Anatomical success rate of pars plana vitrectomy for treatment of complex rhegmatogenous retinal detachment

BACKGROUND: Pars plana vitrectomy (PPV) is preferred surgical procedure for the management of complex rhegmatogenous retinal detachment (RRD). The purpose of this study was to evaluate the anatomical results of primary PPV for the treatment of primary complex RRD and to determine the influence of lens status, tamponading agent, preoperative proliferative vitreoretinopathy (PVR) and axial length (AL) of the eye upon the anatomical outcome. METHODS: A retrospective consecutive chart analysis was performed on 117 eyes from 117 patients with complex RRD managed with PPV. Fifty-nine eyes were phakic and 58 pseudophakic eyes. All patients had a minimum follow-up period of 12 months. Eyes were classified into groups using independent variables (first classification based upon lens status and tamponade used, second classification based upon lens and PVR status and third classification based upon AL of the eye). The groups were compared for anatomical outcomes (dependent variables) using nonparametric- or, in case of normally distributed data, parametric- statistical tests. RESULTS: Retinal reattachment rate in phakic eyes was 94.9% compared to 93.1% in pseudophakic, with no statistically significant difference between the two. The overall retinal reattachment rate with single surgery was 94.0%. Final reattachment rate was 97.4%. In case of established PVR >/= C1, the reattachment rate was not statistically different (92.6%) from eyes with no PVR (91.1%) irrespective of lens status. A statistically significant difference was found between redetachment rates only between phakic eyes with gas tamponade compared to silicon oil (SO) (p = 0.001). Reattachment rate proved to be similar in both AL groups ( 24 mm). CONCLUSIONS: High anatomical success rate of primary vitrectomy for complex RRD with either gas or SO tamponade was achieved in phakic as well as pseudophakic eyes irrespective of AL of the eye

The Etiology Of Chronic Liver Disease And Cirrhosis In Hungarian Men

Mortality of chronic liver disease (CLD) and cirrhosis in the Hungarian population has been high in international comparison. To explore the determinants of chronic liver diseases in the Hungarian population, we performed a case-reference, as well as an embedded cross-sectional study in general practices in 1079 men aged 45-64 years. Our goal was to examine the relationship between CLD and cirrhosis, and lifestyle factors (alcohol consumption, smoking, physical activity, nutrition), viral hepatitis (B, C, E), as well as socio-economic status (educational level, marital status, financial status). An additional research question was how much lifestyle factors explain the relationship between the socio-economic factors and liver disease. In addition, the relationship of serum selenium level with liver damage, and with age, lifestyle and socio-economic factors was also studied. Simple and multiple logistic as well as linear regression methods were used to study the relationship between disease and risk factors; the comparison of laboratory parameters between groups was performed by the Kruskal-Wallis ANOVA method. The risk of CLD and cirrhosis was doubled by heavy drinking, regular smoking, bad financial situation and if someone lived alone. This risk was reduced by high school education. The relationship between liver disease and socio-economic factors (education, marital status) remained after correction for lifestyle factors. Bad financial situation was not related to liver disease after correction for lifestyle factors. The selenium was significantly associated with liver biochemical markers such as GOT, GPT, GOT / GPT, albumin, bilirubin levels, and the change could be detected at an early stage of liver disease, before symptoms appeared. In persons without signs and symptoms of liver disease elderly persons, heavy drinkers and regular smokers had significantly lower concentration of selenium, while higher level of education and consumption of vegetable cooking oil increased it. Based on the results, reduction of the alcohol consumption and smoking should have a priority among actions aiming to reduce the high premature mortality from CLD and cirrhosis, while identification of other important risk factors should help in developing other preventive interventions. A magyar lakosság krónikus májbetegség, májzsugor okozta korai halálozása nemzetközi összehasonlításban igen kedvezőtlen. A magas krónikus májbetegség okozta halálozás mögött álló okok feltárására a háziorvosi alapellátásra épülő eset-referencia, valamint ebbe ágyazott keresztmetszeti vizsgálat került kivitelezésre 1079 45-64 éves, férfi bevonásával. Célunk az volt, hogy a krónikus májbetegség, májzsugor és az életmódbeli tényezők (alkoholfogyasztás, dohányzás, testmozgás, táplálkozás), hepatitis vírusfertőzés (B, C, E), valamint a társadalmi-gazdasági helyzet (iskolai végzettség, családi állapot, anyagi helyzet) közötti összefüggést megvizsgáljuk. További kutatási kérdés volt, hogy az életmódbeli tényezők, milyen mértékben magyarázzák a társadalmi-gazdasági helyzet májbetegséggel való kapcsolatát. Vizsgáltuk ezen kívül, hogy milyen kapcsolat van a szérum szelén szint és a krónikus májbetegség súlyossága, valamint az egyén életkora, életmódja, illetve társadalmi-gazdasági helyzete között. A betegség és a kockázati tényezők közötti összefüggést egyszerű és többszörös logisztikus, illetve lineáris regressziós módszerrel, a laboratóriumi paraméterek csoportok közötti összehasonlítását Kruskal-Wallis ANOVA-val végeztük. A krónikus májbetegség, májzsugor kockázatát jelentősen megnövelte a nagyivás, a rendszeres dohányzás, a párkapcsolat hiánya, illetve a rossz anyagi helyzet. A betegség kockázatát csökkentette a magas iskolai végzettség. A társadalmi-gazdasági tényezők összefüggése a májbetegséggel az életmódbeli tényezőkre történő korrigálást követően is megmaradt, kivételt képez az anyagi helyzet, melynek hatása a korrigálást követően megszűnt. A szelén szignifikáns összefüggést mutatott a máj biokémiai markereivel, úgy mint a GOT, GPT, GOT / GPT, albumin, bilirubin szintekkel, változása már a májbetegség korai stádiumában kimutatható volt, még a tünetek megjelenése előtt. Az átlag populációban a szelén koncentráció szignifikánsan alacsonyabb volt az idősebbek, nagyivók, rendszeresen dohányzók, illetve emelkedett a magasabb iskolai végzettségűek, és a főzéshez növényi zsiradékot (is) használók körében. Az eredményeink alapján a krónikus májbetegség, májzsugor okozta rendkívül kedvezőtlen korai halálozás csökkentésében az alkoholfogyasztás és a dohányzás visszaszorítása elsődleges szerepet kell, hogy kapjon, ugyanakkor egyéb fontos kockázati tényezők azonosítása segíthet további prevenciós intervenciók azonosításában.d

Danish Nationwide Data Reveal a Link between Diabetes Mellitus, Diabetic Retinopathy, and Glaucoma

Aims. To determine the association between treatment against diabetes mellitus (DM) and treatment with antiglaucomatous drugs in the entire Danish population and to investigate the comorbidity between DM and its complications with antiglaucomatous treatment. Methods. Retrospective nationwide cohort study with data over a 16-year follow-up period. The National Danish Registry of Medicinal Products Statistics was used to identify all claimed prescriptions for antiglaucomatous medication and DM drugs. ICD-10 classifications were furthermore used to identify comorbidities between antiglaucomatous medication and the DM complications, diabetic retinopathy (DR), and nephropathy. Results. A total of 6,343,747 individuals in the period between 1996 and 2012 were analyzed. The overall incidence rate of new-onset glaucoma patients was 0.07 per 1000 person-years for the reference population compared to 36 per 1000 person-years for all diagnosed DM cases. Patients treated with DM drugs had about two times higher relative risk of glaucoma, when adjusting for a range of factors. The presence of DR alone or in combination with nephropathy increased the risk of glaucoma. Conclusions. The present study reports a strong association between DM and onset of glaucoma treatment in the entire Danish population

Kontaktlencse-viselés könnyben lévő mediátorokra kifejtett hatása keratoconus esetén

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Outcome of Different Surgical Repair Techniques for Rhegmatogenous Retinal Detachment—A Health Economic Analysis in the Split-Dalmatia County, Croatia

Purpose: The goal of this research is to investigate the characteristics and surgical techniques for repairing rhegmatogenous retinal detachment (RRD) and their influence on anatomical and functional success of the treatment with a special emphasis on the economic costs and outcome quality-adjusted life years (QALYs) of the procedures. Methods: This retrospective study analyzed data from 151 patients with RRD treated at the Department of Ophthalmology, Clinical Hospital Centre Split, Croatia, in a 3-year period, using one of three surgical techniques: pneumoretinopexy (PR), scleral buckling (SB) or pars plana vitrectomy (PPV), followed-up for at least 6 months. Demographic, pre- and post-operative ophthalmic exam parameters and surgical technique used were collected accordingly. Statistical analysis of the influence of the studied parameters upon anatomical and functional outcomes was performed, as well as health economic analysis on costs and derived utilities/QALYs of these surgical methods. Results: Of all patients, 130 (86%) were successfully operated on, and 21 patients (14%) required another surgical procedure. No statistically significant differences in the anatomical success between the 3 surgical techniques were found. However, the functional outcome (based on the final best corrected visual acuity (BCVA)) differed significantly. Despite improvement in the final BCVA, BCVA ≥ 0.5 was achieved in only 52 (34.4%) patients. The final BCVA showed significant association with the time elapsed from the onset of RRD to the surgical intervention, pre-operative BCVA, macular- and preoperative lens- status and type of surgery. The estimated diagnosis-related group (DRG) cost for day and inpatient surgery was based upon existing DRG cost for PPV, which for PR and SB was calculated accordingly. Based upon the success of the procedure and visual outcome, the overall calculated QALYs for PR and SB appeared to be similar, while the QALYs were lower for PPV. Conclusions: The success rate of treating RRD mostly depends on performing an early surgical procedure (especially in the case of attached macula), identification of all retina tears and, most importantly, choosing the appropriate surgical technique. Decisions on treatment for RRD should also be based upon cost-effective and QALYs-assessed procedures, especially in countries like Croatia, where limited healthcare resources exist. This study shows PR to be efficient and most cost-effective for RRD repairment in appropriate cases

Effect of contact lens wear on the release of tear mediators in keratoconus

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Diabetic retinopathy screening using telemedicine tools: pilot study in Hungary

Introduction. Diabetic retinopathy (DR) is a sight-threatening complication of diabetes. Telemedicine tools can prevent blindness. We aimed to investigate the patients’ satisfaction when using such tools (fundus camera examination) and the effect of demographic and socioeconomic factors on participation in screening. Methods. Pilot study involving fundus camera screening and self-administered questionnaire on participants’ experience during fundus examination (comfort, reliability, and future interest in participation), as well as demographic and socioeconomic factors was performed on 89 patients with known diabetes in Csongrád County, a southeastern region of Hungary. Results. Thirty percent of the patients had never participated in any ophthalmological screening, while 25.7% had DR of some grade based upon a standard fundus camera examination and UK-based DR grading protocol (Spectra™ software). Large majority of the patients were satisfied with the screening and found it reliable and acceptable to undertake examination under pupil dilation; 67.3% were willing to undergo nonmydriatic fundus camera examination again. There was a statistically significant relationship between economic activity, education and marital status, and future interest in participation. Discussion. Participants found digital retinal screening to be reliable and satisfactory. Telemedicine can be a strong tool, supporting eye care professionals and allowing for faster and more comfortable DR screening

Diabetic Retinopathy Screening in Patients with Diabetes Using a Handheld Fundus Camera: The Experience from the South-Eastern Region in Hungary

Purpose. Diabetic retinopathy (DR) is the leading cause of vision loss among active adults in industrialized countries. We aimed to investigate the prevalence of diabetes mellitus (DM), DR and its different grades, in patients with DM in the Csongrád County, South-Eastern region, Hungary. Furthermore, we aimed to detect the risk factors for developing DR and the diabetology/ophthalmology screening patterns and frequencies, as well as the effect of socioeconomic status- (SES-) related factors on the health and behavior of DM patients. Methods. A cross-sectional study was conducted on adults (>18 years) involving handheld fundus camera screening (Smartscope Pro Optomed, Finland) and image assessment using the Spectra DR software (Health Intelligence, England). Self-completed questionnaires on self-perceived health status (SPHS) and health behavior, as well as visual acuity, HbA1c level, type of DM, and attendance at healthcare services were also recorded. Results. 787 participants with fundus camera images and full self-administered questionnaires were included in the study; 46.2% of the images were unassessable. T1D and T2D were present in 13.5% and 86.5% of the participants, respectively. Among the T1D and T2D patients, 25.0% and 33.5% had DR, respectively. The SES showed significant proportion differences in the T1D group. Lower education was associated with a lower DR rate compared to non-DR (7.7% vs. 40.5%), while bad/very bad perceived financial status was associated with significantly higher DR proportion compared to non-DR (63.6% vs. 22.2%). Neither the SPHS nor the health behavior showed a significant relationship with the disease for both DM groups. Mild nonproliferative retinopathy without maculopathy (R1M0) was detected in 6% and 23% of the T1D and T2D patients having DR, respectively; R1 with maculopathy (R1M1) was present in 82% and 66% of the T1D and T2D groups, respectively. Both moderate nonproliferative retinopathy with maculopathy (R2M1) and active proliferative retinopathy with maculopathy (R3M1) were detected in 6% and 7% of the T1D and T2D patients having DR, respectively. The level of HbA1c affected the attendance at the diabetology screening (HbA1c>7% associated with >50% of all quarter-yearly attendance in DM patients, and with 10% of the diabetology screening nonattendance). Conclusion. The prevalence of DM and DR in the studied population in Hungary followed the country trend, with a slightly higher sight-threatening DR than the previously reported national average. SES appears to affect the DR rate, in particular, for T1D. Although DR screening using handheld cameras seems to be simple and dynamic, much training and experience, as well as overcoming the issue of decreased optic clarity is needed to achieve a proper level of image assessability, and in particular, for use in future telemedicine or artificial intelligence screening programs