele, mucopyocele, and episodes of acute dacryocystitis, respectively. Seventy-three patients did not receive prophylactic treatment during surgery. A total of 8.3% of lacrimal sacs were culture positive, the most commonly isolated organism being Staphylococcus aureus. The use of antibiotics during surgery was not associated with a lower rate of postoperative complications. A statistically significant association was found between some clinical pictures, such as mucocele, mucopyocele, and dacryocystitis, and a higher rate of positive cultures. CONCLUSIONS: This study questions the generalized use of prophylactic antibiotics for external dacryocystorhinostomy, while providing evidence to indicate their use for patients who have had prior episodes of mucocele, mucopyocele, or acute dacryocystitis.