Retinal microvascular abnormalities in patients after COVID-19 depending on disease severity.

BACKGROUND: Global pandemic SARS-CoV-2 causes a prothrombotic state without fully elucidated effects. This study aims to analyse and quantify the possible retinal microvascular abnormalities. MATERIALS AND METHODS: Case-control study. Patients between 18 and 55 years old with PCR-confirmed SARS-CoV-2 infection within the last 3 months were included. RISK STRATIFICATION: group 1-mild disease (asymptomatic/paucisymptomatic); group 2-moderate disease (required hospital admission with no acute respiratory distress) and group 3-severe disease (subjects who developed an acute respiratory distress were admitted in the intensive care unit and presented interleukin 6 values above 40 pg/mL). Age-matched volunteers with negative serology tests were enrolled to control group. A colour photograph, an optical coherence tomography (OCT) and an angiography using OCT centred on the fovea were performed. RESULTS: Control group included 27 subjects: group 1 included 24 patients, group 2 consisted of 24 patients and 21 participants were recruited for group 3. There were no funduscopic lesions, neither in the colour images nor in the structural OCT. Fovea-centred vascular density (VD) was reduced in group 2 and group 3 compared with group 1 and control group (control group vs group 2; 16.92 vs 13.37; p=0.009) (control group vs group 3; 16.92 vs .13.63; p=0.026) (group 1 vs group 2; 17.16 vs 13.37; p=0.006) (group 1 vs group 3; 17.16 vs 13.63 p=0.017). CONCLUSION: Patients with moderate and severe SARS-CoV-2 pneumonia had decreased central retinal VD as compared with that of asymptomatic/paucisymptomatic cases or control subjects.

Retinal Microperimetry: A New Tool for Identifying Patients With Type 2 Diabetes at Risk for Developing Alzheimer Disease.

Type 2 diabetes is associated with a high risk of cognitive impairment and dementia. Therefore, strategies are needed to identify patients who are at risk for dementia. Given that the retina is a brain-derived tissue, it may provide a noninvasive way to examine brain pathology. The aims of this study were to evaluate whether retinal sensitivity 1) correlates with the specific parameters of brain imaging related to cognitive impairment and 2) discriminates patients with diabetes with mild cognitive impairment (MCI) from those with normal cognition and those with Alzheimer disease (AD). For this purpose, a prospective, nested case-control study was performed and included 35 patients with type 2 diabetes without cognitive impairment, 35 with MCI, and 35 with AD. Retinal sensitivity was assessed by Macular Integrity Assessment microperimetry, and a neuropsychological evaluation was performed. Brain neurodegeneration was assessed by MRI and fludeoxyglucose-18 positron emission tomography (18FDG-PET). A significant correlation was found between retinal sensitivity and the MRI and 18FDG-PET parameters related to brain neurodegeneration. Retinal sensitivity was related to cognitive status (normocognitive > MCI > AD; P < 0.0001). Our results suggest that retinal sensitivity assessed by microperimetry is related to brain neurodegeneration and could be a useful biomarker for identifying patients with type 2 diabetes who are at risk for developing AD.

Telemedicine for a General Screening of Retinal Disease Using Nonmydriatic Fundus Cameras in Optometry Centers: Three-Year Results.

PURPOSE: Describe the first 3 years of highly specialized retinal screening through a web platform using a retinologists' network for image reading. METHODS: All patients who came to centers in the network and consented to fundus photography were included. Images were evaluated by ophthalmologists. We describe number of patients, age, visual acuity, retinal abnormalities, medical recommendations, and factors associated with abnormal retinographies. RESULTS: Fifty thousand three hundred eighty-four patients were included; mean age 52.3 years (range 3-99). Mean visual acuity 20/25. Of the total cohort, 75% had normal retinographies, 22% had abnormalities, 1% referred acute floaters, 1% referred acute symptoms with normal retinography, and 1% could not be assessed. Ophthalmological referral was recommended in 12,634 patients: 9% urgent visit, 11% preferential (2-3 weeks), and 80% an ordinary visit. Age-related maculopathy signs were the most common abnormalities (2,456 patients, 4.8%). Epiretinal membrane was the second (764 cases, 1.5%). Diabetic retinopathy was suspected in 543 patients (1%), and nevi in 358 patients (0.7%). Patients older than 50 years had significantly more retinal abnormalities (31.5%) than younger ones (11.1%) (p < 0.0001; odds ratio [OR] 2.47; confidence interval [CI] 2.37-2.57). Patients with almost one eye with a myopic defect greater than -5 spherical equivalent had a higher risk of presenting abnormalities (p < 0.001; OR 1.04; CI 1.03-1.05). CONCLUSIONS: A high rate of asymptomatic retinal abnormalities was detected in this general screening, justifying this practice. Many patients who visit optometrists in Spain are unaware that they would benefit from ophthalmological monitoring. The ophthalmic community should lead initiatives of the type presented to preserve and guarantee quality standards.

Colecistectomía laparoscópica / Laparoscopic cholecystectomy

Con el fin de hacer conocer a la comunidad médica detalles técnicos y los resultados de nuestras primeras experiencias en la relación de colecistectomías laparoscópicas informamos que desde el 01/07/91 al 30/10/91 hemos empleado esta técnica en 21 pacientes con diagnóstico de: Litiasis Vesicular (n: 16); Cálculo enclavado en Bacinete (n: 2); Colecistitis Aguda Litiásica (n: 2) y Colecistitis Escleroatrófica (n: 1). En 4 casos se debió recurrir a finalizar la operación con la técnica quirúrgica convencional; en una oportunidad por falla de la fuente de iluminación, y en otros dos porque el tamaño del cálculo enclavado en el bacinete impidió la visualización del pedículo cístico y en otro por la característica escleroatrófica de la vesícula. Tres pacientes presentaron complicaciones posoperatorias: 2 con hematoma en la incisión supraumbilical y otra una pancreatitis aguda leve a los 15 días del acto quirúrgico. 13/16 pacientes en los que se realizó colecistectomía laparoscópica estuvieron de alta a las 24 horas y los otros 3 a las 30, 36 y 48 horas respectivamente. Las expectativas de la técnicas en cuanto a dolor posoperatorio, inhabilitación y tiempo de alta se confirmó plenamente en nuestros casos

Colecistectomía laparoscópica / Laparoscopic cholecystectomy

Con el fin de hacer conocer a la comunidad médica detalles técnicos y los resultados de nuestras primeras experiencias en la relación de colecistectomías laparoscópicas informamos que desde el 01/07/91 al 30/10/91 hemos empleado esta técnica en 21 pacientes con diagnóstico de: Litiasis Vesicular (n: 16); Cálculo enclavado en Bacinete (n: 2); Colecistitis Aguda Litiásica (n: 2) y Colecistitis Escleroatrófica (n: 1). En 4 casos se debió recurrir a finalizar la operación con la técnica quirúrgica convencional; en una oportunidad por falla de la fuente de iluminación, y en otros dos porque el tamaño del cálculo enclavado en el bacinete impidió la visualización del pedículo cístico y en otro por la característica escleroatrófica de la vesícula. Tres pacientes presentaron complicaciones posoperatorias: 2 con hematoma en la incisión supraumbilical y otra una pancreatitis aguda leve a los 15 días del acto quirúrgico. 13/16 pacientes en los que se realizó colecistectomía laparoscópica estuvieron de alta a las 24 horas y los otros 3 a las 30, 36 y 48 horas respectivamente. Las expectativas de la técnicas en cuanto a dolor posoperatorio, inhabilitación y tiempo de alta se confirmó plenamente en nuestros casos