[The Granada Diabetic Retinopathy Study. Direct screening of 8,244 patients. I]. / Estudio Granada sobre Retinopatía Diabética. Cribado de 8.244 pacientes diabéticos. I.

OBJECTIVES: To evaluate the results of regular screening for diabetic retinopathy in the geographic area assigned to the San Cecilio University Hospital of Granada. MATERIAL AND METHODS: A multicenter prospective cohort study was carried out over a 2-year follow-up period. Retinal examinations were performed in 8244 diabetics in 14 health centres. 11,924 retinal examinations using an indirect ophthalmoscope, following pupil dilatation, were carried out. The classification of the lesions was as recommended by the simplified international scale of diabetic retinopathy and macular edema. The intervals between fundus examinations followed those recommended by the ETDRS. RESULTS: The crude prevalence of diabetes in the health area concerned was 2.77%. The average screening compliance of the program was 84.1%, and in only 0.3% of the patients was the fundus ophthalmoscopy ungradable. 91.3% of the known diabetic population attended for at least one fundus examination, with only 3.4% of the patients being referred for hospital treatment. The annual cost of the program was set at 53,173 Euros, with the average cost of each examination (6000 per year) being 8.87 Euros. CONCLUSIONS: The Diabetic Retinopathy Screening Program (through dilated pupils) carried out with indirect ophthalmoscopy is cost-effective. It provides coverage to the whole known diabetic population with a high level of compliance. The percentage of patients whose fundus can be considered ungradable is minimal.

Estudio Granada sobre retinopatía diabética. Cribado de 8.244 pacientes diabéticos. I / The Granada diabetic retinopathy study. Direct screening of 8.244 patients. I

Objetivo: Evaluar el programa de cribado regular de la retinopatía diabética en la población asistida del Hospital Universitario San Cecilio de Granada. Material y métodos: Se realizó durante un seguimiento de 2 años, un estudio de cohortes prospectivo y multicentrico. El estudio comprende las exploraciones de la retina de 8.244 diabeticos en 14 centros de salud. Se realizaron 11.924 exámenes de retina en midriasis utilizando un oftalmoscopio indirecto. La clasificación de las lesiones fue la recomendada por la Escala Internacional Simplificada de Retinopatia Diabética y Edema Macular. La periocidad de las exploraciones fueron las recomendadas por el ETDRS. Resultados: La prevalencia de diabetes en el area de salud fue del 2,77%. La asistencia media al programa fue del 84,1%, solamente en un 0,3% de los pacientes el fondo de ojo fue inexplorable. El 91,3% de la poblacion diabética conocida acudió al menos a un examen de fondo de ojo, remitiéndose para tratamiento hospitalario el 3,4% de los pacientes. El costo anual del Programa se cifró en 53.173 euros, con una media de 6.000 exploraciones anuales a un costo de 8.87 euros exploración. Conclusiones: El programa de cribado de la retinopatía diabética realizado con un oftalmoscopio binocular y en midriasis es costo-efectivo. Proporciona cobertura a toda la población diabética conocida con un elevado grado de cumplimentación. El porcentaje de pacientes cuyo fondo de ojo se considera inexplorable es mínimo

Objectives: To evaluate the results of regular screening for diabetic retinopathy in the geographic area assigned to the San Cecilio University Hospital of Granada. Material and methods: A multicenter prospective cohort study was carried out over a 2-year followup period. Retinal examinations were performed in 8244 diabetics in 14 health centres. 11,924 retinal examinations using an indirect ophthalmoscope, following pupil dilatation, were carried out. The classification of the lesions was as recommended by the simplified international scale of diabetic retinopathy and macular edema. The intervals between fundus examinations followed those recommented by the etdrs. Results: The crude prevalence of diabetes in the health area concerned was 2.77%. The average screening compliance of the program was 84.1%, and in only 0.3% of the patients was the fundus ophthalmoscopy ungradable. 91.3% of the known diabetic population attended for at least one fundus examination, with only 3.4% of the patients being referred for hospital treatment. The annual cost of the program was set at 53,173 euros, with the average cost of each examination (6000 per year) being 8.87 euros. Conclusions: The Diabetic Retinopathy Screening Program (through dilated pupils) carried out with indirect ophthalmoscopy is cost-effective. It provides coverage to the whole known diabetic population with a high level of compliance. The percentage of patients whose fundus can be considered ungradable is minimal

[Filtering bleb after surgical cyclodialysis]. / Ampolla filtrante secundaria a cirugía de ciclodiálisis.

CASE REPORT: A 35-year-old man with degenerative myopia suffered blunt ocular trauma due to being hit in the face by a ball. The injury caused four cyclodialysis clefts in his left eye which resulted in hypotony and chorioretinal folds. DISCUSSION: The persisting hypotony was unsuccessfully treated with topical therapy and with laser photocoagulation. Therefore, a surgical treatment with direct cyclopexy was performed. In one of the cyclodialysis clefts, incarcerated vitreous was found, and this was considered to be the reason for its incomplete closure. In the postoperative period complete closure of the cyclodialysis cleft was observed; however an unexpected filtering bleb appeared, which could have affected good control of intraocular pressure.

Ampolla filtrante secundaria a cirugía de ciclodiálisis / Filtering bleb after surgical cyclodialysis

Caso clínico: Hombre de 35 años, miope magno, que recibe un balonazo en su ojo izquierdo. El traumatismo ocular le origina una ciclodiálisis y una hipotonía ocular con aparición de pliegues corioretinianos. Discusión: La hipotonía persistente no cedió al tratamiento tópico, ni a la fotocoagulación, por lo que se procedió al tratamiento quirúrgico mediante ciclopexia directa. En una de las ciclodiálisis se observó la existencia de vítreo, que consideramos pudiera ser la causa de su cierre incompleto. En el postoperatorio se comprobó el cierre completo de la ciclodiálisis, pero apareció una ampolla de filtración inesperada que pudo haber contribuido al buen control de la presión intraocular (AU)

Case report: A 35-year-old man with degenerative myopia suffered blunt ocular trauma due to being hit in the face by a ball. The injury caused four cyclodialysis clefts in his left eye which resulted in hypotony and chorioretinal folds. Discussion: The persisting hypotony was unsuccessfully treated with topical therapy and with laser photocoagulation. Therefore, a surgical treatment with direct cyclopexy was performed. In one of the cyclodialysis clefts, incarcerated vitreous was found, and this was considered to be the reason for its incomplete closure. In the postoperative period complete closure of the cyclodialysis cleft was observed; however an unexpected filtering bleb appeared, which could have affected good control of intraocular pressure (AU)