Autocrine CCL2, CXCL4, CXCL9 and CXCL10 signal in retinal endothelial cells and are enhanced in diabetic retinopathy.

This study aimed at examining the presence and role of chemokines (angiogenic CCL2/MCP-1 and angiostatic CXCL4/PF-4, CXCL9/Mig, CXCL10/IP-10) in proliferative diabetic retinopathy (PDR). Regulated chemokine production in human retinal microvascular cells (HRMEC) and chemokine levels in vitreous samples from 40 PDR and 29 non-diabetic patients were analyzed. MCP-1, PF-4, Mig, IP-10 and VEGF levels in vitreous fluid from PDR patients were significantly higher than in controls. Except for IP-10, cytokine levels were significantly higher in PDR with active neovascularization and PDR without traction retinal detachment (TRD) than those in inactive PDR, PDR with TRD and control subjects. Exploratory regression analysis identified associations between higher levels of IP-10 and inactive PDR and PDR with TRD. VEGF levels correlated positively with MCP-1 and IP-10. Significant positive correlations were observed between MCP-1 and IP-10 levels. In line with these clinical findings Western blot analysis revealed increased PF-4 expression in diabetic rat retinas. HRMEC produced MCP-1, Mig and IP-10 after stimulation with IFN-γ, IL-1ß or lipopolysaccharide. IFN-γ synergistically enhanced Mig and IP-10 production in response to IL-1ß or lipopolysaccharide. MCP-1 was produced by HRMEC in response to VEGF treatment and activated HRMEC via the ERK and Akt/PKB pathway. On the other hand, phosphorylation of ERK induced by VEGF and MCP-1 was inhibited by PF-4, Mig and IP-10. In accordance with inhibition of angiogenic signal transduction pathways, PF-4 inhibited in vitro migration of HRMEC. Thus, regulatory roles for chemokines in PDR were demonstrated. In particular, IP-10 might be associated with the resolution of active PDR and the development of TRD.

Prognostic factors after primary vitrectomy and perfluorocarbon liquids for bullous rhegmatogenous retinal detachment.

PURPOSE: To identify prognostic factors for visual acuity and anatomic outcomes associated with bullous rhegmatogenous retinal detachment (RRD) management using primary pars plana vitrectomy, intraoperative perfluorocarbon liquids (PFCLs), and internal gas tamponade. METHODS: The authors studied a consecutive series of 115 eyes (115 patients) with a bullous RRD not complicated by proliferative vitreoretinopathy (PVR) associated with large, multiple, and/or posterior breaks in 58 (50.4%) eyes. All eyes underwent vitrectomy, injection of PFCL, and gas tamponade as the primary procedure. Encircling scleral bands were placed in all cases. The follow-up period ranged from 3 to 60 months (mean 16.6+/-14.1 months). RESULTS: Retinal reattachment was achieved in 92.2% of eyes (106/115) with one operation and in all eyes after a second procedure. PVR was observed in 1 (0.87%) eye and preretinal membranes in 3 (2.6%) eyes. Progression of pre-existing cataract and development of new cataract occurred in 45 (58.4%) of the 77 phakic eyes. The presence of inferior retinal breaks was significantly associated with redetachment after the first procedure (p=0.0156). On univariate analysis, better preoperative visual acuity (p<0.001), macular sparing retinal detachment (p<0.001), and fewer quadrants involved by the detachment (p=0.0015) were significant positive prognostic factors for final visual acuity. Logistic regression analysis highlighted that macular sparing retinal detachment and absence of trauma were associated with better final visual acuity. CONCLUSIONS: Redetachment was associated with the presence of inferior retinal breaks. Visual recovery was dependent on preoperative visual acuity, macular involvement, extent of retinal detachment, and trauma.

Prognostic factors associated with outcomes after giant retinal tear management using perfluorocarbon liquids.

PURPOSE: To identify prognostic factors for visual acuity and anatomic outcomes associated with giant retinal tear management using intraoperative perfluorocarbon liquids. METHODS: All patients with giant retinal tears without proliferative vitreoretinopathy (PVR) who underwent management with intraoperative perfluorocarbon liquids between 1994 and 2005 were reviewed. RESULTS: The study included 115 patients (117 eyes), 93 (80.9%) males and 22 (19.1%) females, with a mean age of 30.3+/-15.2 years. Mean follow-up period was 29.7+/-26.7 months. Success rate with primary procedure was 78.6%, which increased to 94% with multiple surgeries. On univariate analysis, factors significantly associated with final visual acuity better than 20/200 included phakic/clear lens at presentation (p=0.0113), partial retinal detachment (p=0.0233), absence of all postoperative complications (p=0.0122), absence of recurrent retinal detachment (p=0.0406), and absence of postoperative PVR (p=0.0062). Logistic regression analysis highlighted that phakic/clear lens at presentation, unfolded flap of the giant tear, absence of postoperative cataract, and absence of postoperative PVR were associated with final visual acuity better than 20/200. On univariate analysis, use of gas tamponade was significantly associated with recurrent retinal detachment (p=0.0190). Logistic regression analysis highlighted that placement of an encircling scleral buckle and use of silicone oil tamponade were associated with anatomic reattachment with primary procedure. CONCLUSIONS: Encircling scleral buckling and silicone oil tamponade decrease the risk of recurrent retinal detachment.

Full preoperative panretinal photocoagulation improves the outcome of trabeculectomy with mitomycin C for neovascular glaucoma.

PURPOSE: To investigate the efficacy of full panretinal photocoagulation (PRP) followed by trabeculectomy with mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS: This study is based on 30 consecutive eyes of 27 patients with NVG who underwent full PRP followed by trabeculectomy with MMC. NVG was secondary to proliferative diabetic retinopathy (23 eyes) and central retinal vein occlusion (7 eyes). Kaplan-Meier survival analysis of the surgical outcome was performed. Operative success was defined as an intraocular pressure (IOP) of < or = 21 mmHg without medical therapy. RESULTS: Kaplan-Meier cumulative success rates at the 6-, 12-, and 24-month intervals were 86.5%, 74.7%, and 57.6%, respectively. Pseudophakia was the only identified significant risk factor for failure (p=0.0138; Fisher exact test). Additional surgical procedures were performed in 8 (26.6%) eyes. The mean IOP decreased from 41.0+/-10.2 mmHg to 18.2+/-9.2 mmHg (p<0.001; Wilcoxon signed rank test). The number of anti-glaucoma medications was reduced from 3.1+/-0.5 preoperatively to 0.3+/-0.7 postoperatively (p<0.001; Wilcoxon signedrank test). Twenty-four (80%) eyes were classified as surgical success after a mean followup period of 17.3+/-22.1 months. Twenty-two (73.3%) eyes had improved vision or retained preoperative vision. CONCLUSIONS: Full PRP followed by trabeculectomy with MMC can effectively reduce the elevatedIOP associated with NVG. Presence of pseudophakia is a significant negative predictor of surgical outcome.

Accuracy of hysterosalpingography and laparoscopic hydrotubation in diagnosis of tubal patency.

OBJECTIVE: To compare the diagnostic accuracy of two methods of assessment of tubal patency, viz, hysterosalpingography (HSG) and laparoscopic hydrotubation. DESIGN: One hundred four infertile women who were investigated with both HSG and laparoscopy in King Khalid University Hospital were selected for the study. Complete history of factors that may predispose to tubal occlusion was obtained. Patients with problems of ovulatory failure or poor semen analysis that may contribute to their infertility were excluded. RESULTS: The overall agreement between the two methods was 62.5%. However, the diagnostic accuracy of the two methods differed significantly. CONCLUSION: It would appear that laparoscopic hydrotubation, despite its invasive nature, had an edge in diagnostic accuracy when compared with HSG. It would be advantageous to subject patients in whom HSG has shown tubal blockage to laparoscopy or any of the newer techniques of hysteroscopy or sonographic hydrotubation.

Sequelae of repeat cesarean sections.

OBJECTIVES: To study and analyze the factors related to repeat cesarean section and to highlight the problems that may be associated with it. METHODS: The study was carried out in the Department of Obstetrics and Gynaecology, King Khalid University Hospital, Riyadh, Saudi Arabia, and involved 395 patients who had had two or more previous cesarean sections prior to the current pregnancy. Various factors which may be associated with repeat cesarean sections, as well as the outcome of the operations, were assessed and analyzed. The chi2-test and other analyses were used to examine the association between the number of cesarean sections and the various variables. RESULTS: Four or more previous cesarean sections was significantly associated with dense adhesions. On the other hand, height, parity, antenatal clinic attendance, postoperative complications, fetal weight and fetal outcome had no significant effect on, nor influenced, the multiplicity of cesarean sections. CONCLUSION: No specific risk is associated with repeat cesarean sections that is not normally associated with single cesarean sections.

Outcome of temporary silicone oil tamponade in complex rhegmatogenous retinal detachment.

PURPOSE: To evaluate the anatomic and visual outcomes and complications of temporary silicone oil (SO) retinal tamponade in patients with complex rhegmatogenous retinal detachments (RD). METHODS: The retrospective study included 100 eyes of 93 consecutive patients. Indications for the use of SO were proliferative vitreoretinopathy (PVR) (30 eyes), difficult RD (30 eyes), giant retinal tears (17 eyes), RD after penetrating trauma (14 eyes), and macular holes in highly myopic eyes (9 eyes). Vitrectomy surgery was performed with 5000-centistoke SO as the retinal tamponade. All eyes underwent prophylactic 360 degree retinopexy at the time of the retinal reattachment operation. The mean duration of SO tamponade was 26.4 weeks, with a mean follow-up of 67.5 weeks after removal of SO. RESULTS: . In 6 of 100 eyes (6%), the retina redetached after removal of SO. Including the successfully reoperated eyes, the final anatomic success rate was 96%. Other complications were cataract (61%), increased intraocular pressure (13%), hypotony (4%), keratopathy (4%), intravitreal hemorrhage (1%), and suprachoroidal hemorrhage (1%). Correspondence analysis demonstrated that redetachment and hypotony were associated with PVR and trauma. Overall, good visual outcome (20/200 or better) was achieved in 51% of the whole study group, and in 70.6% of eyes with giant tears, 62.1% of eyes with difficult RD, 44.8% of eyes with PVR, 33.3% of eyes with macular holes, and 28.6% of eyes with trauma (p=0.0382). Logistic regression analysis identified initial visual acuity of 20/200 or better as a factor associated with good visual outcome and occurrence of retinal redetachment/hypotony and old age ( > or = 50 years) as factors negatively associated with good visual outcome. CONCLUSIONS: The low redetachment rate might be due to prophylactic 360 degree retinopexy. Giant tears had the best visual outcome. Redetachment/hypotony had a negative impact on achievement of good visual outcome and were associated with PVR and trauma.

Visual outcome and prognostic factors after vitrectomy for posterior segment foreign bodies.

PURPOSE: To identify the prognostic factors that predict final visual outcome in eyes with posterior segment intraocular foreign body (IOFB) injuries managed by primary pars plana vitrectomy. METHODS: Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Factors analyzed included initial visual acuity (VA), time between injury and presentation, site of entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, endophthalmitis, location and size of IOFB, use of scleral buckling and/or an encircling band, gas tamponade, lensectomy, number of surgical procedures, and development of retinal detachment. Data were analyzed using univariate and multivariate logistic regression analysis. RESULTS: After a mean follow-up of 8.6 months, 63 eyes (65.6%) achieved VA of 20/200 or better, and 9 eyes (9.4%) had total retinal detachment complicated by inoperable proliferative vitreoretinopathy. On univariate analysis, predictors of poor vision (hand movements or less) were poor initial VA, corneoscleral entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, and development of retinal detachment. In contrast, predictors of good visual outcome (20/200 or better) were absence of uveal prolapse, no endophthalmitis, and no retinal detachment. Multivariate analysis identified corneoscleral entrance wound, uveal prolapse, and development of retinal detachment as the only factors significantly associated with poor visual outcome. Absence of uveal prolapse was the only factor significantly associated with good visual outcome. CONCLUSIONS: Final visual outcome is greatly determined by the severity of the primary injury. On multivariate analysis, significant predictive factors of final VA were corneoscleral entrance wound, presence or absence of uveal prolapse, and development of retinal detachment.

Correlation of fundus lesions and hematologic findings in leukemic retinopathy.

This prospective study evaluated the relationship between the fundus findings in leukemic retinopathy and hematologic parameters. Seventy-four newly diagnosed consecutive patients with acute leukemia were included, 49 with acute myelocytic leukemia (AML), and 25 acute lymphocytic leukemia (ALL). Blood parameters were based on data obtained before starting any therapeutic modalities. Leukemic retinopathy was detected in 32 patients (43%). Patients with ALL and retinal hemorrhages had significantly lower hemoglobin and hematocrit levels than those without hemorrhages (p = 0.004 and 0.018 respectively). AML patients with white-centered hemorrhages had a significantly higher leukocyte count than those without (p = 0.0002). ALL patients with cotton-wool spots had significantly lower hemoglobin levels and hematocrit than patients without such lesions (p = 0.044 and 0.05 respectively). AML patients with cotton wool spots had significantly lower leukocyte and platelet counts than those without (p = 0.019 and 0.003 respectively). Our results suggest that anemia is related to the findings of retinal hemorrhage and cotton-wool spots in ALL patients, that high leukocyte count is associated with white centered hemorrhage in AML patients, and that thrombocytopenia is not associated with retinal hemorrhage in this group of patients.

Obstetric outcome in the unbooked mother.

This study aimed at determining the outcome of pregnancy in unbooked mothers with regard to maternal complications and foetal outcome. This retrospective study was based on investigations of medical records of 467 unbooked mothers who presented for delivery at the Obstetrics Unit at King Khalid University Hospital, Riyadh, during the period 1991 and 1992, and 415 booked mothers with regular clinic attendance selected as controls. Data collected from the records included patients' socio-demographic characteristics, past obstetric history, prevalence of pregnancy-related diseases, and data relating to labour, delivery, and foetal outcome. Chi-square test and Fisher's exact test were used for assessing the statistical significance of the association between the various factors which were investigated. The tendency for mothers to be booked was found to be significantly associated with their age, occupation, parity, and gestational age at delivery. Booked and unbooked mothers did not differ significantly in relation to the mode of delivery and foetal outcome, although the prevalence of previous complications of pregnancy was generally lower among unbooked mothers. There was no statistically significant association between the absence of antenatal care and outcome of pregnancies, unbooked mothers had a higher proportion of MICU admissions and dead babies compared with the controls. Educating the community about the benefits of receiving regular antenatal care, even if at primary care level, may be of great importance in improving the pregnancy outcome.

More enlightenment on the essence of applying Fisher's Exact test when testing for statistical significance using small sample data presented in a 2 x 2 table.

The paper illustrates the inconsistent behaviour of the Chi-Square test when applied onto 2 x 2 tables involving independent samples and a small overall sample size. The appropriateness of applying this test to a given 2 x 2 table was judged by the degree of agreement between the probability associated with a value of Chi-Square for that table and that obtained by direct application of Fisher's Exact Test. Data from two different studies were used for the illustration. For one of the tables, the two tests led to divergent conclusions about the Null Hypothesis (H degrees) being tested; and the two probabilities were found to differ quite significantly. When the same procedures were repeated for the data in another 2 x 2 table (also involving a small sample size) the two tests led to the same conclusion about Ho; and in this latter case, the two probabilities were approximately equal: thus implying good approximate accuracy of the Chi-Square test relative to the Exact Test. To avoid these unantisipated variations of results from the Chi-Square test when it is applied onto 2 x 2 tables involving small sample sizes, Fisher's Exact Test is further recommended as a definitive test, always to be resorted to for fourfold tables involving small sample sizes and independent samples.

Socio-demographic characteristics of the "unbooked mother".

In a study to investigate the characteristics of the "Unbooked mother", the medical records of 467 patients who presented for delivery with no prenatal care at the obstetric unit of the King Khalid University Hospital (KKUH), Riyadh, during the period 1991 to 1995 were evaluated. For controls, the records of 415 mothers who had pre-natal care in the Unit over the same period were also evaluated. Data pertaining to their socio-demographic characteristics, previous obstetric history, prevalence of pregnancy-related and familial diseases, gestation age at delivery and weights of the babies, were extracted and analysed using odds ratios and 95% confidence intervals (C.I.). The unbooked mother tended to be young (< or = 24 years), unskilled worker, or student. On the other hand, the booked ones tended to be primigravid, with pregnancy-related (PET) and familial diseases (hypertension and diabetes). However, the level of parity, gestation age and birth weights did not appear to significantly influence the tendency to be booked or unbooked. These findings highlight the group of women who should be targeted for health education counselling regarding the value of prenatal care. This way, one can avoid some of the catastrophes often said to be associated with deliveries in the unbooked mother.

Correlation of smoking and coffee drinking with sperm progressive motility in infertile males.

The objective of the study was to assess the effect of some social characteristics on the forward progressive motion of sperms in males of infertile couples. The study was conducted in the Department of Obstetrics and Gynecology, King Kahlid University Hospital (KKUH), Riyadh, from September 1, 1994 to February 28, 1995. Semen specimens were obtained from 68 Saudi males of infertile couples, and 29 fertile males. Using computer-assisted semen analysis (CASA), sperm forward progressive motion was determined and graded on a scale of 1-4. The actuarial life table survival analysis method was used to investigate the sperm motility potentials across intervals 0-1, 1-2, 2-3, and 3-4 and the effect of smoking and coffee drinking was also determined on the sperm motility. Smoking was found to significantly improve sperm motility among the infertile group. Similarly, frequent coffee drinking was shown to enhance sperm motility. There is a need for further studies on the influence of smoking and coffee drinking, as well as the plethora of other influence of the daily life that may compound the detection of the subtle changes in semen quality.

Interphotoreceptor retinoid-binding protein as biomarker in systemic autoimmunity with eye inflictions.

Autoimmune diseases of the eye, exemplified by Beh cet disease and Vogt-Koyanagi-Harada disease, are a major cause of blindness. We studied interphotoreceptor retinoid-binding protein (IRBP), a dominant autoimmune antigen in the eye. Aqueous humour samples from 28 patients with active uveitis were analysed for immunoglobulin G (IgG) content as a marker for blood-ocular barrier breakdown and by gelatinase B zymography for the detection of inflammation. The data were correlated with the presence of intact IRBP (approximately 140 kD) as determined by Western blot analysis and with the clinical disease activity. Aqueous humour samples from control eyes and eyes with low disease activity showed positive immunoreactivity for intact IRBP. The IRBP signal weakened or disappeared with higher disease activity. Significant positive correlations were observed between disease activity and levels of gelatinase B/matrix metalloproteinase-9 (MMP-9) (rs=0.713; P<0.001) and IgG (rs=0.580; P=0.001). Significant negative correlations were found between levels of IRBP and disease activity (rs=-0.520; P=0.005) and levels of MMP-9 (rs=-0.727; P<0.001) and of IgG (rs=-0.834; P<0.001). Whereas neutrophil elastase converted intact IRBP into an immunoreactive 55 kD peptide in vitro, the conversion by neutrophil degranulates resembled more the in vivo context with a complete degradation of IRBP. Reversal of inflammation with immunosuppressive therapy was accompanied with reappearance of intact IRBP and disappearance of IgG and MMP-9. The analysis of IRBP proteolysis is useful as a biomarker for uveitis and suggests that inhibition of proteinases might become a therapeutic strategy in an inflammatory context of a damaged blood-ocular barrier.

Vogt-Koyanagi-Harada disease in children.

PURPOSE: To identify prognostic factors for outcome in children with Vogt-Koyanagi-Harada (VKH) disease. METHODS: All children 16 years and younger with acute uveitis associated with VKH disease treated between 1999 and 2006 were reviewed. RESULTS: Twenty-three children (46 eyes) were identified; 20 (87%) girls and three (13%) boys with a mean age at presentation of 12.5+/-2.4 years. Mean follow-up period was 48.6+/-30.8 months. Visual acuity of 20/40 or better was achieved in 38 (82.6%) eyes. Eleven eyes developed at least one complication, including cataract in eight eyes, glaucoma in eight eyes, subretinal neovascular membranes in two eyes, and subretinal fibrosis in one eye. Disease recurred during follow-up in 18 eyes. Development of complications was negatively associated with final visual acuity of 20/20 (P=0.0317). Shorter interval between symptoms and treatment was a predictor of final visual acuity of 20/20 (odds ratio=10.4; 95% confidence interval=1.61-67.3). Recurrence of inflammation was significantly associated with development of complications (P=0.003), worse visual acuity (P=0.022) and presence of posterior synechiae of the iris at presentation (P=0.0083), longer interval between symptoms and treatment (P=0.013), initial treatment with intravenous corticosteroids (P=0.0012), and rapid tapering of corticosteroids (P=0.0063). CONCLUSION: Visual prognosis of VKH in children is generally favourable. Clinical findings at presentation, development of complications, interval between symptoms and treatment, recurrence of inflammation, use of intravenous corticosteroids, and method of tapering of systemic corticosteroids were significant prognostic factors.

Risk of retained placenta: multivariate approach.

BACKGROUND: To identify important covariates related to retained placenta using logistic regression analysis. METHODS: The study was carried out in the King Khalid University Hospital, Saudi Arabia, and involved 114 women who had retained placenta, and 116 women with normal deliveries. Chi-square test and logistic regression analysis were used for analysis of data. Adequacy of predictor variables was examined using indices of sensitivity and specificity and plots of probability histograms for prediction of retained placenta among patients and controls. RESULTS: Logistic regression analysis highlighted multiparity, induced labor, small placenta, and large amount of blood loss to be significantly associated with retained placenta. In addition, high pregnancy number, previous injury to uterus, and pre-term labor related significantly to retained placenta. Predictor variables had sensitivity of 65.5% and 87.9% specificity and achieved 77% overall correct classification. CONCLUSIONS: These findings could be used to develop a predictive procedure for identifying high-risk cases of retained placenta.

Prognostic importance of retinopathy in acute leukemia.

This prospective study evaluates the relationship, between the fundus findings in leukemic retinopathy and the survival in patients with newly diagnosed acute leukemia. Fifty-four newly diagnosed consecutive patients with acute leukemia were included in this study. The patients were examined within few days of initial admission and diagnosis. Leukemic retinopathy was detected in 19 (35%) patients. The observation period ranged from 434 days to 1220 days (mean +/- SD 880 +/- 225) for those patients who survived. Despite similar chemotherapy compared to those without retinopathy (332.4 +/- 99.6 and 76 vs. 640.7 +/- 106 and 192 days respectively) although survival did not differ significantly (p = 0.073). Patients with cotton-wool spots had lower mean and median survival times than did those without such lesions (168.8 +/- 70.9 and 27 vs. 609.4 +/- 91.4 and 289 days respectively) and survival differed significantly (p = 0.04). The presence of cotton-wool spots and age > or = 40 years were the major adverse prognostic factors for survival in multivariate analysis. Cotton-wool spots had a more significant adverse prognostic effect than age > or = 40 years (hazard function coefficients: 1.0708 for cotton-wool spots vs 0.0355 for age > or = 40 years). The relative odds of dying among patients with cotton-wool spots were about 8 times higher than that for those without this feature, and about 7 times higher in patients aged > or = 40 years than that for patients aged < 20 years. Our findings suggest that the presence of leukemic retinopathy in general, and cotton-wool spots, in particular is a poor prognostic sign for survival in acute leukemia.

Retinal detachment after posterior segment intraocular foreign body injuries.

PURPOSE: To identify the risk factors for retinal detachment after posterior segment intraocular foreign body (IOFB) injuries and to study the association between the development of retinal detachment and visual outcome. METHODS: Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Vitrectomy techniques were used in primary and secondary treatment. Two eyes were eviscerated after primary repair because of Clostridium perfringens endophthalmitis. Factors analyzed included (1) entrance wound location, (2) presence of uveal prolapse, (3) presence of vitreous prolapse, (4) presence of traumatized iris, (5) presence of endophthalmitis, (6) location of IOFB, (7) size of IOFB, (8) use of scleral buckling and/or an encircling band, (9) use of gas tamponade, (10) use of lensectomy. Data were analyzed using univariate and multivariate logistic regression analysis. RESULTS: Retinal detachment was present in 6 eyes at presentation and occurred in another 19 eyes after vitrectomy. After a mean follow-up of 8.6 months, 63 (65.6%) eyes achieved visual acuities of 20/200 or better, and total retinal detachment complicated by inoperable proliferative vitreoretinopathy was present in 9 (9.4%) eyes. Multivariate analysis identified retinal detachment as a factor significantly associated with a poor visual outcome (odds ratio = 4.54, 95% confidence interval [CI] = 1.05-19.6). Foreign body size of more than 4 mm (odds ratio = 5.8, 95% CI = 1.66-2.03) and presence of endophthalmitis (odds ratio = 11.7, 95% CI = 2.57-52.9) were identified as the only predictive factors for the development of retinal detachment after vitrectomy. Use of prophylactic scleral buckling and/or an encircling band reduced the risk of developing postoperative retinal detachment. CONCLUSIONS: Retinal detachment after posterior segment IOFB injuries is associated with a poor visual outcome. Large IOFB and presence of endophthalmitis are the strongest predictive factors for the development of retinal detachment.

Retinopathy as a predictor of other diabetic complications.

PURPOSE: Early predictors of diabetic complications may aid in the prevention and/or management of these complications. The aim of this cross-sectional study was to determine the predictive value of retinopathy for the presence of other diabetic complications. METHODS: The population studied comprised 648 patients with diabetes mellitus assessed by our service. There were 210 patients (32.4%) with insulin-dependent diabetes mellitus (IDDM), and 438 patients (67.6%) with non-insulin-dependent diabetes mellitus (NIDDM). RESULTS: Univariate analyses revealed that retinopathy significantly predicted the presence of neuropathy (odds ratio [OR] = 2.23; 95% confidence interval [CI] = 1.56-3.18; p < 0.001), nephropathy (OR = 5.68; 95% CI = 3.06-10.62; p < 0.001), and cerebrovascular disease (OR = 6.6; 95% CI = 1.16-67.21; p = 0.0239) in the total group. Similar associations were observed both in subjects with IDDM and NIDDM. The associations between retinopathy severity level and the prevalence rate of nephropathy were significant in the total group (p = 0.0001), in patients with IDDM (p = 0.0113), and in patients with NIDDM (p = 0.01). In patients with mild to moderate non-proliferative retinopathy (NPDR), nephropathy was present in 17.2% of patients with IDDM, and in 11.4% of patients with NIDDM. In patients with severe NPDR, nephropathy was present in 23.3% in patients with IDDM, and in 11.8% of patients with NIDDM. In patients with proliferative retinopathy (PDR), nephropathy was present in 50% in patients with IDDM, and in 45.5% in patients with NIDDM. In multivariate logistic regression analyses, nephropathy was the only significant complication to be independently associated with retinopathy in patients with IDDM (OR = 8.02; 95% CI = 1.95-33), and in patients with NIDDM (OR = 2.48; 95% CI = 1.02-6.03). CONCLUSIONS: Retinopathy, especially the presence of PDR, is an independent predictor for nephropathy. The predictive value of retinopathy for nephropathy is stronger in patients with IDDM than in those with NIDDM. Ophthalmologists should refer patients with retinopathy for regular medical evaluations.