[Lack of correlation between retinal variables before treatment and poor functional response after focal photocoagulation in diabetic macular oedema]. / Falta de asociación entre las características retinianas previas al tratamiento y la mala respuesta funcional a la fotocoagulación focal, en edema macular diabético.

BACKGROUND: Although photocoagulation reduces the incidence of moderate visual loss in eyes with focal diabetic macular oedema, some eyes may lose some vision after treatment. The proportion of eyes with poor functional response after photocoagulation, and whether any retinal variable is associated with this, is unknown. OBJECTIVE: To determine the proportion of eyes with diabetic macular oedema that have a poor functional response after focal photocoagulation, and their associated features. MATERIAL AND METHODS: A non-experimental, longitudinal, comparative and retrospective study was conducted. The proportion and 95% confidence intervals (CI) of diabetics with macular oedema that had a poor functional response after focal photocoagulation (any visual loss after 6 weeks) were identified. The means of retinal variables before treatment were compared between eyes with and without a poor functional response using the Student t test for independent means. RESULTS: The study included 115 eyes of patients aged 59.3 (SD 9.24) years. Visual acuity was greater than or equal to 0.5 in 63 eyes (54.8%). A total of 33 eyes had a poor functional response after photocoagulation (28.7%, 95% CI: 13.3 to 44.1). The comparison between retinal variables and visual acuity before treatment did not show any differences between eyes with or without a poor functional response and eyes. CONCLUSION: Retinal thickening and visual acuity improved or did not change in 71.3% of eyes with diabetic macular oedema with a single photocoagulation procedure. Retinal variables that are usually evaluated were unable to identify the remaining 28.7%, which could lose vision after that treatment, and would require additional interventions.

[Vision-threatening retinopathy in diabetics not referred to an ophthalmologist]. / Retinopatía que amenaza la visión en pacientes diabéticos no referidos al oftalmólogo.

BACKGROUND: Vision-threatening forms of diabetic retinopathy (macular edema and proliferative retinopathy) can be efficiently treated with laser. Any delay in access to ophthalmic care may limit the opportunity of treatment. Diabetics that are not referred to an ophthalmologist are a vulnerable population, which could lose vision as a result of delayed attention. MATERIAL AND METHODS: Observational, descriptive, prospective, cross-sectional study in diabetics attending a hospital for non-ophthalmological causes, without prior evaluation of the ocular fundus. The proportion of eyes with vision-threatening diabetic retinopathy, and that of eyes in which visual loss could be prevented were identified. RESULTS: 100 patients, mean age 55.5 years, 53 females; 48 had diabetic retinopathy, six had proliferative retinopathy (6%; 95% CI: 1.3-10.7), and 23 had macular edema (23%; 95% CI: 14.8-31.2); the proportion of diabetic macular edema was higher than the one reported in the same population 15 years before (odds ratio 4.01; 95% CI: 1.98-8.15). Fifty-six percent of the patients with vision-threatening retinopathy did not have visual deficiency. CONCLUSION: Detection and referral of diabetic patients with risk of visual loss must be made easier, regardless of their visual symptoms, in order to achieve treatment efficacy by timely care.