Factores de riesgo aterogénico como predictores de daño microvascular en la retina

Introducción: Se reconoce la asociación entre los factores de riesgo aterogénico y las alteraciones microvasculares de la retina, pero no hay consenso sobre si estas afectaciones en la retina preceden o son una respuesta fisiopatológica a dichos factores. Objetivo: Determinar si la presencia de los factores de riesgo aterogénico predice las alteraciones vasculares retinianas, a través del fondo de ojo y la retinografía. Métodos: Estudio trasversal en 55 sujetos mayores de 19 años de edad, de cualquier sexo, sin opacidades en los medios transparentes del ojo. Se estudiaron las variables edad, sexo, dislipidemia, hábito de fumar, consumo de alcohol, hipertensión arterial, diabetes mellitus tipo 2, presión arterial sistólica y diastólica, índice de masa corporal, colesterol, glicemia, triglicéridos, creatinina, lipoproteínas de alta densidad, urea, eritrosedimentación y conteo leucocitario. Resultados: El 65,45 % presentó alteraciones en el fondo de ojo: aumento del brillo arteriolar (53,03 %) y disminución del calibre arteriolar generalizado (52,24 %). La retinografía mostró daño en el 58,18 %: rectificación de los cruces arteriovenosos (65,71 %), tortuosidad venosa (28,21 %) y cruces arteriovenosos con aplastamiento (85,71 %). El aumento del colesterol sérico (p= 0,003) se asoció con la presión arterial sistólica (p= 0,037) en el fondo de ojo, y con el antecedente de hipertensión arterial (p= 0,023) en la retinografía. Conclusiones: El colesterol sérico, las cifras elevadas de tensión arterial sistólica y antecedentes de hipertensión arterial son los factores de riesgo que mejor predicen el daño vascular retinal.

Introduction: The association between atherogenic risk factors and retinal microvascular alterations is recognized, but there is no consensus on whether these retinal disorders precede or are a pathophysiological response to these factors. Objective: To determine if the presence of atherogenic risk factors predicts retinal vascular alterations, through fundus examination and retinography. Methods: Cross-sectional study in 55 subjects over 19 years of age, of either sex, without opacities in the transparent media of the eye. The variables studied were age, sex, dyslipidemia, smoking habit, alcohol consumption, arterial hypertension, type 2 diabetes mellitus, systolic and diastolic blood pressure, body mass index, cholesterol, glycemia, triglycerides, creatinine, high-density lipoproteins, urea, erythrocyte sedimentation rate and leukocyte count. Results: 65.45% presented alterations in the fundus of the eye: increased arteriolar brightness (53.03%) and decreased generalized arteriolar caliber (52.24%). Retinography showed damage in 58.18%: rectification of arteriovenous crossings (65.71%), venous tortuosity (28.21%), and arteriovenous crossings with crushing (85.71%). The increase in serum cholesterol (p= 0.003) was associated with systolic blood pressure (p= 0.037) in the fundus, and with a history of arterial hypertension (p= 0.023) in retinography. Conclusions: Serum cholesterol, high systolic blood pressure and a history of hypertension are the risk factors that best predict retinal vascular damage.

Diabetic nephropathy in patients with type 2 diabetes mellitus and its correlation with diabetic retinopathy / Nefropatia diabética em pacientes portadores de diabetes mellitus tipo 2 e sua correlação com a retinopatia diabética

Objective: the present study aimed to evaluate the prevalence of diabetic nephropathy and diabetic retinopathy, in addition to the associations that can be established between these microvascular complications of diabetes mellitus. Methods: this was a retrospective study, a systematic review without metaanalysis. The authors used the Pubmed and SciELO databases to search the terms "diabetic nephropathy", "diabetic retinopathy" and "type 2 diabetes", including publications dated 2011 to 2021. Results/Discussion: the results presented were a synthesis of patients with both pathologies and their correlations, in addition to associated laboratory changes and agreement between the stages or severity of both conditions. Conclusions: DN and DR are pathologies that are directly interconnected and cause repercussions for patients.

Objetivo: o presente estudo teve como objetivo avaliar a prevalência de nefropatia diabética e retinopatia diabética, além das associações que podem ser estabelecidas entre essas complicações microvasculares do diabetes mellitus. Métodos: estudo retrospectivo, revisão sistemática sem metanálise, os autores utilizaram as bases de dados Pubmed e SciELO para busca dos termos "nefropatia diabética", "retinopatia diabética" e "diabetes tipo 2", incluindo publicações datadas de 2011 a 2021. Resultados/Discussão: os resultados apresentados foram uma síntese dos pacientes com ambas as patologias e suas correlações, além de alterações laboratoriais associadas e concordância entre os estágios ou gravidade de ambas as condições. Conclusões: ND e RD são patologias que estão diretamente interligadas e causam repercussões aos pacientes.

Cilostazol protects against changes caused by streptozotocin-induced diabetic retinopathy / Cilostazol protege contra as alterações causadas pela retinopatia diabética induzida por estreptozotocina

ABSTRACT Purpose: This study investigates the protective effect of cilostazol on the development and evolution of diabetic retinopathy in rats. Methods: Sixty male rats were divided into four groups: untreated nondiabetic rats, untreated diabetic rats, cilostazol-treated nondiabetic rats, and cilostazol-treated diabetic rats. The thickness of the internal limiting membrane to the outer limiting membrane, inner plexiform layer, inner nuclear layer, and outer nuclear layer were measured. The number of cell nuclei per 50-μm length in retinal sections was counted to quantify the degree of retinal cell loss. Results: The number of nuclei in the ganglion cell layer was significantly higher in untreated nondiabetic rats (p<0.05). The mean number of nuclei in the cilostazol-treated nondiabetic rats was significantly higher than that in the cilostazol-treated diabetic rats (p<0.05). The cilostazol-treated nondiabetic rats had a significantly higher mean nuclei count in the inner nuclear layer and inner plexiform layer as compared with the other groups (p<0.05). The total mean retinal thickness of the cilostazol-treated nondiabetic rats was significantly higher than that of cilostazol-treated diabetic rats and untreated diabetic rats (p<0.05). Conclusion: By decreasing the loss of ganglion cells and reducing the sensorineural atrophy in the internal retinal layers, cilostazol had a protective effect against changes caused by diabetic retinopathy in diabetic rats.

RESUMO Objetivo: O objetivo deste estudo foi investigar o efeito protetor do cilostazol no desenvolvimento e na evolução da retinopatia diabética em ratos. Métodos: Sessenta ratos machos foram divididos em 4 grupos: ratos não-diabéticos não-tratados, ratos diabéticos não-tratados, ratos não-diabéticos tratados com cilostazol e ratos diabéticos tratados com cilostazol. A espessura da membrana limitante interna à membrana limitante externa, a camada plexiforme interna, a camada nuclear interna e a camada nuclear externa foram medidas. Para quantificar o grau de perda de células da retina, foi contado o número de núcleos de células por 50 μm de comprimento em secções retinianas. Resultados: O número de núcleos no GCL foi significativamente maior em Ratos não-diabéticos não-tratados com cilostazol (p<0,05). O número médio de núcleos em Ratos não-diabéticos tratados com cilostazol foi significativamente maior do que em Ratos diabéticos tratados com cilostazol (p<0,05). A contagem média de núcleos em camada nuclear interna e camada plexiforme interna de ratos não-diabéticos tratados com cilostazol foi significativamente maior do que nos outros grupos (p<0,05). A espessura retiniana média total de Ratos não-diabéticos tratados com cilostazol foi significativamente maior do que em Ratos diabéticos tratados com cilostazol e Ratos diabéticos não-tratados (p<0,05). Conclusão: Os resultados demonstraram que o cilostazol teve um efeito protetor contra as alterações causadas pela retinopatia diabética em ratos diabéticos, diminuindo a perda de células ganglionares e reduzindo a atrofia neurossensorial nas camadas retinianas internas.

Comparing the effects of serum GPER-1 and oxidant/antioxidant levels on retinopathy in patients with diabetes and healthy individuals: a pilot study / Comparando o impacto do soro GPER-1 e dos níveis de oxidante/antioxidante na retinopatia em pacientes diabéticos e em indivíduos saudáveis: um estudo piloto

ABSTRACT Purpose: This study aimed to determine the effect of serum G receptor-mediated protein-1 levels on the development of retinopathy in patients with diabetes in comparison with healthy individuals. Methods: The study enrolled patients with diabetic retinopathy (Group 1), patients without diabetic retinopathy (Group 2), and healthy individuals (Group 3). Levels of serum progesterone, serum G receptor-mediated protein-1, estradiol, oxidant/antioxidants, and thyroid-releasing hormones were analyzed and compared among the groups. Post-hoc analysis was performed to compare the subgroups in which significant differences were found. Results: Groups 1, 2, and 3 each included 40 patients. A significant difference was found among all groups in terms of serum G receptor-mediated protein-1, oxidant/antioxidant, and estradiol levels (p<0.01), but no significant difference was found in terms of thyroid-releasing hormone or progesterone (p=0.496, p=0.220, respectively). In the post-hoc analysis of the groups with significant differences, another significant difference was found among all groups for serum G receptor-mediated protein-1 and oxidant/antioxidant levels (p<0.05). Serum G receptor-mediated protein-1 and oxidant levels were positively correlated, whereas serum G receptor-mediated protein-1 and antioxidant levels were negatively correlated (r=0.622/p<0.01, r=0.453/p<0.01, r=0.460/p<0.01, respectively). The multiple regression analysis showed that increased levels of serum G receptor-mediated protein-1 may help prevent diabetic retinopathy. Conclusions: Serum G receptor-mediated protein-1 levels, which were the highest in the diabetic retinopathy Group, increased as the oxidant/antioxidant balance changed in favor of oxidative stress. This appears to be a defense mechanism for preventing neuronal damage.

RESUMO Objetivo: Esta pesquisa buscou determinar o im­pacto dos níveis de proteína G sérica no desenvolvimento da retinopatia em pacientes diabéticos, comparando-os a indivíduos saudáveis. Métodos: Foram incluídos, no estudo, 40 pacientes com retinopatia diabética (Grupo 1), 40 pacientes sem retinopatia diabética (Grupo 2) e 40 indivíduos saudáveis (Grupo 3). Os níveis hormonais de progesterona sérica, de proteína G sérica, estradiol, oxidante/antioxidante e hormônio liberado pela tireoide foram analisados e comparados. A análise post hoc foi realizada para comparar os subgrupos nos quais diferenças estatisticamente significativas foram encontradas. Resultados: Uma diferença significativa foi encontrada entre todos os grupos em termos de proteína G sérica, oxidante/antioxidante e níveis de estradiol (p<0.01), mas nenhuma diferença significativa foi encontrada em termos de hormônio liberado pela tireoide ou progesterona (p=0,496, p=0,220, respectivamente). Na análise post hoc dos grupos com diferenças estatisticamente significativas, outra diferença significativa foi encontrada entre todos os grupos para proteína G sérica e níveis oxidantes/antioxidantes (p<0,05). Os níveis de proteína G sérica e os níveis de oxidante foram positivamente correlacionados, enquanto os níveis de proteína G sérica e os níveis de antioxidantes foram negativamente correlacio­nados (r=0,622/p<0,01, r=0,453/p<0,01, r=0,460/p<0,01, respectivamente). A análise de regressão múltipla mos­trou que o aumento da proteína G sérica pode ajudar a prevenir a retinopatia diabética. Conclusões: Os níveis de proteína G sérica que eram mais altos no grupo de retinopatia diabética, aumentaram à medida que o equilíbrio oxidante/antioxidante mudou em favor do estresse oxidativo. Este parece ser um mecanismo de defesa para prevenir danos neuronais.

The role of trimethylamine-N-oxide level in the diagnosis of diabetic retinopathy and the differential diagnosis of diabetic and nondiabetic retinopathy / Papel do nível de N-óxido de trimetilamina no diagnóstico da retinopatia diabética e no diagnóstico diferencial da retinopatia diabética e não-diabética

ABSTRACT Purpose: Trimethylamine N-oxide serum levels have been associated with type 2 diabetes mellitus and its complications. The current study aimed to find out if plasma trimethylamine N-oxide level may be a novel marker in the diagnosis of diabetic retinopathy and if it can be used in the differential diagnosis of diabetic and nondiabetic retinopathy. Methods: The study included 30 patients with diabetic retinopathy, 30 patients with nondiabetic retinopathy, 30 patients with type 2 diabetes mellitus without retinopathy, and 30 healthy control participants. Biochemical parameters, serum IL-6, TNF-α, and trimethylamine N-oxide levels were measured in all participants. Results: Trimethylamine N-oxide level was significantly higher in diabetic retinopathy than in the other groups (p<0.001). There was no significant difference in trimethylamine N-oxide levels between nondiabetic retinopathy and control or type 2 diabetes mellitus Groups. There was a significant positive correlation between trimethylamine N-oxide level and elevated FPG, BMI, HOMA-IR score, BUN, IL-6, and TNF-α levels. Conclusion: The current study showed that the trimethylamine N-oxide level is elevated in diabetic retinopathy. These findings suggest that serum trimethylamine N-oxide level might be a novel marker for diabetic retinopathy, and it might be used in the differential diagnosis of diabetic and nondiabetic retinopathy.

RESUMO Objetivo: Os níveis séricos de N-óxido de trimetilamina têm sido associados ao diabetes mellitus tipo 2 e suas complicações. O presente estudo tem como objetivo responder a duas questões, entre elas: O nível plasmático de N-óxido de trimetilamina poderia ser um novo marcador no diagnóstico de retinopatia diabética? e Ele poderia ser utilizado no diagnóstico diferencial de retinopatia diabética e não diabética? Métodos: Trinta pacientes com retinopatia diabética, 30 pacientes com retinopatia não diabética, 30 pacientes com diabetes mellitus tipo 2 sem retinopatia e 30 participantes saudáveis do grupo controle foram incluídos no estudo. Parâmetros bioquímicos, níveis séricos de IL-6, de TNF-α e de N-óxido de trimetilamina foram medidos em todos os participantes. Resultados: O nível de N-óxido de trimetilamina foi significativamente maior na retinopatia diabética do que nos outros grupos (p<0,001). Não houve diferença significativa no nível de N-óxido de trimetilamina entre o grupo de retinopatia não diabética, do grupo controle ou do grupo de diabetes mellitus tipo 2. Houve uma correlação positiva significativa entre o nível de N-óxido de trimetilamina e os níveis elevados de FPG, IMC, HOMA-IR, BUN, IL-6 e TNF-α. Conclusão: O estudo atual mostrou que o nível de N-óxido de trimetilamina encontra-se elevado na retinopatia diabética. Esses achados sugerem que o nível sérico de N-óxido de trimetilamina pode ser um novo marcador na retinopatia diabética, podendo ser usado no diagnóstico diferencial de retinopatia diabética e não diabética.

Applicability of portable retinal cameras and telemedicine as facilitating tools in screening diabetic retinopathy in the COVID-19 pandemic scenario / Aplicabilidade do retinógrafo portátil e telemedicina como ferramentas facilitadoras na triagem de retinopatia diabética no cenário de pandemia de COVID-19

ABSTRACT Purpose: Diabetes mellitus is a leading cause of impaired vision. The objective of this study was to evaluate the feasibility of use of portable retinograph and remote analysis of images along with a virtual questionnaire for screening for diabetic retinopathy in basic health units in the city of Ribeirão Preto/SP during the Covid-19 pandemic. Methods: Standard Covid-19 protocol was followed during the screening. Blood pressure and capillary blood glucose were measured. Demographic and social data were collected through a standardized online questionnaire via smartphone. After pupillary dilation, fundal images were obtained with portable retinographs by trained ophthalmology residents. Two standardized 45° images were acquired: one posterior segment and another nasal to the optic nerve. Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study. Results: A total of 350 patients (64% female; 45% aged 55-70 years; 55% Caucasian) were evaluated. For 40.5% of patients, the campaign was the first opportunity for retinal evaluation; 47.56% had diabetes mellitus for >10 years. On repeat analysis of images stored in a cloud-based repository by retinal specialist, a 7.8% difference was observed in the Early Treatment Diabetic Retinopathy Study diabetic retinopathy classification, compared to the screening findings. Mild diabetic retinopathy was observed in 12.23%, moderate diabetic retinopathy in 6.31%, and proliferative diabetic retinopathy in 2.58% patients. Macular edema was present in 4.58% patients. Diabetic retinopathy was not detected in 72.78% patients. Conclusion: Use of portable retinographs together with telemedicine can provide efficient alternative to traditional methods for screening and diagnosis of diabetic retinopathy.

RESUMO Objetivo: A diabetes mellitus é considerada uma epidemia global e causa de baixa visual em países em desenvolvimento. Este estudo foi realizado com o objetivo de avaliar a viabilidade do retinógrafo portátil e análise remota de imagens associada a questionário virtual para o rastreio de retinopatia diabética em Unidades Básicas de Saúde da cidade de Ribeirão Preto/SP durante a pandemia de Covid-19. Métodos: Trezentos e sessenta pacientes compareceram a campanha. O acolhimento foi realizado na Unidade Básica de Saúde pela equipe de enfermagem, respeitando medidas de prevenção do Covid-19 Os realizou-se aferição da pressão arterial e glicemia capilar seguida de dilatação. Dados demográficos e sociais foram coletados através de questionário on-line padronizado via smartphone e realizou-se a triagem da retinopatia diabética através da obtenção de imagens com retinógrafos portáteis realizados por residentes de oftalmologia previamente treinados, com a aquisição de 2 imagens padronizadas de 45º: uma do segmento posterior e outra nasal ao nervo óptico. Resultados: Trezentos e sessenta pacientes foram atendidos durante a campanha. Dez pacientes (1,02%) foram excluídos devido à opacidade de meios e impossibilidade de obtenção de imagens de fundo de olho. Foram avaliados 350 pacientes, 64% do sexo feminino, 45% entre 55 e 70 anos e 55% brancos. A Campanha foi a primeira avaliação de retina para 40,5% dos pacientes e 47,56% apresentavam diabetes mellitus há mais de 10 anos. Na análise comparativa da classificação da retinopatia diabética segundo Early Treatment Diabetic Retinopathy Study (triagem X Nuvem) observou-se uma diferença de 7,8% nos resultados. Retinopatia diabética leve foi observada em 12,23%, moderada em 6,31%, proliferativa em 2,58%; edema macular presente em 4,58% e ausência de retinopatia diabética em 72,78% dos pacientes. Conclusão: A utilização de retinógrafos portáteis juntamente a telemedicina, para o rastreamento da retinopatia diabética pode ser considerada uma alternativa eficiente para triagem e diagnóstico da retinopatia diabética dentro ou fora do cenário pandêmico, auxiliando na prevenção de perda visual pelo diabetes.

Is there a relationship between the first-day results of anti-VEGF therapy for macular edema due to vascular diseases and longterm outcomes? / Há alguma relação entre os resultados do primeiro dia de terapia anti-VEGF para edema macular devido a doenças vasculares e o resultado a longo prazo?

ABSTRACT Purpose: To evaluate early changes after the first antivascular endothelial growth factor injection for macular edema secondary to diabetic retinopathy and retinal vein occlusion and the relationship between longterm outcomes. Methods: The study enrolled patients who received anti-vascular endothelial growth factor injections for treatment-naive macular edema due to retinal vein occlusion and diabetic retinopathy. The central macular thickness was measured at baseline, post-injection day 1, week 2, and month 1, and at the last visit using spectral-domain optical coherence tomography. A good response was defined as a central macular thickness reduction of ≥10% on post-injection day 1. Patients were reassessed at the last visit with regard to treatment response on post-injection day 1 based on the favorable anatomic outcome defined as a central macular thickness <350 µm. Results: In total, 26 (44.8%) patients had macular edema-retinal vein occlusion and 32 (55.2%) had macular edema-diabetic retinopathy. The mean follow-up time was 24.0 (SD 8.5) months. A statistically significant decrease in the central macular thickness was observed in both patients with macular edema-retinal vein occlusion and macular edema-diabetic retinopathy after antivascular endothelial growth factor injection therapy (p<0.001 for both). All patients with macular edema-retinal vein occlusion were good responders at post-injection day 1. All nongood responders at post-injection day 1 belong to the macular edema-diabetic retinopathy group (n=16.50%). The rate of hyperreflective spots was higher in nongood responders than in good responders of the macular edema-diabetic retinopathy group (p=0.03). Of 42 (2.4%) total good responders, one had a central macular thickness >350 µm, whereas 5 (31.2%) of 16 total nongood responders had a central macular thickness >350 µm at the last visit (p=0.003). Conclusion: The longterm anatomical outcomes of macular edema secondary to retinal vein occlusion and diabetic retinopathy may be predicted by treatment response 1 day after antivascular endothelial growth factor injection.

RESUMO Objetivo: Avaliar as alterações precoces após a primeira injeção de anticorpos antifator de crescimento endotelial vascular (anti-VEGF) em casos de edema macular secundário à retinopatia diabética e oclusão da veia da retina e a relação entre essas alterações e o resultado a longo prazo. Métodos: Foram incluídos no estudo pacientes que receberam uma injeção de antifator de crescimento endotelial vascular para edema macular, virgem de tratamento e devido à oclusão da veia retiniana ou a retinopatia diabética. A espessura macular central foi medida no início do tratamento e no 1º dia, 2ª semana e 1º mês após a injeção, bem como na última visita, através de tomografia de coerência óptica de domínio espectral. Definiu-se uma "boa resposta" como uma redução ≥10% na espessura macular central no 1º dia após a injeção. Os pacientes foram reavaliados na última visita com relação à resposta ao tratamento no 1º dia após a injeção, com base em um resultado anatômico favorável, definido como uma espessura macular central <350 µm. Resultado: Foram registrados 26 (44,8%) pacientes com edema macular e oclusão da veia da retina e 32 (55,2%) com edema macular e retinopatia diabética. O tempo médio de acompanhamento foi de 24,0 meses (desvio-padrão de 8,5 meses). Foi observada uma diminuição estatisticamente significativa da espessura macular central após o tratamento antifator de crescimento endotelial vascular tanto em pacientes com edema macular e oclusão da veia retiniana quanto naqueles com edema macular e retinopatia diabética (p<0,001 para ambos). Todos os pacientes com edema macular e oclusão da veia retiniana responderam bem no 1º dia pós-injeção. Todos os que responderam mal no 1º dia pós-injeção pertenciam ao grupo com edema macular e retinopatia diabética (n=16,50%). A presença de manchas hiperrefletivas foi maior nos pacientes que responderam mal do que naqueles que tiveram boa resposta no grupo com edema macular e retinopatia diabética (p=0,03). Um dos 42 (2,4%) pacientes com boa resposta total teve espessura macular central >350 um, enquanto 5 (31,2%) do total de 16 pacientes com resposta ruim apresentaram espessura macular central >350 µm na última visita (p=0,003). Conclusão: O resultado anatômico de longo prazo do edema macular secundário à oclusão da veia retiniana e à retinopatia diabética pode ser previsto pela resposta ao tratamento no 1º dia após a injeção de antifator de crescimento endotelial vascular.

Rastreamento da retinopatia diabética pelo médico generalista na Atenção Primária de Saúde do Brasil / Screening of diabetic retinopathy by the physician of Primary Health Care in Brazil

RESUMO Objetivo: Avaliar a acurácia de médicos generalistas em reconhecer a retinopatia diabética por meio da retinografia colorida, com um curso de capacitação com duração de 2 horas, comparando a capacidade de rastrear e classificar a retinopatia diabética em relação ao exame presencial com oftalmologista. Métodos: No primeiro braço do estudo, de 142 pacientes diabéticos incluídos, avaliaram-se 274 olhos, em que esses pacientes foram examinados com oftalmoscópio binocular indireto e classificados quanto ao grau da retinopatia diabética. No segundo braço do estudo, 14 médicos não especialistas em oftalmologia receberam um treinamento de 2 horas para o diagnóstico de retinopatia diabética com a retinografia colorida e se aferiu a acurácia desses profissionais em rastrear a retinopatia diabética antes e depois do curso de capacitação, utilizando as retinografias obtidas na primeira frente do estudo. Resultados: Verificou-se aumento significativo da sensibilidade (82% para 99%) e da especificidade (44% para 83%) na detecção da retinopatia diabética pelos médicos generalistas, com o curso de capacitação. Conclusão: O médico generalista capacitado pode avaliar a retinopatia diabética por meio da retinografia colorida, sendo o programa de rastreamento dessa complicação do diabetes uma proposta viável e benéfica ao país.

ABSTRACT Objective: To assess the accuracy of general practitioners in recognizing diabetic retinopathy through color retinal retinography, with a two-hour training course, by comparing the capacity of screening and classifying diabetic retinopathy. Methods: In the first arm of the study, of 142 diabetic patients included, 274 eyes were evaluated, and these patients were examined with an indirect binocular ophthalmoscope and classified according to the degree of diabetic retinopathy. In the second arm of the study, 14 physicians who are not specialists in ophthalmology received two-hour training to diagnose diabetic retinopathy with color retinography, and the accuracy of these professionals in screening for diabetic retinopathy before and after the training course was measured using the photographic images obtained on the first front of the study. Results: There was a significant increase in sensitivity (82% to 99%) and specificity (44% to 83%) in detecting diabetic retinopathy by general practitioners, after attending the training. Conclusion: Qualified general practitioners can assess diabetic retinopathy through color retinography, and the screening program for this diabetes complication is a viable and beneficial proposal for the country.

Diagnóstico da retinopatia diabética por inteligência artificial por meio de smartphone / Diagnosis of diabetic retinopathy by artificial intelligence using smartphone

RESUMO Objetivo: Obter imagens de fundoscopia por meio de equipamento portátil e de baixo custo e, usando inteligência artificial, avaliar a presença de retinopatia diabética. Métodos: Por meio de um smartphone acoplado a um dispositivo com lente de 20D, foram obtidas imagens de fundo de olhos de pacientes diabéticos; usando a inteligência artificial, a presença de retinopatia diabética foi classificada por algoritmo binário. Resultados: Foram avaliadas 97 imagens da fundoscopia ocular (45 normais e 52 com retinopatia diabética). Com auxílio da inteligência artificial, houve acurácia diagnóstica em torno de 70 a 100% na classificação da presença de retinopatia diabética. Conclusão: A abordagem usando dispositivo portátil de baixo custo apresentou eficácia satisfatória na triagem de pacientes diabéticos com ou sem retinopatia diabética, sendo útil para locais sem condições de infraestrutura.

ABSTRACT Introduction: To obtain fundoscopy images through portable and low-cost equipment using artificial intelligence to assess the presence of DR. Methods: Fundus images of diabetic patients' eyes were obtained by using a smartphone coupled to a device with a 20D lens. By using artificial intelligence (AI), the presence of DR was classified by a binary algorithm. Results: 97 ocular fundoscopy images were evaluated (45 normal and 52 with DR). Through AI diagnostic accuracy around was 70% to 100% in the classification of the presence of DR. Conclusion: The approach using a low-cost portable device showed satisfactory efficacy in the screening of diabetic patients with or without diabetic retinopathy, being useful for places without infrastructure conditions.

Prevalence and associated factors of diabetic retinopathy in Latin American countries: a scoping review / Prevalência e fatores associados à retinopatia diabética em países da América Latina: uma revisão de escopo

ABSTRACT Objective To gather the available evidence in the literature on the prevalence and associated factors of diabetic retinopathy (DR) in Latin America. Methods This scoping review was developed according to the PRISMA-ScR. Prevalence data were summarized by weighted mean, considering the type of DM and country. For the analysis of associated factors, meta-analyses were performed with the most homogeneous studies, and the ORs and their 95%CIs were calculated. Results Forty-two articles published between 2004 and 2020 were included in this study. The mean prevalence of DR ranged from 15.0% in Costa Rica to 32.7% in Brazil. Conclusion This variation may be related to the diagnostic method, age of the studied population, duration of disease, glycemic control, or other associated factors such as the presence of diabetic nephropathy or hypertension. This review discloses an important burden of DR in Latin America and highlights the need for further in-country studies.

RESUMO Objetivo O objetivo desta revisão foi reunir as evidências disponíveis na literatura sobre a prevalência e os fatores associados à retinopatia diabética na América Latina. Métodos Esta é uma revisão de escopo desenvolvida de acordo com o PRISMA-ScR. Os dados de prevalência foram resumidos por média ponderada, considerando o tipo de diabetes mellitus e o país. Para a análise dos fatores associados, foram realizadas metanálises com os estudos mais homogêneos e calculados as razões de chance e seus intervalos de confiança de 95%. Resultados Foram publicados 42 artigos entre 2004 e 2020, os quais foram incluídos neste estudo. A prevalência média de retinopatia diabética variou de 15,0%, na Costa Rica, a 32,7%, no Brasil. Conclusão Essa variação pode estar relacionada ao método de diagnóstico, à idade da população estudada, à duração da doença, ao controle glicêmico ou a outros fatores associados, como a presença de nefropatia diabética ou hipertensão. Esta revisão revelou um ônus importante da retinopatia diabética na América Latina e destaca a necessidade de mais estudos nos países.

Comparative analysis of the quality of life among different retinal diseases.

PURPOSE: To assess the impact on the quality of life (QoL) among different retinal diseases such as diabetic macular edema (DME), retinal vein occlusion (RVO), pathologic myopia (PM), neovascular age-related macular degeneration (nAMD) and central serous chorioretinopathy (CSC). METHODS: A cross-sectional study was carried out in 241 patients, affected by DME (n=44), RVO (n=41), PM (n=34) and nAMD (n=85) receiving intravitreal injections due to the presence of macular edema or choroidal neovascularization. The CSC patients included (n=37) were candidates for laser treatment. The patients included completed the National Eye Visual Functioning Questioning-25 (NEI VFQ-25). Best eye visual acuity (BEVA) was recorded using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. RESULTS: There were significant differences between subgroups for all the domains, except for the general vision in which all scores among diseases ranged from 40.7 to 45.2 out of 100 (P=.436), despite the difference in BEVA (CSC: 86.3±11.9; RVO: 78.5±15.5, DME: 73.3±15.2, nAMD: 72.9±12.6 and PM: 68.5±18.1 letters respectively; P<.001). The lowest VFQ-25 total score was observed in the PM patients (52.1±20.9), followed by nAMD (55.3±20.8), RVO (65.0±22.3), DME (68.6±21.0) and CSC (70.9±16.2). The DME group reported the worst score for general health (38.9±21.4). Mental health and role difficulties were lowest for PM (48.2±28.8 and 48.2±31.9, P<.007). CONCLUSIONS: This study reveals the differences in the QoL among DME, RVO, nAMD, PM and CSC, describing the different repercussions that they can suffer, observing a higher impact in PM and nAMD.

Glaucoma neovascular. A propósito de un caso / Neovascular glaucoma. A case report

Se presenta un paciente masculino de 60 años de edad, con antecedentes de padecer diabetes mellitus tipo II complicada con retinopatía diabética, así como glaucoma neovascular de tórpida evolución en el ojo izquierdo. Acude a consulta de glaucoma en el Centro Oftalmológico del Hospital Universitario Clínico- Quirúrgico «Arnaldo Milián Castro» de Villa Clara por presentar visión borrosa y molestias oculares en su ojo derecho. Al examen oftalmológico de dicho ojo se observa: disminución de la visión, sangramiento activo proveniente de vaso iridiano, edema corneal, rubeosis iridiana, hipertensión ocular y al fondo de ojo retinopatía diabética; se realizan complementarios hemáticos que muestran cifras de glicemia elevada (20 mmol/l). Se plantea el diagnóstico de glaucoma neovascular del ojo derecho en el curso de una diabetes mellitus tipo II descompensada. Se le indica tratamiento médico - quirúrgico y se logra una evolución favorable.

We present a 60-year-old male patient with a history of type II diabetes mellitus complicated by diabetic retinopathy, as well as neovascular glaucoma of torpid evolution in his left eye. He came to the glaucoma consultation in the Ophthalmological Center at "Arnaldo Milián Castro" Clinical and Surgical University Hospital in Villa Clara due to blurred vision and ocular discomfort in his right eye. Decreased vision, active bleeding from the iris vessel, corneal edema, iris rubeosis, ocular hypertension was observed in such eye at ophthalmological examination and diabetic retinopathy at eye fundus; blood tests were performed showing elevated glycemia figures (20 mmol /l). The diagnosis of neovascular glaucoma of the right eye is stated in the course of a decompensated type II diabetes mellitus. Medical and surgical treatment is indicated and a favourable evolution is achieved.

Visual impairment associated with diabetic retinopathy and macular edema: a hospital-based study.

BACKGROUND: Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. OBJECTIVE: To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. MATERIAL AND METHODS: Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. RESULTS: A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30%. DR was found in 62% of patients (30% had sight-threatening DR [STDR]), 17% had referable DME, and 3%, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). CONCLUSION: Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.

ANTECEDENTES: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios para orientar los recursos económicos y humanos que disminuyan su prevalencia. OBJETIVO: Estimar la prevalencia de DV relacionada con retinopatía diabética en pacientes con diabetes tipo 2 en un entorno hospitalario. MATERIAL Y MÉTODOS: Estudio transversal realizado de 2014 a 2019 en una consulta externa de oftalmología. Cualquier DV se definió como agudeza visual corregida con agujero estenopeico en el ojo con mejor visión (≥ 0.24 logMAR). Se evaluó la presencia de retinopatía diabética, edema macular diabético (EMD) y cataratas. RESULTADOS: Se incluyeron 840 pacientes; la mediana de duración de la diabetes fue de 15 años. La prevalencia de DV fue de 30 %. Se encontró retinopatía diabética en 62 % (30 % tenía retinopatía diabética que amenazaba la visión [RDAV]); 17 %, EMD y 3 %, cataratas. La razón de momios para DV moderada o de mayor gravedad fue de 9.02 para RDAV (p < 0.001), 5.89 para EMD referible (p = 0.001) y 2.51 para catarata (p = 0.006). CONCLUSIÓN: Treinta por ciento de los participantes tenía algún grado de DV. La DV moderada o de mayor gravedad mostró una fuerte asociación con RDAV y EMD referible.

[Teleophthalmology-based diabetic retinopathy screening in a rural health basic area]. / Cribado de la retinopatía diabética mediante teleoftalmología en una zona básica de salud rural.

OBJECTIVE: To investigate the prevalence of diabetic retinopathy in a rural health basic area, and to establish the type, the severity degree and the relationship with sex and with another cardiovascular risk factors. DESIGN: Cross-sectional or prevalence descriptive study. LOCATION: Rural health basic area in Spain. Primary health care level. PARTICIPANTS: 500 patients over 18 years old with diabetes. MAIN MEASUREMENTS: Study of the retina through retinography under mydriasis, according to the Joslin Vision Network protocol, with the incorporation of a diagnostic reading center. Correlation of the existence and severity of the retinopathy with the cardiovascular risk factors -smoking, hypertension and hyperlipidemia- and the characteristics of the diabetes -type, evolution time, treatment, metabolic control and renal function-. RESULTS: The findings showed a 16.4% prevalence, with no significant differences between both sexes. The variables smoking and high blood pressure were related to the existence of retinopathy, and the variable years of diabetes evolution was correlated to both the existence and the severity of the retinopathy. In the study, 9.6% of the affected people were preferentially referred to the ophthalmologists because of sight-threatening retinopathy, and 6.8% of the people studied were referred due to other ophthalmological pathologies. CONCLUSIONS: It is possible to do the ophthalmological follow-up of 82% of the population with diabetes in primary health care, involving its professionals and team-working with the ophthalmologists. It is paramount to consider diabetic retinopathy within the global context of the person with diabetes, relating diabetic retinopathy with the other microvascular complications and cardiovascular diseases.

Discapacidad visual asociada a retinopatía diabética y edema macular: un estudio de base hospitalaria / Visual impairment associated with diabetic retinopathy and macular edema: a hospital-based study

Resumen Antecedentes: Los datos sobre discapacidad visual (DV) en pacientes con diabetes son necesarios para orientar los recursos económicos y humanos que disminuyan su prevalencia. Objetivo: Estimar la prevalencia de DV relacionada con retinopatía diabética en pacientes con diabetes tipo 2 en un entorno hospitalario. Material y métodos: Estudio transversal realizado de 2014 a 2019 en una consulta externa de oftalmología. Cualquier DV se definió como agudeza visual corregida con agujero estenopeico en el ojo con mejor visión (≥ 0.24 logMAR). Se evaluó la presencia de retinopatía diabética, edema macular diabético (EMD) y cataratas. Resultados: Se incluyeron 840 pacientes; la mediana de duración de la diabetes fue de 15 años. La prevalencia de DV fue de 30 %. Se encontró retinopatía diabética en 62 % (30 % tenía retinopatía diabética que amenazaba la visión [RDAV]); 17 %, EMD y 3 %, cataratas. La razón de momios para DV moderada o de mayor gravedad fue de 9.02 para RDAV (p < 0.001), 5.89 para EMD referible (p = 0.001) y 2.51 para catarata (p = 0.006). Conclusión: Treinta por ciento de los participantes tenía algún grado de DV. La DV moderada o de mayor gravedad mostró una fuerte asociación con RDAV y EMD referible.

Abstract Background: Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. Objective: To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. Material and methods: Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. Results: A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30 %. DR was found in 62 % of patients (30 % had sight-threatening DR [STDR]), 17 % had referable DME, and 3 %, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). Conclusion: Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.

Telemedicine screening program for diabetic retinopathy in patients with type 1 diabetes mellitus.

PURPOSE: To analyze the results of the telemedicine screening program for diabetic retinopathy (DR) in patients with type 1 diabetes conducted by the Endocrinology and Nutrition Management Unit of Virgen del Rocío University Hospital. METHODS: This cross-sectional study comprised patients with type 1 diabetes mellitus (DM) in our DR screening program from January 2018 to November 2020. Fundus photographs are performed by trained nurses and reviewed by a trained endocrinologist. Those suggestive of pathology are sent to ophthalmology through a telematic program for review. RESULTS: Of the 995 fundus photographs evaluated, 646 (65.3%) showed no evidence of DR, 327 (33.1%) presented possible DR, and 16 (1.6%) were not gradable. The diagnosis was confirmed in 254 patients after reviewing by ophthalmology, and the screening program achieved a positive predictive value for DR of 77.7%. Seventy-three were excluded by ophthalmology due to the absence of DR (false positive rate - 22.3%). In 92.5% of the cases classified by the ophthalmologist, the degree of DR was mild or very mild. CONCLUSION: Our telemedicine screening program for DR in patients with type 1 DM is consistent with the literature. Effective screening for DR is performed, with patients diagnosed in the early stages. Telemedicine programs facilitate efficient communication among healthcare personnel.

Visual outcomes and prognostic factors following 23G vitrectomy for vitreous hemorrhage in eyes with proliferative diabetic retinopathy / Desfechos visuais e fatores prognósticos após vitrectomia 23G para hemorragia vítrea em olhos com retinopatia diabética proliferativa

ABSTRACT Purpose: We aimed to evaluate the factors influencing the visual gain following pars plana vitrectomy for vitreous hemorrhage in patients with proliferative diabetic retinopathy. Methods: A retrospective study was conducted on 172 eyes of 143 consecutive patients with diabetes mellitus between January 2012 and January 2018. Demographic data, ophthalmological findings, surgery details, and visual outcomes were gathered after consulting the patients' records. The main outcome measured was the improvement of best corrected visual acuity and the secondary outcomes measured were rebleeding and complications. Results: Best corrected visual acuity improved in 103 eyes (59.88%), worsened in 45 eyes (26.16%), and remained unchanged in 24 eyes (13.95%). Type 2 diabetes mellitus was significantly associated with better final best corrected visual acuity (p=0.0244). Previous treatment by pan-retinal laser photocoagulation or intravitreal bevacizumab determined better final best corrected visual acuity, but not significantly (p>0.05). Preoperative rubeosis iridis and neovascular glaucoma did not influence the outcomes. The lack of fibrovascular proliferation requiring dissection was a significant factor for better final best corrected visual acuity (p=0.0006). Rebleeding occurred in 37.1% of the eyes and it was not influenced by the antiplatelet drugs (p>0.05). Postoperative neovascular glaucoma was a negative prognostic factor (p=0.0037). Conclusion: The final best corrected visual acuity was influenced positively by type 2 diabetes mellitus and the absence of preoperative extensive fibrovascular proliferation and negatively by postoperative neovascular glaucoma.

RESUMO Objetivo: Avaliar os fatores que influenciam o ganho visual após vitrectomia via pars plana para hemorragia vítrea em pacientes com retinopatia diabética proliferativa. Métodos: Foi realizado um estudo retrospectivo de 172 olhos de 143 pacientes consecutivos com diabetes mellitus entre janeiro de 2012 e janeiro de 2018. Dados demográficos, achados oftalmológicos, detalhes da cirurgia e resultados visuais foram coletados através de consulta aos prontuários dos pacientes. A principal medida de desfecho foi o aumento da melhor acuidade visual corrigida e as medidas de desfecho secundário foram a recidiva da hemorragia e a ocorrência de complicações. Resultados: A melhor acuidade visual corrigida aumentou em 103 olhos (59,88%), diminuiu em 45 olhos (26,16%) e permaneceu inalterada em 24 olhos (13,95%). O diabetes mellitus tipo 2 foi significativamente associado a maiores valores finais da melhor acuidade visual corrigida (p=0,0244). O tratamento prévio por fotocoagulação panretiniana com laser ou bevacizumabe intravítreo determinou maiores valores da melhor acuidade visual final corrigida, mas não significativamente (p>0,05). A presença de rubeose iridiana pré-operatória ou de glaucoma neovascular não influenciou os desfechos. A ausência de proliferação fibrovascular com necessidade de dissecção foi um fator significativo para maiores valores da melhor acuidade visual final corrigida (p=0,0006). Ocorreu recidiva da hemorragia em 37,1% dos olhos e não foi influenciada por fármacos antiplaquetários (p>0,05). O glaucoma neovascular pós-operatório foi um fator prognóstico negativo (p=0,0037). Conclusão: O resultado final da melhor acuidade visual corrigida foi influenciado positivamente pelo diabetes mellitus tipo 2 e pela ausência de proliferação fibrovascular extensa no pré-operatório, e negativamente pela ocorrência de glaucoma neovascular pós-operatório.

Relación entre dislipidemia y retinopatía diabética en diabéticos tipo II: Un estudio de caso-control en Perú / Relationship between dyslipidemia and diabetic retinopathy in type II diabetic patients: A case-control study in Peru

RESUMEN Introducción: La retinopatía diabética (RD) es una complicación microvascular mayormente asintomática que - a pesar de ser prevenible - es la primera causa de ceguera irreversible en personas laboralmente activas. La dislipidemia es un factor de riesgo no concluyente de la RD, a raíz de los resultados de un metaanálisis reciente; siendo pertinente la realización de un estudio en población peruana. Objetivo: Evaluar la relación entre dislipidemia y RD en pacientes diabéticos tipo II atendidos en el Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú entre el 2018 y el 2020. Métodos: Estudio de casos y controles. Se incluyeron 219 casos y 219 controles. Los pacientes diabéticos se clasificaron según la presencia o ausencia de RD determinado por el especialista. Se recolectaron datos de los parámetros lipídicos (triglicéridos, LDL, HDL, colesterol total) y otras variables que fueron analizados en STATA 14. Mediante la regresión logística, se estimó el Odds Ratio (OR) crudo y ajustado por variables confusoras. Resultados: La dislipidemia (OR 2.7, p=0.03), los triglicéridos elevados (OR 1.0044, p=0.03) y el colesterol HDL bajo (OR 2.16, p=0.03) se asociaron significativamente con RD. Conclusión: La dislipidemia es un factor de riesgo independiente para la RD en pacientes diabéticos tipo II. Ello permite destacar la importancia de la evaluación del perfil lipídico en los pacientes diabéticos.

ABSTRACT Background: Diabetic retinopathy (DR) is a primarily asymptomatic microvascular complication. Even though it is preventable, it is the first cause of irreversible blindness among working-age adults. Due to recent meta-analysis results, dyslipidemia is an inconclusive risk factor; therefore, the importance of accomplishing our study in the Peruvian population. Objective: Evaluate the relationship between dyslipidemia and DR in type II diabetic patients of the Ophthalmology area from the Edgardo Rebagliati Martins National Hospital in Lima-Peru, from 2018 to 2020. Methods: Case-control study, 219 cases and 219 controls were included. Diabetic patients will be classified based on the presence or absence of DR lesions on the ocular fundus determined by the specialist. Lipids parameters (triglyceride, LDL, HDL, total cholesterol) and other variables were recollected and analyzed in STATA 14. Multivariate logistic regression was used to obtain a crude and adjusted Odds Ratio. Results: Dyslipidemia (OR 2.7, p=0.03), elevated triglycerides (OR 1.0044, p=0.03), and low HDL cholesterol (OR 2.16, p=0.03) were significantly associated with DR. Conclusion: Dyslipidemia is an independent risk factor for DR in type II diabetic patients. This result emphasizes the importance of evaluating a lipid panel in diabetic patients.

Estrategia para la prevención de la retinopatía diabética en la atención primaria de salud / A Strategy for the Prevention of Diabetic Retinopathy in Primary Healthcare

Introducción: La retinopatía diabética puede prevenirse con el óptimo control de la diabetes mellitus; sin embargo, la constante llegada de pacientes con diagnóstico de retinopatía diabética avanzada a los centros oftalmológicos apunta a la insuficiente prevención primaria de esta enfermedad. Objetivo: Proponer herramientas prácticas vinculadas a los principales factores de riesgo que pueden ser controlados o modificados en pacientes diabéticos para lograr una prevención primaria de la retinopatía diabética más efectiva. Métodos: Se consultaron artículos referentes a la prevención de la retinopatía diabética en la atención primaria de salud durante los meses de noviembre-diciembre de 2020 y enero de 2021; publicados en diversas revistas e indexados en las bases de datos PubMed, SciELO, Medscape; otros textos afines, páginas web y blogs del año 2010 en adelante. Las sintaxis empleadas fueron retinopatía diabética, prevalencia y prevención de retinopatía diabética, prevención primaria, complicaciones oculares de la diabetes mellitus y factores de riesgo de la retinopatía diabética. Conclusiones: La adición de nuevas estrategias al control o modificación de los principales factores de riesgo en los pacientes diabéticos constituye una alternativa para perfeccionar la prevención primaria de la retinopatía diabética(AU)

Introduction: Diabetic retinopathy can be prevented with the optimal control of diabetes mellitus; however, the constant arrival of patients with a diagnosis of advanced diabetic retinopathy to ophthalmologic centers points to insufficient primary prevention of this disease. Objective: To propose practical tools related to the main risk factors that can be controlled or modified in diabetic patients to achieve a more effective primary prevention of diabetic retinopathy. Methods: Articles concerning the prevention of diabetic retinopathy in primary healthcare were consulted, covering the months of November-December 2020 and January 2021, published in various journals and indexed in the PubMed, SciELO and Medscape databases; together with other related texts, websites and blogs from 2010 onwards. The used syntaxes were retinopatía diabética [diabetic retinopathy], prevalencia y prevención de retinopatía diabética [prevalence and prevention of diabetic retinopathy], prevención primaria [primary prevention], complicaciones oculares de la diabetes mellitus [ocular complications of diabetes mellitus] and factores de riesgo de la retinopatía diabética [risk factors for diabetic retinopathy]. Conclusions: The addition of new strategies to the control or modification of the main risk factors in diabetic patients is an alternative to perfect primary prevention of diabetic retinopathy(AU)

Retinopatía diabética y su relación con los niveles de hemoglobina glucosilada / Diabetic Retinopathy and its Relationship with Glycosylated Hemoglobin Levels

Introducción: La retinopatía diabética es la principal causa de ceguera en personas diabéticas de 20 a 64 años de edad, e incrementa su aparición frente a un mal control de la enfermedad, que se expresa con valores altos de hemoglobina glucosilada (HbA1C). Objetivo: Establecer la relación entre los niveles de hemoglobina glucosilada y la presencia de retinopatía en los pacientes con diabetes mellitus tipo 2. Métodos: Se llevó a cabo un estudio descriptivo, prospectivo y transversal, en el que se obtuvieron, mediante ficha de observación, datos sociodemográficos, de evaluación oftalmológica y niveles de HbA1C, de los pacientes atendidos en consulta externa del Hospital General Isidro Ayora de la ciudad de Loja, Ecuador, en el período febrero-junio de 2018. Se aplicaron medidas de frecuencia y asociación para el análisis estadístico. Resultados: Se incluyeron 160 pacientes: 108 mujeres y 52 hombres, todos de raza mestiza. Se identificó retinopatía en 26,8 por ciento (N = 43) de los pacientes, de quienes 41 por ciento (N = 18) tenía más de 65 años de edad. La media de HbA1C en pacientes sin retinopatía fue de 7,4 por ciento, y en aquellos con retinopatía de 9,8 por ciento en mayor porcentaje de pacientes con valores de HbA1C de 7 por ciento o más presentaron retinopatía diabética, en comparación con aquellos de HbA1C menores a 7 por ciento (p < 0,0001), la retinopatía no proliferativa moderada fue el principal diagnóstico realizado. Conclusiones: El mal control glucémico en las personas con diabetes mellitus tipo 2 se asocia con mayor probabilidad de aparición de lesiones retinianas(AU)

Introduction: Diabetic retinopathy is the main cause of blindness in diabetic people aged 20 to 64 years; it increases its occurrence due to poor control of the disease, expressed by high values of glycosylated hemoglobin (HbA1c). Objective: To establish the relationship between glycosylated hemoglobin levels and the presence of retinopathy in patients with type 2 diabetes mellitus. Methods: A descriptive, prospective and cross-sectional study was carried out, in which sociodemographic data, others from an ophthalmologic evaluation and HbA1c levels were obtained, by means of an observation card, from patients seen in the outpatient clinic of Hospital General Isidro Ayoraof the city of Loja, Ecuador, in the period February-June 2018. Frequency and association measures were applied for statistical analysis. Results: The study included 160 patients: 108 women and 52 men, all of mixed race. Retinopathy was identified in 26.8percent (N=43) of patients, of whom 41percent (N=18) were over 65 years of age. The mean HbA1c in patients without retinopathy was 7.4percent, and 9.8percent in those with retinopathy. A higher percentage of patients with HbA1c values of 7percent more had diabetic retinopathy, compared to those with HbA1C under 7percent (p<0.0001). Moderate nonproliferative retinopathy was the main diagnosis. Conclusions: Poor glycemic control in persons with type 2 diabetes mellitus is associated with increased likelihood of retinal lesions(AU)