Continuous Glucose Monitoring Alarms in Adults with Type 1 Diabetes: User Characteristics and the Impact of Hypoglycemia and Hyperglycemia Alarm Thresholds on Glycemic Control.

Background: Few studies have evaluated the implications of the alarm thresholds of continuous glucose monitoring (CGM) systems for individuals with diabetes. The present study aimed to investigate the influence of hypoglycemia and hyperglycemia alarm thresholds on glycemic control in adults with type 1 diabetes (T1DM) and the characteristics of patients who use these alarms more frequently. Methods: This observational cross-sectional study included 873 users of the FreeStyle Libre 2 system (501 men, median age 48 years, range 18-90 years) with T1DM from a single center. We investigated the role of demographic and metabolic factors on the use of alarms and the impact of hypoglycemia and hyperglycemia alarms and their thresholds on glycemic control. Results: Alarm users were older than nonusers (median age 49 vs. 43 years, respectively; P < 0.001). The hypoglycemia alarms were set by 76.1% of women and by 69.1% of men (P = 0.022). The hypoglycemia alarms reduced hypoglycemia features and glucose variability, although at the expense of shorter time in range. The higher the hypoglycemia alarm threshold, the greater these effects. The hyperglycemia alarms were effective in reducing hyperglycemia and lowering the glucose management indicator, although at the expense of a greater tendency to hypoglycemia. The lower the hyperglycemia alarm threshold, the greater these effects. Conclusions: CGM alarms contribute to better glycemic control. However, hypoglycemia and hyperglycemia alarms have advantages and disadvantages. Adults with T1DM should explore, under medical supervision, which alarm thresholds will best help them achieve their individual glycemic goals.

Surgical technique: Autologous scleral flap for optic disk pit maculopathy.

PURPOSE: To present a clinical case and surgical technique for management of optic disk pit (ODP) maculopathy. METHODS: Surgical technique video of lens sparring pars plana vitrectomy, autologous scleral flap insertion and gas tamponade. RESULTS: After 1 year follow-up visual acuity was restored to 20/25, retinal serous detachment and schisis were resolved and the autologous scleral flap remained in the (ODP). CONCLUSION: In this case, treatment with pars plana vitrectomy autologous scleral flap insertion and gas tamponade for optic pit maculopathy provided satisfactory anatomical and functional results.

Resultados postquirúrgicos en pacientes con desprendimiento de retina regmatógeno asociado a agujero macular concomitante / Postsurgical results in patients with rhegmatogenous retinal detachment associated with concurrent macular hole

Introducción: el desprendimiento de retina regmatógeno (DRR) y agujero macular concomitante (AM) es una asociación poco frecuente, se reporta alrededor del 1-1,7%. Objetivo: presentar los resultados anatómicos y funcionales obtenidos en 11 casos intervenidos por DRR asociado a AM. Diseño del estudio: estudio observacional descriptivo retrospectivo. Método: estudio retrospectivo. Se registraron 11 pacientes con estas características entre 2010-2018. Se realizó vitrectomía con calibre 23 G, cerclaje escleral, remoción de membrana limitante interna (MLI), endofotocoagulación, lensectomía en los pacientes fáquicos y tamponaje con aceite de silicón o gas. Se evaluaron las siguientes variables: edad, sexo, agudeza visual (AV) al diagnóstico, tiempo de evolución del DRR, número de desgarros, grado de proliferación vitreoretiniana (PVR), si requirió retinectomía, tiempo de tamponaje con aceite de silicón, AV posterior a la extracción de aceite con colocación de lente intraocular y si se obtuvo el cierre del AM. El análisis estadístico descriptivo consistió en las variables cualitativas en frecuencias absolutas y relativas, mientras que en las cuantitativas medidas de tendencia central tipo promedio con rango mínimo y máximo. Resultados: los pacientes presentaban una edad promedio de 63 años (rango 53-74) con agudeza visual (AV) preoperatoria entre proyección luminosa y cuenta dedos. Diez pacientes presentaban mácula desprendida; el número de desgarros fueron de 1 a 2. El grado de PVR al diagnóstico: 2 grado B; 3 grado C2; 2 grado D1; 4 casos sin PVR. En 2 pacientes con PVR C3 y D1 se realizó retinectomía en 180°. En el 82% de los casos se logró la reaplicación de la retina en la primera cirugía, 100% en la segunda y en el 64% se constató el cierre completo del AM. La AV final fue entre 20/200 a 20/50, donde las mejores AV se asocian a casos con intervención precoz y sin PVR. Conclusión: Se encontró una tasa de reaplicación de la retina similar a O'Driscoll et al. donde alcanza el 78%, aunque solo 31% de su serie logra el cierre completo del AM utilizando gas SF6 como tamponaje sin pelaje de la MLI. En este estudio la tasa de cierre del AM es mayor alcanzando el 64% con pelaje de la MLI y una tasa de éxito anatómico con reaplicación de la retina en el 82% en la primera intervención.

Background: rhegmatogenous retinal detachment (RRD) and concomitant macular hole (MH) is a rare association, reported around 1-1,7%. Objective: to report anatomical and functional postoperative results in 11 patients with RD associated with MH. Study design: observational retrospective descriptive study. Method: this is a retrospective study. Eleven patients were registered with RRD and MH between 2010-2018. A 23G vitrectomy, scleral buckling, internal limiting membrane (ILM) peeling, laser photocoagulation, lensectomy in phakic patients and tamponade with silicone oil or gas were performed. The following variables were evaluated: age, sex, visual acuity (VA) at diagnosis, time of evolution of RRD, number of retinal tears, degree of vitreoretinal proliferation (VRP), if retinectomy is required, tamponade time with silicone oil, VA after extraction of silicon oil and scleral fixation of intraocular lens and if closure of the MH was obtained. The descriptive statistical analysis consisted of qualitative variables in absolute and relative frequencies; in the quantitative variables were applied measures of central tendency like average with minimum and maximum range. Results: the patients had an average age of 63 years (range 53-74) with preoperative visual acuity (VA) between luminous projection and counting fingers. Ten patients had detached macula; the number of retinal tears were 1 to 2. The degree VRP at diagnosis: 2 grade B; 3 grade C2; 2 grade D1; 4 cases without VRP. In 2 patients with VRP C3 and D1, a 180° retinectomy was performed. In 82% of the cases, the reapplication of the retina was achieved in the first surgery, 100% in the second and in 64% the complete closure of the MH was confi rmed. The final VA was from 20/200 to 20/50, where the best visual outcomes are associated with early intervention and without VPR. Conclusion: this study found a retinal reapplication rate similar to O'Driscoll et al. where it reaches 78%, although only 31% of this report achieves the complete closure of the MH using SF6 gas as tamponade without ILM peeling. In this study, the closure rate of the MH is greater reaching 64% with ILM peeling and an anatomical success rate with retinal reapplication in 82% in the first intervention.