Resumen Objetivo: Determinar los factores asociados al nivel de conocimiento sobre glaucoma primario de ángulo abierto (GPAA) en un centro de referencia nacional en Perú. Método: Se realizó un estudio observacional, correlacional, transversal y cuantitativo entre marzo y abril de 2021, en el Instituto Nacional de Oftalmología Dr. Francisco Contreras Campos, en Lima, Perú. Se incluyeron pacientes adultos de ambos sexos con diagnóstico de GPAA y se excluyeron aquellos pacientes con problemas psiquiátricos, con incapacidad para contestar el instrumento y quienes no aceptaron participar en el estudio. Se utilizó un cuestionario diseñado y validado en pacientes hispanohablantes en Perú. Resultados: Participaron 362 pacientes, en su mayoría mujeres (51.5%), con una edad promedio de 67.6 ± 13.1 años. El 45.9% había estudiado hasta el nivel secundario, el 50% ya no laboraba, el 87.8% tenía un ingreso mensual de hasta 250 dólares americanos, el 95.9% contaban con Seguro Integral de Salud, el 81.2% ya se habían realizado exámenes oculares previos y el 31.8% tenían un familiar con el mismo diagnóstico. El estado civil soltero y casado (p = 0.046 y p = 0.010) y el grado de instrucción primaria y universitaria (p = 0.012 y p = 0.026) fueron factores asociados al conocimiento sobre GPAA: el 52.1% de los pacientes solteros evidenciaron alto nivel de conocimiento, mientras que el 32.9% de aquellos con estudios hasta el nivel primario presentaron bajo conocimiento. Conclusiones: El estado civil y el grado de instrucción fueron factores socioeconómicos asociados al nivel de conocimiento sobre GPAA en pacientes de nuestro centro.

Abstract Purpose: To determine the factors associated with the level of knowledge about primary open-angle glaucoma (POAG) in a national reference center in Peru. Method: An observational, correlational, cross-sectional, and quantitative study was carried out between March and April 2021 at the National Institute of Ophthalmology Dr. Francisco Contreras Campos, in Lima, Peru. Adult patients of both sexes with a diagnosis of POAG were included, and those patients with psychiatric problems, unable to answer the instrument, and those who did not agree to participate in the study were excluded. A questionnaire designed and validated in Spanish-speaking patients in Peru was used. Results: 362 patients participated, mostly women (51.5%), with a mean age of 67.6 ± 13.1 years, 45.9% studied up to secondary level, 50% no longer worked, 87.8% had a monthly income of up to 250 American dollars, 95.9% had Social Security, 81.2% had already had previous eye exams and 31.8% had a relative with the same diagnosis. Single and married marital status (p = 0.046 and p = 0.010) and grade of primary and university education (p = 0.012 and p = 0.026) were factors associated with knowledge about primary open-angle glaucoma: 52.1% of single patients showed high levels of knowledge, while 32.9% of those with studies up to the primary level presented low knowledge. Conclusions: Marital status and degree of education were socioeconomic factors associated with the level of knowledge about POAG in patients of our center.

RESUMO O objetivo deste artigo foi revisar sobre a desorganização das camadas internas da retina como biomarcador no edema macular diabético. Uma busca sistemática foi realizada no PubMed®/MEDLINE®, Cochrane e Embase até agosto de 2021. As palavras-chave utilizadas foram “disorganization of inner retinal layers (DRIL)”, “diabetic macular edema (DME)” e “biomarkers”. Não foram impostas restrições quanto aos tipos de estudo a serem incluídos. Os estudos selecionados para elegibilidade foram aqueles que incluíram o diagnóstico de edema macular diabético (centro envolvido, resolvido), que foram bem documentados com tomografia de coerência óptica de domínio espectral, que incluíram a desorganização das camadas internas da retina como uma das alterações relatadas, com acompanhamento de pelo menos 3 meses, e aqueles em que a melhor acuidade visual corrigida foi avaliada pré e pós. Não houve limitações quanto ao tipo de tratamento estabelecido. Referências de estudos identificados foram pesquisadas para artigos relevantes adicionais. Foram excluídos os artigos não publicados em revistas de revisão por pares. Todos os estudos foram avaliados por dois investigadores de forma independente. Quando havia dúvida com algum deles, a mesma era avaliada por um terceiro avaliador. Um total de sete estudos foram incluídos. Quatro eram estudos de coorte retrospectivos longitudinais e três eram observacionais transversais. Em relação à população estudada, a proporção de homens foi de 61,5% e de mulheres, 38,4%, a maioria com diabetes mellitus tipo 2 (85,8%). Em relação ao estágio do diabetes, o percentual de pacientes com retinopatia diabética não proliferativa leve foi de 28,2%, retinopatia diabética não proliferativa moderada foi de 28,5%, de retinopatia diabética não proliferativa grave foi de 15,9% e de retinopatia diabética não proliferativa foi de 27,4%. Em 100% dos estudos, o diagnóstico de edema macular diabético no centro envolvido foi incluído pela tomografia de coerência óptica de domínio espectral (Heidelberg). Em todos os estudos, foi registrada a presença de desorganização das camadas internas da retina e avaliada sua associação com a melhor acuidade visual corrigida. A medição foi realizada usando a escala LogMAR. Em todos os estudos, a presença ou ausência de desorganização das camadas internas da retina foi associada a pior/melhor acuidade visual final melhor corrigida usando p<0,05 como significância estática. A desorganização das camadas internas da retina como biomarcador e sua presença têm se mostrado importantes como preditor da acuidade visual no futuro em pacientes com edema macular diabético. Estudos histopatológicos são necessários para entender seu mecanismo de ação.

ABSTRACT 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 Purpose: To identify and assess the available information regarding the frequency of complications following the use of silicone oil (SO). Methods: A systematic search was conducted in PubMed/Medline, Cochrane and Embase, up to June 2020. The reference lists of identified studies and relevant reviews were also reviewed. We included studies in Spanish and English, with no publication date limits, of all types of methodology, with populations over 50 eyes, with patients previously diagnosed with tractional retinal detachment, proliferative diabetic retinopathy, giant retinal tears, traumatic retinal detachment and patients with proliferative vitreoretinopathy from any cause, with a minimum follow-up of 6 weeks. The quality assessment of the studies was conducted according to the Centre for Evidence-Based Medicine classification of levels of evidence. Results: A total of 13 studies were included, most of which were retrospective, with a level of evidence 2b. Cataract (median: 90, interquartile range [IQR]: 80-100%), silicone oil emulsification in the anterior chamber (median: 64.5; IQR: 46.5-82.25%), ocular hypertension (median: 23.3; IQR: 22.15-35.1%) and retinal redetachment (median: 22; IQR: 18.5-30%) were the most frequent complications; while pupillary block (median: 4.3; IQR: 3.8-4.8%), subconjunctival silicone oil deposits (median: 4.15; IQR: 3.75-4.57%), and expulsive suprachoroidal hemorrhage (median: 1; IQR: 0.95-1.05%) were the least frequent. Conclusions: The most frequent complications reported in decreasing order were cataracts, silicon oil emulsification in the anterior chamber, ocular hypertension, retinal redetachment, keratopathy, hypotonia, subretinal silicone oil migration, rebleeding, secondary glaucoma, unexplained visual loss, pupillary block, subconjunctival silicone oil deposits and expulsive suprachoroidal hemorrhage.

Resumen Objetivo: Identificar y evaluar la información disponible sobre la frecuencia de las complicaciones tras el uso del aceite de silicona. Método: Se realizó una búsqueda sistemática en PubMed/Medline, Cochrane y Embase, hasta junio de 2020. Las listas de referencias de los estudios identificados y de las revisiones relevantes también fueron revisadas. Se incluyeron estudios en español e inglés, sin límite de fecha de publicación, de cualquier metodología, con una muestra mayor de 50 ojos, con pacientes con diagnóstico previo de desprendimiento de retina traccional, retinopatía diabética proliferativa, desgarros gigantes, desprendimiento de retina, por trauma, y pacientes con proliferación vitreorretiniana independientemente de la causa, con un seguimiento mínimo de 6 semanas. La evaluación de la calidad de los estudios se realizó según la clasificación del Centre for Evidence-Based Medicine. Resultados: Se incluyeron 13 estudios, la mayoría retrospectivos, con un nivel de evidencia 2b. La catarata (mediana: 90; rango intercuartílico [RIC]: 80-100%), la emulsificación en la cámara anterior (mediana: 64.5; RICL: 46.5-82.25%), la hipertensión ocular (mediana: 23.3; RIC: 22.15-35.1%) y el redesprendimiento de retina (mediana: 22; RIC: 18.5-30%) fueron las complicaciones más frecuentes, mientras que el bloqueo pupilar (mediana: 4.3; RIC: 3.8-4.8%), el depósito conjuntival de aceite de silicona (mediana: 4.15; RIC: 3.75-4.57%) y la hemorragia expulsiva (mediana: 1; RIC: 0.95-1.05%) fueron las menos reportadas. Conclusiones: Las complicaciones más frecuentes en orden decreciente fueron cataratas, emulsificación en la cámara anterior, hipertensión ocular, redesprendimiento de retina, queratopatía, hipotonía, migración de aceite de silicona subretinal, resangrado, glaucoma secundario, pérdida visual inexplicable, bloqueo pupilar, depósitos conjuntivales de aceite de silicona y hemorragia expulsiva.