[Orbital inflammatory diseases]. / Entzündliche Erkrankungen der Orbita.

CLINICAL/METHODICAL ISSUE: Inflammatory orbital processes on imaging are often misinterpreted as tumors. STANDARD RADIOLOGICAL METHODS: Imaging comprises computed tomography (CT) and magnetic resonance imaging (MRI). ACHIEVEMENTS: Clinical and laboratory data play a crucial role in diagnosing many inflammatory orbital diseases. Radiological imaging provides a supporting but relevant role. PRACTICAL RECOMMENDATIONS: Clinical examination, including specialized ophthalmological examinations, laboratory diagnostics, and MRI are important in the diagnosis of inflammatory orbital diseases.

[Evaluation of the management and follow-up of diabetic patients in the prevention of diabetic retinopathy]. / Evaluación del manejo y seguimiento de los pacientes diabéticos en la prevención de la retinopatía diabética.

OBJECTIVE: Diabetes mellitus is a chronic disease with high morbidity and mortality, affecting 537 million adults worldwide. Spain is the second European country in prevalence, with 14.8% in the population aged twenty/seventy-nine years; with 11.6 cases per 1,000 people/year. Diabetic retinopathy (DR) is the fifth cause of vision loss worldwide and the seventh cause of blindness/visual impairment among members of the National Organization of the Blind in Spain (ONCE). Early detection of DR prevents blindness in diabetics and is conditioned by glycosylated hemoglobin. The aim of this paper was to analyze the management of diabetic patients in Aljarafe region (Seville) and identify opportunities for improvement in the coordination of their follow-up between the Primary Care physician and the ophthalmologist. METHODS: A retrospective observational study (2016-2019) was carried out, with patients registered in the diabetic census of the twenty-eight municipalities of Aljarafe. The primary care and hospital health history, and telemedicine program were consulted. About statistical analysis, for qualitative variables, totals and percentages were calculated; for quantitative variables, mean and standard deviation (if normally distributed) and median and quartiles (if non-normally distributed). RESULTS: There were 17,175 diabetics registered in Aljarafe (5.7% of the population); 14,440 patients (84.1%) had some determination of hemoglobin during the period, 9,228 (63.9%) had all of them in the appropriate range. Fundoscopic control was performed on 12,040 diabetics (70.1%), and of those who did not, 346 (10.6%) had all of them out of range. There were 1,878 (10.9%) patients without fundoscopic or metabolic control, 1,019 (54.3%) were women, 1,219 (64.9%) were under sixty-five years of age, 1,019 (54.3%) had severe comorbidity. CONCLUSIONS: Most patients have adequate screening, and more than half have determinations within range. However, a significant percentage with no glycated hemoglobin within range lack fundoscopic control, and another smaller group lack fundoscopic or metabolic control, with inter-municipal variability. We propose to improve communication channels between levels.

OBJECTIVE: La diabetes mellitus es una enfermedad crónica con alta morbimortalidad que afecta a 537 millones de adultos en el mundo. España es el segundo país europeo en prevalencia, con un 14,8% en población de veinte-setenta y nueve años, con 11,6 casos por cada 1.000 personas/año. La retinopatía diabética (RD) es la quinta causa de pérdida de visión a nivel mundial y la séptima causa de ceguera/discapacidad visual entre afiliados a la Organización Nacional de Ciegos de España (ONCE). La detección precoz de RD previene la ceguera en diabéticos y está condicionada por la hemoglobina glicosilada. El objetivo de este trabajo fue analizar el manejo de los pacientes diabéticos en la comarca del Aljarafe (Sevilla) e identificar oportunidades de mejora en la coordinación de su seguimiento entre el médico de Atención Primaria y el médico oftalmólogo. METHODS: Se realizó un estudio observacional retrospectivo (2016-2019) con los pacientes registrados en el censo de diabéticos de los veintiocho municipios del Aljarafe. Se consultó la historia de salud de Atención Primaria y Hospital, así como el programa de Telemedicina. En cuanto al análisis estadístico, para variables cualitativas se calcularon totales y porcentajes; para variables cuantitativas, media y distribución estándar (si distribución normal), y la mediana y cuartiles (distribución no normal). RESULTS: Se registraron 17.175 diabéticos en el Aljarafe (5,7% de población); 14.440 pacientes (84,1%) tenían alguna determinación de hemoglobina durante el periodo, 9.228 (63,9%) las tenían todas en rango adecuado. Tenían control fundoscópico 12.040 diabéticos (70,1%), y de los que no, 346 (10,6%) tenían todas fuera de rango. Hubo 1.878 (10,9%) pacientes sin control fundoscópico ni metabólico, 1.019 (54,3%) eran mujeres, 1.219 (64,9%) menores de sesenta y cinco años, 1.019 (54,3%) con comorbilidad grave. CONCLUSIONS: La mayoría de los pacientes presentan un cribado adecuado y, más de la mitad, determinaciones en rango. Sin embargo, un porcentaje relevante con ninguna hemoglobina glicosilada en rango carecen de control fundoscópico, y otro grupo menor está sin control fundoscópico ni metabólico, con variabilidad intermunicipios. Planteamos mejorar los circuitos de comunicación entre niveles.

Use of digital retinography to detect vascular changes in pre-diabetic patients: a cross-sectional study.

BACKGROUND: Diabetic retinopathy (DR) is a common complication of DM and may go unnoticed until irreversible damage occurs. Its screening can contribute to the early detection. Although, there are no studies which investigate the ability of digital retinography to detect vascular changes in pre-diabetic patients. OBJECTIVE: Identify the prevalence and severity of RD in patients with pre-diabetes. METHODS: Cross-sectionalstudy carried out in a sample of patients with pre-diabetes and weight excess characterized from January 2020 to April 2023. Sociodemographic and clinical variables were collected, in addition to lifestyle habits. Retinographic evaluation was also performed using a Digital Retinography. For the analysis of all variables, the adopted significance level was 5%. The software used for the analysis was SPSS version 25.0. RESULTS: Of 108 patients selected 7.1% have alteration in the exam indicating DR. Among the participants with diabetic retinopathy, four had the moderate form (50%), three the moderate form (37%) and only one participant had the severe form (13%). CONCLUSIONS: Our findings highlight the importance of preventive measures and adequate control of these conditions in pre-diabetic patients, in order to prevent or delay the progression of diabetic retinopathy and, consequently, reduce the risk of blindness and other ocular complications.

Descriptive study of a telemedicine program in palpebral pathology for primary care (tele-eyelid).

BACKGROUND AND OBJECTIVE: In 2013 we implemented an asynchronous telemedicine circuit for the diagnosis of eyelid diseases (tele-eyelid), connecting the outpatient primary healthcare with the hospital's specialists. The purpose of this study is to assess the use of telemedicine in the diagnosis of eyelid diseases by primary care teams, to evaluate its usefulness and to analyse the epidemiology of the pathological conditions referred to the tertiary level hospital, as well as the need for surgery. MATERIALS AND METHODS: This study was carried out in the Spanish public health system, in a mainly rural area assisted by the Institut Català de la Salut (ICS) and Althaia Xarxa Assistencial Universitària de Manresa. This is a retrospective, descriptive analysis of the telematic consultations undertaken between 2013 and 2019. The consultations between 2018 and 2019 underwent a further descriptive retrospective-prospective analysis to assess the conditions referred to the hospital. RESULTS: Unnecessary referrals were avoided in 72% of telematic consultations. More than 50% of primary care practitioners used tele-eyelid. Up to 68% of the referrals were due to eyelid tumours, 50% needed surgery and 18%, a biopsy. Moreover, we found a high reliability between telematic and face-to-face diagnosis. CONCLUSIONS: Teleophthalmology applied to eyelid pathology is a useful tool to improve access to specialized care and helps solving pathological conditions. It avoids unnecessary consultations and increases efficiency, both in primary and hospital care.

An Evaluation System of Fundus Photograph-Based Intelligent Diagnostic Technology for Diabetic Retinopathy and Applicability for Research.

INTRODUCTION: In April 2018, the US Food and Drug Administration (FDA) approved the world's first artificial intelligence (AI) medical device for detecting diabetic retinopathy (DR), the IDx-DR. However, there is a lack of evaluation systems for DR intelligent diagnostic technology. METHODS: Five hundred color fundus photographs of diabetic patients were selected. DR severity varied from grade 0 to 4, with 100 photographs for each grade. Following that, these were diagnosed by both ophthalmologists and the intelligent technology, the results of which were compared by applying the evaluation system. The system includes primary, intermediate, and advanced evaluations, of which the intermediate evaluation incorporated two methods. Main evaluation indicators were sensitivity, specificity, and kappa value. RESULTS: The AI technology diagnosed 93 photographs with no DR, 107 with mild non-proliferative DR (NPDR), 107 with moderate NPDR, 108 with severe NPDR, and 85 with proliferative DR (PDR). The sensitivity, specificity, and kappa value of the AI diagnoses in the primary evaluation were 98.8%, 88.0%, and 0.89, respectively. According to method 1 of the intermediate evaluation, the sensitivity of AI diagnosis was 98.0%, specificity 97.0%, and the kappa value 0.95. In method 2 of the intermediate evaluation, the sensitivity of AI diagnosis was 95.5%, the specificity 99.3%, and kappa value 0.95. In the advanced evaluation, the kappa value of the intelligent diagnosis was 0.86. CONCLUSIONS: This article proposes an evaluation system for color fundus photograph-based intelligent diagnostic technology of DR and demonstrates an application of this system in a clinical setting. The results from this evaluation system serve as the basis for the selection of scenarios in which DR intelligent diagnostic technology can be applied.

[Ophthalmologic reading charts : Part 2: Current logarithmically scaled reading charts]. / Ophthalmologische Leseproben : Teil 2: Aktuelle, logarithmisch abgestufte Leseproben.

PURPOSE: To analyze currently available reading charts regarding print size, logarithmic print size progression, and the background of test-item standardization. METHODS: For the present study, the following logarithmically scaled reading charts were investigated using a measuring microscope (iNexis VMA 2520; Nikon, Tokyo): Eschenbach, Zeiss, OCULUS, MNREAD (Minnesota Near Reading Test), Colenbrander, and RADNER. Calculations were made according to EN-ISO 8596 and the International Research Council recommendations. RESULTS: Modern reading charts and cards exhibit a logarithmic progression of print sizes. The RADNER reading charts comprise four different cards with standardized test items (sentence optotypes), a well-defined stop criterion, accurate letter sizes, and a high print quality. Numbers and Landolt rings are also given in the booklet. The OCULUS cards have currently been reissued according to recent standards and also exhibit a high print quality. In addition to letters, numbers, Landolt rings, and examples taken from a timetable and the telephone book, sheet music is also offered. The Colenbrander cards use short sentences of 44 characters, including spaces, and exhibit inaccuracy at smaller letter sizes, as do the MNREAD cards. The MNREAD cards use sentences of 60 characters, including spaces, and have a high print quality. CONCLUSION: Modern reading charts show that international standards can be achieved with test items similar to optotypes, by using recent technology and developing new concepts of test-item standardization. Accurate print sizes, high print quality, and a logarithmic progression should become the minimum requirements for reading charts and reading cards in ophthalmology.

Diferenças de mensuração de acuidade visual e velocidade de leitura para perto entre pacientes com retinopatia diabética. Repercussão entre conceitos de deficiência visual parcial e cegueira legal / Differences in measurement of visual acuity and reading speed for near vision among patients with diabetic retinopathy. Repercussion in concepts of partial vision loss and legal blindness

RESUMO Objetivo: Comparar a acurácia entre a acuidade visual com melhor correção óptica em pacientes com retinopatia diabética e acuidade visual com correção óptica menor ou igual a 20/200 em ambos os olhos mensurada pela tabela de Snellen e pela tabela ETDRS, além da avaliação do tempo de leitura com tabela de leitura de Jaeger. Métodos: Estudo observacional e transversal. ormação de Grupos de Pesquisa: o Grupo I foi formado por pacientes com acuidade visual de 20/200 e o Grupo II, por pacientes com acuidade visual maior de 20/200. Os pacientes de ambos os grupos foram subdivididos em aqueles com retinopatia diabética não proliferativa e os com retinopatia diabética proliferativa. As variáveis pesquisadas foram sexo, idade, tabela ETDRS nos subgrupos (igual a 20/200, igual a 20/400 e maior de 20/200 e 20/400) e tempo de leitura da tabela de Jaeger para perto. O índice de significância estatística deste estudo foi de 5%. Resultados: Participaram do estudo 62 pacientes diabéticos, sendo 33 com retinopatia diabética não proliferativa e 29 com retinopatia diabética proliferativa. Dentre os pacientes com retinopatia diabética não proliferativa, 19 tinham acuidade visual com melhor correção óptica de 20/200 (30,6% da amostra), e 13 pacientes eram portadores de retinopatia diabética proliferativa com acuidade visual com melhor correção óptica de 20/200 (20,9% da amostra). A correlação entre a tabela Snellen e a tabela ETDRS revelou que 16 pacientes (25,8% da amostra) com cegueira legal apresentaram acuidade visual entre 20/180 e 20/120 segundo a tabela ETDRS. Para os pacientes portadores de retinopatia diabética não proliferativa com acuidade visual de 20/200 pela tabela ETDRS, houve tempo médio de leitura para perto da tabela de Jaeger de 23,6±1,4 segundos. Na análise estatística da acuidade visual mensurada com a Tabela de Snellen em comparação com a Tabela de Leitura para perto (Jaeger), mensurando tempo de leitura, ahouve significância estatística (p=0,04). Conclusão: Pacientes diabéticos com cegueira legal segundo a tabela de Snellen apresentam sua real capacidade visual residual subavaliada. É importante levar em consideração o tempo de leitura e o uso da tabela ETDRS para melhor acurácia.

ABSTRACT Purpose: To compare the accuracy of best-corrected visual acuity in patients with diabetic retinopathy to corrected visual acuity ≤ 20/200 in both eyes, measured by Snellen and ETDRS charts, in addition to evaluation of reading time by Jaeger chart. Methods: An observational and cross-sectional study. Study Groups: Group I, patients with visual acuity 20/200, and Group II, patients with visual acuity >20/200. Patients were subdivided into those with non-proliferative diabetic retinopathy and with proliferative diabetic retinopathy. The study variables were sex, age, ETDRS chart in the subgroups (equal to 20/200; equal to 20/400 and greater than 20/200 and 20/400), and reading time by Jaeger chart on the near vision. The statistical significance was set at 5%. Results: A total of 62 diabetic patients participated in the study; in that, 33 with non-proliferative diabetic retinopathy and 29 with proliferative diabetic retinopathy. Among patients with non-proliferative diabetic retinopathy, 19 had best-corrected visual acuity 20/200 (30.6% of sample), and 13 patients had proliferative diabetic retinopathy with best-corrected visual acuity 20/200 (20.9% of sample). The correlation between the Snellen and ETDRS charts revealed 16 patients (25.8% of sample) with legal blindness presented visual acuity between 20/180 and 20/120, as per the ETDRS chart. For patients with non-proliferative diabetic retinopathy with visual acuity 20/200 measured by the ETDRS chart, the mean reading time to near vision was 23.6±1.4 seconds, as measured by Jaeger chart. In the statistical analysis, the comparison of visual acuity measured by Snellen chart, with the reading chart to near vision (Jaeger) measuring reading time, was statistically significant (p=0.04). Conclusion: Diabetic patients with legal blindness as per Snellen chart showed their real underestimated residual visual capacity. It is important to consider reading time and use of the ETDRS chart for better accuracy.

Evaluation of plasma vitamin A and E levels and tear film changes in patients with psoriasis vulgaris.

PURPOSE: To evaluate whether alterations in plasma vitamin A and E levels in patients with psoriasis have an effect on tear film changes. METHODS: Sixty-two eyes of 31 patients with psoriasis vulgaris (Group A) and 74 eyes of 37 age- and gender-matched control subjects (Group B) were included in the study. Ocular and medical histories and dietary habits were obtained from each patient. The tear film break-up time (TBUT), the Schirmer 1 test results and plasma vitamin A and E levels were evaluated. RESULTS: The mean Schirmer 1 test score was 14.76 ± 6.12 mm/5 min in Group A and 15.69 ± 3.10 mm/5 min in Group B. The mean plasma levels of vitamins A and E in Groups A and B were 1.86 ± 0.62 µmol/L and 1.88 ± 0.65 µmol/L vs. 26.21 ± 5.13 µmol/L and 27.19 ± 8.89 µmol/L, respectively. The Schirmer 1 test results and plasma vitamin A and E levels were not found to be significantly different between the groups (p > 0.05). The mean TBUT was 9.94 ± 6.18 seconds in Group A and 14.47 ± 5.65 seconds in Group B, a significant difference (p < 0.05). No correlation existed between plasma vitamin A and E levels, TBUT or the severity and duration of the disease (p > 0.05). CONCLUSIONS: Plasma vitamin A and E levels do not seem to be related to tear film changes in patients with psoriasis vulgaris.

Perfil morfofuncional de pacientes com retinopatia diabética sem baixa acuidade visual severa em hospital público de referência em diabetes no Brasil / Morpho-functional profile of patients with diabetic retinopathy without severe loss of visual acuity in a public hospital of reference in diabetes in Brazil

OBJETIVO: Demonstrar o perfil morfofuncional da avaliação de pacientes com retinopatia diabética sem baixa acuidade visual severa em hospital público de referência em endocrinologia, determinando nesta amostra, a relação entre o tempo de diabetes, idade e acuidade visual com a espessura retiniana medidas pela tomografia de coerência óptica (OCT) e retinografia (RET). MÉTODOS: Foi realizado estudo prospectivo, linear, em corte transversal de 61 pacientes consecutivos com retinopatia diabética registrados no Hospital Regional de Taguatinga (HRT), e encaminhados pelos serviços de oftalmologia e endocrinologia. Pacientes foram submetidos à avaliação oftalmológica completa, incluindo história clínica, aferição da acuidade visual com correção e com buraco estenopeico. 109 olhos de 55 pacientes foram então submetidos à OCT e RET para avaliação da presença ou ausência de edema macular pela RET e da avaliação quantitativa (medidas da espessura retiniana das 9 regiões classificadas pelo Early Tratment Diabetic Retinophaty Study - ETDRS) e da avaliação qualitativa (presença ou ausência de edema retiniano pela fenda central, número 1). RESULTADOS: O tempo médio de diabetes entre os sujeitos da pesquisa foi de 12 anos, com idade variando de 23 a 86 anos; 51 por cento eram do gênero feminino, e 49 por cento do masculino. A avaliação da acuidade visual melhorou em 47 por cento (51/109) dos pacientes com buraco estenopeico. Somente 22 por cento (24/109) dos olhos apresentavam acuidade visual corrigida de 20/20 com correção e sem edema macular diabético (EMD). Em 83 por cento (91/109) dos casos havia concordância e em 17 por cento (18/109 olhos) havia discordância em relação à presença/ausência de EMD no perfil da avaliação morfológica realizada pela OCT e pela RET nos olhos do grupo amostral. CONCLUSÃO: Não houve correlação estatística significante entre a espessura retiniana e o tempo de diabetes. O grupo da oftalmologia teve 5 vezes mais chance de ...

OBJECTIVE: To demonstrate the morpho-functional profile of the evaluation of patients with diabetic retinopathy without severe loss of visual acuity in a public hospital of reference in endocrinology, determining in this sample, the relation between the time of diabetes, age and visual acuity with the retinal thickness measured by the optical Coherence tomography (OCT) and fundus picture (FP). METHODS: Prospective, linear study was carried through, in transversal cut of 61 consecutive patients with diabetic retinopathy registered in the HRT, and refered from the services of ophthalmology and endocrinology. Patients had been submitted to a complete ophthalmic evaluation including clinical history, visual acuity with correction and pin hole. The patients who had presented diabetic retinopathy, with transparent media, without previous surgery, nor previous Laser photocoagulation and with visual acuity better than 20/100 at Snelen scale, had been included in the study. After the elimination of the patients who had not obeyed the inclusion/exclusion criteria 109 eyes of 55 patients then had been submitted the OCT and FP for evaluation of the presence or absence of edema by the FP and of the quantitative evaluation (measured of the retinal thickness of the 9 regions of the pelo Early Tratment Diabetic Retinophaty Study (ETDRS), and of the qualitative evaluation (presence or absence of retinal edema for the central slit, number 1). RESULTS: The average time of diabetes was of 12 years, varying of 23 to 86 years old. 51 percent were female, and 49 percent male. The OCT demonstrated discrete reduction of the retinal thickness with elapsing of the age. The patients of the ophthalmology had greaters values of retinal thickness of what of the group of the endocrinology. The evaluation of the visual acuity improved with pin hole in 47 percent (51/109). The endocrinology group were 45 percent (23/50) of the eyes and the ophthalmology group were 55 ...