[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.

[Recurrence of bacterial endophthalmitis after penetrating keratoplasty]. / Endoftalmitis recurrente en queratoplastia penetrante, por flora mixta.

OBJECTIVE/METHODS: One month after penetrating keratoplasty, a male patient suffered recurrent abscess and endophthalmitis caused by mixed bacteria (Staphylococcus aureus and Candida Albicans). RESULTS: Two samples of vitreous and aqueous were taken, and a combination of systemic Vancomycin and Amphotericin B were injected intravitreally. The patient was asymptomatic for a month, but the abscess reactivated and was treated with Vancomycin and Ciprofloxacin administered intravenously. Fifteen days after withdrawing the treatment endophthalmitis returned and was treated with vitrectomy and additional systemic/intravitreal antibiotics and antifungal therapy. The final visual acuity was 20/40. CONCLUSIONS: The delayed vitrectomy proved to be necessary to remove established germs and to eliminate recurrent infections.

Keratoconus: age of onset and natural history.

Keratoconus is a corneal dystrophy that degrades the optical function of the cornea. The onset of the process manifests optical signs: evolving astigmatism, failure of optical correction by spectacles, and distorted images. We report data from 74 keratoconus patients in need of keratoplasty. The variables studied included sex, age of onset, and refractive error. We find that the average age of the appearance of keratoconus is the second decade of life (mean age of onset = 15.39 years, SD = 3.95), with earlier onset occurring in females that in males, although the differences are not statistically significant. The mean corneal astigmatism before keratoplasty was 4.07 D (SD = 1.57). Optometrists should refer patients for surgery when all optical treatment has failed.