martes, 12 de mayo de 2015

RETINOPATIA DIABETICA NUEVOS METODOS DIAGNOSTICOS


Creo interesante un articulo de revision donde nombra las nuevas técnicas de optical coherence tomography (OCT) que presenta una mayor capacidad para detectar en cribado edema de macula.
En este interesante documento de Cochrane tambien destaca su papel en esta afectación concreta de retina

y aqui os dejo una busqueda bibliografica por mesh:

Search: "Diabetic Retinopathy/diagnosis"[Majr:NoExp]


PubMed Results
Items 1 - 20 of 1961    (Display the 20 citations in PubMed)

1. JAMA. 2015 Apr 28;313(16):1666-7. doi: 10.1001/jama.2015.107.

Telemedicine screening for eye disease.

Author information:
  • 1VA HSR&D Center for Health Communication and Information, Indianapolis, Indiana2Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana.

  • PMID: 25919530 [PubMed - indexed for MEDLINE]

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    2. Rev Invest Clin. 2014 Jul-Aug;66(4):330-8.

    [Optical coherence tomography and visual evoked potentials in patients with type 2 diabetes with and without retinopathy: preliminary report].

    [Article in Spanish]

    Abstract

    INTRODUCTION:

    Diabetic retinopathy remains the leading visual complication of diabetes mellitus type 2 (DM2) in productive patients. It evolves from a non-proliferative stage, occasionally asymptomatic, until a proliferative phase with neovascularization, retinal detachment and blindness. There are many reports that compare visual, biochemical or electrophysiological parameters among diabetic patients and healthy controls. However, much less information has been published comparing parameters between diabetics with and without non-proliferative retinopathy. Thus, it is essential to know what changes take place in the retina and the visual post retinal pathway as the disease progresses, but before the establishment of a proliferative process involving blindness. Therefore, the purpose of this study was to compare and correlate electrophysiological and visual parameters of diabetics with and without non-proliferative retinopathy, using modern, non invasive techniques. These data will allow us to a better understanding of the process and to determine the use of these parameters in the monitoring of diabetes and its complications.

    MATERIAL AND METHODS:

    This is an observational, prospective, transversal and analytical study. Twenty-two patients with DM2 were divided into two groups (50% on each group): group with non-proliferative retinopathy and group without retinopathy. We measured the central fovea thickness (CFT) by optical coherence tomography, the P100 wave of the Visual Evoked Potentials (VEP) and other visual and biochemical parameters.

    RESULTS:

    Retinopathy patients had lower visual acuity (p < 0.047), lower P100 amplitude (p < 0.043) and lower rate of rise (p < 0.026, 1-tailed). They also showed a more biochemical disturbance with higher glycemia (p < 0.015) and HbA1c (p < 0.033), and longer disease duration (p < 0.011), compared with those without retinopathy. Visual acuity showed a negative correlation with disease duration (r = -0.65; p < 0.017) and severity of ocular damage (r = -0.76; p < 0.007) in patients with retinopathy.

    CONCLUSIONS:

    Patients with retinopathy have lower visual acuity, decreased central visual fibers and a tendency to increase the ECF. Although the data favor the use of these non-invasive techniques to monitor the disease and prevent progression of visual complications, additional studies are needed with larger sample size to confirm the results obtained here.

    PMID: 25695298 [PubMed - indexed for MEDLINE]

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    3. Invest Ophthalmol Vis Sci. 2015 Jan 8;56(2):978-82. doi: 10.1167/iovs.14-15503.

    Correlation between ganglion cell layer thinning and poor visual function after resolution of diabetic macular edema.

    Author information:
  • 1Service d'Ophtalmologie, Hôpital Lariboisière, AP-HP, Université Paris 7-Sorbonne Paris Cité, Paris, France.

    Abstract

    PURPOSE:

    To assess the thickness of the ganglion cell-inner plexiform layer (GCIPL) in eyes with resolved diabetic macular edema (DME), using spectral-domain optical coherence tomography (SD-OCT), and its relationship with the visual function.

    METHODS:

    This retrospective observational case-control cohort study included eyes of diabetic patients with resolved DME (r-DME eyes), that is, normal central macular thickness (CMT) after treatment of DME, and eyes of aged-matched diabetic patients without maculopathy (no-DME eyes). The GCIPL thickness was measured on a macular cube SD-OCT scan using a specific automatic segmentation algorithm. Linear regression analyses were performed to determine the association between the GCIPL thickness and the visual acuity (VA) measured at the time of the OCT measurement.

    RESULTS:

    Average GCIPL thickness was reduced in r-DME eyes compared with no-DME eyes (74 ± 14 μm versus 83.2 ± 6 μm, P = 0.0189), whereas no significant difference in mean CMT was observed (260.0 ± 34 μm versus 265.7 ± 22 μm, P = 0.847). Visual acuity significantly correlated with the average GCIPL thickness (r = 0.8, P < 0.0001) and minimum GCIPL thickness (r = 0.84, P < 0.0001) in r-DME eyes.

    CONCLUSIONS:

    Despite favorable anatomic response and restoration of a CMT in the range of normal values after resolution of DME, the GCIPL thickness in r-DME eyes was lower than that in no-DME eyes and correlated with the VA. These results suggest that inner retinal alterations occurring in patients with DME and diabetic retinopathy may lead to visual deficiency persisting after treatment.
    Copyright 2015 The Association for Research in Vision and Ophthalmology, Inc.

  • PMID: 25574055 [PubMed - indexed for MEDLINE]

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    4. Ir Med J. 2014 Nov-Dec;107(10):321-3.

    A quantitative analysis of diabetic retinopathy screening in a regional treatment centre.

    Author information:
  • 1Department of Ophthalmology, Cork University Hospital, Wilton, Cork. m.james@ucc.ie

    Abstract

    The aim of the study was to assess the current diabetic retinopathy screening infrastructure and implications on workload for a designated treatment centre following roll-out of a national screening programme. A combination of chart analysis and patient questionnaire was undertaken over a 4-week period in 2011 at Cork University Hospital (CUH). Data were collected on 97 patients and categorized. as demographic, medical, and screening-related. The majority of patients (80; 82.5%} had either no retinopathy or background retinopathy only. One (1.0%) patient was deemed to be ungradable due to dense cataract, while 6 (6.2%) patients had non-diabetic ocular pathology requiring follow-up. Only 11% were screened through retinal photography. In all, 74 (76.3%) patients were deemed suitable for community rather than hospital screening. Digital retinal photography is an underused screening resource Significant numbers of patients could be discharged from hospital-based to community screening to offset the increased workload expected from the national screening programme.

  • PMID: 25556258 [PubMed - indexed for MEDLINE]

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    5. Am J Ophthalmol. 2015 Mar;159(3):528-38.e3. doi: 10.1016/j.ajo.2014.12.002. Epub 2014 Dec 9.

    Three-dimensional vascular imaging of proliferative diabetic retinopathy by Doppler optical coherence tomography.

    Author information:
  • 1Department of Ophthalmology, Tokyo Medical University, Ibaraki Medical Center, Ibaraki, Japan; Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan. Electronic address: m-miura@tokyo-med.ac.jp.
  • 2Computational Optics Group, University of Tsukuba, Ibaraki, Japan.
  • 3Department of Ophthalmology, Tokyo Medical University, Ibaraki Medical Center, Ibaraki, Japan; Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan.
  • 4Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan.

    Abstract

    PURPOSE:

    To evaluate the 3-dimensional architecture of neovascularization in proliferative diabetic retinopathy using Doppler optical coherence tomography (OCT).

    DESIGN:

    Prospective, nonrandomized clinical trial.

    METHODS:

    Seventeen eyes of 14 patients with proliferative diabetic retinopathy were prospectively studied. Prototype Doppler OCT was used to evaluate the 3-dimensional vascular architecture at vitreoretinal adhesions.

    RESULTS:

    Proliferative membranes were detected in all eyes with proliferative diabetic retinopathy by standard OCT images. Doppler OCT images detected blood flow by neovascularization of the disc in 12 eyes and neovascularization elsewhere in 11 eyes. Doppler OCT images showed the 3-dimensional extent of new vessels at various stages of neovascularization, and the extent of new vessels could be clearly confirmed at vitreoretinal adhesions.

    CONCLUSIONS:

    Doppler OCT is useful for the detection and evaluation of the 3-dimensional vascular structure of neovascularization, and can assist in the noninvasive assessment of proliferative diabetic retinopathy.
    Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
    Free Article

  • PMID: 25498353 [PubMed - indexed for MEDLINE]

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    6. JAMA Ophthalmol. 2015 Feb;133(2):174-81. doi: 10.1001/jamaophthalmol.2014.4652.

    Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine.

    Collaborators: (58)
    Saaddine J, Saaddine J, Mondesire J, Crews J, Gregg E, Williams D, Moore B, Friedman DS, Gower EW, West SK, Munoz B, Campos C, Greven C, Haines N, Nelson D, Pedley C, Valez R, Sells D, Lanning K, Matthews M, Owsley C, McGwin G Jr, Hullett S, Dreer L, Heckemeyer C, Girkin C, Horn WS, Lolley V, MacLennan P, Mennemeyer S, Rhodes L, Swanson M, Searcey K, Gregg L, Clark M, McKinney A, Lee D, Byrne M, Lam B, McClure L, Ocasio M, Parker D, Stevens M, Arheart K, Zheng D, Davis-Camacho Y, Oliden S, Similien T, Diaz Y, Haller JA, Murchison AP, Pizzi LT, Hark LA, Dai Y, Leiby B, Reber S, Federman J, Park C. Author information:
  • 1Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham.
  • 2Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham.
  • 3Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.
  • 4Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
  • 5Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine, Baltimore, Maryland.
  • 6Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine, Baltimore, Maryland6Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, North Carolina7Department of Ophthalmology, Wake Forest Sc.
  • 7Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
  • 8Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.

    Abstract

    IMPORTANCE:

    The use of a nonmydriatic camera for retinal imaging combined with the remote evaluation of images at a telemedicine reading center has been advanced as a strategy for diabetic retinopathy (DR) screening, particularly among patients with diabetes mellitus from ethnic/racial minority populations with low utilization of eye care.

    OBJECTIVE:

    To examine the rate and types of DR identified through a telemedicine screening program using a nonmydriatic camera, as well as the rate of other ocular findings.

    DESIGN, SETTING, AND PARTICIPANTS:

    A cross-sectional study (Innovative Network for Sight [INSIGHT]) was conducted at 4 urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority and uninsured persons with diabetes. Participants included persons aged 18 years or older who had type 1 or 2 diabetes mellitus and presented to the community-based settings.

    MAIN OUTCOMES AND MEASURES:

    The percentage of DR detection, including type of DR, and the percentage of detection of other ocular findings.

    RESULTS:

    A total of 1894 persons participated in the INSIGHT screening program across sites, with 21.7% having DR in at least 1 eye. The most common type of DR was background DR, which was present in 94.1% of all participants with DR. Almost half (44.2%) of the sample screened had ocular findings other than DR; 30.7% of the other ocular findings were cataract.

    CONCLUSIONS AND RELEVANCE:

    In a DR telemedicine screening program in urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority populations, DR was identified on screening in approximately 1 in 5 persons with diabetes. The vast majority of DR was background, indicating high public health potential for intervention in the earliest phases of DR when treatment can prevent vision loss. Other ocular conditions were detected at a high rate, a collateral benefit of DR screening programs that may be underappreciated.

  • PMID: 25393129 [PubMed - indexed for MEDLINE]

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    7. J Clin Endocrinol Metab. 2015 Feb;100(2):689-96. doi: 10.1210/jc.2014-2498. Epub 2014 Nov 6.

    Diagnosis of diabetes mellitus using HbA1c in Asians: relationship between HbA1c and retinopathy in a multiethnic Asian population.

    Author information:
  • 1Singapore Eye Research Institute (C.S., M.K.I., E.L.M., C.Y.C., T.Y.W.), Singapore 169856; Office of Clinical Sciences (C.S., M.K.I., E.L.M., C.Y.C., T.Y.W.), Duke-NUS Graduate Medical School, Singapore 169856; Departments of Ophthalmology (C.S., M.K.I., E.L.M., C.Y.C., T.Y.W.) and Medicine (E.Y.H.K., M.L.S.T., A.-C.T., E.S.T.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597; Center for Quantitative Medicine (W.K.L.), Duke-NUS Graduate Medical School, Singapore 169856; Department of Epidemiology and Public Health (A.S., J.L.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597; Department of Medicine (S.C.-L., S.T.), Khoo Teck Puat Hospital, Singapore 768828; and Epidemiology and Disease Control Division (D.H., S.M.), Ministry of Health, Singapore 169854.

    Abstract

    CONTEXT:

    Hemoglobin A1c (HbA1c) ≥ 6.5% (47.5 mmol/mol) has recently been included as a criterion for the diagnosis of diabetes mellitus. It is unclear whether this criterion is appropriate in Asians.

    OBJECTIVE:

    To examine the relationship between HbA1c and diabetes-specific moderate retinopathy in Asian ethnic groups.

    DESIGN, SETTING, AND PARTICIPANTS:

    Four independent population-based cross-sectional studies (2004-2011) in Singapore representing the three major Asian ethnic groups (n = 13 170 adults aged ≥ 25 y: Chinese, 5834; Malays, 3596; and Indians, 3740).

    MAIN OUTCOME:

    Moderate retinopathy was assessed from digital retinal photographs and defined as a level >43 using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve for detecting moderate retinopathy were compared across ethnic groups at different HbA1c cut-points.

    RESULTS:

    HbA1c levels were higher in Indians and Malays compared to Chinese (P < .001). The prevalence of moderate retinopathy below HbA1c <6.5% was <1% in all ethnic groups. At HbA1c ≥ 6.5%, the sensitivity for detecting moderate retinopathy was lower in Chinese subjects compared to Indians and Malays (75.8 vs 86.0 and 85.3%), but specificity (89.7 vs 71.9 and 76.3%) was higher; however, positive predictive value and negative predictive value were similar among Chinese, Indians, and Malays (10.5, 12.3, 12.4%; and 99.6, 99.1, 99.2%, respectively). The AUCs were similar across all three ethnic groups (0.861, 0.851, and 0.853).

    CONCLUSIONS:

    Our study supports the use of HbA1c for diagnosing diabetes in Asians. Despite some interethnic variation in the relationship of HbA1c and retinopathy, a cut-point of 6.5% performs reasonably well in the three major Asian ethnic groups.

  • PMID: 25375980 [PubMed - indexed for MEDLINE]

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    8. Gac Med Mex. 2014 Nov-Dec;150(6):518-26.

    [Deficient prevention and late treatment of diabetic retinopathy in Mexico].

    [Article in Spanish]
    Author information:
  • 1Departamento de Retina, Vítreo y Trauma Ocular, Fundación CODET para la Prevención de la Ceguera IBP.
  • 2Facultad de Medicina y Psicología, Universidad Autónoma de Baja California.
  • 3Departamento de Cirugía Refractiva y Segmento Anterior, CODET Vision Institute, Tijuana, Baja California.

    Abstract

    INTRODUCTION:

    Retinopathy is a frequent complication of diabetes, causing visual impairment in 10% and blindness in 2% of diabetic patients. The aim of this study is to describe the clinical profile of diabetic patients in an ophthalmologic unit in Tijuana, México.

    METHODS:

    Retrospective study of a random sample of 500 clinical charts of patients with diabetes who attended the Retina Service of "Fundación CODET para la Prevención de la Ceguera IBP" Ophthalmologic Center between 2006 and 2010.

    RESULTS:

    The main complaint of 58% of patients was decreased visual acuity in first evaluation. Only 6.2% of patients were referred by a health professional. Forty-six percent of the patients had a history of diabetes of at least 15 years. Thirty percent had clinically significant visual impairment at first visit, which was associated with a long history of diabetes and previous eye surgery. Twenty-five percent of these patients who were treated at our clinic experienced visual deterioration due to advanced retinopathy.

    CONCLUSION:

    Patients with diabetic retinopathy are referred to ophthalmological service tardily, when visual loss is usually severe and irreversible.

  • PMID: 25375282 [PubMed - indexed for MEDLINE]

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    9. S Afr Med J. 2014 Sep 3;104(10):700-4. doi: 10.7196/samj.8678.

    Quality assurance in diabetic retinal screening in South Africa.

    Collaborators: (9)
    Bow A, Fairley A, Sinclair A, Power B, Varikkara M, Hanumanthu S, Zachariah S, Zamvar U, Wykes W. Author information:
  • 1The Eye Centre, East London, Eastern Cape, South Africa; Department of Ophthalmology, Faculty of Health Sciences, Walter Sisulu University, Umtata, Eastern Cape, South Africa. dr@eyecentre.co.za.

    Abstract

    BACKGROUND:

    Diabetic retinopathy (DR) is an important biomarker for microvascular disease and blindness. Digital fundus photography is a cost-effective way of screening for DR. Access to DR screening is difficult for many South Africans with diabetes.

    OBJECTIVE:

    To perform external quality assurance (EQA) on graders registered in the Ophthalmological Society of South Africa DR screening programme.

    METHODS:

    Graders registered on the South African (SA) Diabetic Register website were invited to participate in the study. The Scottish EQA software system was used to enable on-line grading of 100 retinal photographs. Expert National Health Service graders provided the consensus expert grading for the image set.

    RESULTS:

    Two hundred and sixty-one participants completed the EQA process, including nine ophthalmologists, 243 optometrists, and nine other graders. A wide range of outcomes were demonstrated, with a mean sensitivity of 0.905 (range 0.286 - 1.000) and mean specificity of 0.507 (0.000 - 0.935). The mean diagnostic odds ratio was calculated to be 12.3 (range 0.147 - 148.2).

    CONCLUSIONS:

    This is the first quality assurance study conducted with SA healthcare professionals. The outcomes are of interest to all stakeholders dealing with the diabetes epidemic. The disparity in grader performance indicates room for improvement. The results demonstrate a high referral rate to ophthalmology, suggesting that on average graders are performing safely, but with a high number of inappropriate referrals.

  • PMID: 25363058 [PubMed - indexed for MEDLINE]

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    10. S Afr Med J. 2014 Jun 26;104(10):661-2. doi: 10.7196/samj.8580.

    Preventing diabetic blindness: a priority for South Africa.

    Author information:
  • 1PRICELESS SA (Priority Cost Eective Lessons for Systems Strengthening), Medical Research Council/Wits Rural Public Health Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Karen.Hofman@wits.ac.za.

    Abstract

    The prevalence of diabetes in South Africa is increasing rapidly, and diabetes is a significant cause of blindness. Diabetic complications can induce a cycle of poverty for affected families. Early detection of retinopathy and appropriate management can prevent blindness. Screening for retinopathy using a mobile retinal camera is highly cost-effective, with costs of screening and follow-up treatment being less than the expense of one year of a disability grant. Such a programme is a prime example of a 'best buy' that should be part of the national diabetes care package.

  • PMID: 25363046 [PubMed - indexed for MEDLINE]

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    11. Diabetes Care. 2014 Nov;37(11):e236-7. doi: 10.2337/dc14-0834.

    Cost of a community-based diabetic retinopathy screening program.

    Author information:
  • 1Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL Department of Surgery, University of Miami Miller School of Medicine, Miami, FL mbyrne2@med.miami.edu.
  • 2Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.
  • 3Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.
  • 4Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.
  • 5Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD.
  • 6Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.

  • PMID: 25342836 [PubMed - indexed for MEDLINE]

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    12. Vestn Oftalmol. 2014 Jul-Aug;130(4):22-6.

    [Results of YAG-laser vitreolysis in proliferative diabetic retinopathy complicated by vitreous hemorrhage].

    [Article in Russian]

    Abstract

    PURPOSE:

    To determine the efficiency of YAG-laser vitreolysis in patients with diabetic vitreous hemorrhage.

    MATERIAL AND METHODS:

    The study enrolled 56 patients (61 eyes) with proliferative diabetic retinopathy complicated by vitreous hemorrhage aged 36-69 years, including 31 women (34 eyes) and 25 men (27 eyes), who underwent YAG-laser vitreolysis. Assessment methods included visual acuity measurement, tonometry, ophthalmic biomicroscopy, glycated hemoglobin blood test and ultrasound exams (B-scan and quantitative echography). YAG-laser vitreolysis was performed with Alcon 3000 LE laser (USA).

    CONCLUSIONS:

    YAG-laser vitreolysis promotes resolution of vitreous hemorrhage in patients with complicated proliferative diabetic retinopathy. Clearance efficiency and the time required depend on the size and density of the hemorrhage as well as the time elapsed since the event. Ultrasound examination is the leading diagnostic method for diabetic vitreous hemorrhage. Density decrease at quantitative echography indicates clearing of the hemorrhage. For the maximal therapeutic effect of YAG-laser vitreolysis, carbohydrate metabolism has to be properly compensated. Few contraindications and minimal complications are benefits of YAG-laser vitreolysis.

    PMID: 25306719 [PubMed - indexed for MEDLINE]

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    13. Am J Ophthalmol. 2015 Jan;159(1):101-10.e1. doi: 10.1016/j.ajo.2014.09.041. Epub 2014 Oct 25.

    Reevaluating the definition of intraretinal microvascular abnormalities and neovascularization elsewhere in diabetic retinopathy using optical coherence tomography and fluorescein angiography.

    Author information:
  • 1Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom.
  • 2Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom.
  • 3National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom.
  • 4Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom.
  • 5National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom.
  • 6University College London, Institute of Ophthalmology, London, United Kingdom.
  • 7Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom.
  • 8Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom. Electronic address: adnan.tufail@moorfields.nhs.uk.

    Abstract

    PURPOSE:

    To evaluate the agreement between clinical examination, spectral-domain ocular coherence tomography (SD OCT), and fluorescein angiography (FA) in diagnosing intraretinal microvascular abnormality (IRMA) and neovascularization elsewhere (NVE) and define the SD OCT features that differentiate NVEs from IRMAs.

    DESIGN:

    Retrospective study.

    METHODS:

    Data were collected from 23 lesions from 8 diabetic patients, seen from July 2012 through October 2013 at Moorfields Eye Hospital, United Kingdom. Main outcomes were SD OCT features and FA leakage of IRMA and neovascular complex. The agreement between 3 evaluations was analyzed by Fleiss' kappa.

    RESULTS:

    The following 5 SD OCT features significantly differentiated IRMAs from NVEs: (1) hyperreflective dots in superficial inner retina (P = .002); (2) the outpouching of internal limiting membrane (ILM) (P = .004); (3) the breach of ILM (P = .004); (4) the breach of posterior hyaloid (P = .0005); (5) hyperreflective dots in vitreous (P = .008). The agreement was moderate between 3 evaluations (κ = 0.48, P = 7.11 × 10(-5)) but substantial between clinical and SD OCT evaluation (κ = 0.72, P = .00055). There was no significant agreement between OCT evaluation and FA leakage (κ = 0.249, P = .232).

    CONCLUSIONS:

    SD OCT will be a valuable adjunct in evaluating IRMA and NVE, since it can verify the histopathologic correlate. SD OCT provides subtle anatomic insights and may be more accurate than clinical examination or leakage on FA, our current method of diagnosing this important endpoint, which has implications in future trial design for proliferative diabetic retinopathy prevention.
    Copyright © 2015 Elsevier Inc. All rights reserved.

  • PMID: 25284762 [PubMed - indexed for MEDLINE]

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    14. Eur J Ophthalmol. 2015 Mar-Apr;25(2):145-52. doi: 10.5301/ejo.5000515. Epub 2014 Sep 18.

    Nonmydriatic fundus camera for diabetic retinopathy screening in a safety net hospital: effectiveness, prevalence, and risk factors.

    Author information:
  • 1Ophthalmology Department, Denver Health Medical Center, University of Colorado, Denver - USA.

    Abstract

    PURPOSE:

    To evaluate diabetic retinopathy (DR) prevalence and risk factors, and the effectiveness of nonmydriatic fundus camera as a screening tool for the detection of DR, in a safety net hospital.

    METHODS:

    This was a retrospective, population-based, cross-sectional study. Diabetic patients, referred by their primary care physicians to a DR community screening program, were included. A Topcon TRC NW-6S camera was used to obtain 45-degree digital color fundus images. Images were interpreted by retina specialists using a quality rating system. Patients with retinal findings or unreadable photographs were referred for a complete examination. Outcome measures were attendance rates, photograph quality, DR prevalence, and associated risk factors.

    RESULTS:

    A total of 948 diabetic patients were sent for camera screening, with an attendance rate of 65.6%, which increased during the study period. The mean age was 55.8 ± 11.6 years, the majority (56.9%) were Hispanic, and 43.5% were uninsured. Overall photograph quality rating was relatively high, with 81.7% graded as good or fair. Thirty photographs (2.9%) were unreadable. The prevalence of newly diagnosed DR was 11.1%. Independent DR-associated risk factors included Hispanic race (odds ratio [OR] = 2.29), lack of health insurance (OR = 2.49), longer duration of diabetes (OR = 1.07), higher HbA1c levels (OR = 1.19), presence of diabetic complications (OR = 2.93), and lack of previous eye examination (OR = 13.22).

    CONCLUSIONS:

    Nonmydriatic fundus camera is an effective and feasible screening tool for the early detection of DR in a safety net institution. It should be considered in areas with limited access to health care to improve quality of care and potentially reduce vision loss rates.

  • PMID: 25264120 [PubMed - indexed for MEDLINE]

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    15. Invest Ophthalmol Vis Sci. 2014 Sep 11;55(12):8513-22. doi: 10.1167/iovs.14-15121.

    Retinal hemorheologic characterization of early-stage diabetic retinopathy using adaptive optics scanning laser ophthalmoscopy.

    Author information:
  • 1The Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.

    Abstract

    PURPOSE:

    Adaptive optics scanning laser ophthalmoscopy (AO-SLO) is a noninvasive technique that allows for the direct monitoring of erythrocyte aggregates in retinal capillaries. We analyzed the retinal hemorheologic characteristics in normal subjects, diabetic patients without diabetic retinopathy (NDR), and diabetic patients with nonproliferative diabetic retinopathy (NPDR), using spatiotemporal (ST) blood flow images to visualize blood corpuscle trajectory.

    METHODS:

    AO-SLO images of the parafoveal capillary network were acquired for three groups: 20 healthy volunteers, 17 diabetic patients with NDR (8 type 1 and 9 type 2 patients), and 10 diabetic patients with NPDR (4 type 1 and 6 type 2). The erythrocyte aggregate velocity assigned to a relative cardiac cycle and the elongation rate of the erythrocyte aggregate were calculated.

    RESULTS:

    Careful observation revealed that flow velocity fluctuations were found with higher frequency in diabetic patients than in normal subjects. The total average velocities were 1.26 ± 0.22 mm/s in the normal group, 1.31 ± 0.21 mm/s in the NDR group, and 1.63 ± 0.35 mm/s in the NPDR group. The average velocities of the NPDR group were higher than those in the normal (P = 0.001) and NDR (P = 0.009) groups. The average elongation rates of the 3 groups were 0.67 ± 0.20, 0.39 ± 0.19, and 0.33 ± 0.11, respectively. Elongation rate differed significantly between the normal and NDR (P = 0.003) groups as well as the normal and NPDR (P = 0.001) groups.

    CONCLUSIONS:

    AO-SLO can be used to detect retinal hemorheologic changes in the early stages of diabetic retinopathy.
    Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  • PMID: 25212778 [PubMed - indexed for MEDLINE]

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    16. Retina. 2014 Dec;34(12):2416-22. doi: 10.1097/IAE.0000000000000262.

    Extent of diabetic macular edema by scanning laser ophthalmoscope in the retromode and its functional correlations.

    Author information:
  • 1*Department of Ophthalmology, University of Padova, Padova, Italy; and †Fondazione G. B. Bietti, IRCCS, Roma, Italy.

    Abstract

    BACKGROUND:

    To determine whether scanning laser ophthalmoscope in the retromode (RM-SLO) is useful to evaluate the extent of diabetic macular edema (DME) and its functional characteristics.

    METHODS:

    Comparative case series of 37 eyes (27 patients with diabetes). Inclusion criteria were: center involving DME determined by optical coherence tomography; RM-SLO, optical coherence tomography, fluorescein angiography (FA), and microperimetry performed on the same day; no significant media opacities. Two masked retinal specialists independently graded all images. The full extent of DME areas and two grades (small and large) DME areas were separately evaluated. The relationship between the DME extent obtained by RM-SLO and FA was assessed by Pearson correlation coefficient, intraclass correlation coefficient, and Bland-Altman plot. T-test was used to compare DME extent to central retinal thickness and macular sensitivity.

    RESULTS:

    The values of RM-SLO from the right and left prospective were highly correlated in the evaluation of the extent of DME (rho = 0.99, P < 0.0001). Mean DME area on RM-SLO was 5.7 + 5.6 mm (range, 0.3-18.2 mm); mean DME area on FA was 6.4 + 5.9 mm (range, 0.3-19.7 mm). The correlation between RM-SLO and FA in the evaluation of DME extent was highly significant (rho = 0.97, P < 0.0001), even when DME extent was divided in 2 major areas (intraclass correlation coefficient >0.8, P < 0.0001). The correlation between retinal sensitivity and DME area (RM-SLO) was significant (rho = -0.61, P = 0.0003).

    CONCLUSION:

    The extent has become an important parameter for monitoring DME, with or without treatment. The extent of DME well correlates with functional data, mainly retinal sensitivity. Retromode SLO can be reliably and easily used in the evaluation of DME extent, avoiding the use of invasive FA.

  • PMID: 25207944 [PubMed - indexed for MEDLINE]

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    17. IEEE J Biomed Health Inform. 2014 Sep;18(5):1717-28. doi: 10.1109/JBHI.2013.2294635.

    DREAM: diabetic retinopathy analysis using machine learning.

    Abstract

    This paper presents a computer-aided screening system (DREAM) that analyzes fundus images with varying illumination and fields of view, and generates a severity grade for diabetic retinopathy (DR) using machine learning. Classifiers such as the Gaussian Mixture model (GMM), k-nearest neighbor (kNN), support vector machine (SVM), and AdaBoost are analyzed for classifying retinopathy lesions from nonlesions. GMM and kNN classifiers are found to be the best classifiers for bright and red lesion classification, respectively. A main contribution of this paper is the reduction in the number of features used for lesion classification by feature ranking using Adaboost where 30 top features are selected out of 78. A novel two-step hierarchical classification approach is proposed where the nonlesions or false positives are rejected in the first step. In the second step, the bright lesions are classified as hard exudates and cotton wool spots, and the red lesions are classified as hemorrhages and micro-aneurysms. This lesion classification problem deals with unbalanced datasets and SVM or combination classifiers derived from SVM using the Dempster-Shafer theory are found to incur more classification error than the GMM and kNN classifiers due to the data imbalance. The DR severity grading system is tested on 1200 images from the publicly available MESSIDOR dataset. The DREAM system achieves 100% sensitivity, 53.16% specificity, and 0.904 AUC, compared to the best reported 96% sensitivity, 51% specificity, and 0.875 AUC, for classifying images as with or without DR. The feature reduction further reduces the average computation time for DR severity per image from 59.54 to 3.46 s.

    PMID: 25192577 [PubMed - indexed for MEDLINE]

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    18. Ophthalmic Epidemiol. 2014 Oct;21(5):318-26. doi: 10.3109/09286586.2014.949781. Epub 2014 Aug 26.

    Sight-threatening diabetic retinopathy at presentation to screening services in Fiji.

    Author information:
  • 1Fred Hollows Foundation , Newmarket, Auckland , New Zealand .

    Abstract

    PURPOSE:

    To report the spectrum of retinopathy at first presentation to photoscreening services, to determine the proportion of patients that present with sight-threatening diabetic retinopathy (STDR), and to raise awareness of the burden of diabetic eye disease in Fiji.

    METHODS:

    This retrospective observational cohort study used data from the initial visit of all new patients presenting to the diabetes retinal screening service at the Pacific Eye Institute in Fiji over the 3-month period between July and September 2012. Patients were assessed using a detailed questionnaire regarding diabetes type, duration of disease, medications, complications and co-morbidities, and blood sugar control. Patients subsequently underwent non-mydriatic fundus photography according to Pacific diabetes retinal screening guidelines. Images were graded at the time of acquisition, and data were entered onto a computerized database. For the purposes of this study, information regarding retinopathy grading, visual acuity and patient demographics was used.

    RESULTS:

    A total of 522 new patients were screened over the 3-month period. STDR was observed in 27% of patients, with 15% observed to have bilateral STDR. Diabetes control was generally poor. Blindness and visual impairment were observed in 2.7% and 6.7% of the cohort, respectively.

    CONCLUSION:

    Severe and advanced diabetic retinopathy was present in this population presenting to screening. This was observed 4 years after the formal expansion of the screening services and reflects the high prevalence of diabetes in the population. The need for increased public awareness and greater resource allocation into diabetes and its complications is emphasized.

  • PMID: 25157913 [PubMed - indexed for MEDLINE]

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    19. Invest Ophthalmol Vis Sci. 2014 Aug 21;55(10):6358-64. doi: 10.1167/iovs.14-14704.

    Prognostic value of multifocal electroretinography and optical coherence tomography in eyes undergoing panretinal photocoagulation for diabetic retinopathy.

    Author information:
  • 1Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, People's Republic of China Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, People's Republic of China.
  • 2Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, People's Republic of China.

    Abstract

    PURPOSE:

    To investigate the prognostic utility on visual acuity of multifocal electroretinography (mfERG) and optical coherence tomography (OCT) in diabetic eyes receiving panretinal photocoagulation (PRP).

    METHODS:

    Patients with severe nonproliferative diabetic retinopathy (NPDR) or early proliferative diabetic retinopathy (PDR) who needed PRP were included in this study. The mfERG and OCT data were recorded before PRP, and the final best-corrected visual acuity (BCVA) was recorded at 6 months after PRP. The correlation between pre-PRP data and post-PRP BCVA was analyzed using Pearson's correlation analysis and multivariate linear regression analysis.

    RESULTS:

    Among the 42 eyes included, 31 eyes (73.8%) had improvement or remained stable in visual acuity, and 11 eyes (26.2%) had deterioration in BCVA. The final BCVA was significantly correlated with the amplitude and latency of mfERG in all nine sectors, and the amplitude had a stronger correlation than latency. The foveal ellipsoid zone of the photoreceptors and external limiting membrane (ELM) status, as well as the retinal thickness in most sectors, were also correlated with the final BCVA. In a multivariate linear regression model, age, pre-PRP BCVA, amplitude of mfERG in the central sector, and foveal ellipsoid zone status were significantly correlated with the final BCVA. The retinal thickness was correlated with the amplitude or latency of mfERG in some sectors, and the correlation was tighter in temporal and inferior sectors.

    CONCLUSIONS:

    A lower amplitude of mfERG and disrupted foveal ellipsoid zone status were significantly correlated with a worse visual prognosis in diabetic eyes after PRP.
    Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  • PMID: 25146984 [PubMed - indexed for MEDLINE]

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    20. Br J Ophthalmol. 2015 Jan;99(1):113-8. doi: 10.1136/bjophthalmol-2014-305324. Epub 2014 Aug 19.

    A comparison of methods used to evaluate mobility performance in the visually impaired.

    Author information:
  • 1Glaucoma Research Center, William and Anna Goldberg Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

    Abstract

    PURPOSE:

    To compare three different approaches to measuring mobility performance when evaluating the visually impaired.

    METHODS:

    488 participants, including 192 glaucoma, 112 age-related macular degeneration, 91 diabetic retinopathy and 93 healthy volunteers, completed the Assessment of Disability Related to Vision (ADREV) mobility course. The performance of participants on the mobility course was evaluated by noting errors made and time required for completion. Errors noted and time taken were compared using multivariate logistic regression to determine which measurement better differentiated patients with visual disease from healthy volunteers. Multivariate logistic regression was also used to evaluate the combined metric of ADREV errors divided by time to determine its ability to discriminate participants with visual disease from healthy volunteers.

    RESULTS:

    Errors noted and time taken while ambulating through the standardised mobility course shared a weak but statistically significant association (Pearson's r=0.36, p<0.05). After controlling for demographic and medical comorbidities, logistic regression analysis revealed that errors noted were better at discriminating individuals with visual disease from healthy volunteers (OR 2.8-4.9, 95% CI 1.5 to 10.3) compared with the time taken for mobility course completion (OR 1.1, 95% CI 1.0 to 1.2). These findings were consistent across all comparisons between healthy volunteers and participants with each type of visual impairment. Finally, the combined metric of ADREV errors divided by time was far more predictive of visual disease compared with either time taken or errors noted during mobility testing (OR 11.0-17.7, 95% CI 3.6 to 77.1).

    CONCLUSIONS:

    A validated scoring system based on errors is more effective when assessing visual disability during mobility testing than recording the time taken for course completion. The combined metric of ADREV errors noted divided by time taken was most predictive of all the methods used to evaluate visual disability during mobility testing.
    Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  • PMID: 25138757 [PubMed - indexed for MEDLINE]

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