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Purpose: To characterize the distribution of the foveal avascular zone circularity and its correlation with parafoveal vessel density, in subjects with and without diabetes., Methods: Observational, descriptive, cross-sectional, and prospective study; subjects without diabetes (Group 1), with diabetes without retinopathy (Group 2), or with diabetic retinopathy (Group 3) were included. Means of foveal avascular zone circularity and parafoveal vessel density were compared between groups (Kruskal-Wallis) and their correlation was calculated with Spearman's Rho test., Results: Seventy-seven eyes; central vessel density mean was higher in Group 1 than in Group 2 and higher in Group 2 than in Group 3; inner and complete vessel density means were also higher in Group 2 than in Group 3. The mean of the foveal avascular zone circularity did not differ between groups, and in Group 3 it had a positive correlation with central (0.45), inner (0.56), and complete (0.53) vessel densities., Conclusions: Circularity does not differ between subjects with diabetes, with and without retinopathy, and has only a low correlation with parafoveal vessel density in people with diabetic retinopathy, which does not allow anticipating a reduction of vessel density in this disease., (Copyright: © 2019 Permanyer.)

Objective: To compare foveal sensitivity in eyes with and without diabetic macular edema, with 20/20 visual acuity., Methods: Non-experimental, comparative, prospective, cross sectional study in eyes with and without retinopathy and focal macular edema, with 20/20 visual acuity. The sample was divided in 3 groups: (1) non-diabetic subjects, (2) diabetics without retinopathy, and 3) diabetics with non-proliferative retinopathy and clinically significant macular edema. Median foveal sensitivity was compared between groups (Kruskal Wallis test)., Results: 86 eyes (28 in group 1, 26 in group 2 and 32 in group (3). Medians shown a statistical difference between groups (p = 0.001). Median foveal sensitivity was significantly lower in group 3 than in group 1 (p = 0.001) and than in group 2 (p = 0.03). Median foveal sensitivity did not differ between groups 1 and 2 (p = 0.10)., Conclusion: Foveal sensitivity in diabetic macular edema and visual acuity 20/20 is lower in eyes with center sparing clinically significant macular edema and 20/20 visual acuity. The prognostic value of this dysfunction requires evaluation, in order to learn whether early treatment is required in these eyes., (Copyright: © 2019 Permanyer.)

Background: Visual improvement after photocoagulation in focal diabetic macular edema is more frequent when temporal perifoveal area is not affected; functional status before treatment could be worse in eyes with perifoveal temporal thickening. The correlation between visual acuity and foveal sensitivity (usually significant), would allow to compare macular function., Objective: To compare the correlation between retinal sensitivity and visual acuity in eyes with diabetic macular edema, with and without temporal perifoveal thickening., Method: Non-experimental, retrospective, comparative, cross-sectional study in type 2 diabetics with macular edema. The correlation between foveal sensitivity and visual acuity was compared in eyes without temporal perifoveal thickening (group 1) and eyes with it (group 2). Multiple regression analysis was used to identify the contribution of foveal sensitivity to the changes of visual acuity; other variables were: center point thickness, center field thickness, temporal perifoveal thickness and macular volume., Results: 60 eyes in group 1, 29 eyes in group 2. Mean sensitivity did no differ between groups (30.0 ± 0.59 vs. 28.4 ± 1.05 dB; p = 0.2), but the correlation between sensitivity and visual acuity did it (group 1, rho: -0.41; group 2, rho: -0.25). In group 1, foveal sensitivity was the only explaining variable of the regression model (beta: -0.52), in group 2 no one explaining variable was included and temporal perifoveal thickness had a negative correlation with foveal sensitivity (rho: -0.60)., Conclusions: Temporal perifoveal thickening reduces the correlation between foveal sensitivity and visual acuity in eyes with diabetic macular edema., (Copyright: © 2019 Permanyer.)

Background: Macular oedema is a form of diabetic retinopathy that can be treated with photocoagulation. The expected effect of treatment varies, and may depend on the previous characteristics of retinal thickening., Objective: To determine whether the change in retinal thickness after focal photocoagulation for diabetic macular oedema varies due to the presence of anatomical features that may justify a separate assessment., Material and Methods: Non-experimental, comparative, retrospective, longitudinal study. The mean percentage change in macular volume was compared in eyes with diabetic macular oedema, 3 weeks after focal photocoagulation. The analysis was stratified according to the presence of central and perifoveal temporal thickening (Mann-Whitney U). A regression analysis was performed to identify the contribution of the anatomical variables before photocoagulation to the change in macular volume., Results: A total of 72 eyes were evaluated. The mean change of macular volume in the sample was -0.68±3.84%. In the multiple regression analysis, the changes of perifoveal temporal (beta 0.54, p<0.001) and central field thickness (beta 0.3, p =0.01) contributed to the change of macular volume (R=0.64). Macular volume decreased by a mean of -2.1±4.3% in eyes with temporal perifoveal thickening, and increased by 0.5±2.8% (p =0.007) in eyes with no thickening., Conclusion: Perifoveal temporal thickening before photocoagulation changes the expected effect of this therapy on macular volume in eyes with focal diabetic macular oedema. It is recommended to evaluate the effect separately, and according to the perifoveal temporal thickness., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.)

Background: Angiotensin converting enzyme inhibitors are effective in delaying the progression of diabetic retinopathy. It is unknown if their use is associated with a better visual outcome in patients with diabetic macular oedema., Material and Methods: A non-experimental, comparative, longitudinal and retrospective study was performed on patients with diabetic macular oedema treated by focal photocoagulation, and with systemic arterial hypertension treated with angiotensin converting enzyme inhibitors (Group 1), and without hypertension (Group 2). The dependent variable was the proportion with visual improvement, operatively defined as the gain of one or more lines of vision three weeks after photocoagulation. The independent variable was the use of angiotensin converting enzyme inhibitors. The proportion of eyes with visual improvement after treatment was compared between groups using the Chi squared (χ(2)) test., Results: A total of 33 eyes (51.6%) were assigned to group 1, and 31 (48.2%), to group 2. The mean of visual acuity improved after three weeks, compared with baseline (p=0.002). The proportion of eyes with visual improvement did not differ between patients treated with angiotensin converting enzyme inhibitors (45.5%) and those that did not use them (51.6%, p=0.4)., Conclusions: There was no statistical difference in the proportion of eyes with visual improvement between patients treated with angiotensin converting enzyme inhibitors and in those where they were not used. There is no support for the inhibition of angiotensin II in addition to photocoagulation for improving the outcome in patients with diabetic macular oedema., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.)

Background: Although photocoagulation reduces the incidence of moderate visual loss in eyes with focal diabetic macular oedema, some eyes may lose some vision after treatment. The proportion of eyes with poor functional response after photocoagulation, and whether any retinal variable is associated with this, is unknown., Objective: To determine the proportion of eyes with diabetic macular oedema that have a poor functional response after focal photocoagulation, and their associated features., Material and Methods: A non-experimental, longitudinal, comparative and retrospective study was conducted. The proportion and 95% confidence intervals (CI) of diabetics with macular oedema that had a poor functional response after focal photocoagulation (any visual loss after 6 weeks) were identified. The means of retinal variables before treatment were compared between eyes with and without a poor functional response using the Student t test for independent means., Results: The study included 115 eyes of patients aged 59.3 (SD 9.24) years. Visual acuity was greater than or equal to 0.5 in 63 eyes (54.8%). A total of 33 eyes had a poor functional response after photocoagulation (28.7%, 95% CI: 13.3 to 44.1). The comparison between retinal variables and visual acuity before treatment did not show any differences between eyes with or without a poor functional response and eyes., Conclusion: Retinal thickening and visual acuity improved or did not change in 71.3% of eyes with diabetic macular oedema with a single photocoagulation procedure. Retinal variables that are usually evaluated were unable to identify the remaining 28.7%, which could lose vision after that treatment, and would require additional interventions., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.)

Background: Clinically significant macular edema has features that are associated with a major risk of visual loss, with thickening that involves the centre of the macula, field 7 or visual deficiency, although it is unknown if these features are related to retinal thickness extension., Material and Methods: An observational, analytical, prospective, cross-sectional and open study was conducted. The sample was divided into initial visual acuity ≥0.5, central field thickness, center point thickness, field 7 and macular volume more than the reported 2 standard deviation mean value in eyes without retinopathy. The extension was determined by the number of the central field area equivalent thickening and these features were compared with by Student's t test for independent samples., Results: A total of 199 eyes were included. In eyes with visual acuity of ≥0.5, the mean extension was 2.88±1.68 and 3.2±1.63 in area equivalent in eyes with visual acuity <0.5 (p=0.12). The mean extension in eyes with less than 2 standard deviation of central field thickness, center point thickness, field 7 and macular volume was significantly lower than in eyes with more than 2 standard deviations (1.9±0.93 vs. 4.07±1.49, 2.44±1.47 vs. 3.94±1.52, 1.79±1.07 vs. 3.61±1.57 and 1.6±0.9 vs. 3.9±1.4, respectively, p<0.001)., Conclusions: The extension of retinal thickness is related with the anatomical features reported with a greater risk of visual loss, but is not related to initial visual deficiency., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.)

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

Background: Photocoagulation reduces the incidence of visual loss in diabetic patients with focal macular edema, but it can induce it for Efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema 6 weeks after treatment and produces visual improvement in some cases. Topical ketorolac may reduce the inflammation caused by photocoagulation and improve visual outcome., Purpose: To determine the efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema., Methods: An experimental, comparative, prospective, longitudinal study in diabetic patients with focal macular edema was conducted. Eyes were randomized into two groups of topical treatment for 3 weeks after photocoagulation (A: ketorolac, B: placebo). Best corrected visual acuity before and after treatment was compared in each group (paired t test), and the proportion of eyes with visual improvement was compared between groups (χ(2)). The evaluation was repeated after stratifying for initial visual acuity (≥ 0.5, < 0.5)., Results: There were 105 eyes included. In group A (n= 46) mean visual acuity changed from 0.50 to 0.58 (p= 0.003), and from 0.55 to 0.55 in group B (n= 59, p= 0.83); mean percent change was 22.3% in group A and 3.5% in group B (p= 0.03). Visual improvement was identified in 25 eyes from group A (54.3%) and 19 from group B (32.2%, p= 0.019, RR 1.65); the difference only persisted when initial visual acuity was ≥ 0.5 (10 [40%], group A, 5 [14.7%], group B, p= 0.02, RR 2.72)., Conclusion: Topical ketorolac was more effective than placebo to improve best corrected visual acuity in diabetic patients with focal macular edema.

Objective: To compare the changes in macular volume after photocoagulation between eyes with diabetic macular edema with and without visual improvement., Methods: Non-experimental, retrospective, longitudinal, comparative study in eyes with diabetic macular edema; the sample was divided in groups: eyes with visual improvement three weeks after photocoagulation (group 1) and eyes without it (group 2). The means of macular volume changes (potential, absolute and percentage) were compared between groups (Student's t test)., Results: 115 eyes, 50 from group 1 and 65 from group 2; mean macular volume before and after photocoagulation and mean potential, absolute, and percentage volume changes did not differ between groups. 13.9% of the sample had visual improvement and a significant volume reduction; the proportion of the latter did not differ between groups (p = 0.3). Macular volume and visual acuity decreased significantly in eyes without previous visual deficiency (p = 0.012); it was more common to find eyes without visual improvement with a non-significant volume reduction, than finding eyes with visual improvement and a significant macular volume reduction., Conclusion: The reduction of macular volume was not enough to explain visual improvement. Optimizing the outcome in patients with diabetic macular edema requires the identification of functional features with a prognostic value.

Background: Center point thickness in diabetic macular edema varies after photocoagulation according to its baseline status; it is unknown whether this variation reduces the correlation between anatomic and visual acuity changes., Objective: to identify the contribution of baseline center point thickness to the correlation between anatomic and visual acuity after photocoagulation, in eyes with diabetic macular edema., Methods: non-experimental, prospective, longitudinal, analytical study in diabetics with macular edema treated with photocoagulation, stratified by groups: visual acuity < 0.5 with (group 1) or without central thickening (group 2), and visual acuity = 0.5 with (group 3) or without central thickening (4). The correlations between changes of center point thickness, macular volume, and visual acuity were identified (Spearman)., Results: 79 eyes, 17 in group 1 (21.5%), 21 in group 2 (26.6%), 14 in group 3 (17.7%) and 27 in group 4 (34.2%). Center point thickness increased in groups 2 and 4, visual acuity decreased in group 3 and macular volume in all the groups. The correlations between center point thickness and best corrected visual acuity changes in group 3, and between macular volume and visual acuity in group 1 were negative. The correlations between anatomic variables and visual acuity were low in the sample (r= 0.14)., Conclusion: the increase of center point thickness in eyes without baseline central thickening produced opposite correlations between groups, which reduced the correlations in the samples. Stratification according to baseline center point thickness would make easier to evaluate other variables that modify the functional outcome after photocoagulation.

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: 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.