Predictive value of intracrystalline interphase point measured by optical low-coherence reflectometry for the estimation of the anatomical position of an intraocular lens after cataract surgery.

PURPOSE: To investigate the predictive value of the intracrystalline interphase point (ICIP) measured with optical low-coherence reflectometry (OCLR) to estimate the final lens position (FLP) of an intraocular lens (IOL) after cataract surgery. SETTING: Alcañiz Hospital, Teruel, Spain. DESIGN: Single-center retrospective descriptive study. METHODS: Patients undergoing cataract surgery were enrolled. They were grouped according to the IOL implanted as follows: Group 1, Acrysof IQ aspheric SN60WF IOL (77 eyes); Group 2, enVista MX60 IOL (71 eyes); Group 3, CT Asphina 409 IOL (44 eyes). An OCLR-based biometer (Lenstar LS 900 system) was used for biometric measurements preoperatively and at 4 to 5 weeks postoperatively. RESULTS: The study comprised 192 eyes of 174 patients (mean age: 76.4 years). One hundred seventy eyes (88.5%) eyes showed an absolute refractive prediction error (ARPE) less than 0.50 diopters (D). The mean ARPE was 0.25 D ± 0.21 (SD). Significantly higher FLP values were found in Group 2 compared with the other two groups (P < .001). Significantly lower ICIP values were found in the eyes with an ARPE of 0.50 D or more compared with eyes that had an ARPE less than 0.50 D in Group 1 (P = .042) and Group 2 (P = .023). The correlation of the FLP with the ICIP was good in all three groups (r ≥ 0.74, P <.001). Three linear expressions were obtained to predict the FLP from the ICIP and other preoperative data (R2: 0.85, 0.69, and 0.49 in Groups 1, 2, and 3, respectively). CONCLUSIONS: The position of the ICIP measured with OCLR correlated with the FLP after cataract surgery, and it can be used to optimize IOL power calculations.

[Diabetic retinopathy and mortality in type 2 diabetic patients]. / Relación entre la presencia de retinopatía diabética y la mortalidad en pacientes con diabetes tipo 2.

BACKGROUND AND OBJECTIVE: This study was intended to assess the independent contribution of retinopathy to mortality in type 2 diabetic patients. PATIENTS AND METHOD: Prospective cohort study. Type 2 diabetic patients with available fundus were included. The clinical end-point was total mortality. The main independent variable was baseline presence of background or proliferative retinopathy. Cox regression models were adjusted for age, sex, duration of diabetes, classical risk factors and baseline presence of nephropathy and cardiovascular disease. RESULTS: 458 patients were included (181 male, 277 females), with a median follow-up of 8 years (inter-quartile range, 6.7-9). There were 125 patients (27.3%) with background retinopathy and 46 (10%) with proliferative retinopathy. Mortality incidence rates per 1,000 patients-year were 20/1,000 (non retinopathy), 36.8/1,000 (background retinopathy) and 45.9/1,000 (proliferative retinopathy) with p = 0.0021. In the multivariate analysis, background retinopathy (HR = 1.87; 95% CI, 1.1-3.1; p = 0.019) and proliferative retinopathy (HR = 2.6; 95% CI, 1.3-5.1; p = 0.0048) were independent predictors of mortality. Other independent predictors were age (HR [1 year] = 1.13; 95% CI, 1.1-1.17; p < 0.0001), total cholesterol (HR [1 mmol/l] = 0.76; 95% CI, 0.6-0.97; p = 0.026), baseline insulin treatment (HR = 1.9; 95% CI, 1,1-3.2; p = 0.017) and baseline proteinuria (HR = 4.1; 95% CI, 2-8.5; p = 0.0001). CONCLUSIONS: The presence of retinopathy increases the mortality risk in type 2 diabetic patients.

Relación entre la presencia de retinopatía diabética y la mortalidad en pacientes con diabetes tipo 2 / Diabetic retinopathy and mortality in type 2 diabetic patients

Fundamento y objetivo: Evaluar la contribución independiente de la retinopatía diabética a la mortalidad de los pacientes con diabetes tipo 2. Pacientes y método: Estudio de cohortes prospectivo. Se incluyó a los pacientes con diabetes tipo 2 y fondo de ojo visualizable. Como variable dependiente, se evaluó la mortalidad total. La variable independiente principal fue la presencia de retinopatía simple o proliferativa, con ajuste para edad, sexo, tiempo de evolución de la diabetes, factores de riesgo clásicos y presencia de otras complicaciones crónicas (nefropatía y macroangiopatía). Se realizaron curvas de supervivencia y regresión de Cox multivariable, con cálculo de cocientes de riesgo (CR). Resultados: Se incluyó a 458 pacientes (181 varones y 277 mujeres), con seguimiento mediano de 8 años (intervalo intercuartil, 6,7-9). Hubo 125 (27,3%) pacientes con retinopatía simple y 46 (10%) con proliferativa. Las tasas de incidencia de mortalidad fueron 20/1.000 pacientes-año (ausencia de retinopatía), 36,8/1.000 pacientes-año (retinopatía simple) y 45,9/1.000 pacientes-año (retinopatía proliferativa); p = 0,0021. En el análisis multivariable, la presencia de retinopatía simple (CR = 1,87; intervalo de confianza [IC] del 95%, 1,1-3,1; p = 0,019) y de retinopatía proliferativa (CR = 2,6; IC del 95%, 1,3-5,1; p = 0,0048) predijeron de modo independiente la mortalidad. Otros predictores independientes fueron la edad (CR [1 año] = 1,13; IC del 95%, 1,1-1,17; p < 0,0001), el colesterol total (CR [1 mmol/l] = 0,76; IC del 95%, 0,6-0,97; p = 0,026), el tratamiento con insulina (CR = 1,9; IC del 95%, 1,1-3,2; p = 0,017) y la proteinuria (CR = 4,1; IC del 95%, 2-8,5; p = 0,0001). Conclusiones: La presencia de retinopatía diabética se relaciona con un incremento de mortalidad en los pacientes con diabetes tipo 2

Background and objective: This study was intended to assess the independent contribution of retinopathy to mortality in type 2 diabetic patients. Patients and method: Prospective cohort study. Type 2 diabetic patients with available fundus were included. The clinical end-point was total mortality. The main independent variable was baseline presence of background or proliferative retinopathy. Cox regression models were adjusted for age, sex, duration of diabetes, classical risk factors and baseline presence of nephropathy and cardiovascular disease. Results: 458 patients were included (181 male, 277 females), with a median follow-up of 8 years (inter-cuartile range, 6.7-9). There were 125 patients (27.3%) with background retinopathy and 46 (10%) with proliferative retinopathy. Mortality incidence rates per 1,000 patients-year were 20/1,000 (non retinopathy), 36.8/1,000 (background retinopathy) and 45.9/1,000 (proliferative retinopathy) with p = 0.0021. In the multivariate analysis, background retinopathy (HR = 1.87; 95% CI, 1.1-3.1; p = 0.019) and proliferative retinopathy (HR = 2.6; 95% CI, 1.3-5.1; p = 0.0048) were independent predictors of mortality. Other independent predictors were age (HR [1 year] = 1.13; 95% CI, 1.1-1.17; p < 0.0001), total cholesterol (HR [1 mmol/l] = 0.76; 95% CI, 0.6-0.97; p = 0.026), baseline insulin treatment (HR = 1.9; 95% CI, 1,1-3.2; p = 0.017) and baseline proteinuria (HR = 4.1; 95% CI, 2-8.5; p = 0.0001). Conclusions: The presence of retinopathy increases the mortality risk in type 2 diabetic patients