Pedro Romero-Aroca

Changes in the diabetic retinopathy epidemiology after 14 years in a population of Type 1 and 2 diabetic patients after the new diabetes mellitus diagnosis criteria and a more strict control of the patients.

OBJECTIVE To determine the differences observed between two transversal studies separated 14 years. METHODS The sample was obtained by randomized hazard selection of 1157 Type 2 and 93 Type 1 diabetic patients in the 2006 study, and 741 Type 2 and 76 Type 1 diabetic patients in the 1993 study. We evaluate the prevalence of diabetic retinopathy (DR), microalbuminuria, overt nephropathy, and its risk factors. RESULTS In Type 2 diabetic patients, we observed a decrease of the prevalence of DR from 39.41% in the 1993 study to 27.48% in the 2006 study, but we did not observe it in Type 1 diabetic patients-35.52% in 1993 to 36.55% in 2006. The diabetic macular edema prevalence is similar in both studies-7.15% in 1993 and 7.86% in 2006 in Type 2 patients, and 11.84-12.90% in Type 1; microalbuminuria decreased in Type 2 but not in Type 1 patients (from 22.13% to 17.02% in Type 2, and 28.33-27.95% in Type 1); overt nephropathy decreased in both types of diabetic patients (in Type 1, decreased from 11.84% to 8.60% and, in Type 2, from 8.63% to 6.74%). We may observe a decrease in the number of patients with blindness, from 11.20% to 4.90% in Type 2, and from 9.21% to 7.52% in Type 1 patients. CONCLUSIONS We may observe a decrease in the prevalence of DR, overt nephropathy, and blindness in Type 1 and 2 patients and a decrease in the prevalence of microalbuminuria only in Type 2 patients.

Results at seven years after the use of intracamerular cefazolin as an endophthalmitis prophylaxis in cataract surgery.

BackgroundTo evaluate results after seven years using prophylactic intracameral cefazolin for the prevention of endophthalmitis in cataract surgery.MethodsA prospective, observational study of all patients submitted to cataract surgery over the period January 1996 to December 2009. All cases of postoperative endophthalmitis over that period were reviewed. The patients were classified in two groups: Group 1 (11,696 patients) operated on between January 1996 and December 2002, Group 2 (13,305 patients) between January 2003 and December 2009 (in whom a 1 mg/0.1 bolus of intracameral cefazolin was instilled).ResultsDuring the study period, 76 cases of endophthalmitis were observed in Group 1, and seven in Group 2. The rate of postoperative endophthalmitis reduced from 0.63% to 0.05% with a cefazolin injection. The relative risk (RR) for endophthalmitis in Group 1 against group 2 was 11.45 [95% CI 5.72-22.84, p < 0.001].ConclusionsAn intracameral bolus injection of cefazolin (1 mg in 0.1 ml solution) at the conclusion of the cataract surgery significantly reduced the rate of postoperative endophthalmitis.

Prospective comparison of two methods of screening for diabetic retinopathy by nonmydriatic fundus camera

Purpose: To compare the results obtained by two screening techniques for diabetic retinopathy. Methods: Patients were assessed in two groups, according to whether the retinal images were analyzed by the general practitioner (Group 1) or by the ophthalmologist (Group 2) in a two-year prospective study using telemedicine. Results: The number of patients referred to the nonmydriatic fundus camera unit was higher in Group 1 than in Group 2 (63.80% versus 17.63%). Greater patient adherence was observed in Group 1 than in Group 2 when patients came to retinography (98.25% versus 87.52%). There were no significant differences in other technique variables. The prevalence of diabetic retinopathy was similar in both groups (8.98% in Group 1 and 9.16% in Group 2), but the prevalence of severe proliferative diabetic retinopathy was higher in Group 2 (1.69% [severe] and 0.45% [proliferative]) than in Group 1 (1.01% and 0.11%, respectively). Diabetic macular edema was more prevalent in Group 2 (2.03%). Conclusions: The inclusion of general practitioners in the screening method seems to be important. A great number of patients with diabetes mellitus were screened, and a higher percentage of patients with diabetic retinopathy or macular edema were detected.

Laser Treatment for Diabetic Macular Edema in the 21st Century

Diabetic macular edema (DME) is the leading cause of blindness in the diabetic population. The diabetes Control and Complications Trial reported that 27% of patients affected by type 1 diabetes develop DME within 9 years of onset. Other studies have shown that in patients with type 2 diabetes, the prevalence increased from 3% to 28% within 5 years of diagnosis to twenty years after the onset. At the present time, despite the enthusiasm for evaluating several new treatments for DME, including the intravitreal therapies for DME (e.g., corticosteroids, and anti-VEGF drugs), laser photocoagulation remains the current gold standard and the only treatment with proven efficacy in a wide range of clinical trials for this condition. Despite being the standard technique for comparison and evaluation of the emerging treatments, we have generally poor understanding of the ETDRS recommendations, and we often forget about the results of laser in DME. The purpose of this review is to update our knowledge on laser photocoagulation for DME with an extensive review of the ETDRS results and discuss the laser techniques. Furthermore, we will describe the new developments in laser systems and review the current indications and results. Finally, we will discuss the results of laser treatments versus the current pharmacological therapies. We conclude by trying to provide a general overview that which laser treatment must be indicated and what types of lasers are currently recommended.

Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory

Diabetic macular edema (DME) can cause blindness in diabetic patients suffering from diabetic retinopathy (DR). DM parameters controls (glycemia, arterial tension, and lipids) are the gold standard for preventing DR and DME. Although the vascular endothelial growth factor (VEGF) is known to play a role in the development of DME, the pathological processes leading to the onset of this disease are highly complex and the exact sequence in which they occur is still not completely understood. Angiogenesis and inflammation have been shown to be involved in the pathogenesis of this disease. However, it still remains to be clarified whether angiogenesis following VEGF overexpression is a cause or a consequence of inflammation. This paper provides a review of the data currently available, focusing on VEGF, angiogenesis, and inflammation. Our analysis suggests that angiogenesis and inflammation act interdependently during the development of DME. Knowledge of DME etiology seems to be important in treatments with anti-VEGF or anti-inflammatory drugs. Current diagnostic techniques do not permit us to differentiate between both etiologies. In the future, diagnosing the physiopathology of each patient with DME will help us to select the most effective drug.

Relationship between diabetic retinopathy, microalbuminuria and overt nephropathy, and twenty-year incidence follow-up of a sample of type 1 diabetic patients

PURPOSE To determine the incidence and relationship of diabetic retinopathy (DR), microalbuminuria and overt nephropathy (ON). METHOD A 20-year prospective study, in a cohort of 110 consecutive type 1 diabetes mellitus (DM) patients, without diabetic retinopathy or microalbuminuria at enrolment in 1990. RESULTS The 20-year incidence of any DR was 70.91%, microalbuminuria 42.72%, and ON was 23.63%. Regarding the risk factors: pre pubertal age at diagnosis was significant for DR and ON, LDL-cholesterol and CT/HDL-cholesterol were significant for DR but not for microalbuminuria or ON. The relationship between DR and ON demonstrated that DR was a significant risk factor for ON, but ON was significant for sight-threatening DR. At the end of the study, two major groups of patients were formed: patients with DR only and patients with DR and ON. For the development of only DR we can assume that the most important risk factor is the duration of DM, followed by the high levels of HbA1c, pre-pubertal age at onset, and arterial hypertension; and for the development of ON and DR simultaneously, risk factors are higher levels of HbA1c, arterial hypertension, DM duration and pre-pubertal age at onset. CONCLUSIONS In the current study, two major groups of patients have been formed, those who developed only DR and those who developed DR and ON. For the former, incidence increased as DM duration increased, and for the latter incidence appeared to be closely related to levels of HbA1c.

Changes observed in diabetic retinopathy: eight-year follow-up of a Spanish population

Background/aims To determine the changes in the incidence of diabetic retinopathy (DR), diabetic macular oedema (DMO) and their risk factors in a population-based study of patients with diabetes mellitus (DM) referred to our 16 Primary Health Care Areas (HCAs). Methods Prospective population-based study of a total of 15 396 Caucasian patients with DM, who represent 86.53% of the total patients with DM in our HCAs, were studied over an 8-year follow-up period. All patients were screened with a mean follow-up of 3.18±1.11 times for each patient over the 8 years. Results The yearly mean value of any DR was 8.37±2.19% (8.09%–8.99%); of advanced DR yearly mean value of 0.46±0.22% (0.03–0.78); and of DMO a yearly mean value of 2.19±0.18% (2%–2.49%). A clear increase was observed in the last 3 years, any DR increased from 8.09% in 2007 to 8.99% in 2014, and DMO from 2% in 2007 to 2.49% in 2014. These increases were more evident in some age groups. For patients with any DR aged 41–50 and 51–60 and for patients with advanced DR aged 41–50, 51–60 and 61–70, the increase was more marked, related to an increase in HbA1c values or to patients treated with insulin. Conclusions An increase in the incidence of DR and DMO was observed, especially in the younger patients aged between 31 and 70 years. This is linked to bad metabolic control of DM. Our results suggest a greater number of ocular complications in the near future, such as neovascular glaucoma, if these current findings are not addressed.

High prevalence of pseudoexfoliation syndrome and its complications in Tarragona in northeast Spain.

Purpose To determine the prevalence of Pseudoexfoliation syndrome (PEX) in our health area, in 4 counties of Tarragona, and its involvement in the health status of the population. Methods This was a cross-sectional study of a sample of 2,342 inhabitants aged >60 years, randomly selected from the population census. Subjects were classified in 3 groups according to age (group 1 = 60–69 years, group 2 = 70–79 years, group 3 = over 80 years). The diagnosis of PEX was made in all cases by the same ophthalmologist, using biomicroscopic and slit-lamp evaluation. Corneal endothelial study was made by specular microscope. Results The prevalence of PEX was 309/2,342 patients (13.19%), unilateral in 219/309 (70.87%). The prevalence of PEX in patients with open-angle glaucoma was 29.48%. Changes in corneal endothelium were higher in patients with PEX, with lower cell density and hexagonality percentage, with higher coefficient of variation, significant in age groups 2 and 3. The prevalence of cataract in patients with PEX was 80.58%, versus 54.64% in patients without PEX. Complications of cataract surgery were higher in patients with PEX and postoperative corneal edema was best correlated with a low hexagonality percentage. No systemic cardiovascular diseases were significant in patients with PEX. Conclusions In our health district area, a high prevalence of PEX exists. A more extensive study of the causes of these differences is needed, including analysis of the genetic makeup of the population.

Importance of telemedicine in diabetes care: Relationships between family physicians and ophthalmologists

Diabetic retinopathy (DR) is the worldwide leading cause of legal blindness. In 2010, 1.9% of diabetes mellitus (DM) patients were legally blind and 10.2% had visual impairment. The control of DM parameters (glycemia, arterial tension and lipids) is the gold standard for preventing DR complications, although, unfortunately, DR still appeared in a 25% to 35% of patients. The stages of severe vision threading DR, include proliferative DR (6.96%) and diabetic macular edema (6.81%). This review aims to update our knowledge on DR screening using telemedicine, the different techniques, the problems, and the inclusion of different professionals such as family physicians in care programs.

Resultados de la implantación de la càmara no midriática como método de screening en pacientes diabéticos en Tarragona

OBJECTIVE The aim of the study is to present the results of the first year of using a non-mydriatic fundus camera. We performed an evaluation of its usefulness and problems. METHODS During the first year of using the non-mydriatic fundus camera we evaluated 3,272 type II diabetic patients who were not being controlled in the hospital. RESULTS The diabetic retinopathy was observed in 164 patients (5.01%), the mild form in 70 patients (2.14%). Diabetic macular oedema was observed in 41 patients (1.25%). In 119 patients (3.63%) the retinography could not be interpreted and were referred to the hospital; 113 patients also were referred due to other pathologies; the largest group of these patients had age-related macular disease or age-related macular degeneration (42 patients). Finally, 458 patients (13.99%) required mydriatic eye-drops. CONCLUSIONS The non-mydriatic fundus camera is a useful technique for assessing the presence of diabetic retinopathy, particularly in patients with poor ophthalmic control. This technique may enable us to diagnose these patients who need laser treatment.