Relationship between diabetic retinopathy, microalbuminuria and overt nephropathy, and twenty-year incidence follow-up of a sample of type 1 diabetic patients.

PURPOSE: To determine the incidence and relationship of diabetic retinopathy (DR), microalbuminuria and overt nephropathy (ON). METHOD: A 20-year prospective study, in a cohort of 110 consecutive type 1 diabetes mellitus (DM) patients, without diabetic retinopathy or microalbuminuria at enrolment in 1990. RESULTS: The 20-year incidence of any DR was 70.91%, microalbuminuria 42.72%, and ON was 23.63%. Regarding the risk factors: pre pubertal age at diagnosis was significant for DR and ON, LDL-cholesterol and CT/HDL-cholesterol were significant for DR but not for microalbuminuria or ON. The relationship between DR and ON demonstrated that DR was a significant risk factor for ON, but ON was significant for sight-threatening DR. At the end of the study, two major groups of patients were formed: patients with DR only and patients with DR and ON. For the development of only DR we can assume that the most important risk factor is the duration of DM, followed by the high levels of HbA1c, pre-pubertal age at onset, and arterial hypertension; and for the development of ON and DR simultaneously, risk factors are higher levels of HbA1c, arterial hypertension, DM duration and pre-pubertal age at onset. CONCLUSIONS: In the current study, two major groups of patients have been formed, those who developed only DR and those who developed DR and ON. For the former, incidence increased as DM duration increased, and for the latter incidence appeared to be closely related to levels of HbA1c.

Results at seven years after the use of intracamerular cefazolin as an endophthalmitis prophylaxis in cataract surgery.

BACKGROUND: To evaluate results after seven years using prophylactic intracameral cefazolin for the prevention of endophthalmitis in cataract surgery. METHODS: A prospective, observational study of all patients submitted to cataract surgery over the period January 1996 to December 2009. All cases of postoperative endophthalmitis over that period were reviewed. The patients were classified in two groups: Group 1 (11,696 patients) operated on between January 1996 and December 2002, Group 2 (13,305 patients) between January 2003 and December 2009 (in whom a 1 mg/0.1 bolus of intracameral cefazolin was instilled). RESULTS: During the study period, 76 cases of endophthalmitis were observed in Group 1, and seven in Group 2. The rate of postoperative endophthalmitis reduced from 0.63% to 0.05% with a cefazolin injection. The relative risk (RR) for endophthalmitis in Group 1 against group 2 was 11.45 [95% CI 5.72-22.84, p < 0.001]. CONCLUSIONS: An intracameral bolus injection of cefazolin (1 mg in 0.1 ml solution) at the conclusion of the cataract surgery significantly reduced the rate of postoperative endophthalmitis.

Ten-year incidence of diabetic retinopathy and macular edema. Risk factors in a sample of people with type 1 diabetes.

AIMS: To determine the 10-year incidence of diabetic retinopathy (DR) and macular edema (DME), and its relationship with its risk factors in a sample of type 1 diabetes mellitus. METHODS: A total of 334 patients without diabetic retinopathy at baseline underwent a 10-year prospective study, the risk factors included: age, gender, diabetes duration, HbA1c, LDL-C, HDl-C, TC/HDL-C ratio, ApoA1, ApoB, ApoB/ApoA1 ratio, and triglycerides were recorded. Risk factors for diabetic macular edema (DME) were also recorded. RESULTS: The 10-year incidence of any DR was 35.90%, and 11.07% developed DME. The risk factors for DR and DME were: diabetes duration, high glycosylated level, and arterial hypertension, and overt nephropathy was well correlated with DME. The lipid study demonstrated that ApoB/ApoA1 ratio was significant for any DR [HRR: 0.594 (0.416-0.848), p=0.01], and DME [HRR: 0.601 (0.433-0.894), p=0.009]. The TC/HDL ratio was only significant for DME [HRR: 0.624 (0.440-0.886), p=0.008]; other lipids values were not significant for any groups studied. CONCLUSIONS: In the present study, the ApoB/ApoA1 ratio was significant to the 10-year incidence of diabetic retinopathy and to macular edema; and the TC/HDL ratio was significant to a 10-year incidence of macular edema.

The incorporation of family physicians in the assessment of diabetic retinopathy by non-mydriatic fundus camera.

AIMS: To evaluate the inclusion of family physicians in screening for diabetic retinopathy. METHODS: We evaluated by non-mydriatic fundus camera 2779 diabetic patients. The family physicians made an initial evaluation of the fundus and pathological images were sent to a reference ophthalmologist. An audit was taken of all the patients at the end of the study. We analysed the concordance in: diabetic retinopathy, diabetic macular edema, and lesions in the macular area. RESULTS: Diabetic retinopathy was observed in 226 patients (8.1%) and diabetic macular edema in 40 patients (1.4%). Other retinal pathologies were diagnosed in 291 (11.0%). The sensitivity of the study was 95.2% for diabetic retinopathy, 96.0% for macular lesions and 92.9% for diabetic macular edema. The specificity was above 98% in the three studied variables. Cohen's Kappa coefficient was 0.82 for diabetic retinopathy, 0.81 for diabetic macular edema and 0.96 for macular lesions. CONCLUSIONS: The inclusion of family physicians in the screening system seems to be effective in the diagnosis of diabetic retinopathy.

Differences between the combination of the 25-gauge vitrectomy with phacoemulsification versus 20-gauge vitrectomy and phacofragmentation.

INTRODUCTION: In the present study we determine the differences observed between 25-gauge-vitrectomy combined with phacoemulsification, and the 20-gauge-vitrectomy combined with pars plana phacofragmentation. METHODS: A prospective study of a sample of 987 eyes of 661 patients randomly divided into two groups. 25-gauge-vitrectomy plus phacoemulsification included 486 eyes, and 20-gauge-vitrectomy plus phacofragmentation 501 eyes. We evaluated the differences at the time of the surgery, the intra-and postoperative complications, and the variations in intraocular pressure. RESULTS: The final visual outcome was similar in both groups. The most important differences between groups were: surgical time was faster in group 1 than in group 2, (mean time: 35.16 +/- 3.49, 44.74 +/- 5.30 minutes). Intraoperative complications were more numerous in group 1. In group 1, postoperative low levels of intraocular pressure are present in all patients with 2.77% of patients with hypotension (<8 mmHg), and three choroidal effusion. In group 2, intraocular lens decentration and retinal detachment are more frequent (2.38% and 1.39%, respectively). CONCLUSIONS: In the present study, both techniques have a similar number of complications and have a similar postoperative outcome, and are valid for the management of the pathologies selected.

Management of nucleus loss into the vitreous: long term follow up in 63 patients.

BACKGROUND: The aim of present study is to determine the long-term results of patients who undergo pars plana vitrectomy after retained nucleus into the vitreous. SETTING: Service of Ophthalmology, Hospital Universitari St Joan, Reus (Barcelona), Spain. METHODS: Retrospective, noncomparative, consecutive case series. Medical records were reviewed of all patients who underwent pars plana vitrectomy for retained nucleus into the vitreous after complicated cataract surgery, over a 9-year period between August 1, 1997 and July 31, 2005. RESULT: The incidence of retained lens fragments was 0.57% (63 patients), the postoperative visual acuity was higher than 20/40 in 59.60% and fell to 48.93% by the end of the study, and was related to the presence of CME and retinal detachment. The CME appeared in 31.91% of the patients and was related to preoperative uveitis an corneal edema. In the group of patients on whom the vitrectomy was performed at the time of cataract complication, visual acuity was higher than 20/40 in 77.77%, and no one developed secondary glaucoma or uveitis. CONCLUSION: Being retrospective, our study was not result conclusive. Despite the initial good results of these patients after PPV surgery, follow-up should be accurate and over a long period of time in order to minimize postoperative complications such as retinal detachment, retinal breaks, secondary glaucoma and CME.

Nonproliferative diabetic retinopathy and macular edema progression after phacoemulsification: prospective study.

PURPOSE: To determine the incidence of diabetic retinopathy (DR) progression after phacoemulsification in patients with type II diabetes. SETTING: Service of Ophthalmology, University of Sant Joan, Barcelona, Spain. METHODS: This prospective study evaluated 132 patients with diabetes mellitus who had monocular phacoemulsification. A control group comprised the patients' contralateral eyes. Data analysis included preoperative retinal findings and DR status; hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, and triglycerides levels; insulin treatment; and arterial hypertension. RESULTS: Postoperative visual acuity increased by 2 or more lines in 105 patients (79.55%); the mean postoperative acuity was 0.63 +/- 0.28 (SD). Diabetic retinopathy in the operated eye progressed in 31 patients (23.48%) and in the fellow eye in 28 patients (21.21%). The progression was associated with high levels of HbA1c and diabetes mellitus duration in both groups. Diabetic macular edema occurred in the operated eye in 8 patients (6.06%) and in the fellow eye in 6 patients (4.54%). Pseudophakic macular edema developed in 2 eyes (1.52%). The progression of diabetic macular edema was not associated with the risk factors studied. CONCLUSION: Uneventful phacoemulsification cataract surgery may not cause DR progression.

El tratamiento con análogos de la LHRH en la pubertad avanzada de la niña no modifica la talla final. estudio longitudinal frente a un grupo control / Treatment with LHRH analogues in girls with advanced puberty does not improve final height. Longitudinal study compared with a control group

FUNDAMENTO: Analizar los efectos del tratamiento con análogos de la LHRH en niñas con inicio puberal a los 8 años. PACIENTES Y MÉTODO: Estudio clínico no aleatorizado con dos grupos paralelos en 32 niñas con pubertad avanzada (16 control y 16 tratadas con triptorelina a 3,75 mg/mes, durante un año). Estudio antropométrico: talla, peso, perímetro braquial y cuatro pliegues subcutáneos; estadios puberales, talla diana, edad de la menarquía y talla final. Se calculó la duración puberal (años desde el inicio puberal hasta el momento de adquisición de la talla final) y el crecimiento puberal en talla (ganancia en centímetros desde el inicio puberal a la talla final). RESULTADOS: a) El tratamiento con análogos de la LHRH retrasa la menarquia (11,5 [1,46] frente a 10,37 [0,67] años; p = 0,03), produce una retrogradación de los caracteres sexuales secundarios, disminuye transitoriamente la velocidad de crecimiento en talla y la progresión de la maduración ósea. Pero son similares la duración puberal (5,1 [1,1] frente a 5,2 [0,6] años; p = NS) y el crecimiento puberal en talla (28,0 [4,2] frente a 30,6 [2,6] cm; p = NS) cuando se comparan el grupo control y el grupo tratado. b) La talla final es similar en ambos grupos (160,5 [5,1] frente a 161,2 [5,7] cm; p = NS). c) Ni con el tratamiento ni en edades posteriores se produce entre ambos grupos una diferencia significativa en la masa grasa corporal. CONCLUSIONES: El tratamiento con análogos de la LHRH en la pubertad avanzada modifica su desarrollo, sin modificar su duración ni el crecimiento puberal en talla, lo que explica que no consiga ninguna mejora de la talla final (AU)