Dulce Milagros Razo Blanco-Hernández

Asociación entre la mejoría visual y el uso de inhibidores de la enzima convertidora de angiotensina, en edema macular diabético

BACKGROUND Angiotensin converting enzyme inhibitors are effective in delaying the progression of diabetic retinopathy. It is unknown if their use is associated with a better visual outcome in patients with diabetic macular oedema. MATERIAL AND METHODS A non-experimental, comparative, longitudinal and retrospective study was performed on patients with diabetic macular oedema treated by focal photocoagulation, and with systemic arterial hypertension treated with angiotensin converting enzyme inhibitors (Group 1), and without hypertension (Group 2). The dependent variable was the proportion with visual improvement, operatively defined as the gain of one or more lines of vision three weeks after photocoagulation. The independent variable was the use of angiotensin converting enzyme inhibitors. The proportion of eyes with visual improvement after treatment was compared between groups using the Chi squared (χ(2)) test. RESULTS A total of 33 eyes (51.6%) were assigned to group 1, and 31 (48.2%), to group 2. The mean of visual acuity improved after three weeks, compared with baseline (p=0.002). The proportion of eyes with visual improvement did not differ between patients treated with angiotensin converting enzyme inhibitors (45.5%) and those that did not use them (51.6%, p=0.4). CONCLUSIONS There was no statistical difference in the proportion of eyes with visual improvement between patients treated with angiotensin converting enzyme inhibitors and in those where they were not used. There is no support for the inhibition of angiotensin II in addition to photocoagulation for improving the outcome in patients with diabetic macular oedema.

Falta de asociación entre las características retinianas previas al tratamiento y la mala respuesta funcional a la fotocoagulación focal, en edema macular diabético

BACKGROUND Although photocoagulation reduces the incidence of moderate visual loss in eyes with focal diabetic macular oedema, some eyes may lose some vision after treatment. The proportion of eyes with poor functional response after photocoagulation, and whether any retinal variable is associated with this, is unknown. OBJECTIVE To determine the proportion of eyes with diabetic macular oedema that have a poor functional response after focal photocoagulation, and their associated features. MATERIAL AND METHODS A non-experimental, longitudinal, comparative and retrospective study was conducted. The proportion and 95% confidence intervals (CI) of diabetics with macular oedema that had a poor functional response after focal photocoagulation (any visual loss after 6 weeks) were identified. The means of retinal variables before treatment were compared between eyes with and without a poor functional response using the Student t test for independent means. RESULTS The study included 115 eyes of patients aged 59.3 (SD 9.24) years. Visual acuity was greater than or equal to 0.5 in 63 eyes (54.8%). A total of 33 eyes had a poor functional response after photocoagulation (28.7%, 95% CI: 13.3 to 44.1). The comparison between retinal variables and visual acuity before treatment did not show any differences between eyes with or without a poor functional response and eyes. CONCLUSION Retinal thickening and visual acuity improved or did not change in 71.3% of eyes with diabetic macular oedema with a single photocoagulation procedure. Retinal variables that are usually evaluated were unable to identify the remaining 28.7%, which could lose vision after that treatment, and would require additional interventions.