Characteristics of pseudophakic retinal detachment and risk factors of recurrence.

BACKGROUND: The present study was designed to gain knowledge about the prognostic factors and evolution of pseudophakic retinal detachment (PRD) and to analyse the main characteristics of PRD, such as the mean time to retinal detachment following cataract surgery, as well as the clinical factors associated with the risk of recurrence and worse anatomical and functional outcomes. METHODS: This was a retrospective monocentric study of 330 patients with PRD who underwent surgery between 2012 and 2020. All patients were pseudophakic and were referred for retinal detachment surgery at Donostia University Hospital (Terciary Hospital, Spain). RESULTS: The mean age of the patients at the time of phacoemulsification was 63.06 ±â€¯10.8 years, and 49.09% of them had moderate myopia [axial length (AL) (23.5-26.5 mm)]. In our series, macular detachment was evident in 69.09% (n = 228) of the patients. The mean time that elapsed between phacoemulsification and PRD surgery was 4.04 ±â€¯4.17 years, which was reduced by half in the event of surgical complications (2.24 ±â€¯2.65). The rate of PRD was 28.79%. The anatomical results in terms of retinal reapplication were better with the combination of vitrectomy and scleral buckling (83.1% vs. 70.5%) (p = 0,127) compared with vitrectomy. The variables associated with a higher risk of recurrence were male sex (hazard ratio (HR) = 1.75), macular detachment (HR = 2.00) and the presence of proliferative vitreoretinopathy (PVR) (HR = 3.21). CONCLUSIONS: PRD usually occurs within 4 years of phacoemulsification, although it may occur significantly earlier in the event of surgical complications. Macular involvement, PVR, and male sex are all associated with a higher risk of PRD recurrence.

Prevención del edema macular en pacientes diabéticos sometidos a cirugía de catarata / Prevention of maclar edema in diabetic patients undergoing cataract surgery

El edema macular pseudofáquico (EMP) es una complicación en la cirugía de catarata. Existen diversos factores que aumentan el riesgo de desarrollar EMP tales como la uveítis, membranas epirretinianas y diabetes mellitus. Se ha demostrado ampliamente que un mayor porcentaje de pacientes diabéticos desarrolla EMP tras someterse a cirugía de catarata frente a los pacientes no diabéticos. El EM es la principal causa de pérdida de agudeza visual en estos pacientes. Existen dos tipos de EM en paciente diabético: 1) El EMP tras cirugía de catarata en pacientes diabéticos. 2) El Edema macular diabético (EMD)que se genera por las alteraciones intrínsecas vasculares que el paciente diabético tiene. Un tratamiento preventivo podría mejorar los resultados de los pacientes diabéticos tras someterse a cirugía de catarata, con los correspondientes beneficios para la calidad de vida del paciente y su repercusión en los costes sanitarios asociados a esta patología. Existen 4 AINEs aprobados por la FDA (Food and Drugs Administration) para el manejo de la inflamación tras la cirugía de catarata: bromfenaco, dicloflenaco, ketorolaco y nepafenaco. Aunque prácticamente todos los AINEs se han venido usando en prevención en pacientes intervenidos quirúrgicamente de catarata, nepafenaco es el único aprobado por la EMA (European Medicines Agency) para esta indicación, y lo ha demostrado en pacientes con retinopatía diabética. El objetivo del presente trabajo es revisar la literatura publicada al respecto y destacarla importancia de una estrategia de prevención de edema macular en pacientes diabéticos sometidos a cirugía de catarata (AU)

Pseudophakic macular edema (PME) is a common complication of cataract surgery. There are several factors that increase the risk of developing PME such as uveitis, epiretinal membranes and diabetes mellitus. There is ample evidence that a higher percentage of diabetic patients develop PME after undergoing cataract surgery compared to patients without diabetes.Macular edema is the main cause of loss of visual acuity in these patients. There are two types of ME in diabetic patients: 1) PME after cataract surgery in diabetic patients. 2) Diabetic Macular Edema (DME) that is generated by intrinsic vascular alterations present in diabetic patients. A preventive treatment could improve outcomes of diabetic patients undergoing cataract surgery, with corresponding benefits to the quality of life and their impact on health care costs associated with this pathology. There are 4 NSAIDs approved by the FDA (Food and Drugs Administration) for the management of inflammation after cataract surgery: bromfenac, dicloflenac, ketorolac and nepafenaco. Although practically all NSAIDs are been used for the prevention in patients with cataract surgery, nepafenac is the only one approved by the EMA (European Medicines Agency) for this indication, and it has demonstrated its effects in patients with diabetic retinopathy. The aim of this paper is to review the published literature and highlight the importance of a macular edema prevention strategy in diabetic patients undergoing cataract surgery (AU)

Prevalencia de retinopatía diabética mediante cribado con retinógrafo no midriático / Prevalence of diabetic retinopathy using non-mydriatic retinography

Objetivo. Estudiar la prevalencia de retinopatía diabética mediante retinógrafo no midriático y valorar su utilidad como método de cribaje en la comarca de Donosti aldea. Métodos. Se realizó un estudio prospectivo incluyendo 2.444 pacientes diabéticos derivados por su médico de atención primaria y/o endocrinólogo. Se realizó una retinografía con cámara no midriática en los 45 grados centrales, agudeza visual y tonómetro de no contacto en todos los pacientes. La información se derivó al hospital para ser evaluado por un oftalmólogo especialista en retina. Resultados. El 15,02% de los pacientes eran diabéticos en tratamiento dietético, el 62,55% eran diabéticos no insulinodependientes y el 22,43% eran diabéticos insulinodependientes. Observamos una prevalencia de retinopatía diabética del 9,36%. El 5,27% presentó retinopatía diabética no proliferativa (RDNP) leve, el 2,21% RDNP moderada, el 1,67% RDNP severa y el 0,12% RD proliferativa. El 8,22% presentó hipertensión ocular. Conclusiones. Se observa una baja prevalencia de RD en los pacientes de nuestra muestra. La utilización de telemedicina con cámara no midriática es un arma importante para el diagnóstico precoz de la retinopatía diabética y puede aplicarse a otras patologías oftalmológicas como el glaucoma (AU)

Objectives. To establish the prevalence of diabetic retinopathy (RD) diagnosed after non-mydriatic retinography and to evaluate its utility as a screening test in the area of San Sebastián. Methods. A prospective study including 2,444 diabetic patients sent by their primary attention doctors and/or their endocrinologists. All patients underwent non mydriatic retinography in the central 45 degrees; visual acuity was explored, as well as IOP through non-contact tonometry. The retinographies and information obtained were sent to our hospital and were revised by an ophthalmologist from the Retina Department. Results. Fifteen point zero two (15.02%) of the patients suffered from diabetes and were under dietary treatment, 62.55% suffered from non-insulin-dependant diabetes, and 22.43% suffered from insulin-dependant diabetes. The prevalence of diabetic retinopathy was 9.36%; 5.27% mild non-proliferative diabetic retinopathy (DR); 2.21% moderate-non-proliferative DR; 1.67 % severe non-proliferative DR; and 0.05% proliferative-diabetic retinopathy. Eight point two two (8.22%) of the sample studied was diagnosed with ocular hypertension. Conclusions. We observed a low prevalence of DR in our sample. Use of non-mydriatic retinopathy in telemedicine plays an important role in the early diagnosis of diabetic retinopathy and it can be applied to other ophthalmic diseases (AU)

[Prevalence of diabetic retinopathy using non-mydriatic retinography]. / Prevalencia de retinopatía diabética mediante cribado con retinógrafo no midriático.

OBJECTIVES: To establish the prevalence of diabetic retinopathy (RD) diagnosed after non-mydriatic retinography and to evaluate its utility as a screening test in the area of San Sebastián. METHODS: A prospective study including 2,444 diabetic patients sent by their primary attention doctors and/or their endocrinologists. All patients underwent non-mydriatic retinography in the central 45 degrees; visual acuity was explored, as well as IOP through non-contact tonometry. The retinographies and information obtained were sent to our hospital and were revised by an ophthalmologist from the Retina Department. RESULTS: Fifteen point zero two (15.02%) of the patients suffered from diabetes and were under dietary treatment, 62.55% suffered from non-insulin-dependant diabetes, and 22.43% suffered from insulin-dependant diabetes. The prevalence of diabetic retinopathy was 9.36%; 5.27% mild non-proliferative diabetic retinopathy (DR); 2.21% moderate-non-proliferative DR; 1.67 % severe non-proliferative DR; and 0.05% proliferative-diabetic retinopathy. Eight point two two (8.22%) of the sample studied was diagnosed with ocular hypertension. CONCLUSIONS: We observed a low prevalence of DR in our sample. Use of non-mydriatic retinopathy in telemedicine plays an important role in the early diagnosis of diabetic retinopathy and it can be applied to other ophthalmic diseases.

[Surgical arteriovenous decompression (sheathotomy) in branch retinal vein occlusion: retrospective study]. / Descompresión venosa quirúrgica en las oclusiones de rama venosa retinianas: estudio retrospectivo.

PURPOSE: To evaluate best-corrected visual acuity (BCVA), incidence of neovascularization and angiographic changes in patients with branch retinal vein occlusion (BRVO) treated with surgical decompression by sheathotomy. METHODS: Retrospective study including 17 cases of temporal BRVO with macular edema treated with surgical decompression. Results of BCVA, incidence of neovascularization and vitreous hemorrhage 6 months following surgery are included. Angiographic changes in the first 8 cases a month after decompression are also evaluated. RESULTS: The mean postoperatory BCVA was 0.40 with a mean improvement of 0.26. Seventy one percent of patients (12/17) improved 2 or more visual acuity lines and 53% of patients (9/17) improved 4 or more lines. Only in one case the vision worsened. There was no evidence of retinal neovascularization or rubeosis iridis six months after surgery. CONCLUSIONS: Surgical decompression is a therapeutical option for those patients suffering BRVO with macular edema. Our initial results are encouraging, not only regarding visual acuity improvement, but also because of a decreased risk of neovascularization. No patient included in our study developed neovascularization.