Análisis de la curva de aprendizaje en cirugía vitreorretiniana / Analysis of the vitreoretinal surgery learning curve

Objetivo: Describir la evolución de las complicaciones intraoperatorias y postoperatorias, así como la evolución en la técnica quirúrgica, en los 4 primeros años de un cirujano de retina y poder evaluar el tiempo de aprendizaje necesario para reducir el número de complicaciones, objetivando aquellas patologías que debieran seguir derivándose a otros centros hasta conseguir una mayor experiencia quirúrgica. Métodos: Se revisaron los pacientes intervenidos de cirugía retiniana por un cirujano novel en Tarragona, entre el 23 de octubre de 2007 y el 31 de diciembre de 2011. Se evaluaron el diagnóstico principal, el tiempo de aprendizaje del cirujano, la técnica quirúrgica, las complicaciones intraoperatorias y las postoperatorias. Resultados: Se revisaron 247 cirugías. El porcentaje de uso de los calibres 20G y 23G durante el tiempo denota un cambio hacia la cirugía transconjuntival a partir del noveno trimestre (98 cirugías realizadas). Las complicaciones descienden a partir del trimestre 12 (130 cirugías), con un incremento en los meses anteriores. Conclusiones: El cambio de tendencia hacia la técnica 23G alrededor de las 100 cirugías se interpreta como una mayor comodidad y seguridad en la cirugía. El aumento de complicaciones quirúrgicas durante los meses siguientes hasta el descenso a partir de las 130 cirugías se puede interpretar como un «exceso de confianza». Puede afirmarse que la curva de aprendizaje es más lenta de lo que el cirujano cree, siendo recomendable el análisis individual de las propias complicaciones y de la evolución quirúrgica para poder determinar en qué situación de la curva de aprendizaje se encuentra (AU)

Objective: To describe intra- and post-operative complications, as well as the evolution of the surgical technique in first 4years of work of a novice retina surgeon, and evaluate minimal learning time required to reduce its complications, deciding which pathologies should still be referred to higher level hospitals, until further experience may be achieved. Methods: A study was conducted on patients that had undergone vitreoretinal surgery by a novice surgeon in Tarragona between 23rd October 2007 and 31st December 2011. The primary diagnosis, surgeon learning time, surgical technique, intra-operative and post-operative complications were recorded. Results: A total of 247 surgeries were studied. The percentage of use of 20G and 23G calibres during the time, marks a change towards trans-conjunctival surgery from the ninth trimester (98 surgeries). Surgical complications decreased towards twelfth trimester (130 surgeries) with an increase in the previous months. Conclusions: The shift towards 23G technique around 100 surgeries is interpreted as greater comfort and safety by the surgeon. Increased surgical complications during the following months until its decline around 130 surgeries can be interpreted as an ‘overconfidence’. It is arguable that the learning curve is slower than what the surgeon believes. An individual analysis of the complications and surgical outcomes is recommended to ascertain the status of the learning curve (AU)

Analysis of the vitreoretinal surgery learning curve. / Análisis de la curva de aprendizaje en cirugía vitreorretiniana.

OBJECTIVE: To describe intra- and post-operative complications, as well as the evolution of the surgical technique in first 4years of work of a novice retina surgeon, and evaluate minimal learning time required to reduce its complications, deciding which pathologies should still be referred to higher level hospitals, until further experience may be achieved. METHODS: A study was conducted on patients that had undergone vitreoretinal surgery by a novice surgeon in Tarragona between 23rd October 2007 and 31st December 2011. The primary diagnosis, surgeon learning time, surgical technique, intra-operative and post-operative complications were recorded. RESULTS: A total of 247 surgeries were studied. The percentage of use of 20G and 23G calibres during the time, marks a change towards trans-conjunctival surgery from the ninth trimester (98 surgeries). Surgical complications decreased towards twelfth trimester (130 surgeries) with an increase in the previous months. CONCLUSIONS: The shift towards 23G technique around 100 surgeries is interpreted as greater comfort and safety by the surgeon. Increased surgical complications during the following months until its decline around 130 surgeries can be interpreted as an 'overconfidence'. It is arguable that the learning curve is slower than what the surgeon believes. An individual analysis of the complications and surgical outcomes is recommended to ascertain the status of the learning curve.

Evaluación objetiva de la aplicación de colirios en personas mayores de 65 años / Objective evaluation of applying eye drops by elderly patients

OBJETIVO: Evaluar las habilidades y destrezas de los pacientes mayores de 65 años en el momento de instilarse un tratamiento ocular en forma de colirio. MÉTODOS: Se realizó un estudio prospectivo sobre un grupo de 25 pacientes afectos de ojo seco o de glaucoma en tratamiento diario con gotas con, por lo menos, un año de evolución a los que procedimos a grabar con una cámara de vídeo en el momento de la instilación. RESULTADOS: Un 64% del total estaban diagnosticados de glaucoma y un 36% de ojo seco. Un 44% necesitaron un único intento para aplicarse la gota y un 56%, dos intentos. En cuanto al número de gotas instiladas, un 52% se instilaba una única gota, un 16% dos gotas, un 12% 3 gotas y un 20% cuatro o más gotas. Las zonas donde se depositó la gota en el primer intento fue en un 32% en el saco conjuntival, en un 32% en el ángulo externo del ojo, en un 8% en el ángulo interno, en un 8% en la nariz, en un 12% en la mejilla y en un 8% en otras zonas. CONCLUSIONES: La autoadministración de colirios en la población de la tercera edad se presenta como una actividad compleja que puede modificar los resultados esperados

OBJECTIVE: To objectively evaluate the ability and skills of patients older than 65 years to successfully administer a topical ocular eye drop. METHODS: A prospective study was conducted on a group of 25 patients with a diagnosis of dry eye or glaucoma, undergoing daily treatment with eye drops for at least one year. The procedure was recorded with a video camera at the time of the application. RESULTS: Of the total, 64% were diagnosed with glaucoma and 36% with dry eye. Almost half (44%) needed a single attempt to apply the drop, and 56% required 2 attempts. In terms of the number of eye drops applied, 52% managed with a single drop, 16% 2 drops, a 12% 3 drops, and 20% 4 or more eye drops. Areas where the eye drop was deposited in the first attempt was, 32% into the conjunctival sac, 32% on the outer corner of the eye, 8% in the inner angle, 8% in the nose, 12% on the cheek, 8% in other areas. CONCLUSIONS: Self-administration of eye drops by the elderly is a complex activity that can have an effect on the expected results

[Objective evaluation of applying eye drops by elderly patients]. / Evaluación objetiva de la aplicación de colirios en personas mayores de 65 años.

OBJECTIVE: To objectively evaluate the ability and skills of patients older than 65 years to successfully administer a topical ocular eye drop. METHODS: A prospective study was conducted on a group of 25 patients with a diagnosis of dry eye or glaucoma, undergoing daily treatment with eye drops for at least one year. The procedure was recorded with a video camera at the time of the application. RESULTS: Of the total, 64% were diagnosed with glaucoma and 36% with dry eye. Almost half (44%) needed a single attempt to apply the drop, and 56% required 2 attempts. In terms of the number of eye drops applied, 52% managed with a single drop, 16% 2 drops, a 12% 3 drops, and 20% 4 or more eye drops. Areas where the eye drop was deposited in the first attempt was, 32% into the conjunctival sac, 32% on the outer corner of the eye, 8% in the inner angle, 8% in the nose, 12% on the cheek, 8% in other areas. CONCLUSIONS: Self-administration of eye drops by the elderly is a complex activity that can have an effect on the expected results.

Prescribing prophylactic antibiotics to users of therapeutic contact lenses.

BACKGROUND: To describe the benefits and optimum use of prophylactic antibiotics in users of therapeutic contact lenses (TCL). METHODS: A microbiological study was carried out on samples from 33 patients who continuously wore TCL. The resistance to antibiotics of bacteria isolated in our health region was also reviewed. An assessment was also made on whether there were microorganisms of a higher pathogenic potential in TCL than conventional contact lenses, as reported in the literature. RESULTS: No bacteria were isolated from 17 (52%) of the 33 lenses studied. From the 16 (48%) remaining lenses, coagulase negative Staphylococci were isolated from 10 (62%), Propionibacterium acnes from 4 (25%), and Corynebacterium from 2 (13%). CONCLUSIONS: The high number of negative cultures and the presence of saprophytic bacteria indicate that prophylactic antibiotic treatment is not precise. The most frequent pathogenic bacteria found in contact lenses are strongly resistant to the current commercially available antibiotics.

Pertinencia de prescribir antibióticos profilácticos en usuarios de lentes de contacto terapéuticas / Prescribing prophylactic antibiotics to users of therapeutic contact lenses

Objetivos: Conocer la pertinencia o no de prescribir antibióticos profilácticos en usuarios de lentes de contacto terapéuticas (LCT). Métodos: Se procedió a realizar un estudio microbiológico sobre 33 LCT de 33 pacientes portadores de LCT. Se valoraron las resistencias de los gérmenes aislados a los antibióticos a partir de los estudios publicados en nuestra región sanitaria durante el año 2010. Valoramos lo mismo en el supuesto que las LCT se encontraran contaminadas por los gérmenes con mayor potencial patógeno según la literatura médica en usuarios de lentes de contacto convencionales. Resultados: De las 33 LCT estudiadas en 17 (52%) no se aisló ningún germen. En las 16 LCT restantes (48%) se aisló en diez (62%) Staphylococcus coagulasa negativo, en cuatro (25%) Propionibacterium acnes y en dos (13%) Corynebacterium. Conclusiones: El elevado número de cultivos negativos y la presencia de gérmenes saprofitos indican que no es preciso el tratamiento antibiótico profiláctico. Los gérmenes con mayor potencial patógeno en usuarios de lentes de contacto presentan severas resistencias a los antibióticos comercializados en forma de colirio(AU)

Background: To describe the benefits and optimum use of prophylactic antibiotics in users of therapeutic contact lenses (TCL). Methods: A microbiological study was carried out on samples from 33 patients who continuously wore TCL. The resistance to antibiotics of bacteria isolated in our health region was also reviewed. An assessment was also made on whether there were microorganisms of a higher pathogenic potential in TCL than conventional contact lenses, as reported in the literature. Results: No bacteria were isolated from 17 (52%) of the 33 lenses studied. From the 16 (48%) remaining lenses, coagulase negative Staphylococci were isolated from 10 (62%), Propionibacterium acnes from 4 (25%), and Corynebacterium from 2 (13%). Conclusions: The high number of negative cultures and the presence of saprophytic bacteria indicate that prophylactic antibiotic treatment is not precise. The most frequent pathogenic bacteria found in contact lenses are strongly resistant to the current commercially available antibiotics(AU)

[Experimental study of pig dislocated intraocular lens shift after Nd: YAG laser capsulotomy]. / Estudio experimental en ojos de cerdo sobre el desplazamiento de las lentes intraoculares subluxadas tras una capsulotomía láser Nd: YAG.

OBJECTIVES: To evaluate the movement from their initial set position of subluxated intraocular lenses (IOL) in pig eyes following Nd: YAG laser capsulotomy. METHODS: An extracapsular surgical intervention of the transparent crystalline lens was performed on 15 pig eyes. After the introduction of an intraocular lens into the capsular sac, a zonular dialysis was carried out to observe the shift of the IOL. We carried out a high intensity Nd: YAG laser capsulotomy in a 3.5mm cross shape in the central optical axis and then measured the final displacement of the IOL using a millimetre ruler. RESULTS: We did not observe a significant shift of the lens in any of the eyes studied. CONCLUSIONS: Nd: YAG laser capsulotomy is a safe short-term operation for static and subluxated intraocular lenses.

Estudio experimental en ojos de cerdo sobre el desplazamiento de las lentes intraoculares subluxadas tras una capsulotomía láser Nd: YAG / Experimental study of pig dislocated intraocular lens shift after Nd: YAG laser capsulotomy

Objetivos: Valorar en los ojos del cerdo el desplazamiento de las lentes intraoculares subluxadasrespecto a la posición inicial tras la realización de una capsulotomía láser Nd: YAG.Métodos: Se utilizaron 15 ojos de cerdo a los que les realizamos una cirugía extracapsular decristalino transparente. Tras la introducción de una lente intraocular (LIO) dentro del sacocapsular se provocó una diálisis zonular hasta objetivar un desplazamiento de la LIO de unvalor mínimo de 4mm. Efectuamos una capsulotomía láser Nd: YAG en forma de cruz enlos 3,5mm centrales del eje óptico a elevadas energías. Se midió el desplazamiento final dela LIO con la ayuda de una regla milimetrada.Resultados: En ninguno de los ojos estudiados se objetivó un desplazamiento significativo enrelación a la situación inicial.Conclusiones: La capsulotomía láser Nd: YAG en LIOs subluxadas se presenta para ojos estáticoscomo una maniobra segura a corto plazo(AU)

Objectives: To evaluate the movement from their initial set position of subluxated intraocularlenses (IOL) in pig eyes following Nd: YAG laser capsulotomy.Methods: An extracapsular surgical intervention of the transparent crystalline lens was performedon 15 pig eyes. After the introduction of an intraocular lens into the capsular sac,a zonular dialysis was carried out to observe the shift of the IOL. We carried out a high intensity Nd: YAG laser capsulotomy in a 3.5mmcross shape in the central optical axis andthen measured the final displacement of the IOL using a millimetre ruler.Results: We did not observe a significant shift of the lens in any of the eyes studied.Conclusions: Nd: YAG laser capsulotomy is a safe short-term operation for static and subluxatedintraocular lenses(AU)

[The non-mydriatic camera as a screening method in diabetics in Tarragona]. / Resultados de la implantación de la càmara no midriática como método de screening en pacientes diabéticos en Tarragona.

OBJECTIVE: The aim of the study is to present the results of the first year of using a non-mydriatic fundus camera. We performed an evaluation of its usefulness and problems. METHODS: During the first year of using the non-mydriatic fundus camera we evaluated 3,272 type II diabetic patients who were not being controlled in the hospital. RESULTS: The diabetic retinopathy was observed in 164 patients (5.01%), the mild form in 70 patients (2.14%). Diabetic macular oedema was observed in 41 patients (1.25%). In 119 patients (3.63%) the retinography could not be interpreted and were referred to the hospital; 113 patients also were referred due to other pathologies; the largest group of these patients had age-related macular disease or age-related macular degeneration (42 patients). Finally, 458 patients (13.99%) required mydriatic eye-drops. CONCLUSIONS: The non-mydriatic fundus camera is a useful technique for assessing the presence of diabetic retinopathy, particularly in patients with poor ophthalmic control. This technique may enable us to diagnose these patients who need laser treatment.

Resultados de la implantación de la càmara no midriática como método de screening en pacientes diabéticos en Tarragona / The non-mydriatic camera as a screening method in diabetics in Tarragona

ObjetivoPresentar los resultados tras el primer año de funcionamiento de la cámara no midriática en nuestra área, evaluando su utilidad y los problemas que hemos observado.MétodosDurante el periodo de un año se han revisado 3.272 pacientes diabéticos tipo 2 mediante la cámara no midiátrica; estos pacientes no estaban siendo sometidos a controles periódicos en nuestro centro en razón a su patología ocular.ResultadosLa retinopatía diabética se observó en 164 pacientes (5,01%), la forma leve en 70 pacientes (2,14%). El edema macular diabético se apreció en 41 pacientes un 1,25%. En 119 (3,63%) pacientes no se pudo interpretar la imagen debiendo ser referidos a las consultas de oftalmología, además se derivaron 113 pacientes sin retinopatía diabética, de estos la mayoría (42 pacientes) presentaban lesiones en el área macular sospechosas de maculopatía o degeneración macular asociada a la edad. Finalmente en 458 (13,99%) pacientes se precisó la instilación de colirio midriático.ConclusionesPodemos extraer que el screening mediante cámara no midiátrica, es altamente útil para poder acceder a una gran parte de la población diabética, en especial aquella que acude con escasa frecuencia al oftalmólogo, permitiéndonos diagnosticar un número importante de pacientes susceptibles de tratamiento láser para evitar su ceguera(AU)

ObjectiveThe aim of the study is to present the results of the first year of using a non-mydriatic fundus camera. We performed an evaluation of its usefulness and problems.MethodsDuring the first year of using the non-mydriatic fundus camera we evaluated 3,272 type II diabetic patients who were not being controlled in the hospital.ResultsThe diabetic retinopathy was observed in 164 patients (5.01%), the mild form in 70 patients (2.14%). Diabetic macular oedema was observed in 41 patients (1.25%). In 119 patients (3.63%) the retinography could not be interpreted and were referred to the hospital; 113 patients also were referred due to other pathologies; the largest group of these patients had age-related macular disease or age-related macular degeneration (42 patients). Finally, 458 patients (13.99%) required mydriatic eye-drops.ConclusionsThe non-mydriatic fundus camera is a useful technique for assessing the presence of diabetic retinopathy, particularly in patients with poor ophthalmic control. This technique may enable us to diagnose these patients who need laser treatment(AU)

[Optical coherence tomography study in tamoxifen maculopathy]. / Maculopatía por tamoxifeno. Estudio mediante la tomografía de coherencia óptica.

CASE REPORT: We describe the case of a patient who presented with progressive and bilateral loss of vision. She had been treated with tamoxifen for 13 years. We performed fluorescein angiography and optical coherence tomography in order to study the macula. DISCUSSION: Loss of visual acuity related to tamoxifen maculopathy may be caused either by retinal nerve fibre atrophy or macular oedema. Macular findings obtained by fluorescein angiography and optical coherence tomography are complementary.

Maculopatía por tamoxifeno. Estudio mediante la tomografía de coherencia óptica / Optical coherence tomography study in tamoxifen maculopathy

Caso clínico: Se describe el caso de una paciente que acudió por pérdida bilateral y progresiva de la visión después de haber recibido tratamiento con tamoxifeno durante 13 años. Para el estudio detallado de las alteraciones maculares se realizaron la angiografía fluoresceínica y la tomografía de coherencia óptica. Discusión: La pérdida de visión debido a la maculopatía por tamoxifeno puede ser debida tanto a la atrofia de las capas de fibras nerviosas de la retina como a la presencia de edema macular. Los hallazgos maculares obtenidos mediante la angiografía fluoresceínica y la tomografía de coherencia óptica son complementarios

Case report: We describe the case of a patient who presented with progressive and bilateral loss of vision. She had been treated with tamoxifen for 13 years. We performed fluoresce in angiography and optical coherence tomography in order to study the macula. Discussion: Loss of visual acuity related to tamoxifen maculopathy may be caused either by retinal nerve fibre atrophy or macular o edema. Macular findings obtained by fluorescein angiography and optical coherence tomography are complementary

[Diabetic retinopathy epidemiology in type II diabetic patients. Effect of the changes in the diagnostic criteria and stricter control of the diabetes between 1993 and 2005 on the incidence of diabetic retinopathy]. / Epidemiología de la retinopatía diabética en pacientes tipo II. Cambios observados en una población entre los años 1993 y 2005, tras los nuevos criterios diagnósticos y un mayor control de los pacientes.

OBJECTIVE: The aim of the study was to compare the results with those of a previous study by the same author in 1993 when 741 type II diabetic patients were recruited. We determined the prevalence of diabetic retinopathy and the impact of the new diagnostic criteria and stricter control of diabetes on the results obtained. METHODS: The study sample was obtained by hazard selection of 741 type II diabetic patients, from the total diabetic patients visited in the interval between January 1 and December 1 in 2005. RESULTS: We observed a decrease in the prevalence of diabetic retinopathy between the two studies. In the first study the incidence was 39.41% while in the present study it was 27.55%. The diabetic macular edema prevalence was similar in both studies (7.15% in the past and 7.90% in the present study). There was also a decrease in the number of blind patients (11.20% in 1993 and 4.90% in the current study). The number of patients treated with laser photocoagulation increased (13.49% in the current study as compared to 6.20% in the previous study). Statistic analysis revealed the risk factors for retinopathy: diabetes mellitus duration, elevated HbA1C levels and the need for insulin treatment. CONCLUSIONS: A better control of diabetes mellitus may lead us to observe an increase in visual acuity, and a better control of diabetic retinopathy. The incidence of diabetic retinopathy certainly decreased between the study periods; however the overall incidence of diabetes in the community has increased during the last few years, making firm conclusions difficult.

Epidemiología de la retinopatía diabética en pacientes tipo II. Cambios observados en una población entre los años 1993 y 2005, tras los nuevos criterios diagnósticos y un mayor control de los pacientes / Diabetic retinopathy epidemiology in type II diabetic patients. Effect of the changes in the diagnostic criteria and stricter control of the diabetes between 1993 and 2005 on the incidence of diabetic retinopathy

Objetivo: Comparar los resultados obtenidos en una muestra de población de 741 pacientes diabéticos tipo II en el año 1993 con una muestra actual de 741 pacientes diabéticos tipo II, determinando la prevalencia de retinopatía diabética, y valorando el impacto sobre la misma de los nuevos criterios diagnósticos y el mayor control de los pacientes diabéticos. Métodos: Estudio transversal en el que la muestra fue recogida mediante selección al azar de 741 pacientes afectos de diabetes mellitus tipo II del total del archivo de pacientes visitados regularmente a lo largo del período comprendido entre el 1 de enero y el 31 de diciembre del año 2005. Resultados: Se observa un descenso de prevalencia de retinopatía diabética del 39,41% en el primer estudio al 27,55% actual, manteniéndose igual el edema macular (7,15% en el primer estudio y 7,90% en el actual). Se ha observado un descenso en el número de pacientes ciegos, de un 11,20% a un 4,90%. Asimismo los pacientes tratados previamente con fotocoagulación láser aumentaron en el estudio actual, un 13,49% frente a un 6,20%. En el estudio estadístico los factores de riesgo son: el tiempo de evolución de la diabetes, el tratamiento con insulina de la misma, y los niveles elevados de HbA1c. Conclusiones: El mayor control ejercido sobre los pacientes diabéticos nos permite observar una mejoría en la agudeza visual. Observándose también que aumenta el número de pacientes tratados. Por otro lado al existir un mayor número de pacientes diabéticos conocidos, se produce un efecto de disminución de la prevalencia de la retinopatía

Objective: The aim of the study was to compare the results with those of a previous study by the same author in 1993 when 741 type II diabetic patients were recruited. We determined the prevalence of diabetic retinopathy and the impact of the new diagnostic criteria and stricter control of diabetes on the results obtained. Methods: The study sample was obtained by hazard selection of 741 type II diabetic patients, from the total diabetic patients visited in the interval between January 1 and December 1 in 2005. Results: We observed a decrease in the prevalence of diabetic retinopathy between the two studies. In the first study the incidence was 39.41% while in the present study it was 27.55%. The diabetic macular edema prevalence was similar in both studies (7.15% in the past and 7.90% in the present study). There was also a decrease in the number of blind patients (11.20% in 1993 and 4.90% in the current study). The number of patients treated with laser photocoagulation increased (13.49% in the current study as compared to 6.20% in the previous study). Statistic analysis revealed the risk factors for retinopathy: diabetes mellitus duration, elevated HbA1C levels and the need for insulin treatment. Conclusions: A better control of diabetes mellitus may lead us to observe an increase in visual acuity, and a better control of diabetic retinopathy. The incidence of diabetic retinopathy certainly decreased between the study periods; however the overall incidence of diabetes in the community has increased during the last few years, making firm conclusions difficult

Objetivo: Comparar los resultados obtenidos en una muestra de población de 741 pacientes diabéticos tipo II en el año 1993 con una muestra actual de 741 pacientes diabéticos tipo II, determinando la prevalencia de retinopatía diabética, y valorando el impacto sobre la misma de los nuevos criterios diagnósticos y el mayor control de los pacientes diabéticos. Métodos: Estudio transversal en el que la muestra fue recogida mediante selección al azar de 741 pacientes afectos de diabetes mellitus tipo II del total del archivo de pacientes visitados regularmente a lo largo del período comprendido entre el 1 de enero y el 31 de diciembre del año 2005. Resultados: Se observa un descenso de prevalencia de retinopatía diabética del 39,41% en el primer estudio al 27,55% actual, manteniéndose igual el edema macular (7,15% en el primer estudio y 7,90% en el actual). Se ha observado un descenso en el número de pacientes ciegos, de un 11,20% a un 4,90%. Asimismo los pacientes tratados previamente con fotocoagulación láser aumentaron en el estudio actual, un 13,49% frente a un 6,20%. En el estudio estadístico los factores de riesgo son: el tiempo de evolución de la diabetes, el tratamiento con insulina de la misma, y los niveles elevados de HbA1c. Conclusiones: El mayor control ejercido sobre los pacientes diabéticos nos permite observar una mejoría en la agudeza visual. Observándose también que aumenta el número de pacientes tratados. Por otro lado al existir un mayor número de pacientes diabéticos conocidos, se produce un efecto de disminución de la prevalencia de la retinopatía

[Tuberculous retinitis with associated periphlebitis]. / Retinitis por tuberculosis asociada a periflebitis.

CASE REPORT: A female 23 years old, from Equador, was referred to us because of a vision decrease in her left eye. Fundus exploration demonstrated an inflammatory chorioretinal lesion with associated periphlebitis. Serology results showed positive for PPD. A vitreous biopsy was carried out together with tuberculosis prophylactic treatment with isoniacide (300 mg/day); the clinical findings improved. Finally, PCR test was positive for mycobacterium tuberculosis. In consequence, therapeutic treatment for tuberculosis was initiated. DISCUSSION: Due to the current increase in prevalence of tuberculosis, we should always take this into account as a possible etiology when dealing with cases of chorioretinitis.

[Is microalbuminuria a risk factor for diabetic retinopathy?]. / La microalbuminurie est-elle un facteur de risque épidémiologique de la rétinopathie diabétique?

PURPOSE: To determine the relationship between microalbuminuria and diabetic retinopathy. METHODS: A prospective 10-year study of 104 younger-onset diabetic patients. The diabetic retinopathy diagnosis was made by fundus retinography, and determination of microalbuminuria was made from urine samples. RESULTS: The incidence of diabetic retinopathy in this group of patients was 39 (37.5%). The epidemiological factors implicated were diabetes duration, higher levels of HbA(1c), male sex, and diastolic arterial hypertension. The incidence of microalbuminuria was 21 patients (20.2%), with high levels of HbA(1c) the epidemiological factor implicated. The association between microalbuminuria and diabetic retinopathy grouped the patients as follows: 56 patients without microalbuminuria or retinopathy, 16 patients who developed microalbuminuria and diabetic retinopathy, 23 patients who developed retinopathy but not microalbuminuria, and nine patients who developed only microalbuminuria. The discriminant analysis showed that the high levels of HbA(1c) were associated with microalbuminuria and diabetes duration and high levels of HbA(1c) were associated with diabetic retinopathy. CONCLUSIONS: In the population studied, microalbuminuria was not a good marker for diabetic retinopathy.

Estudio de relación entre microangiopatía retinianay renal en pacientes diabéticos tipo 1 / Study of the relationship between retinal and renal microangiopathy in patients with diabetes mellitus type 1

Las similitudes en la vascularización de la retina y el riñón hacen que las complicaciones de la diabetes mellitus en los pequeños vasos (microangiopatía) aparezcan en ambos órganos. El presente estudio ofrece los resultados obtenidos de forma prospectiva a lo largo de 10 años en 104 pacientes diabéticos tipo 1, con las características de no presentar microalbuminuria ni retinopatía diabética al inicio del mismo; los resultados tienen por objetivo la relación entre la presencia de retinopatía diabética proliferativa y microalbuminuria, teniendo en cuenta diferentes factores de riesgo epidemiológico: sexo, duración de la diabetes, presencia de hipertensión arterial diastólica, niveles de HbA1c y lípidos sanguíneos. Los resultados obtenidos indican una incidencia de retinopatía diabética a los 10 años de seguimiento de 37,50 por ciento (siendo la forma proliferativa 13,46 por ciento) y la incidencia de microalbuminuria es de un 20,19 por ciento. La aparición de retinopatía diabética proliferativa se asocia a la presencia de hipertensión arterial diastólica, mientras que la aparición de microalbuminuria a los niveles elevados de HbA1c. Los resultados obtenidos de incidencia de retinopatía diabética proliferativa y microalbuminuria son similares a los de otros autores. Al final del estudio se configuran 4 grupos de pacientes según presenten retinopatía diabética proliferativa y/o microalbuminuria. De los resultados obtenidos en el presente estudio se desprende la posible existencia de dos poblaciones de pacientes diabéticos, una que desarrollaría retinopatía diabética proliferativa y lesión renal y una segunda en la que solamente aparecería retinopatía diabética proliferativa (AU)

[Study of the relationship between retinal and renal microangiopathy in patients with diabetes mellitus type 1]. / Estudio de relación entre microangiopatía retiniana y renal en pacientes diabéticos tipo 1.

The similarities in the vascularization of the retina and the kidney give rise to the complications of diabetes mellitus in the small vessels (microangiopathy) that appear in both organs. The present study presents the prospectively obtained results along 10 years in 104 diabetic type 1 patients, with the characteristics not to present microalbuminuria nor diabetic retinopathy at the beginning of the study; the results bear as objective the establishment of the relation between the presence of proliferative diabetic retinopathy and microalbuminuria, taking into account different factors of epidemiological risk: gender, duration of diabetes, presence of diastolic hypertension, levels of HbAlc, and blood lipids. The results obtained indicate a 10 years of follow-up incidence of diabetic retinopathy of 37.50% (being the proliferative form 13.46%) and the incidence of microalbuminuria is of 20.19%. The appearance of proliferative diabetic retinopathy is associated to the presence of diastolic hypertension, while the appearance of microalbuminuria is related to the elevation of levels of HbAlc. The results obtained in the proliferative diabetic retinopathy and microalbuminuria incidence are similar to those of other authors. At the end of the study four groups of patients are configured depending on whether they present proliferative diabetic retinopathy and/or microalbuminuria. The results obtained in the present study suggest the possible existence of two populations of diabetic patients, one that would develop proliferative diabetic retinopathy and renal injury, and a second population in which only would appear proliferative diabetic retinopathy.

[Chronic endophthalmitis in pseudophakic patients caused by bacillus subtilis]. / Endoftalmitis crónica en el seudofaco por bacillus subtilis.

OBJECTIVE/METHODS: We present two cases of patients with chronic endophthalmitis. The treatment included intraocular lens exchange, total capsulectomy and posterior vitrectomy through the limbus. In both cases, samples of the vitreous were taken and sent to the laboratory together with the intraocular lens and remmants of posterior capsule for culture and antibiogram. RESULTS/CONCLUSIONS: Microbiologic examination and culture were positive in two cases for Bacillus subtilis, which is not actually identified in literature as an etiologic agent for chronic endophthalmitis.

[Suprachoroidal bleeding: review and description of eight cases]. / Révision et description de 8 cas cliniques d'hémorragie choroïdienne.

INTRODUCTION: Suprachoroidal hemorrhage (SCH) is a dramatic complication of intraocular surgery that can result in total loss of vision. METHODS: The records of eight cases of SCH during cataract surgery were reviewed. Six of eight patients were treated by combined radial sclerotomies for suprachoroidal drainage and vitrectomy. Risk factors, therapeutic strategies, and functional and anatomical results were analyzed. RESULTS: The incidence of SCH was 0.45%. Preoperative visual acuity of all eyes suffering from SCH was limited to the perception of light. Postoperatively, six patients showed an increase in visual acuity greater than 0.1; one patient achieved 0.5. Ocular and general risk factors (ocular hypotony, myopia, Valsalva-type maneuvers, intraoperative systemic hypertension) and surgery complications were analyzed. CONCLUSIONS: In spite of using state-of-the-art surgical techniques, the prognosis of SCH remains serious, with a poorer outcome associated with increasing complications due to hemorrhage. Secondary treatment combining radial sclerotomies and vitrectomy should be performed to minimize the damaging effect of choroidal hemorrhage.