RESUMEN
BACKGROUND: Diabetic retinopathy (DR) may worsen during pregnancy, but its course in the postpartum remains poorly understood. Understanding the natural history of DR during and after pregnancy can help determine when sight-threatening DR treatment should be administered. METHODS: A prospective longitudinal cohort study recruited pregnant women with pre-existing type 1 (T1D) or type 2 diabetes from two tertiary Diabetes Antenatal Clinics in Melbourne, Australia. Eye examination results in early pregnancy, late pregnancy, and up to 12-months postpartum were compared to determine DR changes. Two-field fundus photographs and optical coherence tomography scans were used to assess DR severity. RESULTS: Overall, 105 (61.4%) women had at least two eye examinations during the observation period. Mean age was 33.5 years (range 19-51); 54 women (51.4%) had T1D; 63% had HbA1c <7% in early pregnancy. DR progression rate was 23.8% (95% CI 16.4-32.6). Having T1D (RR 4.96, 95% CI 1.83-13.46), pre-existing DR in either eye (RR 4.54, 95% CI 2.39-8.61), and elevated systolic blood pressure (adjusted RR 2.49, 95% CI 1.10-5.66) were associated with increased risk of progression. Sight-threatening progression was observed in 9.5% of women. Among the 19 eyes with progression during pregnancy, 15 eyes remained stable, three eyes progressed, and only one eye regressed in the postpartum. CONCLUSIONS: Nearly 1 in 4 women had DR progression from conception through to 12-months postpartum; almost half of these developing sight-threatening disease. DR progression occurring during pregnancy was found to predominantly remain unchanged, or worsen, after delivery, with very few eyes spontaneously improving postpartum.
RESUMEN
BACKGROUND: Diabetic retinopathy (DR) may be affected by pregnancy. The majority of prevalence data regarding DR in pregnancy predate the advent of contemporary guidelines for diabetes management during pregnancy. This study reports DR prevalence and associated risk factors in women with pregestational diabetes during pregnancy and the postpartum in Australia. METHODS: A total of 172 pregnant women with type 1 (T1DM) or type 2 diabetes diagnosed pre-pregnancy were prospectively recruited from two obstetrics hospitals in Melbourne (November 2017-March 2020). Eye examinations were scheduled in each trimester, at 3-, 6-, and 12-months postpartum. DR severity was graded from two-field fundus photographs by an independent grader utilising the Airlie House Classification. Sight-threatening DR (STDR) was defined as the presence of diabetic macular oedema or proliferative DR. RESULTS: Overall, 146 (84.9%) women had at least one eye examination during pregnancy. The mean age was 33.8 years (range 19-51), median diabetes duration was 7.0 years (IQR 3.0-17.0), 71 women (48.6%) had T1DM. DR and STDR prevalence during pregnancy per 100 eyes was 24.3 (95% CI 19.7-29.6) and 9.0 (95% CI 6.1-12.9); while prevalence in the postpartum was 22.2 (95% CI 16.5-29.3) and 10.0 (95% CI 5.4-17.9), respectively. T1DM, longer diabetes duration, higher HbA1c in early pregnancy, and pre-existing nephropathy were significant risk factors. CONCLUSIONS: The prevalence of DR in pregnant women was similar to the non-pregnant diabetic population in Australia. One in nine participants had STDR during pregnancy and the postpartum, highlighting the need to optimise DR management guidelines in pregnancy given the significant risk of vision loss.
Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Retinopatía Diabética , Adulto , Estudios Transversales , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Retinopatía Diabética/complicaciones , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Femenino , Hemoglobina Glucada , Humanos , Masculino , Persona de Mediana Edad , Periodo Posparto , Embarazo , Prevalencia , Factores de Riesgo , Adulto JovenAsunto(s)
Coriorretinitis/diagnóstico por imagen , Infecciones Bacterianas del Ojo/diagnóstico por imagen , Epitelio Pigmentado de la Retina/diagnóstico por imagen , Sífilis/diagnóstico por imagen , Tomografía de Coherencia Óptica , Enfermedad Aguda , Pruebas de Aglutinación , Antibacterianos/uso terapéutico , Coriorretinitis/tratamiento farmacológico , Coriorretinitis/microbiología , Quimioterapia Combinada , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulina M/sangre , Masculino , Penicilina G/uso terapéutico , Prednisona/uso terapéutico , Epitelio Pigmentado de la Retina/patología , Microscopía con Lámpara de Hendidura , Sífilis/tratamiento farmacológico , Sífilis/microbiología , Treponema pallidum/inmunología , Agudeza VisualRESUMEN
PURPOSE: To describe the visual acuity, fundus appearance, and spectral domain optical coherence tomography (SD-OCT) findings in 5 eyes of 3 children with foveal damage from solar retinopathy. METHODS: This was a prospective, observational case series of children who presented to the emergency department at the Royal Victorian Eye and Ear Hospital after having directly viewed the Sun during the transit of Venus on June 6, 2012, or the partial eclipse of the Sun on November 14, 2012. All patients underwent visual acuity testing, dilated fundus examination, and SD-OCT imaging. RESULTS: The 3 patients' ages at presentation were 8, 10, and 11 years. Best-corrected visual acuity in the affected eyes ranged from 20/20 to 20/40 on presentation. Significant foveal pathology was identified on SD-OCT in all 5 eyes, even when visual acuity was normal. At presentation, all eyes showed disruption of the photoreceptor ellipsoid zone and the interdigitation zone on SD-OCT. Additionally, in those eyes with decreased visual acuity, there was disruption of the outer nuclear layer and/or external limiting membrane. At 3-5 months' follow-up, the outer nuclear layer and external limiting membrane lesions had resolved; however, in some eyes the ellipsoid and interdigitation zone abnormalities persisted at 5 months' follow-up, even in the presence of best-corrected visual acuity as good as 20/12.5. CONCLUSIONS: Solar retinopathy in children can cause persistent damage to multiple retinal layers despite recovery of good visual acuity.
Asunto(s)
Traumatismos por Radiación/etiología , Retina/efectos de la radiación , Enfermedades de la Retina/etiología , Luz Solar/efectos adversos , Niño , Femenino , Fondo de Ojo , Humanos , Masculino , Estudios Prospectivos , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/fisiopatología , Retina/patología , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/fisiopatología , Tomografía de Coherencia Óptica , Agudeza Visual/fisiologíaAsunto(s)
Retinopatía Diabética/tratamiento farmacológico , Fenofibrato/uso terapéutico , Hipolipemiantes/uso terapéutico , Australia , Retinopatía Diabética/diagnóstico , Progresión de la Enfermedad , Costos de los Medicamentos , Fenofibrato/efectos adversos , Fenofibrato/economía , Humanos , Hiperlipidemias/tratamiento farmacológico , Hipolipemiantes/efectos adversos , Hipolipemiantes/economía , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores SexualesRESUMEN
This review examines the current evidence of the relationship between sugar consumption and the development of retinal and other eye diseases including diabetic retinopathy, hypertensive retinopathy, age-related macular degeneration, non-arteritic anterior ischaemic optic neuropathy and cataract. Sucrose is comprised of fructose and glucose. Sugar consumption has increased five-fold over the last century, with high quantities of sucrose and high-fructose corn syrup found in processed food and soft drinks. This increased consumption is increasingly recognized as a central factor in the rapidly rising rates of obesity and type 2 diabetes. The body metabolizes fructose and glucose differently, with fructose appearing to have the greater propensity to contribute to the metabolic syndrome. This review examines the effect of high rates of dietary consumption of refined carbohydrates on the eye, including the effect of chronic hyperglycaemia on microvascular disease in diabetic retinopathy, and the pathophysiological changes in the retinal circulation in hypertensive retinopathy.
Asunto(s)
Catarata/etiología , Retinopatía Diabética/etiología , Carbohidratos de la Dieta/efectos adversos , Retinopatía Hipertensiva/etiología , Degeneración Macular/etiología , Neuropatía Óptica Isquémica/etiología , Edulcorantes/efectos adversos , Catarata/fisiopatología , Retinopatía Diabética/fisiopatología , Fructosa/efectos adversos , Glucosa/efectos adversos , Humanos , Retinopatía Hipertensiva/fisiopatología , Degeneración Macular/fisiopatología , Neuropatía Óptica Isquémica/fisiopatologíaRESUMEN
Intravitreal injection is a common procedure performed by ophthalmologists. It is a quick and targeted treatment for a number of ophthalmic conditions. Despite this, the potential to cause serious complications and patient discomfort cannot be ignored. This article presents the level of evidence in the scientific literature supporting common practices such as location of the procedure, anaesthetic choice, sterile procedure techniques, comparison of some common pharmaceutical agents and the use of antibiotics.
Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Inyecciones Intravítreas/métodos , Cuerpo Vítreo/efectos de los fármacos , Anestésicos Locales/administración & dosificación , Antibacterianos/administración & dosificación , Antisepsia/métodos , Desinfección/métodos , Humanos , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
An 82-year-old patient with diabetes was followed up due to moderate nonproliferative diabetic retinopathy with macular edema in the right eye. Visual acuity was 6/36. Focal macular laser was conducted (A). Three years later, the patient presented with blurry vision in the right eye. Visual acuity was 3/60. Vitreous hemorrhage was observed (B), and neovascularization of the disc was suspected (C). Fluorescein angiography (D, mid venous phase; E-F, recirculation phase) confirmed neovascularization of the disc and depicted a striking vertical leakage. Panretinal photocoagulation was started. Possible explanations for the "geyser" leakage may be either a partial posterior vitreous detachment allowing the fluorescein to track upwards but not elsewhere or a pocket of syneretic vitreous allowing the fluorescein passage in which to diffuse, much like the passage the blood would have taken.
Asunto(s)
Retinopatía Diabética/complicaciones , Edema Macular/complicaciones , Neovascularización Retiniana/diagnóstico , Hemorragia Vítrea/diagnóstico , Anciano de 80 o más Años , Retinopatía Diabética/diagnóstico , Diagnóstico Diferencial , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Coagulación con Láser , Edema Macular/diagnóstico , Neovascularización Retiniana/etiología , Neovascularización Retiniana/cirugía , Agudeza Visual , Vitrectomía , Hemorragia Vítrea/etiología , Hemorragia Vítrea/cirugíaAsunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Distrofia Muscular de Duchenne/complicaciones , Neovascularización Retiniana/complicaciones , Neovascularización Retiniana/tratamiento farmacológico , Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Bevacizumab , Angiografía con Fluoresceína , Humanos , Inyecciones Intravítreas , Masculino , Neovascularización Retiniana/diagnóstico , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiología , Adulto JovenRESUMEN
To describe the spectrum of contact lens-related problems in cases presenting to a tertiary referral eye hospital. A retrospective case record analysis of 111 eyes of 97 consecutive patients was undertaken over a period of five months at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia. Contact lens-related complications (CLRC) were classified into microbial keratitis, sterile corneal infiltrates, corneal epitheliopathy and contact lens-related red eye (CLARE). Main parameters examined were nature of the first contact, clinical diagnosis, and management pattern. Forty-two percent of the initial presentations were to health care practitioners (HCPs) other than ophthalmologists. Mean duration from the onset of symptoms to presentation was 6.3 ± 10.9 days. Forty-nine percent (n = 54) of patients had an associated risk factor, most commonly overnight use of contact lenses (n = 14, 13 %). Most common diagnosis at presentation was corneal epitheliopathy (68 %) followed by sterile infiltrates (10 %), CLARE (8 %) and microbial keratitis (6 %). No significant differences were found in the pattern of treatment modalities administered by ophthalmologists and other HCPs. HCPs other than ophthalmologists are the first contact for contact lens-related problems in a significant proportion of patients. These HCPs manage the majority of CLRC by direct treatment or immediate referral.