ABSTRACT Purpose: To compare the outcomes of intravitreal dexamethasone implant used as either an adjuvant or a switching therapy for diabetic macular edema in patients with poor anatomic response after three consecutive monthly injections of ranibizumab. Methods: This retrospective study included patients with diabetic macular edema who received three consecutive doses of ranibizumab as initial therapy and demonstrated poor response. A single dose of intravitreal de xamethasone implant was administered to these patients. The patients were divided into two groups according to the treatment modalities: the adjuvant therapy group, consisting of patients who continued treatment with ranibizumab injection after receiving intravitreal dexamethasone implant, and the switch therapy group, consisting of patients who were switched from ranibizumab treatment to intravitreal dexamethasone implant as needed. The main outcome measurements were best corrected visual acuity and central retinal thickness at baseline and at 3, 6, 9, and 12 months of follow-up. Results: In this study that included 64 eyes of 64 patients, the best corrected visual acuity and central retinal thickness values did not significantly differ between the groups at baseline and at 6 months of follow-up (p>0.05). However, at 12 months, the best corrected visual acuity values in the adjuvant and switch therapy groups were 0.46 and 0.35 LogMAR, respectively (p=0.012), and the central retinal thickness values were 344.8 and 270.9, respectively (p=0.007). Conclusions: In a real-world setting, it seems more reasonable to use intravitreal dexamethasone implant as a switch therapy rather than an adjuvant therapy for diabetic macula edema refractory to ranibizumab despite three consecutive monthly injections of ranibizumab. Patients switched to intravitreal dexamethasone implant were found to have better anatomic and visual outcomes at 12 months than those who continued ranibizumab therapy despite their less-than-optimal responses. Purpose Methods modalities group needed 3 9 1 followup. followup follow up. up Results p>0.05. p005 p p>0.05 . 0 05 (p>0.05) However 046 46 0.4 035 35 0.3 LogMAR p=0.012, p0012 p=0.012 , 012 (p=0.012) 3448 344 8 344. 2709 270 270.9 p=0.007. p0007 p=0.007 007 (p=0.007) Conclusions realworld real world setting lessthanoptimal less optimal responses p00 p>0.0 (p>0.05 04 4 0. 03 p001 p=0.01 01 (p=0.012 34 27 270. p000 p=0.00 00 (p=0.007 p0 p>0. (p>0.0 p=0.0 (p=0.01 2 (p=0.00 p>0 (p>0. p=0. (p=0.0 p> (p>0 p=0 (p=0. (p> p= (p=0 (p (p=

RESUMEN Introducción: Las complicaciones de diabetes son una causa frecuente de discapacidad e invalidez. Objetivo: Determinar la supervivencia de la población con dictamen de invalidez por complicaciones de diabetes en el período 2016-2018. Métodos: Estudio observacional retrospectivo en población asegurada que recibió un dictamen de invalidez por complicaciones de diabetes mellitus tipo 2. Las variables estudiadas fueron: diagnósticos de los dictámenes de invalidez por complicaciones de diabetes tipo 2, años de supervivencia posteriores a la emisión del dictamen y características sociodemográficas. Resultados: Fueron 51 derechohabientes que recibieron un dictamen de invalidez por complicaciones de diabetes mellitus. Predominaron el sexo masculino y la edad promedio de 55,21 ± 9,14 años. El 72,6 % habita en zona urbana con buenas condiciones. Las complicaciones de diabetes más frecuentes fueron las circulatorias (33,3 %). El tiempo promedio de supervivencia fue de 4,7 años. Conclusiones: Se observaron diferencias en los tiempos medios de supervivencia entre las complicaciones retinopatía diabética vs complicaciones múltiples de diabetes que llevan al estado de invalidez. Los factores como el sexo o la situación geográfica del trabajador no influyen en el tiempo de supervivencia.

ABSTRACT Introduction: Complications of diabetes are a common cause of disability and invalidity. Objective: Determine the survival of the population insured by the Mexican Social Security Institute that received a disability ruling due to complications of type 2 diabetes mellitus at the Gineco-Pediatrics Hospital with Family Medicine No. 31 Mexicali Baja California in the period 2016-2018. Methods: Retrospective study in an insured population that received a disability ruling due to complications of type 2 diabetes mellitus. The variables studied were: diagnoses of the disability rulings due to complications of type 2 diabetes, years of survival after the ruling was issued, and characteristics. sociodemographic. Results: There were 51 beneficiaries who received a disability ruling due to complications of diabetes mellitus. Male sex predominated and the average age was 55.21 ± 9.14 years. 72.6% live in urban areas with good conditions. The most common diabetes complications were circulatory complications (33.3%). Average survival time was 4.7 years. Conclusions: Differences were observed in the mean survival times between diabetic retinopathy complications vs. multiple diabetes complications leading to disability. Factors such as the worker's sex or geographical location do not influence survival time.

ABSTRACT Introduction: Diabetes mellitus is a public health issue affecting an increasing number of workers, representing a disease exacerbated by work with a high social, economic, and personal cost. The nature of the work performed, coupled with occupational risks in a hospital setting, significantly contribute to the disease's progression. This study aims to address the impact of this disease on work and the role of Occupational Health in the prevention of exposure to occupational risk factors in the hospital environment, which can contribute to the metabolic imbalance of type I diabetes mellitus. Methodology: The methodology included search in PubMed, Science Direct, and Google Scholar databases, using keywords such as "diabetes mellitus, occupational medicine, risk factors and occupational health”. Filters were applied, considering publications from 2010 to 2024, totaling 463 works. Exclusion criteria focused on non-diabetes-related diseases, exclusive focus on Type II, and non-occupational approaches. Articles on diabetes and occupational health and safety published in Revista Portuguesa de Saúde Ocupacional were also considered, in a total of five studies. Sources also included Direção Geral de Saúde Clinical Guidance, a national epidemiological study, and a technical manual on workplace diabetes, totaling 30 references in the discussion. Results: The authors report two cases of healthcare professionals from a hospital unit, both diagnosed with Type I Diabetes at the age of five. Case 1: A 35-year-old healthcare assistant with a history of depressive syndrome and recent diabetic retinopathy diagnosis. Case 2: A 57-year-old nurse with diabetic retinopathy, nephropathy, neuropathy, undergoing treatment for osteomyelitis of the right big toe, without cardiovascular changes. In both they work or have worked in shifts, including night shifts, engaging in physically demanding tasks. Discussion/Conclusion: Diabetes is a chronic disease requiring continuous medical care and patient education, alongside support in preventing acute complications and reducing the risk of chronic complications. The incidence of new Type I Dm cases is higher between 12-14 years. During the transition to adulthood and entry into the job market, patients face disease stigma, treatment management challenges, and psychosocial workplace-related issues. Implementing preventive measures and monitoring these workers should help reduce work absenteeism, productivity loss, and income loss for the worker.

RESUMO Introdução: A Diabetes mellitus é um problema de Saúde Pública que afeta um número crescente de trabalhadores. Pode ser considerada uma doença agravada pelo trabalho com um elevado custo social, económico e pessoal. O tipo de trabalho realizado e as exposições a riscos laborais em contexto hospitalar, podem contribuir para a sua progressão, segundo alguns autores. Este trabalho pretende abordar o impacto desta patologia no trabalho e o papel da Saúde Ocupacional na evicção da exposição a fatores de risco laborais, em ambiente hospitalar, que contribuem para o descontrolo metabólico da Diabetes Melitus tipo I. Pretende-se identificar as exposições laborais que podem constituir fatores de risco modificáveis, interferem com a aptidão para o trabalho, podem aumentar a frequência de acidentes laborais e acelerar a progressão crónica da doença. Metodologia: Na metodologia de pesquisa e seleção de estudos utilizou as bases de dados PubMed, Science Direct e Google Scholar, com as palavras-chave “diabetes mellitus, occupational medicine, risk factors, occupational health”. Aplicaram-se filtros de revisão e revisão sistemática, considerando publicações de 2010 a 2024, totalizando 463 trabalhos. Critérios de exclusão incidiram em doenças não relacionadas à diabetes, exclusividade na tipo II e abordagens não ocupacionais. Foram ainda considerados os artigos sobre diabetes e saúde e segurança no trabalho publicados na Revista Portuguesa de Saúde Ocupacional, num total de cinco estudos. Incluíram-se a Norma de Orientação Clínica da DGS, um estudo epidemiológico nacional e um caderno técnico sobre diabetes no local de trabalho, totalizando 30 fontes na discussão. Descrição dos casos: Os autores reportam dois casos de profissionais de saúde de uma unidade hospitalar, ambos com diagnóstico de Diabetes tipo I aos cinco anos de idade. Caso 1: Uma auxiliar de ação médica de 35 anos, com antecedentes pessoais de síndrome depressivo e diagnóstico recente de retinopatia diabética. Caso 2: Uma enfermeira de 57 anos com retinopatia e nefropatia diabética, neuropatia, em tratamento para uma osteomielite do 1º dedo do pé direito, sem alterações cardiovasculares. Ambas trabalham ou trabalharam por turnos, com trabalho noturno e com tarefas fisicamente exigentes. Discussão/Conclusão: A diabetes é uma doença crónica que requer cuidados médicos contínuos e educação do doente, juntamente com apoio na prevenção de complicações agudas e redução do risco de complicações crónicas. A incidência de novos casos de Dm tipo I é maior entre os 12-14 anos. Na transição para a idade adulta e entrada no mercado laboral, os doentes podem ser sujeitos ao estigma da doença, ter dificuldade na gestão do tratamento e/ou desafios psicossociais relacionados com o trabalho. A instituição de medidas preventivas e monitorização destes trabalhadores deverá ajudar a reduzir o absentismo laboral, a perda de produtividade e a perda de rendimento para o trabalhador.

Abstract: Vision problems are common in patients with diabetes mellitus (DM) because they may suffer from diabetic retinopathy (DR). Because the symptoms of this condition are not easy to detect without the intervention of an expert technician, the use of convolutional neural networks (CNN) has been implemented to speed up the process of analyzing retina images. Due to the good results of this technology, efforts have been made to combine it with other technologies. In this paper, we present the use of an intelligent hybrid system that uses CNNs and Fuzzy Logic with the aim of improving the accuracy obtained. The implementation of fuzzy logic to adjust the hyperparameters of the network allowed us to obtain a mean of 0.9526 with a standard deviation of 0.008521158 in the binary case study, while in the multiclass case study we obtained a mean of 0.7299 and a standard deviation of 0.015614013, offering better results when fuzzy logic is combined compared to when not.

RESUMEN Introducción: la diabetes mellitus es una enfermedad crónica que, al no ser controlada, puede desencadenar en complicaciones macro y microvasculares. Uno de los indicadores de un adecuado control glucémico es la hemoglobina glicosilada. Objetivos: determinar la frecuencia de complicaciones macro y microvasculares en pacientes diabéticos tipo 2 con hemoglobina glicosilada alterada internados en el Hospital Nacional de Itauguá periodo 2022 - 2023 Metodología: estudio observacional, descriptivo de corte transversal que incluyó a 170 pacientes adultos internados en el servicio de clínica médica del Hospital Nacional (Itauguá, Paraguay) durante los años 2022 y 2023. Resultados: la edad media fue de 58 ± 12 años, con predominio del sexo femenino (51 %). La complicación más frecuentemente diagnosticada fue la enfermedad del pie relacionada a la diabetes con 83 pacientes (49 %), seguido por retinopatía diabética 23 (14 %). El valor promedio de hemoglobina glicosilada fue de 10 ± 2 %. Solamente 6 (4 %) del total de pacientes presentó un valor de HbA1C≥ 7,1 %. La comorbilidad asociada más frecuente fue la hipertensión arterial 87 (51 %). El 91 % de los pacientes conocía ser portador de la enfermedad, el 80 % recibía algún tipo de tratamiento. Conclusiones: el pie diabético fue la complicación vascular diagnosticada con mayor ,frecuencia, especialmente en pacientes con HbA1C≥ 7,1 %.

ABSTRACT Introduction: diabetes mellitus is a chronic disease that, if not controlled, can lead to macro- and microvascular complications. One of the indicators of adequate glycemic control is glycosylated hemoglobin. Objectives: to determine the frequency of macro and microvascular complications in type 2 diabetic patients with altered glycosylated hemoglobin admitted to the Hospital Nacional from 2022 to 2023 Methodology: this was an observational, descriptive, cross-sectional study that included 170 adult patients admitted to the Internal Medicine service of the Hospital Nacional (Itauguá, Paraguay) during the years 2022 and 2023. Results: the mean age was 58 ± 12 years, with a predominance of the female sex (51 %). The most frequently diagnosed complication was foot disease related to diabetes with 83 patients (49 %), followed by diabetic retinopathy 23 (14 %). The average value of glycosylated hemoglobin was 10 ± 2 %. Only 6 (4 %) of the total patients had an HbA1C value ≤7 %. The most frequent associated comorbidity was arterial hypertension 87 (51 %). 91 % of the patients knew they were carriers of the disease, 80 % received some type of treatment. Conclusions: diabetic foot was the most frequently diagnosed vascular complication, especially in patients with HbA1C ≥7.1 %.

Resumen La detección y el diagnóstico de diabetes e hipertensión presentan un escenario desafiante, principalmente en etapas tempranas. Estos dos son degenerativos y de graves consecuencias, provocando daños en múltiples órganos, incluidos los ojos. El oftalmólogo examina el fondo de la retina para discriminar el tipo de enfermedad. En el caso de la retinopatía, como enfermedad crónica, se evidencia en varias clases de progresión. La retinopatía diabética se clasifica en cuatro, que incluyen etapas leve, moderada, grave y proliferativa. En la etapa proliferativa, la retina produce factores vasoproliferativos que estimulan el crecimiento de nuevos vasos sanguíneos, aumentando el riesgo de pérdida de visión. En cuanto a la retinopatía hipertensiva, el método de clasificación más utilizado es la clasificación de Keith-Wagener-Barker. Similar a la retinopatía diabética, también consta de cuatro clases, que van de leves a graves. En la etapa grave, existe un mayor riesgo de desarrollar papiledema o edema retiniano. El objetivo principal de esta investigación es realizar la segmentación y clasificación de imágenes de fondo de retina con retinopatía diabética e hipertensiva. Se propuso una combinación de una red convolucional UNet y una ConvNet para la segmentación de máscara de vasos y la clasificación de retinopatía, respectivamente. El proceso de clasificación se basa en diez clases definidas, donde los valores que van del 0 al 4 representan la retinopatía diabética y los valores del 5 al 9 corresponden a la retinopatía hipertensiva. Los resultados aproximados en la segmentación fueron índices Jaccard de 74%, F1 de 85% y un Accuracy de 96%, y en la clasificación un Accuracy de 80%.

Abstract The detection and diagnosis of diabetes and hypertension present a challenging scenario, mainly in the early stages. These two are degenerative and with severe consequences, causing damage to multiple organs, including the eyes. The ophthalmologist examines the retinal fundus to discriminate between the type of disease. In the case of retinopathy, as a chronic disease, evidence in various classes of progression. Diabetic retinopathy is categorized into four, which include mild, moderate, severe, and proliferative stages. In the proliferative stage, the retina produces vasoproliferative factors that stimulate the growth of new blood vessels, increasing the risk of vision loss. As for the hypertensive retinopathy the most widely used method for classifying is the Keith-Wagener-Barker classification. Like diabetic retinopathy, it consists also of four classes, ranging from mild to severe. In the severe stage, there is an increased risk of developing papilledema or retinal edema. The main objective of this research is to perform segmentation and classification of diabetes and hypertensive retinopathy retinal fundus images. Using a combination of a convolutional network UNet and a ConvNet was proposed for vessel mask segmentation and retinopathy classification, respectively. The classification process relies on ten defined classes, where values ranging from 0 to 4 represent diabetic retinopathy, and values ranging from 5 to 9 correspond to hypertensive retinopathy. The approximate results in the segmentation were Jaccard index of 74%, F1 of 85%, and an Accuracy of 96%, and in the classification was Accuracy of 80%.

RESUMEN Introducción: Se reconoce la asociación entre los factores de riesgo aterogénico y las alteraciones microvasculares de la retina, pero no hay consenso sobre si estas afectaciones en la retina preceden o son una respuesta fisiopatológica a dichos factores. Objetivo: Determinar si la presencia de los factores de riesgo aterogénico predice las alteraciones vasculares retinianas, a través del fondo de ojo y la retinografía. Métodos: Estudio trasversal en 55 sujetos mayores de 19 años de edad, de cualquier sexo, sin opacidades en los medios transparentes del ojo. Se estudiaron las variables edad, sexo, dislipidemia, hábito de fumar, consumo de alcohol, hipertensión arterial, diabetes mellitus tipo 2, presión arterial sistólica y diastólica, índice de masa corporal, colesterol, glicemia, triglicéridos, creatinina, lipoproteínas de alta densidad, urea, eritrosedimentación y conteo leucocitario. Resultados: El 65,45 % presentó alteraciones en el fondo de ojo: aumento del brillo arteriolar (53,03 %) y disminución del calibre arteriolar generalizado (52,24 %). La retinografía mostró daño en el 58,18 %: rectificación de los cruces arteriovenosos (65,71 %), tortuosidad venosa (28,21 %) y cruces arteriovenosos con aplastamiento (85,71 %). El aumento del colesterol sérico (p= 0,003) se asoció con la presión arterial sistólica (p= 0,037) en el fondo de ojo, y con el antecedente de hipertensión arterial (p= 0,023) en la retinografía. Conclusiones: El colesterol sérico, las cifras elevadas de tensión arterial sistólica y antecedentes de hipertensión arterial son los factores de riesgo que mejor predicen el daño vascular retinal.

ABSTRACT Introduction: The association between atherogenic risk factors and retinal microvascular alterations is recognized, but there is no consensus on whether these retinal disorders precede or are a pathophysiological response to these factors. Objective: To determine if the presence of atherogenic risk factors predicts retinal vascular alterations, through fundus examination and retinography. Methods: Cross-sectional study in 55 subjects over 19 years of age, of either sex, without opacities in the transparent media of the eye. The variables studied were age, sex, dyslipidemia, smoking habit, alcohol consumption, arterial hypertension, type 2 diabetes mellitus, systolic and diastolic blood pressure, body mass index, cholesterol, glycemia, triglycerides, creatinine, high-density lipoproteins, urea, erythrocyte sedimentation rate and leukocyte count. Results: 65.45% presented alterations in the fundus of the eye: increased arteriolar brightness (53.03%) and decreased generalized arteriolar caliber (52.24%). Retinography showed damage in 58.18%: rectification of arteriovenous crossings (65.71%), venous tortuosity (28.21%), and arteriovenous crossings with crushing (85.71%). The increase in serum cholesterol (p= 0.003) was associated with systolic blood pressure (p= 0.037) in the fundus, and with a history of arterial hypertension (p= 0.023) in retinography. Conclusions: Serum cholesterol, high systolic blood pressure and a history of hypertension are the risk factors that best predict retinal vascular damage.

RESUMO Objetivo: Determinar as taxas de fechamento de buracos maculares idiopáticos grandes tratados com vitrectomia posterior e técnica de flap invertido 360 graus pediculado de membrana limitante interna, sem posicionamento de cabeça pós-operatório e definir melhora visual, tipos de fechamento do buraco macular e integridade das camadas retinianas externas como objetivo secundário. Métodos: Este estudo foi uma série retrospectiva de casos. Todos os pacientes foram submetidos a vitrectomia com flap invertido 360 graus pediculado de membrana limitante interna e tamponamento com gás, sem posição de cabeça no pós-operatório. Idade, gênero, tempo de redução da acuidade visual, outras patologias oculares e status do cristalino foram compilados. Medida de melhor acuidade visual corrigida e tomografia de coerência óptica foram registradas durante as visitas de pré e pós-operatório (15 dias e 2 meses após cirurgia). Resultados: Vinte olhos de 19 pacientes foram incluídos neste estudo. A idade média foi de sessenta e seis anos. Um total de 19 olhos (95%) atingiu fechamento do buraco, observado através das imagens de tomografia de coerência óptica após 2 meses de cirurgia. Melhor acuidade visual corrigida média aumentou +1,08 pré-operatória para +0,66 LogMAR em 2 meses de cirurgia (p<0,001), com média de 20 letras de melhora visual (0,4 LogMAR) na tabela do Early Treatment Diabetic Retinopathy Study. Dois tipos de fechamento do buraco foram observados: V (47,36%) e U (52,63%). Conclusão: A técnica de flap invertido 360 graus pediculado de membrana limitante interna, sem posicionamento de cabeça no pós-operatório promoveu elevada taxa de fechamento (95%), reestabelecimento das camadas retinianas externas, fechamento com contorno foveal dos tipos V e U, além de melhora visual na maioria dos casos de BMI gran des (mesmo nos buracos maiores que 650 μm). Esta técnica pode representar uma alternativa para o tratamento de buracos maculares grandes em pacientes impossibilitados de cumprir o tradicional posicionamento de cabeça pós-operatório. Objetivo 36 pósoperatório pós operatório secundário Métodos gás pósoperatório. operatório. Idade gênero compilados 15 (1 . cirurgia) Resultados 1 anos 95% 95 (95% 108 08 +1,0 préoperatória operatória 066 0 66 +0,6 p<0,001, p0001 p p<0,001 , 001 (p<0,001) 0,4 04 4 (0, Study observados 47,36% 4736 47 (47,36% 52,63%. 5263 52,63% 52 63 (52,63%) Conclusão 95%, mesmo 65 μm. μm μm) 3 ( 9 (95 10 +1, 06 6 +0, p000 p<0,00 00 (p<0,001 0, (0 47,36 473 (47,36 526 52,63 5 (52,63% (9 +1 +0 p00 p<0,0 (p<0,00 47,3 (47,3 52,6 (52,63 + p0 p<0, (p<0,0 47, (47, 52, (52,6 p<0 (p<0, (47 (52, p< (p<0 (4 (52 (p< (5 (p

ABSTRACT Purpose: This study aimed to determine closure rates of large idiopathic macular holes treated with pars plana vitrectomy and 360-degree pedicled inverted internal limiting membrane flap without face-down posturing and define visual improvement, types of macular hole closure, and external retina integrity as secondary outcomes. Methods: This retrospective case series analyzed all patients who were treated by vitrectomy, 360-degree pedicled inverted internal limiting membrane flap, and gas tamponade, without face-down posturing postoperatively. Age, sex, time of visual acuity reduction, other ocular pathologies, and lens status were collected. The best-corrected visual acuity and optical coherence tomography results were recorded during pre- and postoperative follow-up examinations (15 days and 2 months after surgery). Results: This study enrolled 20 eyes of 19 patients, and the mean age was 66 years. Optical coherence tomography performed 2 months after surgery revealed hole closure in 19 (95%) eyes. The median best-corrected visual acuity improved from +1.08 preoperatively to +0.66 LogMAR 2 months postoperatively (p<0.001), with a median of 20 letters of visual improvement (0.4 LogMAR) on the Early Treatment Diabetic Retinopathy Study chart. V (47.36%)- and U (52.63%)-types of closure were observed. Conclusion: The 360-degree pedicled inverted internal limiting membrane flap technique, without face-down posturing, provided a high closure rate (95%), external layer recovery, and V- and U-type foveal closure contours, in addition to visual improvement in most cases of large macular holes (even macular holes >650 μm). This technique may be a viable alternative to patients in whom traditional postoperative face-down positioning for large macular hole treatment is not possible. Purpose 360degree degree 360 facedown face down outcomes Methods tamponade Age sex reduction pathologies collected bestcorrected best corrected pre followup follow up 15 (1 surgery. . surgery) Results 1 6 years 95% 95 (95% 108 08 +1.0 066 0 +0.6 p<0.001, p0001 p p<0.001 , 001 (p<0.001) 0.4 04 4 (0. chart 47.36% 4736 47 36 (47.36%) 52.63%types 5263types 52.63% 52 63 observed Conclusion 95%, recovery Utype type contours even 650 >65 μm. μm μm) possible ( 9 (95 10 +1. 06 +0. p000 p<0.00 00 (p<0.001 0. (0 47.36 473 3 (47.36% 5263 52.63 5 65 >6 (9 +1 +0 p00 p<0.0 (p<0.00 47.3 (47.36 526 52.6 > + p0 p<0. (p<0.0 47. (47.3 52. p<0 (p<0. (47. p< (p<0 (47 (p< (4 (p

RESUMO Objetivo: Avaliar as alterações precoces após a primeira injeção de anticorpos antifator de crescimento endotelial vascular (anti-VEGF) em casos de edema macular secundário à retinopatia diabética e oclusão da veia da retina e a relação entre essas alterações e o resultado a longo prazo. Métodos: Foram incluídos no estudo pacientes que receberam uma injeção de antifator de crescimento endotelial vascular para edema macular, virgem de tratamento e devido à oclusão da veia retiniana ou a retinopatia diabética. A espessura macular central foi medida no início do tratamento e no 1º dia, 2ª semana e 1º mês após a injeção, bem como na última visita, através de tomografia de coerência óptica de domínio espectral. Definiu-se uma “boa resposta” como uma redução ≥10% na espessura macular central no 1º dia após a injeção. Os pacientes foram reavaliados na última visita com relação à resposta ao tratamento no 1º dia após a injeção, com base em um resultado anatômico favorável, definido como uma espessura macular central <350 µm. Resultado: Foram registrados 26 (44,8%) pacientes com edema macular e oclusão da veia da retina e 32 (55,2%) com edema macular e retinopatia diabética. O tempo médio de acompanhamento foi de 24,0 meses (desvio-padrão de 8,5 meses). Foi observada uma diminuição estatisticamente significativa da espessura macular central após o tratamento antifator de crescimento endotelial vascular tanto em pacientes com edema macular e oclusão da veia retiniana quanto naqueles com edema macular e retinopatia diabética (p<0,001 para ambos). Todos os pacientes com edema macular e oclusão da veia retiniana responderam bem no 1º dia pós-injeção. Todos os que responderam mal no 1º dia pós-injeção pertenciam ao grupo com edema macular e retinopatia diabética (n=16,50%). A presença de manchas hiperrefletivas foi maior nos pacientes que responderam mal do que naqueles que tiveram boa resposta no grupo com edema macular e retinopatia diabética (p=0,03). Um dos 42 (2,4%) pacientes com boa resposta total teve espessura macular central >350 um, enquanto 5 (31,2%) do total de 16 pacientes com resposta ruim apresentaram espessura macular central >350 µm na última visita (p=0,003). Conclusão: O resultado anatômico de longo prazo do edema macular secundário à oclusão da veia retiniana e à retinopatia diabética pode ser previsto pela resposta ao tratamento no 1º dia após a injeção de antifator de crescimento endotelial vascular. Objetivo antiVEGF anti VEGF (anti-VEGF Métodos º ª espectral Definiuse Definiu se 10 ≥10 favorável 350 <35 Resultado 2 44,8% 448 44 8 (44,8% 3 55,2% 552 55 (55,2% 240 24 0 24, desviopadrão desvio padrão 85 8, meses. . meses) p<0,001 p0001 p 001 (p<0,00 ambos. ambos ambos) pósinjeção. pósinjeção pós n=16,50%. n1650 n n=16,50% 50 (n=16,50%) p=0,03. p003 p=0,03 03 (p=0,03) 4 2,4% (2,4% >35 31,2% 312 31 (31,2% 1 p=0,003. p0003 p=0,003 003 (p=0,003) Conclusão ≥1 35 <3 44,8 (44,8 55,2 (55,2 p<0,00 p000 00 (p<0,0 n165 n=16,50 (n=16,50% p00 p=0,0 (p=0,03 2,4 (2,4 >3 31,2 (31,2 p=0,00 (p=0,003 ≥ < 44, (44, 55, (55, p<0,0 (p<0, n16 n=16,5 (n=16,50 p0 p=0, (p=0,0 2, (2, > 31, (31, (p=0,00 (44 (55 p<0, (p<0 n1 n=16, (n=16,5 p=0 (p=0, (2 (31 (4 (5 p<0 (p< n=16 (n=16, p= (p=0 ( (3 p< (p n=1 (n=16 (p= n= (n=1 (n= (n

ABSTRACT Purpose: To evaluate early changes after the first antivascular endothelial growth factor injection for macular edema secondary to diabetic retinopathy and retinal vein occlusion and the relationship between longterm outcomes. Methods: The study enrolled patients who received anti-vascular endothelial growth factor injections for treatment-naive macular edema due to retinal vein occlusion and diabetic retinopathy. The central macular thickness was measured at baseline, post-injection day 1, week 2, and month 1, and at the last visit using spectral-domain optical coherence tomography. A good response was defined as a central macular thickness reduction of ≥10% on post-injection day 1. Patients were reassessed at the last visit with regard to treatment response on post-injection day 1 based on the favorable anatomic outcome defined as a central macular thickness <350 µm. Results: In total, 26 (44.8%) patients had macular edema-retinal vein occlusion and 32 (55.2%) had macular edema-diabetic retinopathy. The mean follow-up time was 24.0 (SD 8.5) months. A statistically significant decrease in the central macular thickness was observed in both patients with macular edema-retinal vein occlusion and macular edema-diabetic retinopathy after antivascular endothelial growth factor injection therapy (p<0.001 for both). All patients with macular edema-retinal vein occlusion were good responders at post-injection day 1. All nongood responders at post-injection day 1 belong to the macular edema-diabetic retinopathy group (n=16.50%). The rate of hyperreflective spots was higher in nongood responders than in good responders of the macular edema-diabetic retinopathy group (p=0.03). Of 42 (2.4%) total good responders, one had a central macular thickness >350 µm, whereas 5 (31.2%) of 16 total nongood responders had a central macular thickness >350 µm at the last visit (p=0.003). Conclusion: The longterm anatomical outcomes of macular edema secondary to retinal vein occlusion and diabetic retinopathy may be predicted by treatment response 1 day after antivascular endothelial growth factor injection. Purpose Methods anti vascular treatmentnaive naive baseline postinjection post 2 spectraldomain spectral domain tomography 10 ≥10 350 <35 Results 44.8% 448 44 8 (44.8% edemaretinal 3 55.2% 552 55 (55.2% edemadiabetic followup follow up 240 24 0 24. SD 8.5 85 months p<0.001 p0001 p 001 (p<0.00 both. . both) n=16.50%. n1650 n n=16.50% 50 (n=16.50%) p=0.03. p003 p=0.03 03 (p=0.03) 4 2.4% (2.4% >35 31.2% 312 31 (31.2% p=0.003. p0003 p=0.003 003 (p=0.003) Conclusion ≥1 35 <3 44.8 (44.8 55.2 (55.2 8. p<0.00 p000 00 (p<0.0 n165 n=16.50 (n=16.50% p00 p=0.0 (p=0.03 2.4 (2.4 >3 31.2 (31.2 p=0.00 (p=0.003 ≥ < 44. (44. 55. (55. p<0.0 (p<0. n16 n=16.5 (n=16.50 p0 p=0. (p=0.0 2. (2. > 31. (31. (p=0.00 (44 (55 p<0. (p<0 n1 n=16. (n=16.5 p=0 (p=0. (2 (31 (4 (5 p<0 (p< n=16 (n=16. p= (p=0 ( (3 p< (p n=1 (n=16 (p= n= (n=1 (n= (n

BACKGROUND: Diabetic retinopathy (DR) is a leading cause of vision loss and preventable blindness, particularly in middle- and high-income countries AIM: This study aimed to assess the characteristics and associated factors of DR in Sudanese patients with type 2 diabetes mellitus (DM SETTING: A cross-sectional hospital-based study included 119 patients with type 2 DM was conducted at EL-Walidain Eye Hospital, Khartoum, Sudan, from February 2021 to May 2021 METHODS: A non-mydriatic digital fundus camera was used for fundus photography, and Scottish Diabetic Retinopathy Grading Scheme was used for the final classification of DR RESULTS: Females comprised 53.8% of patients, mean age of 58.8 ± 8.5 years. Uncontrolled DM was found in 37.8% with a mean duration of 10.5 ± 4.8 years. Myopia was the most common refractive error found in 57.8% of the uncontrolled group, followed by emmetropia (17.8%). Whereas in the controlled group, 47.3% were hyperopic and 39.2% were myopic. Maculopathy grade M1 was found to be 37.8% in the uncontrolled group and 18.9% in the controlled group, with no significant difference (p = 0.361). Conversely, the difference in retinopathy between the two groups was statistically significant (p = 0.043 CONCLUSION: Decreased vision and increased retinopathy were associated with an increase in patients' age. More widespread diabetes awareness and screening programmes to improve diabetes management and control in Sudan and other developing countries CONTRIBUTION: This study observed maculopathy grade M1 and myopia were more common in uncontrolled DM, and vision function was inversely correlated with age (p < 0.05

BACKGROUND: Accurate and objective diagnosis of centre-involving diabetic macular oedema (ci-DMO) requires the use of optical coherence tomography (OCT). There is limited data on the availability and rate of utilisation of OCT for the management of DMO in sub-Saharan Africa (SSA). AIM: To assess the availability and rate of utilisation of OCT for the management of DMO in SSA. SETTING: Retina-practising ophthalmologists in 18 countries across SSA. METHODS: In this cross-sectional survey, a structured questionnaire was distributed among ophthalmologists treating patients with retina diseases in SSA. Data were collected using Google Forms by sharing a link to the Google data sheet with participants via email. The responses were analysed, summarised and presented using proportions and frequency tables. RESULTS: A total of 42 ophthalmologists participated in this study. The proportion of diabetic retinopathy patients with DMO seen on a monthly basis was ≤ 20% among 24 (57.1%) participants and ≥ 40% among 14.3% participants. Thirty-eight (90.5%) participants had access to an OCT facility in their area of practice and 85.7% of them had Spectra Domain OCT. Twenty-five (64%) participants performed 1 to 50 OCT scans monthly and 34% performed > 50 OCT scans monthly. Important factors influencing OCT use in DMO patients were: the availability of OCT in the facility, patients' insurance coverage and the severity of DMO. CONCLUSION: Optical coherence tomography is readily available although there is wide variability in its use in SSA. CONTRIBUTION: This survey uncovers the need for standardising practice patterns and usage of OCT in the treatment of DMO in SSA.

ABSTRACT Introduction: To obtain fundoscopy images through portable and low-cost equipment using artificial intelligence to assess the presence of DR. Methods: Fundus images of diabetic patients’ eyes were obtained by using a smartphone coupled to a device with a 20D lens. By using artificial intelligence (AI), the presence of DR was classified by a binary algorithm. Results: 97 ocular fundoscopy images were evaluated (45 normal and 52 with DR). Through AI diagnostic accuracy around was 70% to 100% in the classification of the presence of DR. Conclusion: The approach using a low-cost portable device showed satisfactory efficacy in the screening of diabetic patients with or without diabetic retinopathy, being useful for places without infrastructure conditions. Introduction lowcost low cost Methods D lens AI, , (AI) algorithm Results 9 45 (4 5 . DR) 70 100 Conclusion retinopathy conditions (AI 4 ( 7 10 1

RESUMO Objetivo: Obter imagens de fundoscopia por meio de equipamento portátil e de baixo custo e, usando inteligência artificial, avaliar a presença de retinopatia diabética. Métodos: Por meio de um smartphone acoplado a um dispositivo com lente de 20D, foram obtidas imagens de fundo de olhos de pacientes diabéticos; usando a inteligência artificial, a presença de retinopatia diabética foi classificada por algoritmo binário. Resultados: Foram avaliadas 97 imagens da fundoscopia ocular (45 normais e 52 com retinopatia diabética). Com auxílio da inteligência artificial, houve acurácia diagnóstica em torno de 70 a 100% na classificação da presença de retinopatia diabética. Conclusão: A abordagem usando dispositivo portátil de baixo custo apresentou eficácia satisfatória na triagem de pacientes diabéticos com ou sem retinopatia diabética, sendo útil para locais sem condições de infraestrutura. Objetivo artificial Métodos 20D D binário Resultados 9 45 (4 5 . diabética) 7 100 Conclusão infraestrutura 4 ( 10 1

ABSTRACT Purpose: This study measured serum hypoxia--inducible factor-1 (HIF-1α) and survivin levels in patients with diabetes and investigated their association with the severity of retinopathy. Methods: This study included 88 patients with type 2 diabetes mellitus who underwent routine eye examinations. Three groups were created. Group 1 consisted of patients without diabetic retinopathy. Group 2 included patients with non-proliferative diabetic retinopathy. Group 3 included patients with proliferative diabetic retinopathy. To measure serum HIF-1α and survivin levels, venous blood samples were collected from patients. Results: The mean HIF-1α levels in groups 1, 2, and 3 were 17.30 ± 2.19, 17.79 ± 2.34, and 14.19 ± 2.94 pg/ml, respectively. Significant differences were detected between groups 1 and 3 (p=0.01) and between groups 2 and 3 (p=0.01). The mean survivin levels in groups 1, 2, and 3 were 42.65 ± 5.37, 54.92 ± 5.55, and 37.46 ± 8.09 pg/ml, respectively. A significant difference was only detected between groups 2 and 3 (p=0.002). Conclusion: The present study revealed that serum HIF-1α and survivin levels are increased in patients with non-proliferative diabetic retinopathy compared to those in patients without diabetic retinopathy. Purpose hypoxiainducible hypoxia inducible factor1 factor factor- HIF1α HIFα HIF 1α α (HIF-1α Methods 8 examinations created nonproliferative non Results 1730 17 30 17.3 219 19 2.19 1779 79 17.7 234 34 2.34 1419 14 14.1 294 94 2.9 pgml pg ml pg/ml respectively p=0.01 p001 p 0 01 (p=0.01 p=0.01. . 4265 42 65 42.6 537 5 37 5.37 5492 54 92 54.9 555 55 5.55 3746 46 37.4 809 09 8.0 p=0.002. p0002 p=0.002 002 (p=0.002) Conclusion 173 17. 21 2.1 177 7 23 2.3 141 14. 29 9 2. p=0.0 p00 (p=0.0 426 4 6 42. 53 5.3 549 54. 5.5 374 37. 80 8. p000 p=0.00 00 (p=0.002 p=0. p0 (p=0. 5. (p=0.00 p=0 (p=0 p= (p= (p