Analysis of the perfusion of the optic nerve using angio-OCT in glaucoma. / Análisis de la perfusión del nervio óptico mediante el uso de angio-OCT en glaucoma.

The introduction of optical coherence tomography angiography (OCT-A) has generated interest in evaluating vascular dysfunctions in the optic nerve head for the diagnosis and monitoring of glaucoma. The purpose of this study is to compare perfusion of the optic disc between normal subjects and subjects with glaucoma using OCT-A in order to detect changes in perfusion of the optic disc. Using the OCT-A AngioVue® system, an examination was performed on 40 eyes of 40 patients (20 with glaucoma and 20 healthy controls). Total radial peripapillary flow density (4.5×4.5mm) was measured at different levels of segmentation. The study demonstrated that the peripapillary vascular flow of OCT-A and exploration of the optic nerve head was better in the normal eyes compared to glaucoma patients. This review provides a comprehensive summary of the most important current and potential applications of OCT-A in glaucoma.

Ocriplasmin retinopathy: Possible cause of macular hole closure failure. / Retinopatía asociada a ocriplasmina: posible causa de fracaso de cierre de agujero macular.

CASE REPORT: A 53 year-old woman with a stage 2 macular hole received ocriplasmin injection as a first approach. She subsequently underwent pars plana vitrectomy due to enlargement of the hole post-injection. The visual gain following the surgery was minimal despite closure of the hole. This could be explained by outer retina atrophy as a consequence of potential toxic mechanisms related to ocriplasmin. DISCUSSION: Further studies may be warranted to fully understand the impact of ocriplasmin on long-term visual function.

Q fever: a new ocular manifestation.

Q Fever is a zoonosis caused by Coxiella burnetii. Ocular manifestations are rare in this infection. We describe the case of a man complaining of an intense retro-orbital headache, fever, arthralgia, and bilateral loss of vision, who showed an anterior uveitis accompanied by exudative bilateral inferior retinal detachment and optic disk edema. At the beginning, a Vogt-Koyanagi-Harada (VKH) syndrome was suspected, but the patient was diagnosed with Q fever and treatment with doxycycline was initiated, with complete resolution after 2 weeks. We wondered if Q fever could unleash VKH syndrome or simulate a VKH syndrome by a similar immunological process.

[Enzymatic vitrectomy by intravitreal autologous plasmin injection as initial treatment for macular epiretinal membranes and vitreomacular traction syndrome]. / Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial de las membranas epirretinianas maculares y el síndrome de tracción vitreomacular.

PURPOSE: To determine the effectiveness of intravitreal plasmin injection in the treatment of macular epiretinal membranes (MEM) and vitreomacular traction syndrome (VMTS) without associated pars plana vitrectomy. DESIGN: Interventional, prospective, case series pilot study. PATIENTS: Seven patients were enrolled in the study, 4 with MEM and 3 with VMTS. TREATMENT: 0.2 ml of autologous plasmin intravitreally injected under topical anesthesia was administered to all patients. The plasmin was obtained by a simplified method with urokinase. MAIN OUTCOME MEASURES: Degree of detachment of the MEM and the VMTS measured by optical coherence tomography (OCT), and the best corrected visual acuity (Snellen scale) before and one month after the plasmin injection. RESULTS: The follow-up period was completed by all the patients. The MEM remained attached to the retina in all cases, as measured either by biomicroscopy or OCT. The VMTS was completely detached from the foveal area in all cases, with the disappearance of secondary tractional retinal folds and recovery of the normal macular anatomic architecture as measured by OCT. Visual acuity was not modified in any of the MEM patients, and improved in all VMTS patients. No adverse effects were observed. CONCLUSION: In our case series, intravitreally injected autologous plasmin was not effective in the treatment of MEM, but resolved VMTS successfully, improving the visual acuity and releasing the retinal traction without the need for associated pars plana vitrectomy. Larger studies to confirm the efficacy of this technique and the possibility of success after repeated injections are warranted.

Intravitreal pegaptanib sodium for refractory pseudophakic macular oedema.

PURPOSE: Evaluate the efficacy of intravitreal pegaptanib sodium (Macugen) in refractory pseudophakic cystoid macular oedema (CME). DESIGN AND METHODS: Prospective, nonrandomized, interventional case series. Four eyes of four patients with refractory pseudophakic CME to pars plana vitrectomy and intravitreal bevacizumab and triamcinolone, were treated with pegaptanib sodium, with a mean follow up of 4 months. Pre- and postinfection examinations included assessment of best-corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy Study chart (ETDRS), fluorescein angiography (FA), and optical coherence tomography (OCT). RESULTS: Visual acuity increased in all patients after intravitreal pegaptanib sodium. OCT showed improvement of the retinal thickness in the macular area. CONCLUSION: Intravitreal pegaptanib sodium (Macugen) is a promising treatment for pseudophakic cystoid macular oedema resistant to other medical treatment strategies. However, further study is needed to assess the treatment's long term efficacy and the need for retreatment.

[Enzymatic vitrectomy by intravitreal autologous plasmin injection, as initial treatment for diffuse diabetic macular edema]. / Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial del edema macular diabético difuso.

PURPOSE: To determine whether intravitreal injection of plasmin is effective in treating diffuse diabetic macular edema (DDME). DESIGN: A prospective, comparative, interventional case study. PATIENTS: Eighteen patients with bilateral DDME received, as their primary therapeutic treatment, an intravitreal injection of plasmin in one eye, with their contralateral untreated eye serving as a control. INTERVENTION: Intravitreal 0.2 ml of autologous plasmin injected under topical anesthesia. The plasmin was obtained by a simplified method. MAIN OUTCOME MEASURES: Central macular thickness (CMT), determined by optical coherence tomography (OCT), and Best Corrected Visual Acuity (LogMAR), assessed at one and three months of follow-up. RESULTS: All patients completed the 3-month follow-up assessments. Before the injection, the CMT was 525.22 SD 80.12 microm [mean +/- standard deviation (SD)] in the eyes to be injected, compared to 525.44 SD 78.13 microm in the control eyes. One month after the injection, the CMT was 323.72 SD 44.87 microm in the injected eyes and 518.44 SD 78.54 microm in the control eyes (P < 0.001, bilateral Wilcoxon test for paired samples). Three months after the injection, the CMT was 310.55 SD 35.38 microm in the injected eyes and 517.66 SD 80 microm in the control eyes (P < 0.001). Macular edema improved in all injected eyes (100%), with a reduction of at least 50% in every treated eye, but no changes occurred in the control group. Nine of the 18 treated eyes (50%) improved their BCVA by at least two vision lines. No adverse effects were observed in any of the patients. CONCLUSION: Intravitreal plasmin injection, as primary treatment, effectively reduces macular thickening due to DDME and improves visual acuity. Further studies are warranted to assess long-term efficacy and safety.