Os fatores de risco para retinopatia diabética podem ser classificados como . RD em geral, da RD proliferativa, da maculopatia e da redução ou perda visual. retiniche, soprattutto della degenerazione maculare e retinopatia diabetica, il Prof. nella diagnostica e nel trattamento di casi rari e difficili di maculopatia. Palabras clave: hiperglucemia, proteína quinasa C, retinopatía diabética, edema . Amías LA, Rouras L. Protocolos de tratamiento de la maculopatia diabética.
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To describe retinal diseases found in patients who were waiting for treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. Patients underwent slit lamp biomicroscopy, dilated diabettica exam and ocular ultrasound. Patients were classified according to phakic status and retinal disease of the most severely affected eye. A total of patients were examined. The mean age was Diabetes was present in Cataract was found in Retinal examination was possible in patients.
Out of 40 patients evaluated due to diabetes, 13 Diabetic retinopathy was the main retinal disease in this population. It is an maculoaptia cause of blindness and can be remotely evaluated, amculopatia its initial stages, by telemedicine strategies. In remote Brazilian areas, telemedicine may be an important tool for retinal diseases diagnosis and follow-up. Brazil is a continent-sized country with very heterogeneous socioeconomic realities.
InBrazil had one ophthalmologist to 11, inhabitants, i. However, the macuopatia of these specialists is uneven, and the North Region is the most challenged: The census of the Conselho Brasileiro de Oftalmologia CBO [Brazilian Council of Ophthalmology] 1 identified only 20 ophthalmologists in the State of Acre, ina ratio of one ophthalmologist to 38, inhabitants.
Retinal diseases are the most common cause of blindness in adults in Brazil urban populations. This marked variation in prevalence can be explained by differences in the methods used to diagnose diabetes in the studies available, and due to underdiagnosed cases of the condition. A Brazilian population-based study carried out macuulopatia investigate the causes of blindness in urban adults showed that retinal diseases are the main cause of blindness, followed by cataracts and glaucoma.
In addition to DR, in our country, age-related macular degeneration and retinal detachment are important causes of retinal blindness.
Retinal detachment, if not treated early, can cause permanent loss of the central and peripheral visions. Locations where specialists are scarce usually have a yet smaller number of subspecialists. Thus, in the first half ofin Rio Branco ACthere was a large number of patients with retinal diseases awaiting out-of-home treatment OHT.
Telemedicine has been successfully applied for monitoring of DR, 6 diabetia 8 meeting the growing demand of diabetic patients. Digital retinal images can be performed by trained diavetica personnel, and submitted to a center maculolatia review by an expert physician.
El ruboxistaurin, una alternativa en el edema macular diabético
To describe the retinal diseases found in patients awaiting out-of-home treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. This study was based on data from patients awaiting OHT for retinal diseases.
An ophthalmologist specialized in retina and an ophthalmic technologist from Hospital Israelita Albert Einstein traveled to Rio Branco ACin Aprilfor this evaluation. The data analysis took into account some demographic information – sex and age, as well as clinical information, such as presence of diabetes mellitus and hypertension. Ophthalmic data were analyzed according to the following examinations: The biomicroscopy evaluated the state of the crystalline lens or the presence of intraocular lenses, as well as cases of crystalline lens subluxation.
The dilated fundus exam evaluated the optic disc and retina, in both posterior pole and periphery. DR, when present, was classified as nonproliferative or proliferative and evaluated for the presence of diabetic macular edema. The retinal evaluation described was based on the eye with the most severe retinal changes. In patients with more than one retinal abnormality, the most severe was described, or the most threatening to the vision. According to the examination protocol, when retinal examination was precluded by media opacity, we tested for the presence of light perception in the eye examined.
If the examined eye had no light perception, the investigation was stopped for that eye. We evaluated data from patients. These patients were aged Diabetes was reported by 49 patients Forty-two patients had transparent crystalline lenses in both eyes Cataract was present in at least one eye, in 32 patients Congenital cataract was diagnosed in two patients both eyesand one patient had subluxated crystalline lenses in both eyes.
Two patients had aphakia one patient in both eyesand one patient had an ocular prosthesis in one eye. Seven patients could not undergo anterior chamber examination in at least one eye due to media opacity, phthisis bulbi or neovascular glaucoma with disorganized anterior chamber one patient could not be examined in both eyes. Six patients were unable to undergo retinal examination due to media opacity and had no light perception in the examined eye.
These patients were excluded from further analysis. Three other patients had retinal examination precluded by media opacity, but there was light perception, and these patients underwent ultrasonography, which revealed attached retinas and no detectable abnormalities.
These patients were also excluded from further analysis.
For the remaining patients, fundoscopic findings were distributed as shown on maculopstia 1. Out of patients awaiting OHT for retinal diseases who were examined, 40 had evaluations ordered due to DR Of these, 32 had retinal changes and 8 had normal retinal exams. As for the crystalline lens evaluation, This piece of data indicates that a significant number of patients had undergone high-complexity eye treatments, such as cataract extraction with intraocular lens implantation, despite the small number of ophthalmologists in the region.
Among the retinal diseases, the two leading macukopatia of retinal changes were rhegmatogenous retinal detachment and DR. These findings are in agreement with literature data that also report the two maculopahia as major causes of retinal blindness in adults from urban populations.
Rhegmatogenous retinal detachment was present in 23 patients Ten patients were in the late postoperative period after surgery for retinal detachment repair, and required follow up diabdtica a retina subspecialist; 6 of these patients had silicone oil in the vitreous cavity and were candidates for further surgery to remove it. Diabetic retinopathy was present in 32 patients DR is a preventable disease that can be monitored remotely in early stages.
Screening since early stages of diabetes mellitus reduces the need for the treatment of DR complications. Diabetic maculopathy can be suspected in patients with diabetes and poor visual acuity, macculopatia patients with these characteristics must often undergo further tests, such as fluorescein angiography and optical coherence tomography to detect subclinical abnormalities.
Maculopatai has an estimated From the health economics perspective, the prevention of DR has been established as more cost-effective than the treatment of this complication.
Some studies show that the amount spent for a patient with advanced DR is more than ten times greater than the cost to treat it at early stages; the cost increases with the progression of the disease. In Brazil, due to the large size of the country and the poor distribution of specialists, the cost is supposed to be even greater, considering the cost of OHT.
Monitoring maulopatia patients with diabetes and absent or early-stage retinopathy can be carried out via telemedicine, with a good cost-effectiveness profile. Telemedicine is included in the recommendations for Brazilian ophthalmology proposed by the CBO. In this way, patients with normal retinal examinations could reschedule their follow-up locally, avoiding travel, and patients requiring more complex treatment approaches could arrange their travel and treatment with more urgency.
We believe that, in order to reduce cases of avoidable blindness resulting from retinal diseases, in remote areas of Brazil, some measures can be taken, such as: The main retinal diseases in diabftica group of patients were diabetic retinopathy and retinal detachment. Diabetic retinopathy is a preventable cause of blindness, maculopatiz can be remotely monitored at early stages, through telemedicine strategies.
In remote Brazilian locations, telemedicine can be an important tool for monitoring of retinal diseases. Foram atendidos pacientes. Tiveram o exame da retina possibilitado pacientes. Emo Brasil contava kaculopatia um oftalmologista para cada Compete a esse programa oferecer: Foram avaliados dados referentes a pacientes atendidos. National Center for Biotechnology InformationU. Journal List Einstein Sao Paulo v.
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Author information Article notes Copyright and License information Disclaimer. Received Sep 21; Accepted Nov This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which duabetica unrestricted use, distribution, and reproduction in any medium, provided the maculkpatia work is properly cited.
Methods Patients underwent slit lamp biomicroscopy, dilated fundus exam and ocular ultrasound. Results A total of patients were examined. Conclusion Diabetic retinopathy was the main retinal disease in this population. Diabetic retinopathy, Telemedicine, Retinal detachment, Cataract, Blindness.
Prof. Bruno Lumbroso
Cataract Forty-two patients had transparent crystalline lenses in both eyes Retinal diqbetica Six patients were unable to undergo retinal examination due to media opacity and had no light perception in the examined eye. Table 1 Fundoscopic changes in patients awaiting out-of-home treatment in Rio Branco, Acre, April Change Number of patients Observation Chorioretinal scar 6 – Retinal dystrophy 3 – Age-related macular degeneration 5 1 exudative case with indication for treatment Rhegmatogenous retinal detachment 23 – Postoperative management of retinal detachment 10 6 eyes with silicone jaculopatia Glaucoma 14 1 case of congenital glaucoma Vitreous hemorrhage 1 Not associated with diabetes Undetermined maculopathy 4 – Epiretinal membrane 3 – Ischemic optic neuropathy 1 Sequela Choroidal nevus or tumor 2 – Normal exam 20 Of these, 8 patients with diabetes Diabetic retinopathy 32 10 non-proliferative, of which 5 with macular edema; the other 22 cases were proliferative Hypertensive retinopathy 3 2 with retinal vascular occlusion Posterior uveitis 2 – Total Open in a separate window.
An Acad Bras Cienc. Prevalence of mavulopatia and diabetic retinopathy in a Brazilian population. Changes in detection of retinopathy in type 2 diabetes in the first 4 years of a population-based diabetic eye screening program.