[Bilateral posterior scleritis]. / Escleritis posterior bilateral.

Posterior scleritis is an inflammatory process of the posterior part of the sclera. Its prevalence is very low and its diagnosis can be complicated due to the absence of external ocular signs. It is more frequent in women. In young patients it does not usually have other associated pathologies, but in those over 55 years nearly one-third of the cases have a relation with some systemic disease, above all rheumatoid arthritis. The diagnosis of this pathology can require a multidisciplinary approach and the collaboration of ophthalmologists with neurologists, internists or rheumatologists. This article describes a case of idiopathic bilateral posterior scleritis.

Escleritis posterior bilateral / Bilateral posterior scleritis

La escleritis posterior es un proceso inflamatoriode la parte posterior de la esclera. Su prevalencia esmuy baja y el diagnóstico puede resultar complicadopor la ausencia de signos oculares externos. Es más frecuenteen mujeres. Cuando aparece en pacientes jóvenesno suele tener otras patologías asociadas, pero enmayores de 55 años hasta un tercio de los casos tienenrelación con alguna enfermedad sistémica, sobre todola artritis reumatoide. El diagnóstico de esta patologíapuede requerir un abordaje multidisciplinar y la colaboraciónde oftalmólogos con neurólogos, internistas oreumatólogos. En este artículo se describe un caso deescleritis posterior bilateral idiopática (AU)

Posterior scleritis is an inflammatory process ofthe posterior part of the sclera. Its prevalence is verylow and its diagnosis can be complicated due to theabsence of external ocular signs. It is more frequentin women. In young patients it does not usually haveother associated pathologies, but in those over 55 yearsnearly one-third of the cases have a relation with somesystemic disease, above all rheumatoid arthritis. Thediagnosis of this pathology can require a multidisciplinaryapproach and the collaboration of ophthalmologistswith neurologists, internists or rheumatologists.This article describes a case of idiopathic bilateral posteriorscleritis (AU)

[Leber's miliary aneurysm]. / Aneurismas miliares de Leber.

CASE REPORT: A 45-year-old man was referred to us with a scotoma sensation in his right visual field. Funduscopic examination showed aneurysmal dilatations with lipid exudation in the superior and inferior temporal retinal arcades in his right eye. Angiofluorography showed vascular dilatations and late dye leakage. DISCUSSION: Leber's disease is a primary retinal vasculopathy characterized by several aneurysms associated with intraretinal lipid exudates. Visual compromise depends on macular involvement by the exudates. Differential diagnosis must be established with other primary retinal vasculopathies and secondary aneurysms. Treatment consists of argon laser photocoagulation of the aneurysms.

[Agreement among ophthalmologists and primary care physicians in the evaluation of retinographies of diabetic patients]. / Concordancia en el estudio de retinografías en diabéticos: oftalmólogos vs médicos de familia.

PURPOSE: To assess the extent of agreement in the evaluation of non-mydriatic retinographies of diabetic patients among ophthalmologists and a group of primary care physicians with previous training. METHODS: The study was divided in two phases. In the first phase, the four participants were instructed in the interpretation of retinographies. The second phase involved the evaluation of 1000 images of 200 patients, 100 without retinopathy and 100 with signs of diabetic retinopathy. The four participants had to decide if the images did or did not show evidence of diabetic retinopathy. Kappa index was used to assess the extent of agreement. A percentage disagreement of 15% with a precision of 5% (+/-5%) with a confidence level of 95% was considered adequate. RESULTS: The percentage of coincident diagnoses among ophthalmologists and primary care physicians was between 89 and 97.5%. With respect to the assessment of the agreement, the kappa index was between 80 and 95%. In all cases the confidence interval was at least 85%. CONCLUSIONS: After an adequate training process, the reliability of evaluation of non-mydriatic retinographies of diabetic patients by primary care physicians was very high. This could allow the establishment of screening for diabetic retinopathy at the primary care level. Advantages of this system include a greater involvement of primary care physicians in the global management of diabetic patients and a lower demand for ophthalmic attention.

Concordancia en el estudio de retinografías en diabéticos: oftalmólogos vs médicos de famlia / Agreement among ophthalmologists and primary care physicians in the evaluation of retinographies of diabetic patients

Objetivo: Determinar la concordancia en la interpretación de retinografías no midriáticas de pacientes diabéticos entre oftalmólogos y un grupo de médicos de atención primaria previamente sometidos a un proceso de adiestramiento. Métodos: El estudio fue dividido en dos fases. En la primera se adiestró a los participantes en la interpretación de imágenes retinográficas. La segunda fase se realizó sobre 1000 imágenes correspondientes a 200 pacientes, 100 sin retinopatía diabética y 100 con retinopatía. Los participantes debían decidir si las imágenes presentaban o no signos de retinopatía diabética. Para la valoración de la concordancia se utilizó el índice kappa. Se estimó como adecuado un porcentaje de desacuerdo del 15% con una precisión del 5% (±5%) con un nivel de confianza del 95%. Resultados: El porcentaje de diagnósticos coincidentes entre oftalmólogos y médicos de atención primaria está entre 89 y 97,5%. Por lo que respecta a la evaluación de la concordancia, el índice kappa se sitúa entre 80 y 95%. En todos los casos el intervalo de confianza incluye el 85%. Conclusiones: Después de un adecuado adiestramiento, la fiabilidad de facultativos de atención primaria en interpretar retinografías no midriáticas de diabéticos es muy alta. Esto permitiría establecer en atención primaria el filtro para el cribado de la retinopatía diabética. Las ventajas de esta medida serían una mayor implicación de atención primaria en el manejo global de los diabéticos y una disminución de la demanda de atención oftalmológica

Purpose: To assess the extent of agreement in the evaluation of non-mydriatic retinographies of diabetic patients among ophthalmologists and a group of primary care physicians with previous training. Methods: The study was divided in two phases. In the first phase, the four participants were instructed in the interpretation of retinographies. The second phase involved the evaluation of 1000 images of 200 patients, 100 without retinopathy and 100 with signs of diabetic retinopathy. The four participants had to decide if the images did or did not show evidence of diabetic retinopathy. Kappa index was used to assess the extent of agreement. A percentage disagreement of 15% with a precision of 5% (±5%) with a confidence level of 95% was considered adequate. Results: The percentage of coincident diagnoses among ophthalmologists and primary care physicians was between 89 and 97.5%. With respect to the assessment of the agreement, the kappa index was between 80 and 95%. In all cases the confidence interval was at least 85%. Conclusions: After an adequate training process, the reliability of evaluation of non-mydriatic retinographies of diabetic patients by primary care physicians was very high. This could allow the establishment of screening for diabetic retinopathy at the primary care level. Advantages of this system include a greater involvement of primary care physicians in the global management of diabetic patients and a lower demand for ophthalmic attention (Arch Soc Esp Oftalmol 2008; 83: 527-532)

[Coats disease of adult onset]. / Enfermedad de Coats de comienzo en adulto.

CASE REPORT: We report a 66-year-old male who exhibited an exudative retinal vasculopathy, diagnosed as Coats disease of adult onset, treated with laser photocoagulation. DISCUSSION: Most cases of Coats disease are diagnosed in childhood. When this entity appears in adults it usually exhibits a more benign clinical course. Diagnosis of this condition must be considered in those patients showing a retinal vasculopathy with a marked exudative component. Treatment is indicated if the fovea is threatened by lipid deposition.

Enfermedad de Coats de comienzo en adulto / Coats disease of adult onset

Caso clínico: Se describe a un varón de 66 años que presentaba una vasculopatía retiniana exudativa que fue diagnosticada como enfermedad de Coats de aparición en adulto y fue tratada mediante fotocoagulación con láser. Discusión: La mayor parte de los casos de enfermedad de Coats se diagnostican en la infancia. Cuando este proceso aparece en adultos el curso clínico es más benigno. Debemos considerar este diagnóstico en aquellos pacientes que presenten vasculopatías retinianas con un importante componente exudativo. El tratamiento estará indicado cuando la fovea esté amenazada por el depósito de exudados

Case report: We report a 66-year-old male who exhibited an exudative retinal vasculopathy, diagnosed as Coats disease of adult onset, treated with laser photocoagulation. Discussion: Most cases of Coats disease are diagnosed in childhood. When this entity appears in adults it usually exhibits a more benign clinical course. Diagnosis of this condition must be considered in those patients showing a retinal vasculopathy with a marked exudative component. Treatment is indicated if the fovea is threatened by lipid deposition

Retinopatía diabética / Diabetic retinopathy

La diabetes mellitus es una patología metabólicaque en su evolución afecta a diferentes órganos, entreellos los ojos. La microangiopatía diabética afecta demanera precoz y específica a la retina. La aparición dela retinopatía está directamente relacionada con eltiempo de evolución de la enfermedad y del controlmetabólico. La microangiopatía diabética en la retinamuestra alteraciones específicas como son los microaneurismas,los exudados duros o blandos, las microhemorragiasintrarretinianas, dilataciones venosas arrosariadasy anomalías microvasculares intrarretinianas.Estas alteraciones en la microcirculación retiniana causandos fenómenos fisiopatológicos: cierre capilar conla consiguiente isquemia o extravasación del contenidointravascular al estroma provocando edema. Eneste capítulo se exponen la clasificación y tratamientosde la retinopatía diabética, excluyendo el edema macular,según los diferentes estudios multicéntricos presentesen la bibliografía actual

Diabetes mellitus is a metabolic pathology whoseevolution affects different organs, amongst them theeye. Diabetic microangiopathy affects the retina in anearly and specific way. The appearance of retinopathyis directly related to the time of evolution of thedisease and metabolic control. Diabeticmicroangiopathy in the retina shows specificalterations such as micro-aneurysms, soft or hardexudates, intra-retinal micro-haemorrhages, beadedveins and intraretinal microvascular anomalies.These alterations in the retinal microcirculation causetwo physiopathological phenomena: capillary closurewith the resulting ischaemia or extravasation ofintravascular content to the stroma causing edema. Inthis chapter we set out the classification andtreatments of diabetic retinopathy, excluding macularedema, according to the different multicentric studiespresent in the current bibliography