The effect of panretinal photocoagulation on confocal laser scanning ophthalmoscopy and stereo photographic parameters of optic disk topography in patients with diabetic retinopathy / Efeito da panfotocoagulação retiniana na oftalmoscopia confocal de varredura a laser e parâmetros da estereofotografia do disco óptico em pacientes com retinopatia diabética

ABSTRACT Purpose: To determine the effect of panretinal photocoagulation on optic disk topographic parameters in non-glaucomatous patients with proliferative diabetic retinopathy. Methods: This was a prospective, single-center, observational study. Thirty-eight eyes of 26 patients with diabetes underwent panretinal photocoagulation for proliferative diabetic retinopathy. Stereoscopic disk photographs and optic nerve head parameters were evaluated using the Zeiss fundus camera and the confocal scanning laser ophthalmoscope (Heidelberg Retinal Tomograph), respectively, at baseline and 12 months after the completion of panretinal photocoagulation. Results: Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 (range 26-74) years were recruited. No significant difference was found between the stereo photography determined mean horizontal and vertical cup-to-disk ratio before and after panretinal photocoagulation treatment (p=0.461 and 0.839, respectively). The global values of the optic nerve head parameters analyzed with the HRT3 showed no significant change from baseline to 12 months, including the disk area, cup area, rim area, cup volume, rim volume, cup-to-disk area ratio, linear cup-to-disk ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness, and cross-sectional area. Conclusion: Our results suggest that panretinal photocoagulation does not cause morphological optic disk changes in patients with diabetic proliferative retinopathy after 1 year of follow-up.

RESUMO Objetivo: Determinar o efeito da panfotocoagulação retiniana nos parâmetros topográficos do disco óptico em pacientes não glaucomatosos com retinopatia diabética proliferativa. Métodos: Este é um estudo observacional pros­pectivo e unicêntrico. Trinta e oito olhos de 26 pacientes dia­béticos foram submetidos à panfotocoagulação retiniana para retinopatia diabética proliferativa. As estereofotografias e os parâmetros do disco óptico foram avaliados usando o retinógrafo Visucam da Zeiss e o oftalmoscópio confocal de varredura a laser (Heidelberg Retinal Tomograph), respectivamente, no início e 12 meses após a conclusão da panfotocoagulação. Resultados: Trinta e oito olhos de 26 pacientes (15 mulheres) com média de idade de 53,7 anos (intervalo de 26-74) foram recrutados. Nenhuma diferença significativa foi encontrada entre a média horizontal e vertical para relação escavação/disco óptico determinadas pelas estereo­fotografias antes e após o tratamento com panfotocoagulação retiniana (p=0,461 e 0,839, respectivamente). Os valores globais dos parâmetros do disco óptico analisados com a tomografia de varredura a laser não mostraram nenhuma mudança significativa entre o início até os 12 meses, incluindo disk area, cup area, rim area, cup volume, rim volume, C/D area ratio, linear C/D ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness e cross-sectional area. Conclusão: Nossos resultados sugerem que a panfotocoagulação retiniana não causa alterações morfológicas no disco óptico em pacientes com retinopatia diabética proliferativa após um ano de seguimento.

Prevalence of diabetic retinopathy in Peruvian patients with type 2 diabetes: results of a hospital-based retinal telescreening program / Prevalencia de retinopatía diabética en pacientes con diabetes tipo 2 en el Perú: resultados de un programa hospitalario de detección sistemßtica mediante telemedicina

OBJECTIVE: To estimate the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes and to determine any association with clinical factors. METHODS: This hospital-based screening project was designed to prospectively detect the presence of DR in patients with type 2 diabetes by grading images acquired with a digital retinal camera. RESULTS: Of 1 311 patients screened, appropriate retinal images were obtained in 1 222 subjects (93.2 percent). DR was detected in 282 patients (23.1 percent) [95 percent confidence interval (CI): 20.71-25.44]; 249 patients (20.4 percent) (95 percent CI: 18.1-22.6) had nonproliferative DR and 33 (2.7 percent) (95 percent CI: 1.8-3.6) had proliferative DR. In 32 patients (11.3 percent), DR was unilateral. The frequency of DR was the same in both sexes. Prevalence of blindness was twice as frequent in patients with DR as in those without it (9.4 percent and 4.6 percent, respectively) (P = 0.001). The frequency of DR at diagnosis was 3.5 percent and it increased with the duration of diabetes. DR was more frequent in patients with arterial hypertension, macrovascular or microvascular complications, and hemoglobin A1c (HbA1c) > 7.0 percent and in those treated with insulin or sulfonylureas. It was less prevalent in those with HbA1c < 7.0 percent, with greater body mass index, and who had been treated with metformin. CONCLUSIONS: The prevalence of DR in these patients with type 2 diabetes was 23.1 percent. Nonproliferative retinopathy accounted for 77.0 percent of cases. Although less prevalent than in a previous report, it doubled the frequency of blindness in the people affected. A national screening DR program should be considered in order to detect this prevalent condition early and treat it in a timely fashion.

OBJETIVO: Calcular la prevalencia de la retinopatía diabética en pacientes con diabetes tipo 2 y determinar su asociación con factores clínicos. MÉTODOS: Este proyecto de detección sistemßtica hospitalaria se dise±ó para detectar de manera prospectiva la presencia de retinopatía diabética en pacientes con diabetes tipo 2 mediante la valoración de imßgenes obtenidas con una cßmara digital para fotografía retiniana. RESULTADOS: Se evaluó a 1 311 pacientes y se obtuvieron imßgenes retinianas apropiadas en 1 222 de ellos (93,2 por ciento). Se detectó retinopatía diabética en 282 pacientes (23,1 por ciento) (intervalo de confianza [IC] de 95 por ciento: 20,71-25,44): 249 pacientes (20,4 por ciento) (IC de 95 por ciento: 18,1-22,6) tenían retinopatía diabética no proliferativa y 33 (2,7 por ciento) (IC 95 por ciento: 1,8-3,6) presentaban retinopatía diabética proliferativa. En 32 pacientes (11,3 por ciento), la retinopatía diabética era unilateral. La frecuencia de retinopatía diabética fue la misma en ambos sexos. La prevalencia de ceguera fue del doble en los pacientes con retinopatía diabética que en aquellos sin ella (9,4 por ciento y 4,6 por ciento, respectivamente) (P = 0,001). La frecuencia de retinopatía diabética en el momento del diagnóstico fue de 3,5 por ciento y aumentó con la duración de la diabetes. La retinopatía diabética fue mßs frecuente en los pacientes con hipertensión arterial, complicaciones macrovasculares o microvasculares y hemoglobina A1c (HbA1c) > 7,0 por ciento, y en aquellos tratados con insulina o sulfonilureas. Fue menos prevalente en los pacientes con HbA1c < 7,0 por ciento, en aquellos con mayor índice de masa corporal y en los tratados con metformina. CONCLUSIONES: La prevalencia de retinopatía diabética en estos pacientes con diabetes tipo 2 fue de 23,1 por ciento. La retinopatía no proliferativa representó 77,0 por ciento de los casos. Aunque la prevalencia de la ceguera fue menor que en un informe anterior...