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Background: complications of proliferative diabetic retinopathy require surgical treatment. In 2007 Flaxel reported visual improvement after vitreoretinal surgery in 37% of Latino diabetics; in our country it is estimated that a higher proportion of patients improves, but this has not been documented., Aim: to identify the efficacy of vitreoretinal surgery for improving best corrected visual acuity, in diabetic patients treated at a hospital in Mexico City., Methods: an observational, longitudinal, retrospective, descriptive study was conducted in diabetics who underwent vitreoretinal surgery (2007-2010) with one year follow-up. Visual acuity was measured before surgery and one year after, and it was registered when the retinopexy orphacoemulsification was performed, or silicone tamponade wasused. The proportions and 95% confidence intervals (CI) of patients whose visual acuity improved, did not change or worsened, were compared with those reported by Flaxel in Latino patients (χ(2), relative risk [RR])., Results: 63 patients, mean age 58.5 ± 11.6 years, 26 with retinal detachment (41.3%), phacoemulsification was performed in 50 (79.4%), and silicone was used in 27 (42.9%). BCVA worsened in 12 patients (19%), did not change in 5 (8%) and improved in 46 (73%, 95% CI 62-84); the latter proportion exceeded that reported by Flaxel (p = 0.0005, RR 1.97, 95% CI 1.25-3.1)., Discussion: although the difference was not clinically significant, the efficacy of vitreoretinal surgery to improve visual acuity in the sample was consistently higher than that reported by Flaxel in Latinos, and did not vary from other studies. These results do not support an association between an ethnic group and a lower surgical efficacy.

Background: Risk of retinal damage in open globe eye injuries increases as the zone (location of the wound vertex) is more rearward. The value of clinical exploration to assess this variable is unknown., Objective: To establish the efficacy of clinical exploration as a diagnostic test to identify the injury zone in open globe ocular trauma., Methods: Assessment of patients with open globe ocular trauma, preoperative clinical assessment of injury zone and surgical description of the wound were carried out. The proportion and 95% confidence intervals (CI) of eyes whose zone changed during surgical repair were established, and the efficacy of clinical evaluation to diagnose zone was estimated. Features of eyes with and without zone change were compared using χ(2) test., Results: 89 eyes, mean age 27.1 years. Clinically, the identified zone was I in 36 eyes (40.4%), II in 38 (31.5%) and III in 25 (28.1%); the identified zone during surgery was I in 36 eyes (40.4%), II in 43 (48.3%) and III in 10 (11.2%). Zone changed in 30 eyes (34%, 95% C.I. 24 to 44). Specificity (96%), positive predictive value (93%) and positive likelihood ratio (13.9) were high only for zone II. No feature was associated with zone change., Conclusions: Clinical exploration was not efficient enough to identify injury zone in open globe trauma and has low prognostic value. It is not necessary to define the injury zone at first contact; it is enough identifying properly the agent, visual function and pupil reflexes for an efficient assessment.

Background: Photocoagulation reduces the incidence of moderate visual loss in patients with clinically significant macular edema (CSME). However, the incidence of visual improvement after treatment is low. Diffuse retinal thickening identified with optical coherence tomography (OCT) and visual loss before treatment have been associated with visual improvement., Objective: To identify features associated with visual improvement after focal photocoagulation for CSME., Methods: Observational, analytical, longitudinal, retrospective study. Diabetic patients with CSME treated with focal photocoagulation were evaluated. Study variables were: visual improvement (defined as a gain of one or more lines in a vision chart) and ocular and systemic features before treatment. Clinical and ancillary test variables were compared between eyes with and without visual improvement. Mann-Whitney's U was used to compare quantitative variables; χ(2) was used for qualitative variables., Results: 99 eyes of 72 patients mean age 60.6 years, 59.6% females. 38.4% had visual improvement after treatment. The incidence of visual improvement was higher in eyes with vision < 20/40 before treatment (58.8 vs. 16.7%, p < 0.001, relative risk 3.53). In eyes with vision = 20/40 before treatment, the probability of improving was 12 times higher when field 7 of the OCT map had no thickening (p < 0.001). The remaining variables showed no significant associations., Conclusions: Up to 48% of treated eyes could achieve visual improvement. Consistently with previous reports, the probability increased in eyes with vision < 20/40 before photocoagulation; when vision before treatment was = 20/40, the incidence of visual improvement increased significantly in eyes without thickening in the temporal parafoveal retina.

Background: Visual prognosis of injured eyes estimated by the Ocular Trauma Score (OTS) can be used to evaluate the efficacy of open globe treatment. The aim of this study was to identify the OTS features over which interventions could be performed to improve visual outcome in patients with open globe trauma., Methods: We carried out an observational, longitudinal, retrospective-prospective, analytical study. Patients with open globe trauma from a general hospital were evaluated. The initial proportions of visual deficiency (best corrected visual acuity <20/40) and ambulatory vision (best corrected visual acuity >20/200) were identified, and the corresponding expected proportions and 95% confidence intervals (CI) after treatment were estimated using the OTS; both proportions were compared with those obtained in the sample (χ(2)). OTS features associated with a higher proportion of visual improvement were identified., Results: Fifty eyes were studied (mean age 28.6 ± 19 years, 58.4% males). The initial proportion of visual deficiency changed from 92% to 72% (p = 0.009) and that of ambulatory vision changed from 24% to 52% (p = 0.004); the expected proportion of visual deficiency was 58% (95% C.I. 44-72) and that of ambulatory vision was 64% (95% CI 52-77). In eyes with OTS category 3 where neither ruptures nor surgical retinal diseases were initially found, visual improvement was more common but less than expected., Conclusions: Treatment significantly changed the proportions of visual deficiency and ambulatory vision, but its efficacy was the minimal expected. Standardization of anterior segment surgical procedures may improve visual outcome in eyes with open globe trauma with OTS categories 3 to 5.

Background: The tomographic cut-off point to detect macular edema uses an international reference of retinal thickness, which is greater than that in our population. We undertook this study to identify the expected value of central subfield mean thickness (CSMT) in Mexican patients with diabetes with clinically significant macular edema (CSME) and the proportion in which using only the tomographic cut-off point for clinical macular edema (>300 μm) could overlook the diagnosis., Methods: We carried out an observational, analytical, crosssectional and prospective study. Eyes of diabetic patients with CSME (January 2006-June 2007) with a fluorescein angiography and optical coherence tomography were included. The sample was divided according to angiographic type: monofocal (group 1), multifocal (group 2), or diffuse (group 3). The mean of CSMT of each group was weighed by the proportion represented by each group to calculate the all-type expected value. The proportion of eyes with CSMT = 300 μm was identified., Results: Ninety-three eyes were included. Mean age was 60.9 years; there were 57 females (61.3%). Forty-one eyes were assigned to group 1 (44.1%, CSMT 210.63 μm), 31 to group 2 (33.3%, CSMT 279.65 μm), and 21 to group 3 (22.6%, CSMT 327.14 μm). The expected value of CSMT was 259.9 μm, 37.75% over the normal reference in the study population and 23% over the American reference. CSMT was <300 μm in 79.6% of the eyes (95% CI 71.4-87.8)., Conclusions: The expected value of CSMT in Mexican patients with diabetes with CSME was within the range internationally regarded as subclinical. Using local references of CSMT is recommended to avoid overlooking the diagnosis of CSME and overestimating its treatment effect.

Background: Optical coherence tomography (OCT) quantifies changes of foveal thickness and macular volume after photocoagulation 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, retrospective, 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., Results: Sixty eight eyes were included; 47 eyes had nonproliferative retinopathy (69.1%). CPT increased significantly in 14.7% of the sample; CSMT in 8.8%, and macular volume in 11.8%. CPT decreased significantly in 4.4%, CSMT in 8.8%, and macular volume in 42.6%. Concordance was regular for CPT and CSMT increased (57%). Concordance was good for CPT and CSMT decreased (64%). Concordance was regular for CSMT and macular volume decreased in eyes with center involvement (43%). The remaining concordances were poor., Discussion: Two independent events happen after focal photocoagulation: involution of the original thickening and increase in CPT. In order to detect both events, evaluation of either foveal thickness alone or macular volume alone is insufficient., Conclusion: Identifying the efficacy and safety of treatments for diabetic macular edema requires simultaneous measurement of CPT and macular volume.

Background: Usual retinal surgery (vitrectomy or surgery for retinal detachment) may require additional procedures to deal with complex cases, which increase time and resource use and delay access to treatment. We undertook this study to identify the proportion of primary retinal surgeries that required complex procedures and the associated causes., Methods: We carried out an observational, descriptive, cross-sectional, retrospective study. Patients with primary retinal surgery were evaluated (January 2007-December 2010). The proportion and 95% confidence intervals (CI) of preoperative diagnosis and cause of the disease requiring retinal surgery as well as the causes for complex retinal surgery were identified. Complex retinal surgery was defined as that requiring lens extraction, intraocular lens implantation, heavy perfluorocarbon liquids, silicone oil tamponade or intravitreal drugs, in addition to the usual surgical retinal procedure. The proportion of complex retinal surgeries was compared among preoperative diagnoses and among causes (χ(2), odds ratio [OR])., Results: We studied 338 eyes. Mean age of subjects was 53.7 years, and there were 49% females. The most common diagnoses were vitreous hemorrhage (27.2%) and rhegmatogenous retinal detachment (24.6%). The most common cause was diabetes (50.6%); 273 eyes required complex surgery (80.8%, 95% CI: 76.6-85). The proportion did not differ among diagnoses but was higher in diabetic retinopathy (89%, p <0.001, OR 3.04, 95% CI: 1.63-5.7)., Conclusions: Of the total sample, 80.8% of eyes required complex surgical procedures; diabetic retinopathy increased by 3-fold the probability of requiring these complex procedures. Early treatment of diabetic retinopathy may reduce the proportion of complex retinal surgery by 56%.

Background: The International Clinical Diabetic Macular Edema Disease Severity Scale grades retinal thickening according 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., Results: We studied 118 eyes (mean ± SD: 59.9 ± 8.3 years). Seventy one eyes had nonproliferative retinopathy (60.1%), 94 eyes (79.7%) had focal macular edema, and 24 eyes (20.3%) showed diffuse edema. Edema severity was mild in 27 eyes (22.9%, 95% CI 15.3-30.5), moderate in 23 (19.5%, 95% CI 12.3-26.6) and severe in 68 (57.6% 95% CI 48.7-66.5)., Conclusions: Standardization of the International Clinical Scale using OCT showed that the most common severity level of macular edema was severe; the minimum expected proportion of eyes with high risk of visual loss secondary to severe edema approached 50%. Opportune detection needs reinforcement because more than half of these eyes require immediate treatment.

Background: Photocoagulation is the standard treatment for clinically significant macular edema (CSME). This procedure is effective in reducing macular thickening, but it has been reported that initially it does not improve the thickness at the area of best visual function (center point of the fovea). We undertook this study to compare the effect of focal photocoagulation on center point thickness (CPT) and macular volume 3 weeks after treatment in Mexican diabetic patients with CSME, with and without center point involvement., Methods: We carried out an observational, retrospective, longitudinal, analytical, open study. Type 2 diabetic patients undergoing focal photocoagulation for CSME at a general hospital in Mexico City were evaluated. Mean CPT and macular volume were compared before and 3 weeks after photocoagulation (paired t test) in the sample and in eyes with (group 1) and without (group 2) baseline center point involvement. Absolute and percent CPT and macular volume changes were identified., Results: Fifty-nine eyes (mean age 59.6 years) were studied. CPT mean increased from 193 to 197 μm (p = 0.3), statistically in group 2 (168.8 to 178.5 μm, p <0.001). Macular volume mean changed from 7.8 to 7.6 mm(3) (p <0.001). CPT increased 3.9 μm (3%) in the sample, whereas macular volume decreased 0.26 mm(3) (3.1%). Correlation between changes was 0.089., Conclusions: Although macular volume decreased statistically 3 weeks after photocoagulation, CPT did not and increased statistically in eyes without baseline center point involvement, which was unnoticed in the sample effect. These changes should not be overlooked because dealing with them could improve the early results of treatment.

Background: Ocular trauma affects males more often than females, but the impact of this condition regarding visual prognosis is unknown. We undertook this study to compare the probability of developing ocular trauma-related visual deficiency between genders, as estimated by the ocular trauma score (OTS)., Methods: We designed an observational, retrospective, comparative, cross-sectional and open-label study. Female patients aged ≥6 years with ocular trauma were included and matched by age and ocular wall status with male patients at a 1:2 male/female ratio. Initial trauma features and the probability of developing visual deficiency (best corrected visual acuity <20/40) 6 months after the injury, as estimated by the OTS, were compared between genders. The proportion and 95% confidence intervals (95% CI) of visual deficiency 6 months after the injury were estimated. Ocular trauma features and the probability of developing visual deficiency were compared between genders (χ(2) and Fisher's exact test); p value <0.05 was considered significant., Results: Included were 399 eyes (133 from females and 266 from males). Mean age of patients was 25.7 ± 14.6 years. Statistical differences existed in the proportion of zone III in closed globe trauma (p = 0.01) and types A (p = 0.04) and type B (p = 0.02) in open globe trauma. The distribution of the OTS categories was similar for both genders (category 5: p = 0.9); the probability of developing visual deficiency was 32.6% (95% CI = 24.6 to 40.5) in females and 33.2% (95% CI = 27.6 to 38.9) in males (p = 0.9)., Conclusions: The probability of developing ocular trauma-related visual deficiency was similar for both genders. The same standard is required.

Background: ocular trauma produces psychological, social and occupational effects that can cause significant impairment. Evaluation of ocular trauma has been standardized by a system for classifying mechanical injuries of the eye (SCMIE). Parameters that are most commonly a source of error for the evaluator and that may lead to classification errors have not been identified., Methods: an observational, retrospective, descriptive, cross-sectional and open study was conducted. Files of patients of either gender, aged 6 years or older, with ocular trauma graded with the SCMIE between 1997 and 2009 were re-evaluated by an independent investigator. The rate and 95% confidence intervals (95% CI) of evaluations that resulted in errors during the re-evaluation of ocular trauma were identified in the sample and in general for each parameter. The disparity between the initial evaluation and the re-evaluation (MacNemar) and the concordance between the evaluations (kappa) were analyzed., Results: of 817 evaluations, 294 had at least one grading error (36%, 95% CI 32.7-39.3). The most frequent error source was the parameter type. The disparity was significant in parameters type A, D, grade 2 and zone II. Overall concordance was good., Conclusions: it is necessary to reinforce the learning curve for some parameters of the SCMIE, especially type, in order to improve its evaluation, so that it can become a valid communication tool that favors early referral to the specialist.

Background: Ocular trauma (OT) is a common cause of monocular blindness and visual impairment worldwide. The Ocular Trauma Score (OTS) is a scale that estimates visual function that an injured eye can achieve 6 months after OT. In a sample population, the OTS may be useful to compare the expected functional result with the result of therapeutic interventions in OT. We undertook this study to identify the expected effect of treatment on the rate of visual deficiency 6 months after OT., Methods: The rate of eyes with trauma-related visual deficiency (best corrected visual acuity <20/40) at the time of diagnosis was compared with that estimated 6 months later using the OTS (95% confidence intervals, CI)., Results: We evaluated 742 patients; 46% had visual deficiency initially (95% CI 43-50.2) and 32.1% would demonstrate it 6 months later (95% CI 28.7-35.4, p <0.001, OR 0.54). The rate changed from 29.1 to 18% in closed-globe (CG) trauma and from 84.3 to 63% in open-globe (OG) trauma., Conclusions: Treating OT would reduce the proportion of visual deficiency by 14.5 percentage points (11 in CG, 21.3 in OG trauma). Up to 66% of the injured eyes could reach normal vision. OT prevention requires enhancement because a high rate of eyes would remain disabled despite receiving the best available treatment.

Background: The system for classifying mechanical injuries of the eye can identify the status of an injured eye at the trauma room, but it has no prognostic value. The ocular trauma score (OTS) estimates the 6-month visual prognosis, but some of its variables require evaluation by an ophthalmologist. We identified the proportion of injured eyes without diseases that required assessment of an ophthalmologist during the initial evaluation in order to determine whether the OTS could be used by non-ophthalmologists at the trauma room., Methods: We evaluated patients with ocular trauma who attended a general hospital in Mexico City between 1995 and 2008 and graded them with the system for classifying mechanical injuries of the eye. The rate of eyes with retinal detachment and endophthalmitis that needed evaluation by an ophthalmologist was identified, and all the eyes were assigned an OTS category. The proportion and 95% confidence intervals (95% CI) of eyes that could be graded using the OTS in a trauma room was determined., Results: We evaluated 742 eyes. Retinal detachment was found in six eyes (0.8%, 95% CI 0.16-1.44) and endophthalmitis in two eyes (0.3%, 95% CI 0-0.69). The proportion of eyes that could be graded using the OTS in a trauma room was 98.9% (95% CI 98.15-99.65)., Conclusions: OTS can be used to estimate the visual prognosis of almost every injured eye during the initial evaluation in a trauma room without the evaluation of an ophthalmologist.

Background: The most common features of the system for classifying ocular injuries of the eye in patients who require urgent retinal surgery were identified, and their predictive value was estimated in order to determine whether they are useful in detecting these patients., Methods: Patients with ocular trauma between 1998 and 2007 were retrospectively evaluated and assigned to one of two groups: group 1 (with injuries that required urgent retinal surgery) and group 2 (without those injuries). The rate and 95% confidence intervals (CI) that group 1 accounted for were identified. The rate of the most common features in group 1 was identified and compared with their rate in group 2 using chi(2) and odds ratio. Predictive values of those features for detecting group 1 were calculated., Results: Two hundred thirty eight eyes (mean age: 27.5 years) were included. Ten eyes were assigned to group 1 (4.2%, 95% CI 1.6-6.7) and 228 eyes were assigned to group 2. The most frequent features in group 1 were open globe (90%), type A open globe (50%), type C open globe (30%), grade 4 (70%) and zone III (70%). The positive predictive value was 60% for type C open globe, and <50% for the remaining features., Conclusions: Although some clinical features had a statistical and clinical association with the need for urgent retinal surgery, their predictive value was insufficient because the rate of eyes that required this intervention was low. The results suggest that open globe and visual loss should be used as referral criteria, regardless of the injuries found.

Background: Diagnosis of traumatic optic neuropathy is difficult during primary care as a result of the absence of optic disk changes or coexisting injuries that may be more apparent. Although there are functional signs that suggest its presence, the lack of a comparison parameter may further prevent its detection. A case of bilateral traumatic optic neuropathy is analyzed to emphasize the need for functional evaluation in the injured eye., Clinical Case: A 34-year-old male presented with severe head trauma, loss of consciousness and type III Lefort facial fracture as a result of a vehicular accident. Seventy two hours after the accident, the left eye had only light perception and an afferent pupillary defect. The right eye had visual deficiency not explained by anterior segment injuries. Therapy was aimed at the left eye and, during follow-up, involvement of the right eye was identified very late. The patient's evolution is analyzed, as well as the causes that prevented early detection of traumatic optic neuropathy in the right eye., Conclusions: Functional evaluation must be used to search for traumatic optic neuropathy in every injured eye. The absence of ocular fundus abnormalities does not rule out the disease, especially when visual deficiency exists. Detection of patients with a positive pupil during initial evaluation of trauma is required in order to refer the patient in a timely manner to the ophthalmologist. The specialist should identify atypical cases and therapy should be initiated as early as possible.

Background: Optical coherence tomography quantifies retinal thickness, localizes diabetic macular edema (DME), and determines whether it implies visual risk. Evaluation is standardized by the macular mapping technique in two versions: 6 mm and 3.45 mm. The latter version measures with greater detail the zone adjacent to the central 1000 microm but does not evaluate the entire macula. Concordance between maps was evaluated in order to define which version better evaluated DME prospectively., Methods: The rate and 95% confidence intervals (95% CI) of eyes with DME, which had thickening adjacent to the central 1000 microm, was identified in fields of the 6-mm map and in the corresponding fields of the 3.45-mm map. The disparity between rates was identified using McNemar test, and concordance between fields was determined using kappa coefficient., Results: The rate of thickening in the studied area ranged from 31.9 to 50% with overlapping 95% CI between corresponding fields. Although significant differences existed (p <0.05), there was good concordance for 3/8 comparisons and very good concordance in five., Conclusions: Information generated by the 6-mm macular mapping was as valid as that generated by the 3.45 mapping to identify thickening adjacent to the central 1000 microm. We recommend using the 6-mm mapping prior to surgery because it has the advantage of completely measuring the macula.

Clinical Case: We present a case study of a patient with sudden visual loss, who had 20/200 visual acuity and macular edema at initial evaluation. Angiographies showed no interruption of vascular flow and in the visual field a central island of vision in the inferior hemifield was identified, surrounded by absolute scotoma., Discussion: Clinical aspect at the initial evaluation required a differential diagnosis between retinal and neural disease. The clinical approach used to integrate the retrospective diagnosis of central retinal artery occlusion is presented, and an explanation is proposed for the visual recovery after 3 months of visual loss (20/20 visual acuity)., Conclusion: Central retinal artery occlusion is a clinical diagnosis, but anatomical variants may modify the prognosis., Conclusions: Although the diagnosis of central retinal artery occlusion may be clinically evident, an angiography is required to evaluate the type of treatment to be instituted and to determine prognosis.

Background: A high rate of traumatic retinal injuries does not require a directed ocular fundus evaluation but those that deserve urgent care need it. The rate of traumatic retinal injuries that require urgent care was identified in order to learn whether there is a need of evaluating the ocular fundus in an emergency room., Methods: Patients with ocular trauma and ocular fundus evaluation who were referred to an Ophthalmology Service of a general hospital were included; patients with superficial foreign bodies were excluded. The rate of injuries that require urgent care (retinal detachment, intraocular foreign body) was identified and 95% confidence intervals (CI) were calculated., Results: One hundred fifty-three eyes of 148 patients (age 3-74 years, mean 26.4 years) were examined. Of 75 retinal injuries, 7 required urgent care (4.6%, 95% CI 1.3-7.9); the rate was 0.8% in closed globe trauma (95% CI 0-2.37) and 20.7 in open globe trauma (95% CI 5.9-35.5)., Conclusions: According to the rate of retinal injuries that would require urgent care in similar groups, in closed-globe trauma ocular fundus evaluation in the Emergency Room could be substituted by the evaluation of the fundus reflex; findings of any of these injuries in open-globe trauma does not modify the initial approach.

Background: Allergic etiology is suspected whenever a patient with conjunctivitis presents the typical clinical features; however, in ophthalmic practice, confirmation of the immune disease is uncommon. Ocular involvement is common in allergic rhinitis, and the current name of this entity is allergic rhinoconjunctivitis (ARC). Conjunctivitis diagnosis in ARC is inferred by the symptoms, but the most common ocular findings in patients with a confirmed allergic disease are unknown. The most common findings in allergic patients with ocular involvement were identified., Methods: Anterior segment of patients with an ARC diagnosis offered by an immunologist were evaluated, and the rates of the most common (whether considered related to allergy or not) were determined; 95% confidence intervals (CI) for rates were calculated., Results: One hundred and nineteen patients were evaluated, and the most common finding was conjunctival fornix edema (89.7%, 95% CI 83.5-94.7), followed by tarsal papillae (70.6%, 95% CI 62.4-78.8); the most common non-allergy-related finding was tear film deficiency (52.9%, 95% CI 43.9-61.9)., Conclusions: Conjunctival fornix edema was consistently more frequent than most of the signs used to diagnose allergic conjunctivitis in medical journals. It is suggested to intentionally look for this as recommended, in order to make a more easy diagnosis.

Background: Lid wounds are traditionally repaired at primary care centers. The intervention of the ophthalmologist is reserved for cases with lachrymal system affection. High rates of ocular injuries associated with lid wounds have been reported (61%, American series; 44%, European). The purpose of the study was to identify the rate of ocular injuries in patients with lid wounds, in order to learn whether early ophthalmic evaluation is recommended, regardless of the lachrymal system status., Methods: A retrospective, transversal, observational, analytical, open study was carried out., Statistical Analysis: 95% confidence intervals (CI) for rates, z for rates, chi(2). Referrals for lid wounds between 1996 and 2002 were reviewed. The rate of ocular injuries and lachrymal system injuries was determined and compared with those reported. The rate of ocular injuries in patients with and without lachrymal system injuries was compared, and the rate of ocular injuries was compared with that of the lachrymal system., Results: Fifty-five patients were included (ages 1-80 years, average 26.3 years). Nine had lachrymal system injuries (16.4%, 95% CI 6.7-26.1), 37 had ocular injuries (67.3%, 95% CI 55-79.6). The rate was similar to the American study and higher than the European study (p < 0.001). Of the patients with lachrymal system injuries, 55% had ocular injuries, and 74% of patients without it had them (p < 0.05)., Conclusions: At a high rate (67.3%) of lid wounds, ocular injuries coexisted. Although a lid wound not affecting the lachrymal system may be repaired at a primary care center, early ophthalmic evaluation is recommended to rule out ocular globe damage.

Introduction: We identified whether ocular trauma presentation, according to the system for classifying mechanical injuries of the eye, had modifications among different age groups, which could be useful as damage predictors during the initial evaluation of these patients., Material and Methods: Ocular trauma referrals between 1995 and 2003 were re-qualified according to the system for classifying mechanical injuries. Patients were divided into 5-year groups and the most frequent categories of type, grade, pupil and zone were determined by group. Mean age of each category and the rate of categories between groups were compared (ANOVA and Kruskal-Wallis, chi2 and odds ratio [OR])., Results: Five hundred sixty-six eyes of 551 patients were evaluated (age: 0.5-90 years, mean age: 27.7); mean age was lower for type B closed globe trauma and zone II (p < 0.05). There was a higher rate of grade 1 in patients > 60 years (OR 3.8), of grade 4 in patients < 54 years (OR 3.25) and of type B closed globe in patients > 20 years (OR 3.3). The remaining comparisons showed no clinical differences., Conclusions: There were no significant modifications in the presentation of most of the categories between age groups. Age difference was not useful as a predictor for detecting traumatic ocular damage.

Background: Prevalence of reported trauma-related blindness is 0.6% with almost half of serious ocular injuries involving the retina. Causes of visual deficit (VD) in ocular trauma were identified in patients with different grades (visual capacity), in order to determine the rate of poor functional prognosis at initial evaluation caused by posterior segment involvement and to identify a grade that could predict it., Methods: Ocular trauma referrals were re-qualified (1995-2003) according to the standardized classification. VD (grade >1) and zone were evaluated. The rate of VD and zone III with VD were determined. Injuries causing VD were identified and grouped by zone. The rate of these injuries was compared by zone, between each grade and the remaining, with chi2., Results: Five hundred fifty-seven eyes were included (mean age 27.7 years), 165 had VD (29.6%, CI 95% 25.8-33.4); 93 had zone III involvement (16.7%), 53 of whom had VD (9.5%, CI 95% 7.1-11.9%). Among injuries that caused VD (n = 323), 102 involved zone I (31.6%), 144 zone II (44.6%), and 77 zone III (23.8%). Injuries in zone III were more frequent in grade 5 (52%) than in the remaining groups (21.5%, p = 0.0005, OR 3.9)., Conclusions: In 90.5% of the eyes (CI 95%, 88.1-92.9), injuries caused VD by means of anterior segment involvement or did not cause it at all. A high rate of ocular trauma patients, even those with grade 5 at initial evaluation, may have an opportunity for visual recovery with early referral.

Introduction: Ocular hypotony is an indirect open-globe injury sign that can be evaluated during primary care. A study was performed to ascertain the chances of a patient with ocular trauma and hypotony during initial evaluation of having open-globe injury compared with another patient without hypotony, and to estimate the value of hypotony as a predictor of open-globe injury., Material and Methods: Patients with ocular trauma evaluated between 1995 and 2003 with intraocular pressure records were included; patients with other causes of hypotony were excluded. Patients with hypotony were assigned to group 1 and those without hypotony to group 2. Rate of open-globe injury was compared between groups with chi2, odds ratio (OR), and 95% confidence intervals (95% CI)., Results: Three hundred sixty one patients (aged 1-90 years average age 26.3 years) were evaluated; 329 patients had closed-globe (91.1%) and 32, open-globe injury (8.9%). Thirty six were assigned to group 1 (10%) and 325 (90%) to group 2. Twenty three patients in group 1 had open-globe injury (63.9%) while nine in group 2 had open-globe injury (2.8%, p <0.001, OR 62.12, 95% CI 21.81-183.6). There was hypotony in 71.9% of eyes with open-globe injury and in 4% of eyes with closed-globe injury., Discussion: Although hypotony was not present in every open-globe injury, the chance of finding the latter when there was hypotony was 62 times greater than without it. Absence of hypotony might be a useful tool to rule out open-globe injury. It would be convenient to validate ocular hypotony as a diagnostic test of open-globe injury by means of a prospective study.

Introduction: Prevalence of lens opacity (LO) and its association with visual deficiency (VD, visual capacity < 20/40) and diabetic retinopathy (DR) were identified in diabetic patients to estimate rate of patients in whom VD could be lowered by surgery and whether DR rate was higher in patients with LO., Materials and Methods: Type 2 diabetics without prior ophthalmic examination were evaluated; rate of LO was determined and compared with those previously reported by z for rates. Patients with LO were assigned to group 1 and those without to group 2. Rates of VD and RD in each group were compared by chi2 test and odds ratio (OR)., Results: Three hundred thirteen patients were evaluated (age range 41-87 years, mean 58.5 years) and mean diabetes duration mean was 7.8 years. LO rate was higher than expected (49%, p < 0.001): 109 patients in group 1 (53.4%) and 18 in group 2 (16.5%) had VD (p < 0.001, OR 5.59), while 46 patients in group 1 and 13 in group 2 (11.9%) had DR, which was not clinically different (p = 0.03, OR 2.15)., Discussion: Presence of LO should be considered during ophthalmic evaluation in diabetics; VD could be erroneously attributed to DR, whose detection could be limited by LO. Should LO cause significant visual impairment, extraction would help improve vision if there is no DR and would help to have an adequate optic medium to follow-up and treat the latter, if it is present.

Background: Subconjunctival hemorrhage is frequent in ocular trauma and is traditionally left untreated, awaiting spontaneous resolution unless associated with open globe injury. A study was performed to identify characteristics of eyes with subconjunctival hemorrhage, rate of coexisting additional injuries, and whether visual acuity might allow detection of the latter., Material and Methods: Patients evaluated for ocular trauma at our service between 1996 and 2000 with subconjunctival hemorrhage were included; eyes without visual acuity record were eliminated. Each eye was re-qualified according to standardized classification of ocular trauma. Presence of additional ocular injuries in eyes with different grade (visual acuity) was recorded. Rate of additional injuries by grade was compared with chi-square and odds ratio (OR)., Results: A total of 178 eyes of 168 patients aged 1 to 84 years (average 27.63 years, standard deviation (SD) 17.3) were evaluated; grade (visual acuity) was 1 in 107 eyes (60.1%), 2 in 35 (19.7%), 3 in 22 (12.3%), 4 in 11 (6.2%) and 5 in three (1.7%) eyes. Seventy six eyes had additional injuries (42.7%, 95% confidence interval [CI 95%] 35.5-49.9%). A higher proportion of additional injuries was found in patients with grade < 1 (66.2%) than in those with grade 1 (27.1%, p < 0.001 OR 5.27, 95% CI 2.72-10.68)., Discussion: A high rate of patients with subconjunctival hemorrhage presented additional injuries. Visual acuity < 1 increased probability of having additional damage. It is suggested that visual acuity be evaluated in every injured eye, even when diagnosis of subconjunctival hemorrhage is evident and data of open globe absent, to help detect eyes that require specialized evaluation.

Objective: To identify whether tessellated fundus unrelated to myopia modifies the rate of diabetic patients with retinopathy., Method: Diabetic patients evaluated ophthalmoscopically for the first time from September 1998 to December 1999 were retrospectively reviewed, and the presence of diabetic retinopathy was compared with those with tessellated fundus (group 1) and without (group 2). Duration of diabetes and presence of retinopathy were evaluated. Differences were analysed with x2., Results: 621 patients were evaluated, 138 of whom (22%) had tessellated fundus. The rate of patients with diabetic retinopathy was statistically lower in group 1 than in group 2 (p = 0.00); this difference was maintained after correction for cumulated diabetes duration., Discussion: The presence of tessellated fundus was associated with a lower rate of patients with diabetic retinopathy and with delayed onset. Manifestations of diabetic retinopathy in patients with tessellated fundus might have a different expression, and this expression might not necessarily reflect the microvascular status of the patient.