1.
Diabetic retinopathy screening and the use of telemedicine.
Zimmer-Galler, IE, Kimura, AE, Gupta, S
Current opinion in ophthalmology. 2015;(3):167-72
Abstract
PURPOSE OF REVIEW Evidence-based practice guidelines and treatments are highly effective in reducing vision loss from diabetic retinopathy. However, less than half of the total number of patients with diabetes mellitus receive recommended annual retinal evaluations, and vision loss due to diabetic retinopathy remains the leading cause of blindness in adults. Poor adherence to screening recommendations stems from a number of challenges which telemedicine technology may address to increase the evaluation rates and ultimately reduce vision loss. The aim of this review was to provide an update on the recent advances in tele-ophthalmology and how it may expand our current concept of eye care delivery for diabetic eye disease. RECENT FINDINGS The benefits of telemedicine diabetic retinopathy are proven for large population-based systems. Outcomes information from community-based programs is now also beginning to emerge. Improved screening rates and less vision loss from diabetic retinopathy are being reported after implementation of telemedicine programs. New imaging platforms for telemedicine programs may enhance the ability to detect and grade diabetic retinopathy. However, financial factors remain a barrier to widespread implementation. SUMMARY Telemedicine diabetic retinopathy screening programs may have a significant impact on reducing the vision complications and healthcare burden from the growing diabetes epidemic.
2.
Comparative evaluation of 23- and 25-gauge microincision vitrectomy surgery in management of diabetic macular traction retinal detachment.
Kumar, A, Duraipandi, K, Gogia, V, Sehra, SV, Gupta, S, Midha, N
European journal of ophthalmology. 2014;(1):107-13
Abstract
PURPOSE To compare the efficacy, outcomes, and complications of 23-G and 25-G microincision vitrectomy surgery (MIVS) in cases of diabetic tractional retinal detachment (TRD). METHODS This is a prospective, single-blinded, randomized, comparative study. Fifty eyes of 50 patients with diabetic TRD involving or threatening macula were randomized into 2 groups of 25 each. Group 1 underwent 23-G MIVS and group 2 underwent 25-G MIVS. Patients were followed up at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. The primary outcome measure was anatomic and visual success after surgery. We also compared the 2 alternative MIVS systems and assessed various intraoperative and postoperative parameters. RESULTS Anatomic achievement was achieved in all eyes and both groups showed a significant improvement in vision after surgery (p = 0.033 and p = 0.004, respectively) and were comparable (p = 0.584). Mean surgical time in 25-G surgery was significantly longer than in 23-G surgery by 4.60 minutes (p<0.001). Postoperative mean astigmatism was comparable in the 2 groups and postoperative hypotony was not encountered in either group. No port-related breaks were seen in either group; however, iatrogenic breaks occurred in 4 eyes in the 23-G group and 5 eyes in the 25-G group (p = 1.000). There was significantly less immediate postoperative pain and foreign body sensation in the 25-G group compared with the 23-G group. CONCLUSIONS Both 23-G and 25-G MIVS have comparable visual and anatomic results for diabetic TRD; however, 25-G surgery may be associated with less postoperative pain and discomfort than 23-G surgery.