Diabetic retinopathy in Greece: prevalence and risk factors studied in the medical retina clinic of a Greek tertiary hospital.

PURPOSE: To determine the prevalence of diabetic retinopathy (DR) and diabetic macular edema (DME) in a cohort of Greek diabetic patients and identify possible risk factors. METHODS: This is a non-interventional, cross-sectional study of 300 diabetic Greek patients attending the Ophthalmology Department of a tertiary hospital. Clinical and imaging data were recorded and statistical analysis was performed. Confidence intervals (CI) at 95% and statistically significant p values ≤ 0.05 were set. RESULTS: A total of 300 diabetic patients were included. Of these patients, 21 (7%) were diagnosed with diabetes mellitus (DM) type I and 279 (93%) with DM type II. The average duration of diabetes was 15 ± 9.4 years (95% CI 13.9-16.1) and the mean level of HbA1c was 7.2 ± 1.3 (95% CI 7.1-7.4) overall. Prevalence of DR was 38.7% (116 patients), only 15 patients (5%) had proliferative DR and DME was detected in 19 patients (6.3%). In DM type I patients, 52.4% had DR and 9.5% had DME, while in the DM type II group, 37.6% had DR and 6.1% had DME. Binary logistic regression analysis identified duration of diabetes, increased HbA1c and hypertriglyceridemia as potential risk factors. CONCLUSIONS: This study is the first one to present the extent and severity of DR and DME in a Greek cohort of diabetic patients and also identify risk factors associated with these entities. Our findings highlight the significance of a properly organized national screening program for the early detection and management of the vision-threatening complications of DR.

Relationship between short-wavelength automatic perimetry and Heidelberg retina tomograph parameters in eyes with ocular hypertension.

AIM: To compare and correlate optic nerve head parameters obtained by Heidelberg retina tomograph (HRT) with short-wavelength automatic perimetry (SWAP) indices in eyes with ocular hypertension (OHT). METHODS: One hundred and forty-six patients with OHT included in the present study. All subjects had reliable SWAP and HRT measurements performed within a 2wk period. The eyes were classified as normal/abnormal according to visual field criteria and Moorfields regression analysis (MRA). Correlations between visual field indices and HRT parameters were analyzed using Pearson correlation coefficient (r). RESULTS: Twenty-nine eyes (19.9%) had SWAP defects. Twenty-nine eyes (19.9%) were classified as abnormal according to global MRA. Six eyes (4.1%) had abnormal global MRA and SWAP defects. The k statistic is 0.116 (P=0.12) indicating a very poor agreement between the methods. No statistical significant correlation between HRT and SWAP parameters was detected. CONCLUSION: SWAP defects may coexist with abnormalities of optic disc detected by HRT in eyes with OHT. In most eyes, however, the two methods detect different glaucoma properties.

Complications and outcomes of phacoemulsification cataract surgery complicated by anterior capsule tear.

PURPOSE: To study the results of phacoemulsification cataract surgery complicated by anterior capsule tear. DESIGN: Retrospective interventional controlled case series. METHODS: Consecutive series of eyes suffering intraoperative anterior capsule tear and others with uneventful cataract surgery at Moorfields Eye Hospital were investigated. Biometric, intraoperative, and postoperative details were recorded. The exclusion criteria were combined surgical procedures, planned manual extracapsular cataract extraction, and history of previous intraocular surgery or eye trauma. The main outcome measures were intraoperative capsule complication rates, refractive and visual outcomes, and incidence of short-term postoperative complications. Two-sided Fisher exact and paired t tests were used for categorical and continuous data, respectively. RESULTS: The study and control groups included 239 and 212 eyes, respectively. In the study group, planned phacoemulsification was converted to manual extraction in 5 cases (2%); a concurrent posterior capsule rupture occurred in 58 eyes (24%) with a rate of nuclear lens material drop in the posterior segment of 5% (11 cases). Over 11% of eyes (n = 27) underwent unplanned secondary surgical procedures. Overall, the refractive outcomes were poor in 22.4% of eyes (postoperative refraction ≥1 diopter of target), and were statistically worse (P < .0001). A significant visual improvement was observed in the majority of the study group eyes (71%); permanent visual loss occurred in 4 eyes (1.7%). CONCLUSIONS: Anterior capsule tear can lead to additional intraoperative complications, with a relatively high incidence of secondary interventions. Overall, permanent visual loss can be observed and worse refractive outcomes are to be expected, particularly if the lens is being implanted out of the bag.

Comparison of dynamic contour tonometry and Goldmann applanation tonometry following penetrating keratoplasty.

OBJECTIVE: To evaluate dynamic contour tonometry (DCT) versus Goldmann applanation tonometry (GAT) intraocular pressure (IOP) measurements in eyes that underwent penetrating keratoplasty PKP). Prospective, cross-sectional, observational study. PARTICIPANTS: Thirty-one eyes of 28 patients were examined after PKP. METHODS: All eyes had undergone PKP with interrupted sutures. The postoperative period was more than 1 year for 25 eyes and less than 1 year for 6. Sutures were removed based on corneal topography and refraction. IOP was measured by both DCT and GAT methods and was correlated to the number of remaining sutures. RESULTS: IOP readings were successfully obtained in 25/31 (80.6%) with DTC and in 21/31 (67.7%) with GAT (p = 0.25). In eyes with fewer than 4 remaining sutures, both methods were successful. In eyes with more than 4 sutures, the success rates of DCT and GAT were 66.7% and 44.4%, respectively (p = 0.18). In PKPs with a postoperative period of more than 1 year, the success rates of DCT and GAT were 96% and 84%, respectively (p = 0.16). In 20 eyes, both methods measured the IOP. The mean IOP obtained by DCT (16.6 [SD 2.8] mm Hg) was higher than the mean IOP obtained from GAT (15.1 [SD 3.6] mm Hg). The IOPs from the 2 instruments correlated significantly (p < 0.05) and the mean difference was 1.5 mm Hg. CONCLUSIONS: The success rate in measuring IOP with DCT and GAT did not show any statistically significant difference. Both methods were less effective measuring the IOP after recent PKPs and regrafts. However, DCT seemed to be superior to GAT in corneas with more than 4 remaining sutures and in PKPs performed more than 1 year earlier. The absolute values of IOP were higher with DCT than with GAT.

Preliminary results following the use of a fixed combination of timolol-brimonidine in patients with ocular hypertension and primary open-angle glaucoma.

PURPOSE: The purpose of this prospective study was to evaluate the efficacy in intraocular pressure (IOP) control and the tolerance of a topically administered fixed combination of timolol-brimonidine in 50 patients with ocular hypertension and primary open-angle glaucoma. METHODS: After determining a baseline IOP, the fixed combination timolol-brimonidine was used twice daily for two months, while IOP, ophthalmic signs, and/or symptoms were monitored. RESULTS: The mean IOP value was decreased from 23.09 mm Hg (+/-1.98 SD) to 17.46 mm Hg (+/-1.47 SD) during the 1st month (paired Student's t test = 9.88 kappaalphaiota p < 0.001), and to 17.51 mm Hg (+/-1.43 SD) in the 2nd month. Between the 1st and 2nd month, no statistical difference was observed (paired Student's t test = 0.02 kappaalphaiota p > 0.1). In 8% of the patients during the 1st month and 10% of patients in the 2nd month, some ophthalmic signs were observed, while only mild ophthalmic symptoms were reported in 6% and 8% of the patients, respectively. CONCLUSIONS: In conclusion, the fixed combination of timolol-brimonidine has a satisfactory IOP-lowering effect without any serious side effects due to the topical use.