Utilidad de las retinografías en el diagnóstico del edema macular diabético / Use of retinal photography in the diagnosis of diabetic macular edema

Objetivo: Determinar la validez de las retinografías en el diagnóstico del edema macular diabético. Fijar el número y amplitud de las fotografías necesarias para su correcto diagnóstico. Métodos: Estudio observacional transversal constituido por 650 ojos de pacientes con retinopatía diabética, a los que se realizó una combinación de retinografías (simples, estereoscópicas y luz aneritra), previa dilatación, para determinar su validez, en el diagnóstico del edema macular diabético. Se calcularon sensibilidad, especificidad, valores predictivo positivo y negativo, así como la concordancia con la prueba de referencia (tomografía de coherencia óptica). Las fotografías fueron evaluadas por tres expertos y sus resultados analizados con el programa estadístico SPSS 15.0 Windows. Resultados: Se obtuvieron valores de sensibilidad inferiores al 80% en el caso de fotografías simples, superando el 80% las retinografías estereoscópicas o aquellas que asocian filtros verdes, siendo la fotografía estereoscópica verde a 30° la que alcanzó mayor sensibilidad, próxima al 94,3%. La especificidad fue del 95% en el caso de fotografías estereoscópicas en color y aneritra a 45 y 30°, respectivamente. El valor predictivo positivo superior al 95% y negativo del 90% con un coeficiente de acuerdo del 80% y un grado de concordancia con la prueba de referencia superior al 80%. Conclusiones: Las retinografías estereoscópicas ofrecen resultados suficientes, como para ser utilizadas en el cribado del edema macular diabético. La utilización de filtros verde (luz aneritra) y su combinación con la agudeza visual mejora los resultados en el diagnóstico de esta enfermedad (AU)

Objective: To determine the validity of retinal photography in the diagnosis of diabetic macular edema. Determine the number and size of the photographs for its correct diagnosis. Methods: Cross-sectional observational study consisting of 420 eyes of patients with diabetic retinopathy, using a combination of retinography (simple, stereoscopic, red-free light), after expansion, to determine its validity in the diagnosis of diabetic macular edema. Sensitivity, specificity, positive and negative predictive values and the correlation with the gold standard test (optical coherence tomography) were calculated. The retinographs were evaluated by three experts and their results analyzed by the statistical program SPSS 15.0 Windows. Results: Sensitivities were below 80% in simple photographs and above 80% in the stereoscopic retinography, whereas those associated with red-free filters, reaching the 30° green stereoscopic photography, showed a sensitivity of 94.3%. The specificity was 95% in color and red-free stereoscopic retinography of 45° and 30°. The positive predictive value was greater than 95% and the negative value greater than 90% with a coefficient of agreement of 80%, and a degree of consistency with the benchmark of over 80%. Conclusions: The results of the stereoscopic retinographs are sufficient to enable them to be used in screening for diabetic macular edema. The use of a green filter and its combination with visual acuity improves results in the diagnosis of this disease (AU)

[Use of retinal photography in the diagnosis of diabetic macular edema]. / Utilidad de las retinografías en el diagnóstico del edema macular diabético.

OBJECTIVE: To determine the validity of retinal photography in the diagnosis of diabetic macular edema. Determine the number and size of the photographs for its correct diagnosis. METHODS: Cross-sectional observational study consisting of 420 eyes of patients with diabetic retinopathy, using a combination of retinography (simple, stereoscopic, red-free light), after expansion, to determine its validity in the diagnosis of diabetic macular edema. Sensitivity, specificity, positive and negative predictive values and the correlation with the gold standard test (optical coherence tomography) were calculated. The retinographs were evaluated by three experts and their results analyzed by the statistical program SPSS 15.0 Windows. RESULTS: Sensitivities were below 80% in simple photographs and above 80% in the stereoscopic retinography, whereas those associated with red-free filters, reaching the 30° green stereoscopic photography, showed a sensitivity of 94.3%. The specificity was 95% in color and red-free stereoscopic retinography of 45° and 30°. The positive predictive value was greater than 95% and the negative value greater than 90% with a coefficient of agreement of 80%, and a degree of consistency with the benchmark of over 80%. CONCLUSIONS: The results of the stereoscopic retinographs are sufficient to enable them to be used in screening for diabetic macular edema. The use of a green filter and its combination with visual acuity improves results in the diagnosis of this disease.

[Diagnosis of systemic disease after bilateral retinal arterial macroaneurysm]. / Diagnóstico de patología sistémica tras macroaneurisma arterial retiniano bilateral.

CASE REPORT: An 85 year old male suffered vision loss in both eyes due to ruptured bilateral retinal arterial macroaneurysms. DISCUSSION: We report this unusual case and show the importance of studying these types of patients in order to detect associated systemic diseases.

Diagnóstico de patología sistémica tras macroaneurisma arterial retiniano bilateral / Diagnosis of systemic disease after bilateral retinal arterial macroaneurysm

Caso clínico: Un varón de 85 años sufrió pérdida de visión en ambos ojos debido a la roturade macroaneurismas arteriales retinianos bilaterales.Discusión: Se comenta este caso inusual y hablamos de la importancia de estudiar a estospacientes para detectar enfermedades sistémicas asociadas(AU)

Case report: An 85 year old male suffered vision loss in both eyes due to ruptured bilateralretinal arterial macroaneurysms.Discussion:We report this unusual case and show the importance of studying these types ofpatients in order to detect associated systemic diseases(AU)

[Posterior polymorphous dystrophy and LASIK]. / Distrofia polimorfa posterior y LASIK.

OBJECTIVE/METHOD: A 50-year-old hyperopic woman requested information about refractive surgery. Vesicle and band lesions at Descemet's membrane and endothelium were suggestive of posterior polymorphous dystrophy (PPD). Lower than normal endothelial cell densities were detected. A corneal refractive procedure was not recommended in this case. RESULTS/CONCLUSIONS: The presence of vesicles and bands at Descemet's membrane and endothelium is suggestive of PPD. Specular microscopy is mandatory in such patients, although corneal decompensation is not evident. A low endothelial cell count may be a contraindication for a hyperopic LASIK procedure in cases of PPD because of the possible risk of corneal decompensation.

Lattice corneal dystrophy type II: clinical, pathologic, and molecular study in a Spanish family.

PURPOSE: To report a family with lattice corneal dystrophy type II (LCD II) associated with systemic amyloidosis type V. METHODS: A 69-year-old woman presented a LCD II and marked dermachalasis. A lower blepharoplasty was performed. Two years later a penetrating keratoplasty was performed in her left eye. Three children of the patient were studied. Subtle manifestations of LCD were identified in two of them. Pathologic study of the excised skin and corneal button was made. DNA from peripheral blood was obtained, and was subjected to amplification of exon 5 of the gelsolin. RESULTS: Pathologic examination of the skin of blepharoplasty specimen demonstrated the presence of amyloid. Microscopic examination of the corneal button showed the presence of amyloid deposits beneath the normal-appearing Bowman layer and also within the stroma. Immunostaining for S-100 protein did not demonstrate a significant relationship between amyloid deposits and corneal nerves. Electron microscopic evaluation demonstrated the presence of amyloid fibrils. No clear relationship was found between amyloid deposits and corneal nerves. These findings confirm LCD type II or Meretoja syndrome. A mutation analysis of the gelsolin gene demonstrated the presence of G to A transition at nucleotide 654. Two children with manifestations of LCD also showed the identical mutation in gelsolin gene. CONCLUSIONS: A new family with Meretoja syndrome is reported. This is the first documented family with Meretoja syndrome in Spain and in the Mediterranean countries. The molecular study shows the same mutation of reported families from Finland, Japan, the United States, and the United Kingdom.