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Introduction: The high prevalence of Diabetes Mellitus type 2 in Mexico has positioned diabetic retinopathy as the main cause of blindness in adults of productive age in Mexico. Therefore, the timely detection of this disease is a priority task for the public health system. This article studies the efficiency of a new algorithm for determining the shape of the Major Temporal Arcade of the retina, using image segmentation techniques and numerical modeling of curves. Method: The proposed methodology uses Gaussian Matched Filters that enhance the geometry of the blood vessels. Subsequently, the vascular structure is segmented by global thresholding of the enhanced image. Said segmentation is used as input to build a numerical model of the Superior and Inferior Temporal Arcades, using Spline functions. Results: The performance evaluation was carried out using 136 images of 6000 x 4000 pixels. The automatic retinal vein segmentation algorithm using the GMF method obtained an Accuracy of 0.9852; the numerical modeling algorithm gave a result of 6.01 pixels for the metric Mean Distance to the Closest Point (MDCP). Another previous study reported 12.33 pixels. Regarding time, the method reported an average time of 10.65 seconds per image. Discussion: The proposed method was able to carry out the numerical modeling of temporal arches in fundus images efficiently. The results show that this method is an useful computational tool for the diagnosis of alterations in the anatomy of the eye. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the retinal blood vascular network of the retinographies of patients with different grades of diabetic retinopathy. Methods: Ninety Retinographies (MESSIDOR database) were used, with different grades of diabetic retinopathy divided into 4 groups: no retinopathy (n=23), grade one (n=20), grade two (n=20) and grade three (n=27) diabetic retinopathy. The grades of diabetic retinopathy were classified according to the number of microaneurysms, number of hemorrhages and the presence of neovascularization. The images were skeletonized and quantified by fractal methods: dimension of box-counting (Dbc) and information (Dinf). Results: The means of Dbc values of groups were around 1.25, without statistically significant difference in the dimension values between groups for whole retina. There was also no statistical difference in Dinf values between groups, whose means ranged between 1.294 ± 0.013 (group of grade 1) and 1.3 ± 0.017 (group of grade 3). The retinographies were divided into regions of equal areas. The fractal values of some retinal regions showed statistical differences, but these differences were not enough to show the sensitivity of fractal methods in identifying diabetic retinopathy. Conclusion: The fractal methods were not able to identify the different grades of diabetic retinopathy in retinographies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of diabetic retinopathy (DR) screening using color retinography in diabetic patients. Methods: Retrospective descriptive study, evaluating reports of all retinographs performed since the implementation of the protocol for screening for diabetic retinopathy in diabetic patients followed up at the endocrinology outpatient clinic of a tertiary hospital of the Unified Health System, from May 2018 to May 2020. Results: 727 diabetic with age range from 14 to 91 years old, the majority being 60 years old or older (53.2%), female (68%) and white (87.6%), patients underwent retinography. Of the patients, 467 (64.2%) did not have DR, 125 (17.2%) had non-proliferative DR, 37 (5.1%) had severe non-proliferative DR and/or suspected macular edema, 65 (8.9%) had proliferative DR, 21 (2.9%) had suspicion signs of other pathologies and 12 (1.7%) had unsatisfactory images. A total of 114 (15.68%) patients were considered at high risk (those with severe non-proliferative NP and/or EM, proliferative DR or poor image) and were referred for comprehensive ophthalmic evaluation. Conclusion: The screening of RD with color retinography enabled the detection of high-risk diabetic patients who needed assistance sooner and enabled their access to ophthalmologic consultation, which decreased disease morbidity. The others were referred to primary care for regulation through the Regulation System (SISREG). [ABSTRACT FROM AUTHOR]

The objective of this article was to review the disorganization of inner retinal layers as a biomarker in diabetic macular edema. A systematic search was conducted in PubMed®/MEDLINE®, Cochrane and Embase until August 2021. The keywords used were: "disorganization of inner retinal layers (DRIL)", "diabetic macular edema (DME)" and "biomarkers". No restrictions were imposed on the types of study to be included. The studies selected for eligibility were those that included the diagnosis of diabetic macular edema (center involved, resolved), that were well documented with spectral domain optical coherence tomography, that included disorganization of inner retinal layers as one of the reported alterations, with a follow-up of at least 3 months, and those in which the best corrected visual acuity was evaluated pre and post. There were no limitations regarding the type of treatment established. References of identified studies were searched for additional relevant articles. Articles not published in peer review journals were excluded. All studies were evaluated by two investigators independently. When one of them was in doubt, it was assessed by a third evaluator. A total of seven studies were included. Four were retrospective, longitudinal cohort study and three cross-sectional observational. Regarding the population studied, 61.5% were men and 38.4% were women, most of them had diabetes mellitus type 2 (85.8%). Regarding the stage of diabetes, the percentage of patients with mild nonproliferative diabetic retinopathy was 28.2%, with moderate nonproliferative diabetic retinopathy was 28.5%, with severe nonproliferative diabetic retinopathy was 15.9% and with nonproliferative diabetic retinopathy was 27.4%. In 100% of the studies, the diagnosis of diabetic macular edema in the center involved was included by spectral domain optical coherence tomography (Heidelberg). In all the studies, the presence of disorganization of inner retinal layers was recorded and its association with best corrected visual acuity was evaluated. The measurement was carried out using the LogMAR scale. In all the studies, the presence or absence of disorganization of inner retinal layers was associated with the best corrected worse/better final visual acuity using p <0.05 as a statical significance. The disorganization of inner retinal layers as a biomarker and their presence have shown to be important predictors of visual acuity in the future in patients with diabetic macular edema. Histopathological studies are required to understand its mechanism of action. [ABSTRACT FROM AUTHOR]

Macular edema is the first cause of reduction in visual acuity among diabetic patients. Clinical manifestations may start at any time during diabetic retinopathy development and progression and may be associated with additional comorbidities that may affect other organs as well. Diabetics with macular edema require a multidisciplinary approach. The evidence suggest that early diagnosis and prompt treatment may reduce the visual loss associated with this entity. Therefore, non-ophthalmologist attending diabetic patients may contribute to the management of this condition by early detection. The purpose of this review is to provide information on the contribution of optical coherence tomography to the diagnosis of macular edema, and to recognize tomographic biomarkers that allow to predict visual outcomes and treatment. [ABSTRACT FROM AUTHOR]

Introduction: the more frequent diabetes's micro vascular complications involve mainly to the retina and the kidney. A narrow relationship has been recognized between diabetic retinopathy and micro albuminuria. Objective: to determine the behavior of the micro albuminuria in patient with diabetes type 2 and diabetic retinopathy. Methods: an observational, descriptive, cross-sectional study in patients with diabetes type 2 and diabetic retinopathy at the Arnaldo Milián Castro Hospital in the period between 2018 and 2019. Results: the women bigger than 60 years old were more affected with diabetic retinopathy (43, 2%). The proliferative retinopathy diabetic predominated (47, 7%) in patients with more than 10 years of evolution. The 38, 6% of patients had high micro albuminuria. The 32, 4% of patients with high micro albuminuria had a proliferative diabetic retinopathy and bad metabolic control. The number of patient with proliferative diabetic retinopathy, arterial hypertension associate and high micro albuminuria was smaller than we hoped to find. Conclusions: a little more than a 1/3 of the patients with diabetes and some grade of severity of diabetic retinopathy present high micro albuminuria. More than half of the patients with high micro albuminuria have a bad metabolic control, of these the majority with proliferative diabetic retinopathy. The number of patient with proliferative diabetic retinopathy, arterial hypertension associate and high micro albuminuria was smaller than we hoped to find in this series. [ABSTRACT FROM AUTHOR]

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Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Evidence-based Healthcare is the property of Journal of Evidence-based Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: La prevalencia de diabetes aumenta paulatinamente a nivel mundial y con ello, se incrementa el riesgo de complicaciones microvasculares como la retinopatía diabética. El riesgo de ceguera se reduce con control metabólico estable, diagnóstico temprano y tratamiento adecuado. Objetivo: Comparar el resultado del examen oftalmológico realizado antes de iniciar el tratamiento con Heberprot-P, con el realizado a los cinco meses de iniciado, a diferentes dosis. Métodos: Se realizó un estudio observacional, retrospectivo, en 77 pacientes incluidos en cuatro ensayos clínicos de Heberprot-P. Se realizó análisis de las variables examen oftalmológico antes y después del tratamiento, tipo de diabetes y años de evolución. Resultados: Se observó predominio de los diabéticos tipo 2 respecto a los tipo 1 en una razón 11:1, con una media de 16,3 años de evolución de la diabetes. La mitad de los pacientes tenían retinopatía diabética no proliferativa, con predominio de la forma leve, en el examen realizado antes del tratamiento con Heberprot-P. Solo un paciente anciano con otras comorbilidades, desarrolló una retinopatía diabética proliferativa, luego de un examen previo en que se observó retinopatía diabética no proliferativa y edema macular diabético. Conclusiones: La aparición o progresión de retinopatía diabética es infrecuente en pacientes complicados con úlcera del pie diabético tratados con Heberprot-P, hasta cinco meses después de tratamiento.

Introducción Los programas de teleoftalmología se han transformado en una de las principales herramientas para detectar oportunamente la retinopatía diabética. Evaluar la implementación de estos programas es fundamental para contextualizar y comprender su funcionamiento en diferentes regiones. El objetivo de este trabajo fue evaluar la tasa anual de fondo de ojos en personas con diabetes antes y después de implementar un programa de teleoftalmología en la provincia de La Pampa (Argentina). Métodos Se llevó a cabo un diseño de antes y después, comparando la tasa de fondo de ojos realizado antes y después del comenzar con el Programa. La evaluación se realizó mediante una encuesta aleatoria a personas con diagnóstico de diabetes. Para el análisis se incluyeron personas de la zona rural y urbana de la provincia. El programa fue implementado solamente en la zona rural, mientras que la zona urbana cuenta con el sistema tradicional de atención. Resultados La tasa anual de fondo de ojos realizado antes y después de la implementación del Programa en áreas rurales paso de un 39,3% a un 78,6%. Siendo superior en un 22,9% al de la zona urbana. Conclusión El programa de teleoftalmología evaluado logró un aumento significativo en la evaluación del fondo de ojos de las personas con diabetes. Implementar este tipo de programas es fundamental para combatir la ceguera por diabetes en la región rural de la Argentina.

Introducción: Las similitudes microvasculares de la retina y el riñón hacen que las manifestaciones de microangiopatía diabética se presenten en ambos sistemas. Existen pocos datos epidemiológicos en este grupo de pacientes con enfermedad rena crónica (ERC) estadio 5 por lo que el objetivo del presente estudio fue determinar la prevalencia de retinopatía diabética proliferativa (RDP) y no proliferativa en pacientes sometidos a hemodiálisis. Métodos: En el presente estudio transversal, se evaluaron 205 pacientes diabéticos tipo 2 con ERC estadio 5 sometidos a hemodiálisis en el Hospital Eugenio Espejo en el período de junio 2013- mayo 2014. En todos los pacientes (n=205) se determinó comorbilidades asociadas, hemoglobina glicosilada, tiempo de evolución de DM2, momento de diagnóstico de retinopatía diabética. En todos los ojos (n=410) se determinó, agudeza visual, grado de retinopatía diabética y complicaciones de retinopatía diabética. Resultados: De 205 pacientes, el 62.9% fueron mujeres, el 53.7% en edad entre 70-79 años, el tiempo de evolución de DM 2 fue mayor a 20 años en el 65.9%, el 83.4% eran tratados con insulina. El 92.2% tuvieron RD, 58% fueron casos de RD no proliferativa y el 34.2 % RDP. Conclusiones: Se observa una alta prevalencia de RD en este grupo, de tipo no simétrica. La severidad de la afectación en relación al daño renal, ya que más de la mitad de los pacientes presentan RDNP mientras que el riñón está en falla renal terminal.

Objetivos. Comparar las diferentes capas retinianas y coroides en pacientes con diabetes mellitus tipo 1 (DM1) mediante tecnología swept-source, detectar presencia de retinopatía diabética (RD) y edema macular diabético (EMD) y analizar la relación entre sus espesores y marcadores analíticos de control metabólico. Material y métodos. Estudio transversal con muestreo consecutivo de pacientes ≥18 años diagnosticados DM1, al menos 5 años de evolución, ausencia de RD o RD leve o moderada. Se excluyeron a los pacientes con edema macular secundario a otras patologías. Se les realizó una retinografía no esteroscópica de 45º y una tomografía de coherencia óptica swept-source (SS-OCT) macular radial de 12mm con DRI Triton plus (Topcon, Japón). Se analizó el espesor de las diferentes capas de la retina y coroides y se correlacionó con los últimos parámetros metabólicos de control de la enfermedad. El análisis estadístico se realizó mediante Jamovi (versión 1.2). Resultados. Se examinaron 192 ojos (96 pacientes), el 49% hombres, edad media: 42±12.5 años; el 31.1% con RD; media de glucosa: 147±70.1mg/dl; urea: 34.6±10.6mg/dl; creatinina: 0.80±0.19mg/dl; triglicéridos: 78.8±33.4mg/dl; colesterol: 189±32.4mg/dl; colesterol HDL: 63.2±13.5mg/dl; LDL: 111±26.6mg/dl y hemoglobina glicosilada: 7.61±1.24%. Se hallaron correlaciones inversas leves entre retina, capa de células ganglionares (CCG+) y tiempo de evolución (p

Objective: To assess effectiveness of fundus photography and fluorescein angiography in diagnosis and screening of diabetic retinopathy. Methods: A retrospective study of 398 diabetic patients, based on analysis of results of both tests. Results: Results of fluorescein angiography and fundus photography coincided in 77.4% of cases, and there was no significant difference in staging and identification of retinopathy by both methods. Conclusion: There was no significant difference between both methods regarding the capacity to diagnose the disease, showing no benefit in indicating fluorescein angiography as initial assessment of diabetic patients. [ABSTRACT FROM AUTHOR]

RESUMO Objetivo: Avaliar a efetividade da retinografia colorida e a da angiografia fluorescente no diagnóstico e no rastreio da retinopatia diabética. Métodos: Estudo retrospectivo, com base na análise de resultados de ambos os exames de 398 pacientes diabéticos. Resultados: Os resultados da angiografia coincidiram com os da retinografia em 77,4% dos casos, e não houve diferença significativa no estadiamento e na identificação da retinopatia pelos dois métodos. Conclusão: Não houve diferença significativa em relação à capacidade diagnóstica da doença pelos métodos descritos, demonstrando não existir benefício em indicar a angiografia como avaliação inicial do paciente diabético.

RESUMEN Introducción: La retinopatía diabética es una complicación microvascular de la diabetes mellitus y una de las primeras causas de ceguera a nivel mundial. Objetivo: Determinar la asociación de causalidad de diferentes factores con la progresión de la retinopatía diabética en pacientes diabéticos tipo 2. Método: Se realizó un estudio observacional, analítico, de casos y controles anidado en una cohorte, en el Centro Oftalmológico de Santiago de Cuba en el periodo comprendido desde octubre de 2017 a octubre de 2019. Las variables estudiadas fueron: edad, sexo, color de la piel, antecedentes patológicos personales y familiares, tiempo de evolución de la diabetes, tipo de retinopatía diabética, evolución de la retinopatía, valores de hemoglobina glicosilada y albuminuria. Como medidas de resumen se utilizó la media, la desviación estándar y el porcentaje. Para la validación estadística se utilizaron el test de Ji cuadrado con nivel de significación de 5 %. Se determinó la fuerza de asociación, mediante el cálculo del odds ratio (razón de productos cruzados), riesgo atribuible porcentual en expuestos y riesgo atribuible poblacional porcentual. Resultados: La HbA1c mayor de 7 % y la microalbuminuria fueron factores de riesgo para la progresión de la retinopatía diabética. Conclusiones: El mal control metabólico, representado por valores de hemoglobina glicosilada superiores a 7 % y la presencia de microalbuminuria, son factores de riesgo en los que se debe trabajar en los diferentes niveles de atención para evitar la progresión de la retinopatía diabética y por ende la ceguera por esta causa.

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: diabetes mellitus is the leading cause of mortality and early disability in the world. It is characterized by hyperglycemia and late development of vascular complications that lead to blindness in adults and increase the risk of retinopathy. Objective: characterize diabetic retinopathy in patients belonging to the Doctor’s Office 16-10 of the Santa Clara Polyclinic. Method: a descriptive quantitative cross-sectional study was conducted on patients belonging to the Doctor’s Office 16-10 of the Santa Clara Polyclinic from December 2015 to February 2017. The data were collected through a form and the review of medical records. Results: in the sample, 56.1% of patients presented diabetic retinopathy, with a predominance of mild non-proliferative retinopathy in women and in those with 65 years of age or older. The association of risk factors, such as having more than 10 years of evolution, the lack of control of the glycemia and arterial hypertension favored the appearance of the disease. Conclusions: in type II diabetic patients, there was a significant number with retinopathy, the female sex predominated and those patients 65 years of age and older with mild non-proliferative diabetic retinopathy, the disease occurred more frequently in patients with 10 or more years of evolution and in those who were controlled with oral monotherapy, and all risk factors had a significant weight in the onset of the disease.

Para determinar la frecuencia y el grado de severidad de retinopatía diabética (RD) en pacientes con diabetes mellitus (DM) tipo 2 se realizó un estudio descriptivo transversal en 3239 pacientes del Instituto Regional de Oftalmología de la ciudad de Trujillo, región La Libertad, Perú. Previa dilatación pupilar, personal entrenado tomó dos fotografías de cada ojo, centrado en mácula y nervio óptico. La frecuencia de RD fue de 25,9 % con mayor proporción en varones con RD (28,2%) y en aquellos con más de 10 años de enfermedad por DM (49,0%). La mayoría de pacientes tuvieron retinopatía diabética no proliferativa (RDNP) leve a moderada (79,3%), el 10,1% tuvo RDNP severa y el 10,6 % RD proliferativa. Concluimos que la RD se presenta en uno de cada cuatro pacientes y alrededor del 20% en grados avanzados. Es preciso ampliar la cobertura de tamizaje desde el momento del diagnóstico de DM e implementar medidas preventivas como el control metabólico y el examen periódico del fondo de ojo.

Pars plana vitrectomy in proliferative diabetic retinopathy initially fulfils three central objectives: to clear the media, when there is cataract or haemorrhage in the vitreous cavity; to apply the retina in case of tractional or combined retinal detachment; stabilise proliferative diabetic retinopathy by performing endopanophotocoagulation. It may or may not be combined with cataract surgery depending on the clinical case to be treated.

Introducción: la diabetes mellitus (DM) es una epidemia mundial. La retinopatía diabética proliferativa (RDP), el edema macular diabético (EMD) y las complicaciones de la diabetes mellitus son las principales causas de discapacidad visual y ceguera en los adultos en la edad productiva. Aproximadamente, 1 de cada 3 personas con DM tiene retinopatía diabética (RD) y 1 de cada 10 tiene RDP o EMD. En el presente estudio se hace énfasis en esta última, siendo el primero con estas características en Colombia. Métodos: estudio transversal descriptivo donde se incluyeron 1.203 pacientes con diagnóstico de DM atendidos en la jornada “No más ciegos por Diabetes” del Hospital San Vicente Fundación de Medellín, en el 2017 y 2018. Se evaluó la presencia de RD y EMD clínico y sus características epidemiológicas en un análisis bivariado. Resultados: del total de pacientes con DM tamizados (1.203), el 5,4 % (65) tenían EMD; dentro de estos, el 7,7 % tenía DM tipo 1 y el 89,2 % DM tipo 2. El 10,8 % tenía RDP, 73,8 % tenía RD no proliferativo (RDNP). En un 93,8 % se hizo diagnósticos de novo de RD. La mediana del tiempo de la diabetes fue de 14 años, con un rango intercuartílico (RIQ) entre 7 y 19,5. La mediana de la hemoglobina glicosilada (HbA1C) fue de 8,3 % (RIQ: 7,1-11). De 65 pacientes con EMD, 28 (56 ojos de los 130 con EMD) fueron estudiados con tomografía de coherencia óptica (OCT) y al 85,7 % se le confirmó EMD. La mediana del grosor macular central fue de 249 micras (RIQ: 231-341) en los pacientes con EMD por OCT (n = 48 ojos). Conclusión: las complicaciones de la diabetes son más prevalentes en los pacientes con RD. La media del tiempo de aparición de EMD fue similar al tiempo de inicio de las complicaciones microvasculares de la diabetes reportada en la literatura, pero debe ser considerada en el contexto del control metabólico de los pacientes.

RESUMO Objetivo: Estimar a prevalência da retinopatia diabética em pacientes diabéticos de uma capital brasileira e correlacioná-la com fatores de risco presentes na população estudada. Métodos: Estudo observacional transversal, realizado a partir do relatório de atendimentos prestados em mutirão ocorrido em 2018. O relatório foi preenchido pelos médicos oftalmologistas durante a campanha, com informações referentes a sexo do paciente, idade, classificação do diabetes mellitus, tempo de doença, uso de insulina, índice de massa corporal, hábitos de vida (tabagismo e atividade física) e história de hipertensão arterial sistêmica, dislipidemia, infarto agudo do miocárdio e acidente vascular cerebral, além de exame clínico oftalmológico realizado na ação. Resultados: Dentre os 219 participantes do estudo, a prevalência da retinopatia diabética foi de 31,96%. As variáveis que se apresentaram como fator de risco com significância estatística foram sexo masculino, idade de 51 a 70 anos, mais de 10 anos de diabetes mellitus, insulinoterapia, índice de massa corporal ≥40kg/m2 e história prévia de infarto agudo do miocárdio. Atividade física mostrou-se como fator protetor significativo. Conclusão: Estudos populacionais ao longo dos anos comprovaram a variabilidade geográfica na prevalência da retinopatia diabética justificada pela diferente exposição aos fatores de risco. Dentro de tal conjuntura, ressalta-se o quão fundamental é o conhecimento das características regionais, de modo a orientar as políticas de saúde pública, permitindo atuar com impacto na redução das estatísticas de cegueira evitável.

Introdução – A retinopatia diabética é uma das principais complicações microvasculares da diabetes e é a principal causa de cegueira evitável na população ativa nos países desenvolvidos. Com um longo período assintomático, o diagnóstico precoce permite que se evitem terapêuticas agressivas, repetidas e dispendiosas. No entanto, a realização anual de exames ao polo posterior para deteção precoce da retinopatia diabética através de câmaras não midriáticas, apesar de ser o método gold standard, apresenta algumas fragilidades. Objetivo – Descrever a evidência científica existente relativa às limitações do uso isolado da retinografia não midriática como método de rastreio da retinopatia diabética. Métodos – Estudo descritivo de scoping review baseado na metodologia do Joanna Briggs Institute. Para a pesquisa de artigos científicos utilizaram-se as bases de dados PubMed e Web of Science. Foram definidos como critérios de inclusão artigos com uma população constituída por diabéticos que realizaram rastreio da retinopatia diabética através de retinografia não midriática; e artigos redigidos nos idiomas inglês ou português e publicados entre janeiro de 2000 e junho de 2020. Resultados – Selecionaram-se seis artigos para elaborar o presente estudo, tendo em conta os critérios de elegibilidade. A taxa de imagens não classificáveis é a grande limitação deste método. Foi encontrada uma correlação positiva entre o aumento da idade e imagens não classificáveis na maioria das vezes devido a opacidades dos meios óticos, ao menor diâmetro pupilar e à presença de outras patologias. Vários estudos reportaram ainda que a retinografia tem capacidade limitada na deteção do edema macular diabético. Conclusões – Novas tecnologias e novos métodos de processamento de imagem da retina podem potencialmente no futuro ser adotados pelos programas de rastreio, de modo a fornecer soluções para a deteção mais eficaz e eficiente da retinopatia diabética e do edema macular diabético reduzindo a percentagem de doentes com retinografias não classificáveis.

This article proposes two methodologies for the detection of lesions in the retina, which may indicate the presence of diabetic retinopathy (DR). Through the use of digital image processing techniques, it is possible to isolate the pixels that correspond to a lesion of RD, to achieve segmenting microaneurysms, the edges of the objects contained in the image are highlighted in order to detect the contours of the objects to select by size those that meet an area of 15 to 25 pixels in the case of 512x512 images and identify the objects as possible microaneurysms, while for the detection of exudates the green channel is selected to contrast the luminous objects in the retinography and from the conversion to gray scale, a histogram is graphed to identify the ideal threshold for the segmentation of the pixels that belong to the exudates at the end of the optical disk previously identified by a specialist. A confusion matrix supervised by an ophthalmologist was created to quantify the results obtained by the two methodologies, obtaining a specificity of 0.94 and a sensitivity of 0.97, values that are outstanding to proceed with the classification stage. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of diabetic retinopathy in patients with diabetes, from a Brazilian capital city, and to correlate with the risk factors present in the studied population. Methods: A cross-sectional observational study, based on the report of care provided by a campaign, in 2018. The report was filled out by ophthalmologists during the joint effort, with information on patient's gender, age, classification of diabetes mellitus, duration of illness, use of insulin, body mass index, lifestyle (smoking and physical activity), history of hypertension, dyslipidemia, myocardial infarction, stroke, and the clinical ophthalmic examination. Results: Among the 219 study participants, the prevalence of diabetic retinopathy was 31.96%. The variables considered risk factors with statistical significance were male sex, age 51-70 years, diabetes mellitus for over 10 years, insulin therapy, body mass index ≥40 kg/m2, and previous history of myocardial infarction. The physical activity proved to be a significant protective factor. Conclusion: Over the years, population studies have proven the geographical variability in prevalence of diabetic retinopathy justified by different exposure to risk factors. Therefore, knowledge of regional characteristics is crucial and emphasized in the text, since it can guide public health policies, aiming to have an impact on reduction of preventable blindness statistics. [ABSTRACT FROM AUTHOR]

Introduction - Diabetic retinopathy is one of the main microvascular complications of diabetes and it is the leading cause of preventable blindness in working-age adults in developed countries. With a long asymptomatic period, early diagnosis allows avoiding aggressive, repeated, and expensive therapies. The annual examination for early detection of diabetic retinopathy, using non-mydriatic retinography, is accepted as a gold standard method, however, this method has some weaknesses. Aim of the study - To describe the existing scientific evidence of the limitations of the isolated use of non-mydriatic retinography as a screening tool of diabetic retinopathy. Methods - Descriptive study of scoping review based on Joanna Briggs Institute methodology. PubMed and Web of Science databases were used to search for scientific articles. The following inclusion criteria were used: articles with a population of diabetic subjects who underwent screening for diabetic retinopathy through non-mydriatic retinography; articles written in English or Portuguese and published between January 2000 and June 2020. Results - After the data screening, six references were included based on inclusion criteria. The rate of unclassifiable images is the major limitation of this method. A positive correlation was found between increasing age and non-gradable images, most of the time due to opacities of the optical media, smaller pupil diameter, and presence of other pathologies. Several studies have also reported that retinography has limited ability to detect diabetic macular edema. Conclusions - New technologies and new methods of retinal imaging can potentially be adopted by screening programs, in the future, in order to provide solutions for the most effective and efficient detection of diabetic retinopathy and diabetic macular edema, reducing the percentage of patients with unclassifiable images. [ABSTRACT FROM AUTHOR]

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RESUMEN Objetivo: Caracterizar los pacientes con retinopatía diabética desde el punto de vista epidemiológico y clínico. Métodos: Se realizó un estudio descriptivo y transversal en el Centro Oftalmológico de Santiago de Cuba, desde octubre del año 2017 hasta octubre de 2019, en una población de 42 pacientes diabéticos tipo 2. Resultados: Predominaron los pacientes con tiempo de diabetes mellitus mayor de 10 años, y edades de 55 años o más (60,0 %); el mayor porcentaje correspondió al color de piel negra (66,7 %); la agudeza visual mayor de 0,6 se presentó en el 49,4 % de los casos; la retinopatía diabética proliferativa fue la más presentada con 55,9 %. Hubo predominio, además, de los valores de hemoglobina glicosilada por encima del 7 % y de la normoalbuminuria con 46,7 y 66,7 %, respectivamente, en ambos grupos. Conclusiones: Los valores elevados de hemoglobina glicosilada y la normoalbuminuria se asocian, desde el punto de vista clínico, a la retinopatía diabética proliferativa.

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Scientia Medica is the property of EDIPUCRS - Editora Universitaria da PUCRS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Latinoamericana de Hipertension is the property of Revista Latinoamericana de Hipertension and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Evidence-based Healthcare is the property of Journal of Evidence-based Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La retinopatía diabética (RD) es una enfermedad ocular caracterizada por cambios anormales a nivel de la retina, que se manifiesta con gran frecuencia en personas que padecen diabetes mellitus. El debido seguimiento y tratamiento puede evitar que la enfermedad afecte gravemente al paciente, sin embargo, debido a la necesidad de contar con profesional especializado y lo costoso del proceso, puede resultar difícil realizar diagnósticos periódicamente, corriendo el riesgo de presentar ceguera. Para contribuir a la solución de dicho problema, se han visto en los últimos años trabajos que emplean tecnología de inteligencia artificial, más precisamente aplicando técnicas de Deep Learning (DL) para el reconocimiento automatizado de los síntomas de la RD presentes en la retina. En este artículo se plantean las bases para la detección de la RD, así como las técnicas DL utilizadas por diversos investigadores para su diagnóstico automatizado y el desempeño de dichos sistemas en este ámbito.

RESUMEN Objetivo: Identificar la relación de la hemoglobina glicosilada y la albuminuria con la progresión de la retinopatía diabética. Métodos: Se realizó un estudio descriptivo y transversal en el Centro Oftalmológico de Santiago de Cuba desde octubre del año 2017 hasta octubre de 2019. La muestra fue de 42 pacientes diabéticos tipo 2. Resultados: Predominaron los pacientes con tiempo de diabetes mellitus mayor de 10 años y las edades de 55 años o más con el 60,0 %. El color de piel negra fue mayor con 66,7 %; la agudeza visual mayor de 0,6 se presentó en el 49,4 % y la retinopatía diabética proliferativa fue la más presentada con 55,9 %. Predominaron además valores de hemoglobina glicosilada mayores de 7 % en ambos grupos y la normoalbuminuria fue la que predominó en ambos grupos con 46,7 y 66,7 %. Conclusiones: Los valores elevados de hemoglobina glicosilada y la normoalbuminuria se asocian de forma clínica a retinopatía diabética proliferativa.

Introducción. El presente artículo resume la guía de práctica clínica (GPC) para el diagnóstico y tratamiento de la retinopatía diabética y el edema macular diabético en el Seguro Social de Salud del Perú (EsSalud). Objetivo. Proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de la retinopatía diabética y el edema macular diabético en EsSalud. Métodos. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 4 preguntas clínicas a ser respondidas por la presente GPC. Para cada una de estas preguntas se realizó búsquedas de revisiones sistemáticas y de estudios primarios (cuando se consideró pertinente) en PubMed durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y el flujograma de manejo. Resultados. La presente GPC abordó 4 preguntas clínicas sobre el tamizaje, diagnóstico, tratamiento de elección y tratamiento adyuvante. En base a estas preguntas se formularon 6 recomendaciones (4 fuertes y 2 condicionales), 19 puntos de buena práctica clínica y 1 flujograma de manejo. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de la retinopatía diabética y el edema macular diabético en EsSalud.

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Optometry is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetic retinopathy (RD) is a complication caused by diabetes. This can cause blindness, becoming a worldwide threat due to the affectation of people at an early age and linked to the labor field. The role of medicine in the diagnosis of this disease is associated to the analysis of pathologies (micro aneurysms, hemorrhages and exudates) presented in fundus images. This task is tedious, time-consuming for medical personnel and it makes delays in diagnosis because of the high demand of RD patients. From the engineering of CAD system designs (Computer-Aided Design) an automated method is proposed for the identification of reference characteristics such as the optical disc, the fovea and the blood vessels. This article presents a methodology for the detection and segmentation of the optical disc and blood vessels. first, a preprocessing stage based on the algorithms of contrast-adaptive histogram equalization (CLAHE) and dynamic diffuse histogram equalization that preserve brightness (BPDFHE) is proposed aiming of improving the fundus image and highlighting the blood vessels for later removal. Next, it is proposed the methodology of segmentation of blood vessels through neural networks that a posteriori, it is going to contribute information for the correct segmentation of the optical disc, which is located through iterative opening and closing morphological operations, demonstrating that it is invariability against pathological lesions of the exudates that coincide in color information with the ocular structure of interest. Once the optic disc is located, the blood vessels inside are removed by inpainting algorithm (Functional Mumford-Shah), which replaces the presence of the blood vessels with statistical information of color discrimination of the optical disc. Finally, the Graph Cut algorithm is implemented for the segmentation of the optical disc. [ABSTRACT FROM AUTHOR]

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Este artículo tiene el objetivo de presentar los hallazgos clínicos en dos pacientes diabéticos, mediante angiografía fluoresceínica, retinografía y campimetría. Se adelantó un estudio observacional descriptivo de corte transversal tipo reporte de caso, donde se seleccionaron dos pacientes diabéticos tipo I y II con diagnóstico mayor de 10 años de evolución de DM. Como resultado, se presentan dos casos clínicos de pacientes masculinos, con diagnóstico de DM mayor a 10 años de evolución; paciente de 86 años con DM tipo II de 20 años de evolución con cambios característicos de RD, con panfotocoagulación en el OD y paciente de 25 años con DM tipo I de 11 años de evolución, que muestra cambios incipientes de RD, a pesar del tiempo de evolución de la enfermedad. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the choroidal thickness (CT) in healthy Brazilian subjects using spectral-domain optical coherence tomography (SD-OCT) and to compare with choroidal thickness measured in Brazilian patients with diabetic macular edema (DME), neovascular age-related macular degeneration (AMD) and high myopia. Methods: A retrospective analysis of spectral domain optical coherence tomography (SD-OCT) images of 181 Brazilian subjects. A total of 74 eyes were included in the normal control group, 50 eyes in the nvAMD group, 44 eyes in the DME group and 13 eyes in the high myopia group. CT was measured from the posterior edge of the retinal pigment epithelium (RPE) to the choroid/sclera junction at the fovea and at 500 µm intervals temporal and nasal to the fovea. All measurements were performed by two independent observers and were averaged for analysis. The statistical analysis and comparison were performed using Mann Whitney (unpaired t-test). Results: Seventy-four eyes from 74 patients with a mean age of 51.4 years were analyzed in the normal group with a mean nasal, subfoveal and temporal choroidal thickness measurements were 301.30 ± 12.86 µm, 311.61 ± 12.62 µm and 309.28 ± 12.28 µm respectively. All groups with disease demonstrated a statistically significant choroidal thinning when compared with matched-aged normal eyes. The mean reduction in the nvAMD group compared to normal were 60.65 µm nasally, 59.77 µm temporally and 56.59 µm at subfoveal position. In the DME group, the subfoveal reduction was 51.10 µm, 63.03 µm and 46.30 µm, nasally and temporally. The patients with high myopia presented the greatest reduction in CT compared to normal eyes, with a mean reduction of 159.9 nasal, 159.98 subfoveal and 154.65 at temporal. Conclusions: The present study evaluated choroidal thickness in Brazilian subjects, with intense miscegenation. The results demonstrated a statistically significant decrease of the choroidal thickness in all subtypes of chorioretinal disease. The small sample size in this study was a limitation. Additional research with a larger study population to better understand these findings. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. Methods: A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. Results: A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. Conclusion: Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources. [ABSTRACT FROM AUTHOR]