[Diabetic retinopathy epidemiology in type II diabetic patients. Effect of the changes in the diagnostic criteria and stricter control of the diabetes between 1993 and 2005 on the incidence of diabetic retinopathy]. / Epidemiología de la retinopatía diabética en pacientes tipo II. Cambios observados en una población entre los años 1993 y 2005, tras los nuevos criterios diagnósticos y un mayor control de los pacientes.

OBJECTIVE: The aim of the study was to compare the results with those of a previous study by the same author in 1993 when 741 type II diabetic patients were recruited. We determined the prevalence of diabetic retinopathy and the impact of the new diagnostic criteria and stricter control of diabetes on the results obtained. METHODS: The study sample was obtained by hazard selection of 741 type II diabetic patients, from the total diabetic patients visited in the interval between January 1 and December 1 in 2005. RESULTS: We observed a decrease in the prevalence of diabetic retinopathy between the two studies. In the first study the incidence was 39.41% while in the present study it was 27.55%. The diabetic macular edema prevalence was similar in both studies (7.15% in the past and 7.90% in the present study). There was also a decrease in the number of blind patients (11.20% in 1993 and 4.90% in the current study). The number of patients treated with laser photocoagulation increased (13.49% in the current study as compared to 6.20% in the previous study). Statistic analysis revealed the risk factors for retinopathy: diabetes mellitus duration, elevated HbA1C levels and the need for insulin treatment. CONCLUSIONS: A better control of diabetes mellitus may lead us to observe an increase in visual acuity, and a better control of diabetic retinopathy. The incidence of diabetic retinopathy certainly decreased between the study periods; however the overall incidence of diabetes in the community has increased during the last few years, making firm conclusions difficult.

Intravitreal ganciclovir treatment in progressive outer retinal necrosis.

PURPOSE: To report two patients with progressive outer retinal necrosis, which is presumed to be caused by the varicella-zoster virus in patients with acquired immunodeficiency syndrome (AIDS). METHOD: Case report. RESULTS: The patients were treated with intravenous foscarnet, 60 mg per kg of body weight three times per week, without response. Remission of retinal necrosis occurred with the commencement of intravitreal ganciclovir treatment, 400 mg two times per week. Laser photocoagulation was performed in both cases. Neither patient developed retinal detachment. CONCLUSIONS: Intravitreal ganciclovir treatment combined with systemic antiviral agent therapy in patients with progressive outer retinal necrosis may delay progress of the disease. Early photocoagulation may prevent the development of retinal detachment if retinal necrosis is controlled.

[Suprachoroidal bleeding: review and description of eight cases]. / Révision et description de 8 cas cliniques d'hémorragie choroïdienne.

INTRODUCTION: Suprachoroidal hemorrhage (SCH) is a dramatic complication of intraocular surgery that can result in total loss of vision. METHODS: The records of eight cases of SCH during cataract surgery were reviewed. Six of eight patients were treated by combined radial sclerotomies for suprachoroidal drainage and vitrectomy. Risk factors, therapeutic strategies, and functional and anatomical results were analyzed. RESULTS: The incidence of SCH was 0.45%. Preoperative visual acuity of all eyes suffering from SCH was limited to the perception of light. Postoperatively, six patients showed an increase in visual acuity greater than 0.1; one patient achieved 0.5. Ocular and general risk factors (ocular hypotony, myopia, Valsalva-type maneuvers, intraoperative systemic hypertension) and surgery complications were analyzed. CONCLUSIONS: In spite of using state-of-the-art surgical techniques, the prognosis of SCH remains serious, with a poorer outcome associated with increasing complications due to hemorrhage. Secondary treatment combining radial sclerotomies and vitrectomy should be performed to minimize the damaging effect of choroidal hemorrhage.

[Is microalbuminuria a risk factor for diabetic retinopathy?]. / La microalbuminurie est-elle un facteur de risque épidémiologique de la rétinopathie diabétique?

PURPOSE: To determine the relationship between microalbuminuria and diabetic retinopathy. METHODS: A prospective 10-year study of 104 younger-onset diabetic patients. The diabetic retinopathy diagnosis was made by fundus retinography, and determination of microalbuminuria was made from urine samples. RESULTS: The incidence of diabetic retinopathy in this group of patients was 39 (37.5%). The epidemiological factors implicated were diabetes duration, higher levels of HbA(1c), male sex, and diastolic arterial hypertension. The incidence of microalbuminuria was 21 patients (20.2%), with high levels of HbA(1c) the epidemiological factor implicated. The association between microalbuminuria and diabetic retinopathy grouped the patients as follows: 56 patients without microalbuminuria or retinopathy, 16 patients who developed microalbuminuria and diabetic retinopathy, 23 patients who developed retinopathy but not microalbuminuria, and nine patients who developed only microalbuminuria. The discriminant analysis showed that the high levels of HbA(1c) were associated with microalbuminuria and diabetes duration and high levels of HbA(1c) were associated with diabetic retinopathy. CONCLUSIONS: In the population studied, microalbuminuria was not a good marker for diabetic retinopathy.

[Chronic endophthalmitis in pseudophakic patients caused by bacillus subtilis]. / Endoftalmitis crónica en el seudofaco por bacillus subtilis.

OBJECTIVE/METHODS: We present two cases of patients with chronic endophthalmitis. The treatment included intraocular lens exchange, total capsulectomy and posterior vitrectomy through the limbus. In both cases, samples of the vitreous were taken and sent to the laboratory together with the intraocular lens and remmants of posterior capsule for culture and antibiogram. RESULTS/CONCLUSIONS: Microbiologic examination and culture were positive in two cases for Bacillus subtilis, which is not actually identified in literature as an etiologic agent for chronic endophthalmitis.

[Study of the relationship between retinal and renal microangiopathy in patients with diabetes mellitus type 1]. / Estudio de relación entre microangiopatía retiniana y renal en pacientes diabéticos tipo 1.

The similarities in the vascularization of the retina and the kidney give rise to the complications of diabetes mellitus in the small vessels (microangiopathy) that appear in both organs. The present study presents the prospectively obtained results along 10 years in 104 diabetic type 1 patients, with the characteristics not to present microalbuminuria nor diabetic retinopathy at the beginning of the study; the results bear as objective the establishment of the relation between the presence of proliferative diabetic retinopathy and microalbuminuria, taking into account different factors of epidemiological risk: gender, duration of diabetes, presence of diastolic hypertension, levels of HbAlc, and blood lipids. The results obtained indicate a 10 years of follow-up incidence of diabetic retinopathy of 37.50% (being the proliferative form 13.46%) and the incidence of microalbuminuria is of 20.19%. The appearance of proliferative diabetic retinopathy is associated to the presence of diastolic hypertension, while the appearance of microalbuminuria is related to the elevation of levels of HbAlc. The results obtained in the proliferative diabetic retinopathy and microalbuminuria incidence are similar to those of other authors. At the end of the study four groups of patients are configured depending on whether they present proliferative diabetic retinopathy and/or microalbuminuria. The results obtained in the present study suggest the possible existence of two populations of diabetic patients, one that would develop proliferative diabetic retinopathy and renal injury, and a second population in which only would appear proliferative diabetic retinopathy.

Endoftalmitis crónica en el seudofaco por Bacillus subtilis / Chronic endophthalmitis in pseudophakic patients caused by Bacillus subtilis

Objetivo/Método: Presentamos dos casos clínicos de pacientes con endoftalmitis crónica, en los que se practicó recambio de lente intraocular asociado a capsulectomía, vitrectomía media posterior por vía límbica anterior. En ambos casos se obtuvo muestra de vítreo que se remitió al laboratorio, junto a la lente intraocular y restos de la cápsula posterior para cultivo y antibiograma. Resultados/Conclusiones: El estudio microbiológico fue positivo en dos casos para Bacillus subtilis, este germen actualmente no se ha asociado a endoftalmitis crónica en la literatura (AU)

Objective/Methods: We present two cases of patients with chronic endophthalmitis. The treatment included intraocular lens exchange, total capsulectomy and posterior vitrectomy through the limbus. In both cases, samples of the vitreous were taken and sent to the laboratory together with the intraocular lens and remmants of posterior capsule for culture and antibiogram. Results/Conclusions: Microbiologic examination and culture were positive in two cases for Bacillus subtilis, which is not actually identified in literature as an etiologic agent for chronic endophthalmitis (AU)

Estudio de relación entre microangiopatía retinianay renal en pacientes diabéticos tipo 1 / Study of the relationship between retinal and renal microangiopathy in patients with diabetes mellitus type 1

Las similitudes en la vascularización de la retina y el riñón hacen que las complicaciones de la diabetes mellitus en los pequeños vasos (microangiopatía) aparezcan en ambos órganos. El presente estudio ofrece los resultados obtenidos de forma prospectiva a lo largo de 10 años en 104 pacientes diabéticos tipo 1, con las características de no presentar microalbuminuria ni retinopatía diabética al inicio del mismo; los resultados tienen por objetivo la relación entre la presencia de retinopatía diabética proliferativa y microalbuminuria, teniendo en cuenta diferentes factores de riesgo epidemiológico: sexo, duración de la diabetes, presencia de hipertensión arterial diastólica, niveles de HbA1c y lípidos sanguíneos. Los resultados obtenidos indican una incidencia de retinopatía diabética a los 10 años de seguimiento de 37,50 por ciento (siendo la forma proliferativa 13,46 por ciento) y la incidencia de microalbuminuria es de un 20,19 por ciento. La aparición de retinopatía diabética proliferativa se asocia a la presencia de hipertensión arterial diastólica, mientras que la aparición de microalbuminuria a los niveles elevados de HbA1c. Los resultados obtenidos de incidencia de retinopatía diabética proliferativa y microalbuminuria son similares a los de otros autores. Al final del estudio se configuran 4 grupos de pacientes según presenten retinopatía diabética proliferativa y/o microalbuminuria. De los resultados obtenidos en el presente estudio se desprende la posible existencia de dos poblaciones de pacientes diabéticos, una que desarrollaría retinopatía diabética proliferativa y lesión renal y una segunda en la que solamente aparecería retinopatía diabética proliferativa (AU)

Hallazgos oftalmológicos asociados al hipertelorismo / Ocular findings associated with hypertelorism

Objetivo: Mostrar que en el hipertelorismo (distopia horizontal en la que está aumentada la distancia interorbitaria) son varias las alteraciones oftalmológicas que aparecen asociadas: estrabismo, nistagmo, ambliopía, defectos de refracción, malposiciones palpebrales, vías lagrimales no permeables, lesiones fundoscópicas y del segmento anterior. Se pretende mostrar la mayor frecuencia y gravedad de estas alteraciones en relación al grado de hipertelorismo, así como la evolución y tratamiento de estas alteraciones oftalmológicas de forma independiente al tratamiento del hipertelorismo. Métodos: Hemos revisado 12 casos de hipertelorismo. Todos los pacientes fueron sometidos a una exploración oftalmológica que incluía: agudeza visual, motilidad ocular, refracción bajo cicloplejía, estática palpebral, vías lagrimales, exploración con lámpara de hendidura y oftalmoscopia indirecta. La intervención quirúrgica consistió en realizar osteotomías liberadoras de las paredes óseas respecto a los huesos frontal, maxilar, nasal, zigomático y esfenoides. Tras la intervención quirúrgica se realizó nueva exploración oftalmológica que incluyó los mismos exámenes que en la preoperatoria. Resultados: La ambliopía y el estrabismo aparecieron en más de un 50 por ciento de pacientes cada uno de ellos, predominando las exotropías. El defecto de refracción más frecuente fue la hipermetropía. Otros hallazgos fueron las ptosis, imperforación de vías lagrimales, heterocromía de iris, hipoplasia papilar y enoftalmos. Ninguno de los hallazgos se modificó tras la corrección quirúrgica del hipertelorismo. Conclusiones: Los hallazgos oftalmológicos asociados al hipertelorismo no son causados por la deformidad, siendo más frecuentes cuanto mayor es el grado de hipertelorismo. Las alteraciones oftalmológicas no se modifican tras la correción quirúrgica del hipertelorismo, salvo que se actúe expresamente sobre ellas (AU)