Diabetic macular edema

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Retinal Thickness After Focal Photocoagulation For Diabetic Macular Edema With and Without Temporal Perifoveal Thickening

Retinal Thickness After Focal Photocoagulation For Diabetic Macular Edema With and Without Temporal Perifoveal Thickening

Background: Visual improvement after focal photocoagulation in diabetic macular edema is more common in eyes without temporal perifoveal thickening. This feature is related to a lower macular volume before treatment; the higher proportion of visual improvement could be associated with a shorter need of volume reduction. Objective: To compare macular volume before and after focal photocoagulation in eyes with diabetic macular edema, with and without temporal perifoveal thickening. Methods: Non-experimental, retrospective, longitudinal, comparative study in diabetics with macular edema treated with focal photocoagu- lation. Macular volume measured with optical coherence tomography, and best corrected visual acuity were compared between eyes with (group 1) and without temporal perifoveal thickening (group 2, independent samples Student’s t test). The comparison was also performed after stratifying the groups by baseline visual acuity. Results: One hundred and twenty eyes, 65 eyes from group 1 (54.2%) and 55 from group 2 (45.8%). Mean volume before and after treatment and mean absolute and percentage changes were lower in group 2 (p < 0.001) regardless of visual acuity. Macular volume decreased significantly in eyes of group 1; only eyes in group 2 with visual acuity < 0.5 before treatment increased their visual function (p < 0.001). Conclusions: Eyes without temporal perifoveal thickening had visual improvement, although their volume did not change statistically. The significant volume reduction in eyes with temporal perifoveal thickening was not associated to visual improvement. The anatomical change was not enough to explain the functional improvement. (REV INVEST CLIN. 2015;67:25-32)
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Combined therapy in diabetic macular edema

Combined therapy in diabetic macular edema

Controlled clinical, experimental, prospective, longitudi- nal, comparative and blind essay, including those patients from the Department of Ophthalmology at the ‘‘Dr. José Eleuterio González’’ University Hospital using the follow- ing inclusion criteria: male and female with diabetes (type I or II), 18 years of age or older, with a clinical and tomo- graphic DME diagnosis, best corrected visual acuity (BCVA) higher than 20/400. Patients who did not present any of the exclusion criteria; presence of significant cataract (accord- ing to the researcher’s criteria), diagnosis of glaucoma, vitreous hemorrhage, previous intraocular surgery, macular laser treatment and/or intravitreal drug therapy in the three months previous to the study. Patients who for any reason did not complete treatment or developed complications dur- ing treatment were eliminated. The protocol was evaluated and approved by our institution’s Ethics Committee and reg- istered under the code OF11-010. The study was conducted following the guidelines established in the Helsinki Decla- ration and the International Conference on Harmonization Guidelines for Good Clinical Practices. All patients signed an informed consent form respecting the Official Mexican Standards on the patients’ right to know everything about their illness and its possible treatment options.
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Treatment of Diabetic Macular Edema (DME): Shifting paradigms

Treatment of Diabetic Macular Edema (DME): Shifting paradigms

6. González Cortés JH, Mohamed Noriega K. Evaluación terapéutica del anticuerpo monoclonal anti factor de crecimiento endotelial vascular, Bevacizumab, intravitreo, en el tratamiento del edema macular clínicamente significativo diabético. Proyecto de Tesis doctoral del Dr. med. Karim Mohamed concluido. Departamento de Oftalmología, Hospital Universitario, Facultad de Medicina, Universidad Autónoma de Nuevo León; 2008.

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Baja recurrencia del edema macular diabtico focal, 6 meses despus de la fotocoagulacin

Baja recurrencia del edema macular diabtico focal, 6 meses despus de la fotocoagulacin

Objective: To identify the proportion of eyes with recurrence of diabetic macular edema, six months after focal photocoagu- lation. Method: Non-experimental, analytical, cross-sectional and prospective study in patients with diabetic macular edema treated with focal photocoagulation. The proportion and 95% confidence intervals (95% CI) of eyes with recurrence of edema were identified; the distribution of anatomical variables and visual acuity was compared between eyes with and without recu- rrence, using Mann-Whitney's U. Results: 145 eyes were evaluated, and only 10 (95% CI: 2.8-11) had a recurrence. Center point thickness and center field thickness means were higher in eyes with recurrence than in eyes without it, but the differen- ce of change mean betwwen groups was not statistically significant. Conclusion: The proportion of recurrent diabetic macu- lar edema recurrence six months after successful focal photocoagulation was lower than the one reported for other treatments of diabetic macular edema, and by recent studies that used photocoagulation.
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El ruboxistaurin, una alternativa en el edema macular diabtico

El ruboxistaurin, una alternativa en el edema macular diabtico

Development: the hyperglycemia among other metabolic alterations, to active the kinase C protein contributing to microvascular dysfunction, an important disorder in the pathogenesis of the diabetic macular edema. Different therapeutical procedures have been used in its treatment. In past years the ruboxistaurin has showed its ability to inhibit the activation of C kinase protein. Some authors consider that this drug is able to improve the diabetic macular edema and thus, the vision. It has been reported that the administration of 32 mg daily de ruboxistaurin prevents the progression of the diabetic retinopathy and decrease the risk of visual loss from diabetic macular edema. Other studies describe similar results and also, report that this drug decreases the risk or worsening and progression of this type of edema as well as to reduce the need of laser treatment.
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Modificacin del volumen macular por engrosamiento del rea temporal, en edema macular diabtico focal

Modificacin del volumen macular por engrosamiento del rea temporal, en edema macular diabtico focal

Background. Eyes with diabetic macular edema without thickening in the temporal sector of the macula, improve their vision more frequently after photocoagulation; a larger volume reduction or a larger visual deficiency before treatment could be associated with a larger functional change, but it is unknown whether these variables differ significantly between eyes with and without thickening in the temporal sector of the macula. Material and methods. Non-interventional, comparative, retrospective, cross- sectional study. Patients with focal diabetic macular edema who had an optical coherence tomography fast macular map before photocoagulation were included; eyes were assigned to one of two groups: 1 (with thickening in field 7, external temporal sector of the macula) or 2 (without it). The means of best corrected visual acuity and macular volume (Student’s t) and the proportions of best corrected visual acuity < 0.5 and thickening of the center point (χ 2 , odds ratio [OR]) were compared between groups. Results.
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Disparidad entre grosor foveal y volumen macular en edema macular diabtico  Por qu no utilizar uno solo para el seguimiento?

Disparidad entre grosor foveal y volumen macular en edema macular diabtico Por qu no utilizar uno solo para el seguimiento?

Background: Optical coherence tomography (OCT) quantifies changes of foveal thickness and macular volume after photoco- agulation in diabetic macular edema. Macular volume evaluates the whole macula, but it may underestimate changes in foveal thickness induced by photocoagulation. We undertook this study to evaluate the concordance between macular volume and foveal thickness for identifying clinically significant changes of retinal thickness after photocoagulation for diabetic macular edema. methods: We carried out an observational, prospective, longitudinal, analytical study. Center point thickness (CPT), central subfield mean thickness (CSMT) and macular volume were measured with OCT before photocoagulation and 3 weeks after in diabetic patients with focal macular edema (January 2006–January 2010). Concordance among variables to detect clinically significant changes (CPT >17%, CSMT >11%, macular volume >3%) was identified using the kappa test.
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Intravtrea de bevacizumab vs  bevacizumab y triamcinolona para el edema macular diabtico

Intravtrea de bevacizumab vs bevacizumab y triamcinolona para el edema macular diabtico

Objective: to evaluate the use of intravitreal bevacizumab injection alone or combined with triamcinolone as well as the adverse effects and the correlation between the best corrected visual acuity and the central macular thickness. Methods: prospective, longitudinal and observational double-blinded case control study performed in 90 patients with untreated diabetic macular edema and no vitreous traction in the vitreous-retina service of "Ramón Pando Ferrer" Institute of Ophthalmology of Cuba. They were randomly divided into 3 groups for treatment: a control group treated with laser, another one with intravitreal bevacizumab (1,25 mg in 0,05 mL) and the other with bevacizumab plus triamcinolone (1,25 mg in 0,05 mL plus 4 mg in 0,1 mL, respectively). Each group had 30 patients, with progress evaluated at 6, 12, 16, 24, 30 weeks and one year.
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Recomendaciones para el uso de ranibizumab en edema macular diabtico en el IMSS

Recomendaciones para el uso de ranibizumab en edema macular diabtico en el IMSS

Diabetic macular edema can occur at any stage of diabetic retinopa- thy. It represents the main cause of vision loss in diabetes type I and II with a prevalence of 3-10% in diabetic patients of the Instituto Mexicano del Seguro Social (IMSS). Our aim is to elaborate treatment guidelines and provide recommendations for the use of intravitreal ranibizumab for diabetic medical edema at IMSS. Nine retina specialists and 10 ophthal- mologists from IMSS high specialty medical units gathered to discuss the bibliographic evidence for the safety and efficacy of ran bizumab for this disease, in order to create consensus on its use in the institution. Intravit- real ranibizumab injection should be used on patients presenting diffuse or cystic diabetic macular edema who have strict metabolic control and visual acuity between 20/30 and 20/200 ETDRS, as well as structural features, such as inferior foveal limit of 280 μm and ischemic areas no larger than 50% of the central foveal area. Treatment regime should con- sist of a loading charge of three monthly injections of ranibizumab 0.5 mg, followed by monthly follow-ups and treatment as needed according to anatomic and functional criteria. This consensus decision-making pro- cess on the criteria to treat and re-treat patients with this drug will result in better health outcomes than those currently observed among patients with diabetic macular edema at IMSS.
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Distribucin de la gravedad del edema macular diabtico al momento del diagnstico

Distribucin de la gravedad del edema macular diabtico al momento del diagnstico

Background: The International Clinical Diabetic Macular Ede- ma Disease Severity Scale grades retinal thickening accord- ing 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. methods: 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.
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Triamcinolona intravtrea como coadyuvante en el tratamiento del edema macular diabtico difuso

Triamcinolona intravtrea como coadyuvante en el tratamiento del edema macular diabtico difuso

Methods: 20 eyes of 10 patients with diabetic macular edema were enrolled in the study. Right eyes were assigned to the study group; left eyes were used as control. Macular photocoagulation was applied in both eyes; study group eyes received 4 mg intravitreal triamcinolone. Changes in visual acuity and intraocular pressure were registered at 30, 90, and 120 days. Results: Mean visual acuity was 20/50 in both groups. At 6 months 40% in the study group improved visual acuity, 70% in the control group worsened. Intraocular pressure elevated in 20% of the study group.

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Distribucin topogrfica del edema macular diabtico por tomografa de coherencia ptica

Distribucin topogrfica del edema macular diabtico por tomografa de coherencia ptica

El EM se evalúa clínicamente con lentes de contacto, que permiten identificar las zonas afectadas, al compararlas con la retina que no está engrosada (4). La identificación puede dificultarse si la diferencia de grosor no es evidente, pero un método cuantitativo de medición superaría la limitación. La tomografía de coherencia óptica (OCT) proyecta una luz infrarroja a través de la pupila y luego al vítreo, retina y coroides; la coherencia de dos rayos de luz en la retina ge- nera un patrón de interferencia que el instrumento cuantifi- ca (5). La OCT puede medir el grosor retiniano (6) y cuan- tificar el EM objetivamente (2) y de manera reproducible (7), información que no se obtiene con métodos cualitativos. La prueba de mapeo rápido macular (fast macular map), in- tegra un mapa topográfico de grosor en tres círculos concéntri- cos de 1, 3 y 6 mm, dividido en 9 zonas (figura 1) (8) y deter- mina también el grosor foveal central y el volumen macular.
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Comparacin del grosor macular con y sin edema en pacientes diabticos mexicanos

Comparacin del grosor macular con y sin edema en pacientes diabticos mexicanos

mente la presencia de retinopatía proliferativa indica la presencia de isquemia que puede limitar aún más la visión (3). En los casos más comunes de edema macular, asociado a retinopatía no proliferativa, el engrosamiento retiniano po- dría disminuir satisfactoriamente con el tratamiento láser; mientras menor sea el porcentaje de engrosamiento la sepa- ración de los fotorreceptores también será menor y teórica- mente existe una mayor probabilidad de mejoría visual.

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Revisin bibliogrfica: edema macular diabtico, repercusiones y tratamiento

Revisin bibliogrfica: edema macular diabtico, repercusiones y tratamiento

In our country there is a report of prevalence of Diabetes Mellitus in the adult population of a 10%, occupying one of the fi rst causes of morbidity- mortality, also visual and labor incapacity. Macular edema is the fi rst cause of lost vision in the diabetic patient. There are classic methods to detect it, as the examination with biomicroscope, indirect ophthalmos- copy, fl uorangiography (FAR), and the new and gold standard method for diagnostic and sequence examination, Ocular Coherence Tomography (OCT). With OCT had been possible the study of distinct types of macu- lar edema, that could represent distinct clinical states, with specifi c treat- ments. The protocol of treatment of macular edema, continues changing. The traditional methods as metabolic control and fotocoagulation with Laser now have more options as intravitreal injection of triamcinolone, or antiangiogenic substances, even surgical treatment with vitrectomy. There are many prospective and randomized studies evaluating this methods, so until now is diffi cult to determine wich treatment is the best.
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Dorzolamida en el tratamiento del edema qustico macular posciruga de catarata

Dorzolamida en el tratamiento del edema qustico macular posciruga de catarata

De tal manera, la historia natural referente al EQM ha quedado descrita como un primer día posterior a la cirugía de catarata en el cual el grosor macular aumenta 10 % por OCT, sin la aparición de quistes habitualmente. La incidencia de quistes aumenta entre la cuarta y la sexta semana de la cirugía, con la afectación de la agudeza visual. La resolución espontánea puede ocurrir, aunque puede ocasionar daños irreversibles en la arquitectura retinal y secuelas visuales. 2,4

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Acetonido de triamcinolona intra vitreo en el edema macular diabético

Acetonido de triamcinolona intra vitreo en el edema macular diabético

Existen limitaciones en el presente estudio. El diseño no randomizado del estudio y sin grupo control, es por sobre todo el punto más débil de la presente investigación. Se realizó un estudio piloto previo, donde se observó un efecto positivo del acetónido de triamcinolona sobre el edema macular diabético y por consiguiente sobre la agudeza visual de los pacientes, por lo que nos planteamos que no era éticamente aceptable, dejar a un grupo de pacientes sin tratamiento. Por otra parte no era justificable, inyectar un placebo a un grupo control, sólo con fines de investigación y exponerlos a las potenciales complicaciones de una inyección intravítrea. Encontramos otra limitación del estudio en
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Microperimetra y triamcinolona intravtrea en el edema macular clnicamente  significativo

Microperimetra y triamcinolona intravtrea en el edema macular clnicamente significativo

Clinical  case:  a  patient  with  macular  edema  clinically  significant  associated  with  moderate  non­proliferative  diabetic  retinopathy  was  evaluated  through  visual  acuity  test  with  best  correction,  biomiscroscopy  of  the  anterior  and  posterior  segment,  indirect ophthalmoscopy, tonometry, microperimetry, automatic protocol to the macula  of  12  degrees,  45  macular  points  was  used.  Eyeground  examination  and  biomiscroscopy of the posterior segment showed intraretinal rounded bleeding in four  quadrants, beaded venae in a quadrant, intraretinal microvascular abnormalities in two  quadrants, thick and tortuous vessels, macula with hard exudate in posterior pole and  microaneurysms  outside  of  the  foveolar  avascular  zone,  in  circinate  forms,  and  scattered microhemorrhagia. 
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Correlacin entre grosor macular y capacidad visual en pacientes con retinopata diabtica y edema macular clnicamente significativo

Correlacin entre grosor macular y capacidad visual en pacientes con retinopata diabtica y edema macular clnicamente significativo

Actualmente contamos con la tomografía óptica cohe- rente (OCT) que es un método diagnóstico nuevo, que per- mite obtener mediciones cuantitativas reproducibles del grosor macular (21). Este sistema se basa en la interfero- metría de baja coherencia, lo que permite obtener imáge- nes topográficas de la reflectividad óptica de la retina, con una alta resolución. Se puede comparar con una ecografía modo B, sólo que el OCT mide la reflectividad óptica y no la acústica, con una resolución de 10 micras. Las imágenes obtenidas se muestran con una escala de color en donde las zonas de alta reflectividad se representan con colores cáli- dos y brillantes, y las zonas con baja reflectividad corres- ponden a las áreas representadas con colores fríos. La me- dida del grosor retiniano se obtiene directamente de los cortes realizados, y se calcula como la distancia medida entre la interfase vítreorretiniana y la zona de alta reflectividad (roja) que corresponde al epitelio pigmentado de la retina y coriocapilaris (22). Actualmente es el méto- do más preciso para determinar el grosor macular y docu- mentar cambios en el mismo.
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Combinacin de antiangiognico y esteroides intravtreos en el tratamiento del edema macular diabtico

Combinacin de antiangiognico y esteroides intravtreos en el tratamiento del edema macular diabtico

El edema macular es una enfermedad crónica con una respuesta variable y manifestaciones clínicas que afectan al paciente a lo largo de su vida. Los tratamientos disponibles están encaminados a atacar diferentes mecanismos fisiopatológicos de la enfermedad por lo que resulta interesante evaluar la posibilidad de una terapia combinada que pudiera resultar efectiva. En general es bien sabido que los esteroides intravítreos pueden contrarrestar la parte inflamatoria responsable de adhesión leucocitaria mientras que los agentes anti-VEGF disminuyen de manera importante los efectos de esta molécula a nivel retiniano y vascular, sobre todo en lo que referente a la permeabilidad
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Colesterol, triglicridos y otros factores de riesgo en pacientes con edema macular diabtico

Colesterol, triglicridos y otros factores de riesgo en pacientes con edema macular diabtico

Se  realizó  un  estudio  observacional  descriptivo  de  corte  transversal  con  el  objetivo  de  identificar  la  presencia  de  dislipidemia  y  otros  factores  de  riesgo  en  pacientes  con  diagnóstico  de  edema  macular  diabético  (EMD)  realizado  en  la  consulta  de  retina  del  Centro Oftalmológico del Hospital Universitario Manuel Ascunce Domenech de Camagüey  en el período comprendido entre octubre de 2011 a octubre de 2012. 

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