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Mexico City, Mexico

Lima-Gomez V.,National Polytechnic Institute of Mexico | Blanco-Hernandez D.M.R.,Hospital Juarez de Mexico
Cirugia y Cirujanos | Year: 2012

Background: The tomographic cut-off point to detect macular edema uses an international reference of retinal thickness, which is greater than that in our population. We undertook this study to identify the expected value of central subfield mean thickness (CSMT) in Mexican patients with diabetes with clinically significant macular edema (CSME) and the proportion in which using only the tomographic cut-off point for clinical macular edema (>300 μm) could overlook the diagnosis. Methods: We carried out an observational, analytical, crosssectional and prospective study. Eyes of diabetic patients with CSME (January 2006-June 2007) with a fluorescein angiography and optical coherence tomography were included. The sample was divided according to angiographic type: monofocal (group 1), multifocal (group 2), or diffuse (group 3). The mean of CSMT of each group was weighed by the proportion represented by each group to calculate the all-type expected value. The proportion of eyes with CSMT ≤300 μm was identified. Results: Ninety three eyes were included. Mean age was 60.9 years; there were 57 females (61.3%). Forty one eyeswere assigned to group 1 (44.1%, CSMT 210.63 μm), 31 to group 2 (33.3%, CSMT 279.65 μm), and 21 to group 3(22.6%, CSMT 327.14 μm). The expected value of CSMT was 259.9 μm, 37.75% over the normal reference in the study population and 23% over the American reference. CSMT was <300 μm in 79.6% of the eyes (95% CI 71.4-87.8). Conclusions: The expected value of CSMT in Mexican patients with iabetes with CSME was within the range internationally regarded as subclinical. Using local references of CSMT is recommended to avoid overlooking the diagnosis of CSME and overestimating its treatment effect.

Lima-Gomez V.,Hospital Juarez de Mexico
Cirugia y cirujanos | Year: 2011

The International Clinical Diabetic Macular Edema Disease Severity Scale grades retinal thickening according to its distance from the macular center, but its definitions have not been standardized quantitatively. We undertook this study to identify the severity distribution of diabetic macular edema at the time of diagnosis. We used optical coherence tomography (OCT) in a standardized manner and identified the proportion of eyes that required immediate treatment. We carried out an observational, prospective, cross-sectional, descriptive study. Diabetic patients with a diagnosis of clinically significant macular edema were evaluated. Severity levels according to the International Clinical Scale were operatively defined, guided by the thickening location in a 6-mm OCT fast macular map, as mild (thickening outside the 3-mm circle), moderate (thickening outside the 1-mm circle), and severe (thickening within the 1-mm circle). The proportion and 95% confidence intervals (CI) were identified for each severity level. We studied 118 eyes (mean ± SD: 59.9 ± 8.3 years). Seventy one eyes had nonproliferative retinopathy (60.1%), 94 eyes (79.7%) had focal macular edema, and 24 eyes (20.3%) showed diffuse edema. Edema severity was mild in 27 eyes (22.9%, 95% CI 15.3-30.5), moderate in 23 (19.5%, 95% CI 12.3-26.6) and severe in 68 (57.6% 95% CI 48.7-66.5). Standardization of the International Clinical Scale using OCT showed that the most common severity level of macular edema was severe; the minimum expected proportion of eyes with high risk of visual loss secondary to severe edema approached 50%. Opportune detection needs reinforcement because more than half of these eyes require immediate treatment.

Background: Vision-threatening forms of diabetic retinopathy (macular edema and proliferative retinopathy) can be efficiently treated with laser. Any delay in access to ophthalmic care may limit the opportunity of treatment. Diabetics that are not referred to an ophthalmologist are a vulnerable population, which could lose vision as a result of delayed attention. Material and methods: Observational, descriptive, prospective, cross-sectional study in diabetics attending a hospital for non-ophthalmological causes, without prior evaluation of the ocular fundus. The proportion of eyes with visionthreatening diabetic retinopathy, and that of eyes in which visual loss could be prevented were identified. Results: 100 patients, mean age 55.5 years, 53 females; 48 had diabetic retinopathy, six had proliferative retinopathy (6%; 95% CI: 1.3-10.7), and 23 had macular edema (23%; 95% CI: 14.8-31.2); the proportion of diabetic macular edema was higher than the one reported in the same population 15 years before (odds ratio 4.01; 95% CI: 1.98-8.15). Fifty-six percent of the patients with visionthreatening retinopathy did not have visual deficiency. Conclusion: Detection and referral of diabetic patients with risk of visual loss must be made easier, regardless of their visual symptoms, in order to achieve treatment efficacy by timely care.

Blanco-Hernandez D.M.R.,Hospital Juarez de Mexico | Lima-Gomez V.,National Polytechnic Institute of Mexico | Asbun-Bojalil J.,National Polytechnic Institute of Mexico
Cirugia y Cirujanos | Year: 2014

Background: Photocoagulation reduces the incidence of visual loss in diabetic patients with focal macular edema, but it can induce it for 6 weeks after treatment and produces visual improvement in some cases. Topical ketorolac may reduce the inflammation caused by photocoagulation and improve visual outcome.Purpose: To determine the efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema.Methods: An experimental, comparative, prospective, longitudinal study in diabetic patients with focal macular edema was conducted. Eyes were randomized into two groups of topical treatment for 3 weeks after photocoagulation (A: ketorolac, B: placebo). Best corrected visual acuity before and after treatment was compared in each group (paired t test), and the proportion of eyes with visual improvement was compared between groups (χ2). The evaluation was repeated after stratifying for initial visual acuity (≥ 0.5, < 0.5).Results: There were 105 eyes included. In group A (n= 46) mean visual acuity changed from 0.50 to 0.58 (p= 0.003), and from 0.55 to 0.55 in group B (n= 59, p= 0.83); mean percent change was 22.3% in group A and 3.5% in group B (p= 0.03). Visual improvement was identified in 25 eyes from group A (54.3%) and 19 from group B (32.2%, p= 0.019, RR 1.65); the difference only persisted when initial visual acuity was ≥ 0.5 (10 [40%], group A, 5 [14.7%], group B, p=0.02, RR 2.72).Conclusion: Topical ketorolac was more effective than placebo to improve best corrected visual acuity in diabetic patients with focal macular edema. © 2014 Cir Cir.

Blanco-Hernandez D.M.,Hospital Juarez de Mexico
Cirugia y cirujanos | Year: 2011

Ocular trauma affects males more often than females, but the impact of this condition regarding visual prognosis is unknown. We undertook this study to compare the probability of developing ocular trauma-related visual deficiency between genders, as estimated by the ocular trauma score (OTS). We designed an observational, retrospective, comparative, cross-sectional and open-label study. Female patients aged ≥6 years with ocular trauma were included and matched by age and ocular wall status with male patients at a 1:2 male/female ratio. Initial trauma features and the probability of developing visual deficiency (best corrected visual acuity <20/40) 6 months after the injury, as estimated by the OTS, were compared between genders. The proportion and 95% confidence intervals (95% CI) of visual deficiency 6 months after the injury were estimated. Ocular trauma features and the probability of developing visual deficiency were compared between genders (χ(2) and Fisher's exact test); p value <0.05 was considered significant. Included were 399 eyes (133 from females and 266 from males). Mean age of patients was 25.7 ± 14.6 years. Statistical differences existed in the proportion of zone III in closed globe trauma (p = 0.01) and types A (p = 0.04) and type B (p = 0.02) in open globe trauma. The distribution of the OTS categories was similar for both genders (category 5: p = 0.9); the probability of developing visual deficiency was 32.6% (95% CI = 24.6 to 40.5) in females and 33.2% (95% CI = 27.6 to 38.9) in males (p = 0.9). The probability of developing ocular trauma-related visual deficiency was similar for both genders. The same standard is required.

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