Alteraciones estructurales y funcionales en pacientes con Diabetes Mellitus tipo 2 y Retinopatía Diabética no proliferativa moderada

Objetivo: Estudiar las alteraciones estructurales y funcionales de los pacientes con Diabetes Mellitus tipo 2 y Retinopatía Diabética Moderada. Métodos: Realizamos un estudio descriptivo transversal unicéntrico con una serie de 128 ojos (53 ojos de pacientes con Diabetes Mellitus tipo 2 con Retinopatía Diabética Moderada y 75 de sujetos sanos sin historia previa de enfermedades oculares) a los que se les evaluó mediante Tomografía de Coherencia Óptica y Microperimetría, con el fin de estudiar el espesor de las distintas capas de la retina y la sensibilidad. Resultados: El grupo de DM2 presentó diferencias estadísticamente significativas respecto al espesor de la retina frente al grupo control en las regiones SI (p = 0,030) y Central (p = 0,022) en retina total; en las áreas SI (p = 0,001), TI (p = 0,002), II (p = 0,007), y NI (p = 0,020) en la capael protocolo GCL+; y en la capael GCL++ en las áreas SI (p = 0,002) y TI (p = 0,041). Al comparar los resultados obtenidos mediante el microperímetro, el grupo de DM2 presentó diferencias estadísticamente significativas en todos los sectores a excepción del sector SE. Al correlacionar ambos hallazgos, nuestros resultados mostraron una correlación negativa significativa de -0,305 (p = 0,033) de la retina total, no siendo significativa para las capaslos protocolos GCL + (-0,158, p = 0,277) ni para GCL ++ (-0,176, p = 0,227). Respecto a la correlación entre los anillos cuadrantes internos superior, nasal, inferior y temporal del anillo parafoveal del ETDRS (OCT) y los umbrales de los radios de 3 y 5 grados (MAIA), no se observó una correlación significativa. También objetivamos una correlación negativa entre la MAVC y el E.S. con la sensibilidad retiniana mediante mediante microperimetría y entre los niveles de HbA1C HbA1c y la sensibilidad retiniana en las áreas IE, NE, SI, II, NI y C global (p < 0,05). Conclusión: Demostramos una reducción significativa del espesor y de la sensibilidad retiniana en los pacientes con Diabetes Mellitus tipo 2 y Retinopatía Diabética Moderada respecto al grupo control, así como una correlación negativa entre las alteraciones a nivel anatómico del anillo central del ETDRS (OCT) y las alteraciones a nivel funcional centrales y del anillo interno del Microperímetro. Los hallazgos sugieren la existencia de una neurodegeneración con anomalías funcionales en este tipo de pacientes.<br /

Carcinoma de vesícula biliar en nuestro medio. Epidemiología, supervivencia, manejo y factores de riesgo asociados.

Objetivo: Conocer la epidemiología e incidencia del cáncer de vesícula biliar y describir el manejo clínico de estos pacientes en nuestro medio. Evaluar los posibles factores de riesgo asociados a su desarrollo. Material y métodos: Estudio multicéntrico, descriptivo, observacional, retrospectivo, incluyendo pacientes diagnosticados de cáncer de vesícula biliar en los últimos 10 años (1 Enero 2006-31 Diciembre 2015) en los Sectores de Salud Zaragoza II y III. Se calculó la tasa de incidencia ajustada por edad -ASR- (casos/100.000personas/año) sobre el total de la población diana (n=711.139). Se evaluaron variables clínicas y relacionadas con el tratamiento. Resultados: Se detectaron 148 casos de cáncer de vesícula biliar, siendo más frecuente en mujeres (75%, 111/148), con una edad media de 78'4 años (70'3-84'2). La incidencia Estandarizada por Edad -ASR- fue 1'08 (IC(95%)=0'91-1'26), 0'65(IC(95%)=0'44-0'85) en hombres y 1'42 (IC(95%) = 1'15-1'68) en mujeres. Un 52% (76/148) de los pacientes fue diagnosticado en estadios avanzados (IVA y IVB). El 52'5% (77/148) requirieron cirugía y un 11% (16/148) recibieron quimioterapia. La media de supervivencia fue de 6'12 meses (IC(95%)=4'19-8'05). En un 33.8% (50/148) de los casos el diagnóstico fue incidental, siendo re-intervenidos solo un 34%(17/50). Un estadio TNM precoz al diagnóstico (p<0'001), la realización de tratamiento quirúrgico (p<0'001) y re-intervenir en caso de hallazgo incidental (p=0'013) se asociaron de forma significativa con mejor supervivencia. El consumo crónico de aspirina a dosis bajas (LDA) fue significativamente mayor en el grupo control (26'01% vs 14'89%, OR 0'49, IC(95%)= 0'29-0'84, p= 0'009). Conclusiones: El cáncer de vesícula biliar fue significativamente más frecuente en mujeres de edad avanzada. La mayoría de los pacientes fueron diagnosticados en estadios avanzados. Gran parte de los casos se diagnosticaron de forma incidental y la mayoría no fueron manejados de forma adecuada. El estadio de la enfermedad y un tratamiento adecuado influyeron significativamente en la supervivencia. La toma crónica de aspirina a dosis baja constituyó es un factor protector en el desarrollo de este cáncer

Choroidal and Retinal Thicknesses in Type 2 Diabetes Mellitus with Moderate Diabetic Retinopathy Measured by Swept Source OCT

Background: To study choroidal thickness (CT) in type 2 diabetes mellitus (DM2) patients with moderate diabetic retinopathy (DR) and to correlate with changes in retinal thickness (RT) with swept-source OCT (SS-OCT) compared to healthy subjects. Methods: Fifty-four DM2 patients with moderate DR without diabetic macular edema (DME) and 73 age-matched healthy subjects were evaluated using SS-OCT to measure changes in total RT and CT in the nine areas of the Early Treatment Diabetic Retinopathy Study (ETDRS) macular grid. Results: The mean age was 64.06 ± 11.98 years and 60.79 ± 8.62 years in the diabetic and control groups, respectively. Total RT showed statistically significant differences in the temporal inner area, with higher values in the DM2 group (p = 0.010). CT did not show differences between the groups. There was a significant negative correlation between RT and age in all of the outer ETDRS areas and a positive significant correlation in the central area for the DM2 group. There was also a negative significant correlation between CT and age in all of the ETDRS areas except for the inferior inner area. In the DM2 group, a negative correlation was observed between RT and CT in the central area (p = 0.039) and in both horizontal parafoveal areas (temporal inner, p = 0.028; nasal inner, p= 0.003). Conclusion: DM2 patients with moderate DR have no changes with regard to CT. Both CT and RT decreased with age in DM2, showing a negative correlation between these factors in the central and horizontal parafoveal areas of the ETDRS grid

Long-Term Follow-Up of Macular Perfusion Evaluated by Optical Coherence Tomography Angiography after Rhegmatogenous Retinal Detachment Surgery

Background: The goal of this study was to investigate macular microvascular changes using optical coherence tomography angiography (OCTA) at one year after successful rhegmatogenous retinal detachment (RRD) surgery. Methods: We performed a cross-section study including RRD treated by pars plana vitrectomy (PPV) with or without scleral buckling and SF6 tamponade. After 12 months, DRI-Triton SS-OCTA was performed. Superficial and deep retinal capillary plexuses (SCP and DCP), choriocapillaris (CC) vessel density (VD), and foveal avascular zone (FAZ) morphology were analyzed. Results were compared with the unaffected contralateral eye. Results: Sixty eyes were included. We observed an increase in VD in the central area of both the SCP and DCP in macula-off eyes treated with PPV + SB and in the SCP of macula-off eyes treated with PPV. Macula-off eyes had a diminished VD for both plexuses in the superior quadrant and in the SCP inferior quadrant in those treated with PPV + SB. The CC flow was diminished in the temporal quadrant of macular-off eyes treated with PPV + SB. Healthy eyes presented higher diameter values than macula-off eyes treated with PPV + SB. FAZ horizontal and vertical diameters were smaller in patients with macula-off RRD vs. macula-on RRD and control groups. Conclusion: Macular vascularity remains almost unchanged one year after successful RRD surgery, irrespective of the surgical technique or prior macular status

Retinal Vascularization Abnormalities Studied by Optical Coherence Tomography Angiography (OCTA) in Type 2 Diabetic Patients with Moderate Diabetic Retinopathy

Diabetic retinopathy (DR) is the most severe and frequent retinal vascular disease that causes significant visual loss on a global scale. The purpose of our study was to evaluate retinal vascularization in the superficial capillary plexus (SCP), the deep capillary plexus (DCP) and the choriocapillaris (CC) and changes in the foveal avascular zone (FAZ) by optical tomography angiography (OCTA) in patients with type 2 diabetes mellitus (DM2) with moderate DR but without diabetic macular oedema (DME). Fifty-four eyes of DM2 with moderate DR (level 43 in the ETDRS scale) and without DME and 73 age-matched healthy eyes were evaluated using OCTA with swept-source (SS)-OCT to measure microvascularization changes in SCP, DCP, CC and the FAZ. The mean ages were 64.06 ± 11.98 and 60.79 ± 8.62 years in the DM2 and control groups, respectively. Visual acuity (VA) was lower in the DM2 patients (p = 0.001), OCTA showed changes in the SCP with a significant diminution in the vascular density and the FAZ area was significantly higher compared to healthy controls, with p &lt; 0.001 at the SCP level. The most prevalent anatomical alterations were peripheral disruption in the SCP (83.3%), microaneurysms (MA) in the SCP and in the DCP (79.6% and 79.6%, respectively) and flow changes in the DCP (81.5%). A significant positive correlation was observed between the DM2 duration and the FAZ area in the SCP (0.304 with p = 0.025). A significant negative correlation was also found between age and CC central perfusion (p &lt; 0.001). In summary, a decrease in the vascular density in DM2 patients with moderate DR without DME was observed, especially at the retinal SPC level. Furthermore, it was found that the FAZ was increased in the DM2 group in both retinal plexuses and was greater in the SCP group

Non-Simultaneous Bilateral Ischemic Optic Neuropathy Related to High Altitude and Airplane Flight in a Patient with Cerebral Small Vessel Disease

Non-arteritic anterior ischemic optic neuropathy (NA-AION) is considered the most frequent type of acute optic neuropathy. A 61-year-old woman presented with a NA-AION in her right eye within 24 h following an airplane flight. One year later, after driving for 10 days with a daily accumulated altitude of 1500 m, she developed a NA-AION in her left eye. Systemic disorders were investigated, and cerebral small vessel disease was observed via cranial computed tomography. An inadequate response to hypoxia, in a patient with individual susceptibility, could lead to reduced blood supply to the optic nerve head, which could represent an underlying cause of NA-AION

Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review

Background: Diabetic retinopathy (DR) is the leading cause of legal blindness in the working population in developed countries. Optical coherence tomography (OCT) angiography (OCTA) has risen as an essential tool in the diagnosis and control of diabetic patients, with and without DR, allowing visualisation of the retinal and choroidal microvasculature, their qualitative and quantitative changes, the progression of vascular disease, quantification of ischaemic areas, and the detection of preclinical changes. The aim of this article is to analyse the current applications of OCTA and provide an updated overview of them in the evaluation of DR. Methods: A systematic literature search was performed in PubMed and Embase, including the keywords “OCTA” OR “OCT angiography” OR “optical coherence tomography angiography” AND “diabetes” OR “diabetes mellitus” OR “diabetic retinopathy” OR “diabetic maculopathy” OR “diabetic macular oedema” OR “diabetic macular ischaemia”. Of the 1456 studies initially identified, 107 studies were screened after duplication, and those articles that did not meet the selection criteria were removed. Finally, after looking for missing data, we included 135 studies in this review. Results: We present the common and distinctive findings in the analysed papers after the literature search including the diagnostic use of OCTA in diabetes mellitus (DM) patients. We describe previous findings in retinal vascularization, including microaneurysms, foveal avascular zone (FAZ) changes in both size and morphology, changes in vascular perfusion, the appearance of retinal microvascular abnormalities or new vessels, and diabetic macular oedema (DME) and the use of deep learning technology applied to this disease. Conclusion: OCTA findings enable the diagnosis and follow-up of DM patients, including those with no detectable lesions with other devices. The evaluation of retinal and choroidal plexuses using OCTA is a fundamental tool for the diagnosis and prognosis of DR.Spanish Ministry of Universities (FPU18/02964) and the Health Research Fund Instituto de Salud Carlos III (Fondo de Investigación Sanitaria, Spanish Ministry of Health) PI20/00740

Changes in Inner Retina Thickness and Macular Sensitivity in Patients with Type 2 Diabetes with Moderate Diabetic Retinopathy

The increase in diabetic retinopathy (DR) prevalence demonstrates the need for the determination of biomarkers for assessing disease development to obtain an early diagnosis and stop its progression. We aimed to analyse total retinal (RT) and inner retinal layer (IRL) thicknesses in type 2 diabetes mellitus (DM2) patients and correlate these results with retinal sensitivity using swept-source OCT (SS-OCT) and microperimetry. For this purpose, a total of 54 DM2 subjects with moderate diabetic retinopathy (DR) with no signs of diabetic macular oedema (DME) and 73 age-matched healthy individuals were assessed using SS-OCT to quantify retinal thickness in the nine macular areas of the ETDRS grid. Retinal sensitivity was measured via microperimetry with a Macular Integrity Assessment Device (MAIA). The mean ages were 64.06 ± 11.98 years for the DM2 group and 60.79 ± 8.62 years for the control group. DM2 patients presented lower visual acuity (p p = 0.01). The retinal nerve fibre layer (RNFL) was significantly lower in the outer nasal area (50.38 ± 8.20 μm vs. 45.17 ± 11.25 μm, p = 0.005) in ganglion cells and inner plexiform layers (GCL+) in DM2. A positive correlation between the LDL-C and RNFL and a negative correlation between HDL-C levels and the inner temporal and central RNFL thickness were detected. The central (p = 0.021) and inner nasal (p = 0.01) areas were negatively correlated between the RNFL and MAIA, while GCL++ was positively correlated with the outer inferior (p = 0.015) and outer nasal areas (p = 0.024). Retinal sensitivity and macular RNFL thickness decrease in DM2 patients with moderate DR with no DME, and this study enables an accurate approach to this disease with personalised assessment based on the DR course or stage. Thus, GCL+ and GCL++ thinning may support ganglion cell loss before the RNFL is affected

Microperimetry-Assessed Functional Alterations and OCT-Changes in Patients after Retinal Detachment Surgery Using Pars Plana Vitrectomy and SF6 Tamponade

Background: We study the retinal function measured by macular integrity assessment microperimetry (MAIA) and structural changes assessed by scanning swept source optical coherence tomography (SS-OCT) between healthy individuals and patients undergoing pars plana vitrectomy (PPV) after rhegmatogenous retinal detachment (RRD). Methods: Cross-sectional study. Early Treatment Diabetic Retinopathy Study (ETDRS) grids were measured by SS-OCT and compared with the MAIA parameters. Results: Thirty-eight eyes with RRD (19 macula-on and 19 macula-off) were compared with 113 healthy eyes. The retinal sensitivity and average total threshold were reduced in all sectors in the RRD group; macular integrity index was increased. Macular thicknesses in total retina and ganglion cell layer (GCL)++ protocols were higher in the RRD group in nasal outer (NO) and central (C) sectors and only in C sector for GCL+ protocol. Thicknesses were lower in total retina, GCL++ protocols in the temporal outer (TO) sector and in the GCL+ protocol in NO sector. Best-corrected visual acuity (BCVA) correlated moderately with retinal sensitivity in all sectors and in just several sectors with time between the date of surgery and the test. The central nasal (CN) sector thickness and the average total threshold were higher in the macula-on subgroup. Conclusions: RRD and subsequent surgery results in functional and structural changes, especially in individuals with macular detachment