A stepwise implementation of the Slovenian National Diabetic Retinopathy Screening Program - evaluation of the first 4.5 years.

BACKGROUND: This retrospective cohort study aimed to assess the characteristics of patients enrolled in the national diabetic retinopathy (DR) screening program and evaluate the selected program's quality elements in the first five years after implementation. METHODS: Patients who underwent DR screening between February 2018 and June 2022 at the University Medical Centre Ljubljana were included. General patient characteristics (age, sex, type and therapy of diabetes mellitus (DM), duration of DM, blood HbA1c levels), best corrected visual acuity, stage of DR, presence of sight-threatening diabetic retinopathy (STDR), and selected quality indicators (quality of photographs, re-screening interval, time to treatment) were recorded and evaluated. RESULTS: A total of 34 654 screening examinations were performed on 13 513 patients with diabetes. The majority (77.3%) had Type 2 diabetes, with a mean DM duration of 9.74 ± 9.87 years. In 55.9% of patients, DM duration was less than ten years, and the mean HbA1c was 7.33% ± 1.49. DR signs were noted in 29.1% of patients and 0.89% of patients exhibited STDR. After establishing the diagnosis of STDR, treatment was initiated in 3.43 ± 1.98 months. CONCLUSION: Implementing the DR screening program provides valuable insights into managing diabetic retinopathy nationwide. It allows for the early detection of sight-threatening DR and facilitates timely and effective treatment, which could help prevent severe visual impairment.

PREDICTING VISUAL OUTCOMES OF SECOND EYE VITRECTOMY FOR PROLIFERATIVE DIABETIC RETINOPATHY.

PURPOSE: To investigate predictive factors for visual outcome in the second operated eye of patients undergoing bilateral vitrectomy for proliferative diabetic retinopathy. METHODS: Clinical records of 55 patients undergoing bilateral vitrectomy for proliferative diabetic retinopathy at the University Eye Hospital Ljubljana between January 2009 and December 2014 were examined retrospectively. Statistical analysis was performed to identify variables associated with good visual outcomes. RESULTS: Mean preoperative visual acuity was 6/181 Snellen (1.48 ± 0.47 logarithm of minimal angle of resolution [logMAR]). The follow-up period after vitrectomy was at least 1 year and mean postoperative visual acuity improved to 6/31 Snellen (0.71 ± 0.62 logMAR). On univariate analysis, variables predicting good postoperative vision (6/12 Snellen or better) were the following: absence of macular detachment (P = 0.009), previously performed full panretinal laser (P = 0.03), and good vision in the previously vitrectomized fellow eye (P < 0.001). On multivariate analysis, the absence of macular detachment (P = 0.001) and good vision in the previously vitrectomized fellow eye (P < 0.001) were both independently associated with good visual outcome. CONCLUSION: In patients undergoing second eye vitrectomy for complications of proliferative diabetic retinopathy, the visual acuity of previously operated fellow eye and the presence of macular detachment in the eye due for vitrectomy may be strong independent predicting factors for visual outcome.

Treatment of submacular haemorrhage in patients with neovascular age related macular degeneration.

To evaluate the efficacy of the pneumatic displacement of the submacular haemorrhage combined with the intravitreal injection of the tissue plasminogen activator. We present a retrospective clinical case series of nine eyes of nine patients that were treated with the intravitreal injection of the tissue plasminogen activator and expansile gas for the submacular haemorrhage due to the age related macular degeneration. We evaluated visual acuities and complications. Selected patients were additionally treated with the intravitreal bevacizumab injections after the procedure. Mean postoperative followup was 19 weeks. Four (4/9) eyes (44%) received additional treatment with the intravitreal bevacizumab during the postoperative period. Statistical analysis was performed using the Student's paired t-test. The mean visual acuity was 1.77 logMAR preoperatively and 1.06 logMAR postoperatively. After the surgery, 4 or more Snellen lines were gained in 7/9 eyes (78%). The improvement of the visual acuity postoperatively was statistically significant (p = 0.002). In 2/9 eyes (22%) the visual acuity did not get better after the procedure. We observed no complications during the follow up period. In our case series, pneumatic displacement of the submacular haemorrhage with the use of the intravitreal tissue plasminogen activator (with or without additional bevacizumab treatment in the selected cases) turned out to be an effective and safe method leading to the improvement of the visual acuity in the majority of cases. To maximise the treatment success, prompt referral to the retinal surgeon is imperative.