An Eye for A Foot: Alarming Unawareness of Diabetic Retinopathy Among Diabetic Foot Patients.

This study aims to determine the awareness of diabetic retinopathy in patients hospitalized for diabetic foot ulcers, examine their clinical and demographic characteristics, and evaluate their treatment needs. In this prospective study, 62 consequent patients with diabetic foot ulcers who were hospitalized for further treatment in Diabetic Foot Department between June and August 2023 were subjected to ophthalmological examinations. Detailed anterior and posterior segment examinations were performed. Clinical and demographic characteristics and HbA1c levels were recorded. Thirty-nine patients (62.9%) were male and 23 (37.1%) were female. The mean age was 61 ± 11.4 years. The patients had diabetes mellitus (DM) for an average of 19.2 ± 9.6 years. The average HbA1c value of the patients was 9 ± 2.3%. Minor amputation was performed in 35 of 62 patients (56.5%) during treatment. Thirty-one patients (50%) were unaware of the risk of diabetic retinopathy. Of those "unaware" 31 patients, 26 (83.9%) had diabetic retinopathy. Diabetic retinopathy was detected in 57 patients (91.9%) and 3-month interval ophthalmological follow-up screening was recommended for 77 eyes. Eighty percent of the patients never had ophthalmological examination. Intravitreal (IV) injection was performed in 44 eyes, panretinal photocoagulation (PRP) in 2 eyes, and intravenous injection + PRP + vitreoretinal surgery in one eye. Diabetic foot ulcers and diabetic retinopathy are often accompanied by each other. Patients should be informed about this and strongly encouraged to undergo routine ophthalmological examinations, especially when they have advanced diabetic foot disease. Diabetic foot surgeons should keep in mind that a poor eye cannot detect diabetic foot problems.

Patologías Oftalmológicas en lactantes menores de 6 meses en un servicio de oftalmopediatría de un hospital de referencia

Introducción: Las afecciones oftalmológicas en niños menores de 6 meses pueden producir alteraciones visuales e incluso la ceguera total. Objetivos: Describir la frecuencia y los tipos de patologías oftalmológicas en lactantes menores de 6 meses en un servicio de oftalmopediatría de un hospital infantil. Materiales y Métodos: estudio observacional, descriptivo, retrospectivo. Se revisó la base de datos del servicio de oftalmopediatría. Por muestreo de casos consecutivos fueron incluidos lactantes con edad ≤6 meses, que consultaron en el periodo de marzo a septiembre del 2022, en cuyas fichas figuraban el número telefónico. Variables: edad, sexo, motivo de consulta, antecedentes perinatales y de patologías oftalmológicas, resultado del examen oftalmológico y tratamiento. Los datos fueron analizados en SPSS con estadísticas descriptivas. El comité de ética aprobó el protocolo con consentimiento de los padres. Resultados: Ingresaron 137 lactantes con edad 2,9 ± 1,8 meses, peso de nacimiento 2995 ± 621, edad gestacional 38 ± 2,1 semanas, 53% varones, 31% para control, el 83%, con antecedente de patología ocular. Presentaron patología ocular el 32% (44/137), 59% (26/44) de origen congénito y 41%(18/44) adquiridas. El 18% (8/44) de las alteraciones oculares recibieron tratamiento quirúrgico. Conclusión: El 32% de los lactantes atendidos en el servicio de oftalmopediatria presentaron patologías oculares, de las cuales el 59% fueron congénitas, las dos más frecuentes la catarata congénita y la obstrucción del conducto nasolagrimal.

Introduction: Ophthalmological conditions in children under 6 months can cause visual disturbances and even total blindness. Objectives: To describe the frequency and types of ophthalmological pathologies in infants under 6 months of age in a pediatric ophthalmology service at a children's hospital. Materials and Methods: this was an observational, descriptive and retrospective study. The database of the ophthalmopediatric service was reviewed. By sampling consecutive cases, infants aged ≤6 months, who consulted from March to September 2022 and whose records included the telephone number were included. Variables: age, sex, chief complaint, perinatal history and ophthalmological pathologies, result of ophthalmological examination and treatment. Data were analyzed in SPSS with descriptive statistics. The ethics committee approved the protocol and parental consent was obtained. Results: 137 infants, aged 2.9 ± 1.8 months, birth weight 2995 ± 621, gestational age 38 ± 2.1 weeks, of which 53% were male were selected for this study. 31% presented for a routine follow-up, 83% had a history of ocular pathology. 32% (44/137) presented ocular pathology, 59% (26/44) congenital and 41% (18/44) acquired. 18% (8/44) of the ocular alterations received surgical treatment. Conclusions: 32% of the infants seen in the ophthalmopediatric service presented ocular pathologies, of which 59% were congenital, the two most frequent being congenital cataracts and nasolacrimal duct obstruction.

[Ability of ophthalmic technicians to identify a normal ophthalmological examination]. / Capacité discriminative de la normalité de l'examen ophtalmologique par les orthoptistes.

INTRODUCTION: Ophthalmology care has been growing for several years. Since ophthalmic technicians have the opportunity to perform delegated procedures, it is important to evaluate their training. OBJECTIVE: To evaluate the ability of 3rd year ophthalmic technician students and graduates to assess the normality of an ophthalmological examination and to determine a proposed time delay for seeing an ophthalmologist. MATERIALS AND METHODS: One hundred records including ophthalmology examinations were shown to 8 ophthalmic technician students in their third year of study and to 3 graduated technicians. Three ophthalmologists determined the content of the files, the pathological nature or not of the case, as well as the proposed time for seeing an ophthalmologist. We calculated the sensitivity and specificity to recognize the normality of the case, as well as the concordance between the proposed time for seeing an ophthalmologist. RESULTS: For recognition of a normal case, the sensitivity was 80%, and the specificity was 83% in the group of technician students, and 81% versus 80% respectively in the group of graduated technicians. For the proposed time of consultation for seeing an ophthalmologist, the kappa agreement coefficient was 0.30 in the group of students and 0.41 in the group of graduates (low and moderate agreement respectively). CONCLUSION: The study showed a good ability of technicians to recognize the normality or not of clinical cases, but their ability to judge the appropriate timing of treatment by an ophthalmologist remains insufficient.

Safety management in treatment with antimalarials in rheumatology. Interdisciplinary recommendations on the basis of a systematic literature review.

BACKGROUND: Antimalarial medication (AM) plays an important role in the treatment of rheumatic diseases. OBJECTIVE: Updated evidence-based recommendations on the safety management of rheumatological treatment with AM are presented. METHODS: A systematic literature search in the databases Medline (PubMed) and Cochrane identified 1160 studies on the safety of treatment with AM in rheumatology. In addition, a manual search was carried out and 67 publications considered to be particularly relevant by the authors were analyzed in more detail. These publications served as a basis for consensus-based recommendations. RESULTS: Treatment with AM in rheumatology should be carried out with hydroxychloroquine (HCQ) with a dosage not exceeding 5 mg/kg body weight/day. Patients should undergo a basic ophthalmological examination within the first 6 months of AM treatment. Pre-existing maculopathy, renal insufficiency (glomerular filtration rate, GFR <60 ml/min), tamoxifen comedication, a daily dose of >5 mg/kg HCQ or treatment with chloroquine (CQ) show an increased risk for AM-induced retinopathy. These patients should undergo an annual ophthalmological check from the beginning of the treatment, whereas patients with no risk factors are recommended to start this only after 5 years of taking the medication. The ophthalmological examination should comprise at least both an appropriate subjective and an objective method and these are usually an automated visual field test and optical coherence tomography (OCT). A visual field test revealing a parafoveal sensitivity loss and an OCT showing a parafoveal circumscribed loss of the photoreceptor layer or focal interruptions of the structural line of the outer segment are signs of a possible AM retinopathy. Determination of creatine kinase (CK) and lactate dehydrogenase (LDH) in blood is appropriate to screen for cardiomyopathy and myopathy and should be checked before starting the treatment and then ca. every 3 months. The use of cardiac biomarkers, such as brain natriuretic peptide (BNP) or troponin in serum, electrocardiograph (ECG) or cardiac imaging should be considered depending on the situation. An intake of HCQ is safe during pregnancy and breastfeeding according to the current state of knowledge and is protective for mother and child in patients with systemic lupus erythematosus. CONCLUSION: The updated recommendations on AM treatment in rheumatology in particular include a more rigorous measuring of doses, risk stratification in monitoring and defined ophthalmological examination methods to detect a possible retinopathy.

[Safety management of the treatment with antimalarial drugs in rheumatology. Interdisciplinary recommendations based on a systematic literature search]. / Sicherheitsmanagement der Therapie mit Antimalariamitteln in der Rheumatologie. Interdisziplinäre Empfehlungen auf der Basis einer systematischen Literaturrecherche.

BACKGROUND: Antimalarial medication (AM) plays an important role in the treatment of rheumatic diseases. OBJECTIVE: Updated evidence-based recommendations on the safety management of rheumatological treatment with AM are presented. METHODS: A systematic literature search in the databases Medline (PubMed) and Cochrane identified 1160 studies on the safety of treatment with AM in rheumatology. In addition, a manual search was carried out and 67 publications considered to be particularly relevant by the authors were analyzed in more detail. These publications served as a basis for consensus-based recommendations. RESULTS: Treatment with AM in rheumatology should be carried out with hydroxychloroquine (HCQ) with a dosage not exceeding 5 mg/kg body weight/day. Patients should undergo a basic ophthalmological examination within the first 6 months of AM treatment. Pre-existing maculopathy, renal insufficiency (glomerular filtration rate, GFR <60 ml/min), tamoxifen comedication, a daily dose of >5 mg/kg HCQ or treatment with chloroquine (CQ) show an increased risk for AM-induced retinopathy. These patients should undergo an annual ophthalmological check from the beginning of the treatment, whereas patients with no risk factors are recommended to start this only after 5 years of taking the medication. The ophthalmological examination should comprise at least both an appropriate subjective and an objective method and these are usually an automated visual field test and optical coherence tomography (OCT). A visual field test revealing a parafoveal sensitivity loss and an OCT showing a parafoveal circumscribed loss of the photoreceptor layer or focal interruptions of the structural line of the outer segment are signs of a possible AM retinopathy. Determination of creatine kinase (CK) and lactate dehydrogenase (LDH) in blood is appropriate to screen for cardiomyopathy and myopathy and should be checked before starting the treatment and then ca. every 3 months. The use of cardiac biomarkers, such as brain natriuretic peptide (BNP) or troponin in serum, electrocardiograph (ECG) or cardiac imaging should be considered depending on the situation. An intake of HCQ is safe during pregnancy and breastfeeding according to the current state of knowledge and is protective for mother and child in patients with systemic lupus erythematosus. CONCLUSION: The updated recommendations on AM treatment in rheumatology in particular include a more rigorous measuring of doses, risk stratification in monitoring and defined ophthalmological examination methods to detect a possible retinopathy.

Neuro-Ophthalmology at the Bedside: A Clinical Guide.

Neuro-ophthalmological signs and symptoms are common in the emergency department but are a frequent source of diagnostic uncertainties. However, neuro-ophthalmological signs often allow a precise neuro-topographical localization of the clinical problem. A practical concept is presented how to perform a neuro-ophthalmological examination at the bedside and to interpret key findings under the aspect of emergency medicine with limited resources.

[Microscope-integrated intraoperative optical coherence tomography in examination of pediatric patients under anesthesia]. / Mikroskopintegrierte intraoperative optische Kohärenztomographie bei der Narkoseuntersuchung von pädiatrischen Patienten.

BACKGROUND: The therapeutic principle of examinations of children under general anaesthesia using microscope-integrated optical coherence tomography (MI-OCT) is presented. The aim was to assess novel indications as well as limitations for MI-OCT to enhance ophthalmological examinations of neonates and children under general anesthesia. METHODS: The study was based on a review of the literature from google.scholar.com and PubMed and our own data from a prospective study (Department for Ophthalmology, University of Cologne) of 14 children with anterior and posterior segment anomalies undergoing examinations under anesthesia. Patients were examined using a commercially available MI-OCT device. The study analyzed the general feasibility of MI-OCT for ophthalmological examination of children under general anesthesia for the anterior and posterior eye segments and the benefits of indications and intraoperative findings. RESULTS: The MI-OCT significantly enriched the examinations of children under general anesthesia and delivered additional information not visible with the surgical microscope. Even in situations with a limited anterior chamber view MI-OCT enabled estimation of distances, such as corneal thickness. In addition to influencing therapeutic decisions, in 12/14 children MI-OCT also enabled examination of the thickness of the nerve fibre layer of the optic nerve disc and the retina. CONCLUSION: The data presented here underline the benefit of the intraoperative MI-OCT in ophthalmological examinations of children under general anesthesia. In particular MI-OCT enables examinations of children with corneal opacification, if an ophthalmological examination under general anesthesia becomes necessary.

Ocular Disorders in Turkish Children with Sensorineural Hearing Loss: A Cross-Sectional Study and Literature Review.

PURPOSE: To investigate types and frequencies of ocular disorders in children with sensorineural hearing loss (SNHL), and to emphasize the importance of ophthalmological examination in these children. METHODS: A retrospective analysis of the examination records of children examined in our instutititon between January 2011 and September 2014 was performed. Ocular disorders of children with SHNL were selectively reviewed. RESULTS: Among 55340 patients, SNHL was present in 110 (0.2%). SNHL was bilateral in 104 patients (94.5%) and unilateral in 6 (5.5%). Ninety-one cases had congenital hearing loss (83%), and 19 (17%) had acquired SNHL. Forty cases (36%) had an ocular disorder, either refractive or non-refractive or both. Seventy cases (64%) had normal ocular examination. No difference was found between congenital or acquired SNHL cases in terms of possessing an ocular disorder (p=0.0962). The most common ocular abnormality was refractive error, mainly hypermetropia (21%). There was no significant difference between the prevalences of ocular abnormalities among cases with different lateralites or severities of SNHL (p=0.051, p=0.874, respectively). Twenty-six cases (23.6%) had SNHL as a component of a genetically defined syndrome. All of them had coexisting refractive or non-refractive ocular abnormalities. Some genetic, non-syndromic abnormalities, including Achondroplasia, Celiac disease, and focal segmental glomerulosclerosis, were diagnosed in four cases, among whom refractive errors and/or strabismus were detected. CONCLUSIONS: Due to the common coexistence of ocular problems and SNHL in children, ophthalmological screening is crucial. Families and healthcare providers should be informed about the critical role of ophthalmic assesment in these children for their future quality of life.

Spectrum of retinal abnormalities in renal transplant patients using chronic low-dose steroids.

PURPOSE: To assess the ophthalmological characteristics of asymptomatic patients with a renal transplant on chronic low-dose steroids for at least the last 2 years prior to examination. METHODS: Cross-sectional study. All patients underwent an extensive ophthalmological examination. RESULTS: Of the 37 included patients [25 male, 12 female; 59 ± 11 years (range, 38-77 years)] ophthalmological phenotyping revealed abnormalities in 22 patients (59%). Findings characteristic for (subclinical) central serous chorioretinopathy were detected in ten patients (27%), including two patients with serous subretinal fluid in the macula. An epiretinal membrane of the macula was present in six patients (16%). Mean subfoveal choroidal thickness was significantly increased in patients with ophthalmological abnormalities, in comparison with patients without abnormalities. CONCLUSIONS: Retinal abnormalities are common in the majority of renal transplant patients using chronic low-dose steroids. These retinal changes may be associated with the renal disease and/or the effect of chronic steroid use on the choroid and retina.

Necessity of Periodic Ophthalmological Examinations in Binocular B Class Driving Licence Holders Over 50 Years of Age.

OBJECTIVE: To determine whether binocular B class driving licence (BBCDL) holders over 50 years old are in compliance with the BBCDL criteria for visual acuity, to determine the age-based prevalence of ophthalmological disorders reducing visual acuity in this group, and to investigate whether periodic ophthalmological examinations are needed in licence holders over 50 years of age. MATERIALS AND METHODS: This prospective study enrolled 451 adults over 50 years old having a BBCDL. The study subjects were categorized into 3 age groups as group 1 (51-60 years), group 2 (61-70 years), and group 3 (over 71 years). RESULTS: The mean age of the subjects was 60.02±7.27 years; 338 (74.9%) were male and 113 (25.1%) were female. The BBCDL criteria were met by 353 (78.3%) subjects whereas 98 (21.7%) subjects did not meet them. Eighty-four (85.7%) of 98 patients not meeting BBCDL criteria still drove. The mean age of the subjects meeting BBCDL criteria (58.82±6.77 years) was significantly lower than the subjects not meeting them (64.34±7.40 years) (p<0.001). The most common pathologies in the individuals still driving despite not meeting BBCDL criteria were senile cataract (38.5%) and diabetic retinopathy (23.1%) in group 1, senile cataract (55.3%) and diabetic retinopathy (14.9%) in group 2, and senile cataract (63.6%) and senile macular degeneration+senile cataract (18.2%) in group 3. CONCLUSION: More than a fifth of individuals over 50 years old did not meet the BBCDL criteria, due predominantly to senile cataract, and the majority of these individuals continue to drive. Therefore, we believe that individuals over 50 years old who have a BBCDL should undergo periodic ophthalmological examinations.

[The effect of drugs used in treatment of skin disorders on visual system]. / Wplyw leków stosowanych w chorobach skóry na narzad wzroku.

Drugs with side effects affecting vision are often used in the treatment of skin disorders. The study evaluated principal groups of medicines which may negatively influence vision and the eye itself. Antimalaric drugs may cause a number of disorders of vision and a diagnosed retinophaty is an absolute contraindication. Retinoids often cause a dry eye condition, which results in intolerance to wearing contact lenses. They can also be a cause of poor nightly vision. Psoralens, used in photochemotherapy, can penetrate to the frontal part of the eye, inducing clouding of the lens and cataract. Glucocorticosteroids, often used in skin conditions, increase intraocular pressure, which may result in development of glaucoma. Methotrexate may also cause complications, such as eyelid edema, conjunctival hyperemia, increased lacrimation and photophobia. A prolonged use of tetracyclines may induce side effect in eye organs. Swelling of the optic nerve head with subsequent decreased vision, and even accumulate of metabolites of tetracycline within the conjunctival were observed. In the study a distinction was made between the medications which may lead to a temporary visual impairment and the medication with a side effect lasting beyond the treatment. It was pointed out that some of the side effects could be avoided or minimised by not combining retinoids and tetracyclines or with the use of protective eyewear during photochemotherapy. An examination by ophthalmologist is a crucial step prior to the treatment with chloroquine, hydroxychloroquine or psoralens. Regular eye exams are necessary when using, especially in a protracted fashion, most of the discussed drugs. Finally, the cooperation between dermatologist and ophthalmologist is fundamental for ensuring patient's safety.

[Reduction of intraocular pressure and ocular pulse amplitude during general anesthesia]. / Sinken des Augeninnendrucks und der okularen Pulsamplitude während der Intubationsnarkose.

AIM: Measurement of the intraocular pressure (IOP) is an important tool for glaucoma diagnostics in children or patients with impaired cooperation. General anesthesia (GA) may significantly influence the IOP. This study aimed to evaluate the reduction of IOP during GA. PATIENTS AND METHODS: The IOP was measured in 229 patients in a recumbent position in the non-operated eye prior to and 5 min after the beginning of GA with a dynamic contour tonometer (DCT). RESULTS: The average IOP decreased from 19.9 ± 3.7 mmHg prior to GA to 14.1 ± 3.5 mmHg 5 min after beginning GA (p < 0.0001, IOP decrease 30 %). The GA caused a decrease of up to 2 mmHg in 6.1 %, 2-4 mmHg in 18.8 %, 4-6 mmHg in 21.0 %, 6-8 mmHg in 36.6 %, 8-10 mmHg in 13.6 %, 10-12 mmHg in 2.2 % and more than 12 mmHg in 1.7 % of the eyes. The ocular pulse amplitude (OPA) decreased from a mean of 3.4 ± 1.5 mmHg to 1.9 ± 1.0 mmHg (p < 0.0001, OPA decrease 41 %) under GA. CONCLUSION: A significant decrease of IOP (mean 6 mmHg) occurs during GA and under extreme conditions up to 13.8 mmHg. A decrease of OPA of 1.5 mmHg should be taken into consideration for patients under general anesthesia and under extreme conditions up to 7 mmHg.

Relation between near work and myopia progression in student population.

AIM: To determine relation between near work and myopia progression in student population. Causes of myopia occurrence are not sufficiently explained. METHODS: This retrospective-prospective, descriptive research included 100 students with verified myopia up to -3 Dsph. Ophthalmological examination and measurement diopter-hours variable (Dh) were done twice, in the period from January 2011 until January 2012. RESULTS: A multivariate regression analysis of impact on the difference of distance visual acuity without correction to the right and left eye and difference of automatic computer refractometry in cycloplegia of both eyes indicates that, diopter-hours variable (Dh) had statistically significant impact on increase of distance visual acuity difference (right eye OR: I measurement-Dh 1.489, II measurement-Dh 1.544, p<0.05; left eye OR: I measurement-Dh 1.602, II measurement-Dh 1.538, p<0.05) and automatic computer refractometry in cycloplegia (right eye OR: I measurement 1.361, II measurement 1.493, p<0.05; left eye OR: I measurement 0.931, II measurement 1.019, p<0.05) during both measurements. CONCLUSION: Near work cause the increase of myopia. This research opened a perspective for other researches on the impact of near work on myopia.

Hypertensive retinopathy and risk of cardiovascular diseases in a national cohort.

BACKGROUND: Retinal vascular examination using direct ophthalmoscopy can be used to determine the extent of hypertensive vascular changes. We studied the association of these changes in a large national cohort. METHODS: First National Health and Nutrition Survey (NHANES I) was conducted from 1971 through 1975. A subgroup (n=5500) of participants aged 25 to 74 years received standardized ophthalmologic examination and hypertensive changes were documented. Participants of the study had follow-up interviews and examinations up to 1992. All health care facility records and death certificates were ascertained and reviewed. Participants who were admitted with or died of primary diagnosis of either ischemic stroke or coronary heart disease were identified. We used Cox proportional-hazards regression to study the association of hypertensive retinopathy with cardiovascular disease. RESULTS: After excluding patients with previous history of stroke or myocardial infarction and/or missing blood pressure information, 4753 participants were included in the analysis. Participants with hypertensive retinopathy were older (61 ± 11 vs 47 ± 15) and more likely to be men (54% vs 62%). After adjustment for age, sex, race/ethnicity, body-mass index, cigarette smoking, systolic blood pressure, cholesterol, and diabetes mellitus patients with hypertensive retinopathy had a relative risk (RR) of 1.2 (95% confidence interval [CI] 1.0 - 1.3) for any cardiovascular disease and RR of 1.2(95% CI 0.9-1.5) for ischemic stroke. CONCLUSION: The presence of hypertensive retinal vascular changes is associated with increased risk of cardiovascular disease. Identification of such changes in the clinical setting can be used for stratification of high risk patients.