BACKGROUND Knowing the pattern and presentation of the diseases is critical for management strategies. To inform eye-care policy we quantified the pattern of vitreo-retinal (VR) diseases presenting at the national referral hospital in Bhutan. METHODS We reviewed all new patients over three years from the retinal clinic of the Jigme Dorji Wangchuck National Referral Hospital. Demographic data, presenting complaints and duration, treatment history, associated systemic diseases, diagnostic procedures performed, and final diagnoses were quantified. Comparisons of the expected and observed frequency of gender used Chi-squared tests. We applied a sampling with replacement based bootstrap analysis (10,000 cycles) to estimate the population means and the standard errors of the means and standard error of the 10th, 25th, 50th, 75th and 90th percentiles of the ages of the males and females within 20-year cohorts. We then applied t-tests employing the estimated means and standard errors. The 2913 subjects insured that the bootstrap estimates were statistically conservative. RESULTS The 2913 new cases were aged 47.2 ± 21.8 years. 1544 (53.0%) were males. Housewives (953, 32.7%) and farmers (648, 22.2%) were the commonest occupations. Poor vision (41.9%), screening for diabetic and hypertensive retinopathy (13.1%), referral (9.7%), sudden vision loss (9.3%), and trauma (8.0%) were the commonest presenting symptoms. Coexistent diabetes and hypertension were the most common associated systemic diseases. Haematological tests (blood sugar, HbA1c and lipid profile, 31.8%), OCT (27.4%), refraction (9.9%), B-scan (8.7%), fundus photography (8.0%) were the most commonly performed diagnostic tests. Hypertensive retinopathy (18.9%) was the commonest VR disease, followed by refractive errors referred for retinal evaluation (16.7%), diabetic retinopathy with macular oedema (15.8%), and AMD (11.0%). Retinal detachment was more prevalent in females (83 vs. 41, p = 0.007). Rare vision-threatening diseases like seasonal hyper-acute pan-uveitis also presented. CONCLUSIONS The developing VR service in Bhutan is challenged by the spectrum of diseases, limited human resources (e.g. one retinal surgeon during the study), and accessibility to tertiary eye-care services, all amidst difficult terrain. Sustained effort and robust coordination among the eye-care professionals, government and non-governmental organisations are critical for optimising VR services, especially as rates of diseases such as diabetes and hypertension grow.

中文翻译：

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不丹国家转诊医院的玻璃体视网膜疾病模式：一项基于医院的回顾性研究。

背景技术了解疾病的模式和表现对于管理策略至关重要。为了告知眼保健政策，我们量化了不丹国家转诊医院的玻璃体视网膜（VR）疾病模式。方法我们回顾了吉格梅·多吉·旺楚克国家转诊医院视网膜诊所三年来的所有新患者。人口统计学数据，提出的投诉和持续时间，治疗史，相关的全身性疾病，进行的诊断程序以及最终的诊断均被量化。使用卡方检验比较预期和观察到的性别频率。我们应用了基于替换的自举分析（10,000个周期）进行抽样，以估算总体均值，均值的标准误以及10、25、50，20年队列中男性和女性年龄的75％和90％。然后，我们使用估计的均值和标准误差进行t检验。2913名受试者确保引导估计在统计上是保守的。结果2913例新病例年龄为47.2±21.8岁。1544（53.0％）是男性。家庭主妇（953，32.7％）和农民（648，22.2％）是最常见的职业。最常见的症状是视力低下（41.9％），筛查糖尿病和高血压性视网膜病（13.1％），转诊（9.7％），突然视力下降（9.3％）和外伤（8.0％）。糖尿病和高血压并存是最常见的全身性疾病。血液学检查（血糖，HbA1c和脂质分布，31.8％），OCT（27.4％），验光（9.9％），B扫描（8.7％），眼底照相（8。0％）是最常执行的诊断测试。高血压性视网膜病（18.9％）是最常见的VR疾病，其次是进行视网膜评估的屈光不正（16.7％），糖尿病性黄斑水肿性视网膜病（15.8％）和AMD（11.0％）。视网膜脱离在女性中更为普遍（83比41，p = 0.007）。还出现了罕见的威胁视力的疾病，如季节性超急性全葡萄膜炎。结论不丹发展中的VR服务面临着疾病范围，有限的人力资源（例如研究期间的一名视网膜外科医生）以及难以获得地形的三级眼保健服务的挑战。眼保健专家，政府和非政府组织之间的持续努力和强有力的协调对于优化VR服务至关重要，