[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.

[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.

Endoftalmitis crónica en el seudofaco por Bacillus subtilis / Chronic endophthalmitis in pseudophakic patients caused by Bacillus subtilis

Objetivo/Método: Presentamos dos casos clínicos de pacientes con endoftalmitis crónica, en los que se practicó recambio de lente intraocular asociado a capsulectomía, vitrectomía media posterior por vía límbica anterior. En ambos casos se obtuvo muestra de vítreo que se remitió al laboratorio, junto a la lente intraocular y restos de la cápsula posterior para cultivo y antibiograma. Resultados/Conclusiones: El estudio microbiológico fue positivo en dos casos para Bacillus subtilis, este germen actualmente no se ha asociado a endoftalmitis crónica en la literatura (AU)

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 (AU)

[Is basic the anesthetist presence in cataract surgery?]. / Es necesaria la presencia del médico anestesista en la cirugía de la catarata?

PURPOSE: To determine the need for anesthesiology in cataract surgery. METHODS: For the present study a total of 406 consecutive patients who underwent cataract surgery under regional peribulbar anesthesia were selected. RESULTS: In 109 cases (28,5%) the anesthetist was required, the causes of intervention were: high blood pressure in 68 patients (16.74%), perturbation in 20 patients (4.92%), cardiac arrhytmia in 20 patients (4.92%) and one case of myocardial infarction. CONCLUSIONS: Anesthetist intervention was requiered in one third of cataract surgery cases. This is why the anesthetist care seems to be justified in cataract surgery under local anesthesia.

¿Es necesaria la presencia del médico anestesista en la cirugía de la catarata? / Is basic the anesthetist presence in cataract surgery?

Objetivo: Determinar la necesidad de la presencia del médico anestesista en las intervenciones de catarata. Métodos: Estudio sobre 406 pacientes intervenidos de catarata escogidos de forma aleatoria y sometidos a bloqueo anestésico local peribulbar, bajo monitorización. Resultados: El médico anestesista intervino en 109 (28,5 por ciento) ocasiones para controlar el estado general del paciente, siendo las causas: crisis de hipertensión arterial en 68 pacientes (16,74 por ciento), agitación nerviosa en 20 pacientes (4,92 por ciento), alteraciones del ritmo cardíaco en 20 pacientes (4,92 por ciento) y una paciente presentó infarto agudo de miocardio. Conclusiones: La presencia del médico anestesista creemos que está justificada debido que una tercera parte de los pacientes requirieron su intervención, y a la gravedad de las patologías controladas peroperatoriamente (AU)

[Results in the treatment of acute endophthalmitis by vitrectomy using limbal incision]. / Resultados obtenidos en el tratamiento de la endoftalmitis aguda mediante vitrectomía vía limbar.

PURPOSE: To describe the results obtained in the treatment of acute onset endophthalmitis after cataract surgery in our center using vitrectomy with corneal limbal incisions. METHODS: Study carried out in 12 patients with acute endophthalmitis after cataract surgery in whom a posterior vitrectomy by limbic incisions was performed followed by intravitreal injections of antibiotics (vancomycin + ceftazidime/amikacin) with systemic and topical antibiotic and corticosteroid treatment in the post-operative period. RESULTS: The incidence of endophthalmitis in our center was 0.92%. The most frequently isolated microorganism was Staphylococcus epidermidis (4 cases, 33.33%). Four cases were negative (33.33%). A visual acuity equal to or greater than 0.5 at three months was obtained in 6 patients (50%). Only one case required a second administration of intravitreal injections. One patient suffered vitreal hemorrhaging in the post-operative period, and no other complications were observed in the remaining patients. CONCLUSIONS: We consider that vitrectomy through limbal incisions is a valid alternative for acute onset endophthalmitis treatment.

Resultados obtenidos en el tratamiento de la endoftalmitis aguda mediante vitrectomía vía limbar / Results in the treatment of acute endophthalmitis by vitrectomy using limbal incision

Objetivo: Describir los resultados obtenidos en el tratamiento de la endoftalmitis aguda, tras cirugía de catarata en nuestro centro, mediante vitrectomía con incisiones límbicas corneales Métodos: Estudio realizado en 12 pacientes con endoftalmitis aguda tras cirugía de catarata, en los que se practicó vitrectomía posterior a través de incisiones límbicas, seguido de inyecciones intravítreas de antibióticos (vancomicina + ceftazidime / amikacina); con tratamiento antibiótico y corticoide, sistémico y tópico en el postoperatorio Resultados: La incidencia de endoftalmitis en nuestro centro fue de 0,92 por ciento. El germen aislado con mayor frecuencia fue el Staphilococcus epidermidis (4 casos 33,33 por ciento), resultando negativos 4 casos (33,33 por ciento); de los doce casos tratados se consiguió una agudeza visual a los 3 meses, igual o superior a 0,5 en 6 pacientes (50 por ciento), solo un caso requirió la administración de una segunda serie de inyecciones intra vítreas. Una paciente sufrió una hemorragia vítrea en el postoperatorio, no observándose ninguna otra complicación en el resto de pacientes. Conclusiones: Creemos que la vitrectomía por vía límbica corneal es una alternativa válida para la endoftalmitis aguda (AU)

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[Anterior optic neuritis do to ulcerative colitis]. / Neuritis óptica anterior por colitis ulcerosa.

PURPOSE/METHODS: We present the case of a 27 year old woman with acute bilateral loss of vision associated with abdominalgia, bloody diarrhea and arthralgia. In the present article, the different forms of ocular complications in relationship to chronic intestinal inflammations and their possible causes are discussed. RESULTS/CONCLUSIONS: On examination, bilateral anterior uveitis associated to a picture of optic nerve lesion compatible with a bilateral anterior optic neuritis was observed. The patient was diagnosed of ulcerative colitis by intestinal biopsy. The ocular affectation resolved after the ulcerative colitis was treated with systemic mesalamine.

Neuritis óptica anterior por colitis ulcerosa / Anterior optic neuritis do to ulcerative colitis

Objetivo/Métodos: Presentamos un caso clínico de una paciente de 27 años de edad, que acudió por un cuadro de pérdida aguda de visión bilateral asociada a artralgia y diarrea serosanguinolenta. En el presente artículo se discuten las diferentes formas de afectación ocular en la inflamación crónica intestinal y sus posibles causas patogénicas. Resultados/Conclusiones: A la exploración se apreció uveítis anterior bilateral, asociada a la presencia de un cuadro de afectación del nervio óptico compatible con neuritis óptica anterior bilateral, se realizo el diagnóstico de colitis ulcerosa, mediante biopsia intestinal. El cuadro remitió al tratar la inflamación intestinal crónica con mesalamina por vía oral (AU)

Rinomucormicosis supervivencia a largo plazo tras tratamiento conservador / Long life survival in rhino-mucormycosis after conservative treatment

Objetivo/Métodos: Presentamos un caso de rinomucormicosis en un paciente varón de 52 años de edad, afecto de diabetes mellitus tipo 2, que debutó con parálisis completa de III nervio craneal derecho y ceguera del mismo ojo por obliteración de la arteria y vena central de la retina, tratado con anfotericina B y exéresis de los tejidos necróticos de las mucosas nasal y paranasales etmoidal, maxilar y esfenoidal derechas, sin recurrir a la exanteración orbitaria. Resultado/Conclusiones: Tras un seguimiento posterior durante cinco años, en los que no presentó ningún tipo de recidiva, desarrolló glaucoma neovascular (AU)

[Long-term survival in rhino-mucormycosis after conservative treatment]. / Rinomucormicosis supervivencia a largo plazo tras tratamiento conservador.

OBJECTIVE/METHODS: We describe a case of rhino-mucormycosis, in a 52-year-old male, with diabetes mellitus type 2, III cranial nerve palsy and blindness due to obliteration of central retinal artery and vein of the right eye The patient was treated with anfotericin B and necrotic tissues exeresis of nasal and paranasal (ethmoidal, maxillar and esfenoidal) sinuses, without orbital exenteration. RESULTS/CONCLUSIONS: After a follow up of five years, no type of relapse was detected, but neovascular glaucoma developed.

[Risk factors in retinopathy of prematurity]. / Factores de riesgo en la retinopatía del prematuro.

OBJECTIVE: The objective of this study was to determine the potential risk factors in acute retinopathy of prematurity (ROP). PATIENTS AND METHODS: A retrospective study of preterm infants with birth weights less than 1,501 g, or more if mechanical ventilation and oxygen administration were needed, was carried out. Indirect ophthalmoscopy (mydriasis) with indentation was done every 15 days from the fourth week. Fifteen factors were analyzed. Statistically significant differences between the groups with and without ROP were sought with Fisher's exact probability test, two-sample t-test, and the chi-square contingency-table. A logistic regression was done. RESULTS: Thirty-six of the 137 infants examined (26.2%) with birth weight < or = 1,500 g had acute ROP. Only 7.1% of the infants with birth weights > or = 1,501 g had retinopathy. There were significant differences (p < 0.05) in the following variables: birth weight, gestational age, blood transfusion, mechanical ventilation, FiO2 (fraction inspired oxygen) maximum, time of FiO2 > or = 0.60 (hours) and time of FiO2 > or = 0.21 (days). However, the birth-weight was the only independent risk factor related to ROP. CONCLUSIONS: Retinopathy of the premature has a multifactorial etiology. The low gestational age and the oxygen had influence on ROP; however, low birth weight was the independent risk factor.