RESUMEN El edema macular diabético (EMD) es la primera causa de disminución de la visión entre los pacientes diabéticos. Puede empezar en cualquiera de las etapas de la retinopatía diabética y estar asociada a comorbilidades que pueden afectar varios sistemas del organismo. Muchas veces el paciente diabético con edema macular necesita un manejo multidisciplinario por el que recibe atención inicial de especialistas no oftalmólogos. Existe evidencia que respalda que el diagnóstico precoz y el tratamiento oportuno del EMD puede minimizar la pérdida visual permanente. Los especialistas no oftalmólogos que atienden pacientes diabéticos pueden contribuir a detectar precozmente el EMD que pudiera tener su paciente para recibir la atención oftalmológica correspondiente. El propósito de esta revisión es proveer a la comunidad médica de información sobre la contribución de la tomografía de coherencia óptica en el diagnóstico del EMD y cómo reconocer los biomarcadores tomográficos que permitan pronosticar el resultado visual de su tratamiento.

SUMMARY Diabetic macular edema (DME) is the leading cause of decreased vision among diabetic patients. It can begin in any of the stages of diabetic retinopathy and be associated with comorbidities that can affect various body systems. Many times, the diabetic patient with macular edema needs multidisciplinary management through which he receives initial care from non-ophthalmologist specialists. There is evidence to support that early diagnosis and prompt treatment of DME can minimize permanent visual loss. Non-ophthalmologist specialists who care for diabetic patients can help to detect the DME that their patient may have early to receive the corresponding ophthalmological care. The purpose of this review is to provide the medical community with information on the contribution of optical coherence tomography in the diagnosis of DME and how to recognize tomographic biomarkers that allow predicting the visual outcome of its treatment.

RESUMO A angiografia de campo amplo permite avaliar áreas periféricas com melhor qualidade e proporciona maior foco profundo, melhorando a imagem da periferia. Alguns estudos têm proposto a utilidade desses sistemas angiográficos nas doenças inflamatórias da retina. No entanto, poucos estudos avaliaram esta técnica na doença de Eales. Apresentamos uma série de casos em que 5 olhos de 3 pacientes com doença de Eales foram avaliados usando angiografia de fluoresceína da retina com lentes de 30º, 50º e 150º em um oftalmoscópio de varredura a laser. Esses casos destacam a utilidade da angiografia com fluoresceína de campo amplo no diagnóstico e no acompanhamento das áreas isquêmicas periféricas da retina na doença de Eales, permitindo um melhor acompanhamento do o possível com imagens por angiofluoresceinografia convencional.

ABSTRACT Wide-field angiography enables assessing peripheral areas with better quality and gives greater deep focus, which improves the image periphery. Some studies have proposed the usefulness of these angiographic systems in inflammatory diseases of the retina. However, few studies have evaluated this technique in Eales disease. We present a case series in which 5 eyes of 3 patients with Eales disease were evaluated by using retinal fluorescein angiography with 30º, 50º, and 150º lenses in a laser-scanning ophthalmoscope. These cases highlight the usefulness of wide-field fluorescein angiography in the diagnosis and follow-up of peripheral ischemic retinal areas in Eales disease, which enables better follow-up than possible with conventional fluorescein angiography images.

A 35 year old man patient was admitted to the Ophthalmology Service of Hospital Nacional Arzobispo Loayza with 15 days of proptosis, diplopia, limited ocular motility, ocular pain, and visual acuity exam just count fingers to 40cm in his left eye. He had no fever, no trauma, no sinusitis, and there was no evidence of previous intake of any medication. He had dental cavities without treatment. Corticoid therapy was installed for an inespecific inflammatory syndrome of the orbit. A week later purulent material was obtained after puncture and then antibiotic therapy was installed. Orbital signs worsened initially and after a few days a favorable response was obtained. The case is discussed and pertinent literature reviewed.

Un paciente varón de 35 años fue admitido en el Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza con una historia de 15 días de proptosis, diplopía, limitación de la motilidad ocular, dolor y agudeza visual de cuenta dedos a 40 cm en su ojo izquierdo. No hubo antecedentes de fiebre, trauma, sinusitis, ni evidencia de medicación previa. Tuvo caries dentales sin tratamiento. Se instaló terapia con corticoide pensando en un síndrome inflamatorio inespecífico de la órbita. Una semana después se obtuvo material purulento después de una aspiración con aguja fina, por lo que se inició terapia antibiótica. Luego de la punción-aspiración los signos orbitarios empeoraron pero a los pocos días se obtuvo buena respuesta. Se discute el caso y se revisa la literatura pertinente.