Treatment of neovascular age-related macular degeneration within 48 h from diagnosis improves long-term functional outcome.

PURPOSE: To evaluate long-term visual and anatomical outcomes in neovascular age-related macular degeneration (nAMD) patients treated with anti-vascular endothelial growth factor (VEGF) agents depending on the time delay from confirmed diagnosis to treatment initiation. MATERIALS AND METHODS: Seventy-three nAMD patients (73 eyes) treated with anti-VEGF agents for 12 months using the pro re nata regimen were included in this retrospective longitudinal study. Patients were split into 3 groups according to the time from diagnosis to first anti-VEGF injection: < 48 h (group 1); 48 h-7 days (group 2); > 7 days (group 3). Decimal best-corrected visual acuity (VA) and macular thickness (MT) were recorded at baseline and 1-2-, 3-4-, 6- and 12-month later. Furthermore, age, gender as well as the applied treatment and number of injections after 12 months of treatment were also registered and compared. RESULTS: Long-term effect of the treatment demonstrated enhanced VA in group 1 patients compared with the rest of groups after 1-2-, 6-, and 12-month follow-up (P < 0.05). Positive effects of early treatment were additionally corroborated by the augmented percentage of patients with normal VA in the group 1 respect to the rest of groups over studied time points (P < 0.05). Moreover, the VA gain in nAMD at group 1 was obtained with a mean of 3.7 intravitreal injections over 1-year follow-up period. Regarding MT, non-significant difference was observed among groups. CONCLUSIONS: An early initial treatment with VEGF inhibitors is critical to achieve the best functional benefits of this therapy in new-onset nAMD patients.

Mapping the surface astrocytes of the optic disc: a fluid-conducting role of the astrocytic covering of the central vessels.

BACKGROUND: The vitreous interface of the optic nerve has been studied to delimit the covering of Elschnig's astrocytes and interstitial pathways of flow through the prelaminar region. METHODS: Perfusion of the prelaminar tissue under controlled pressure with a fluorescent marker injected into the vitreous cavity in pig eyes. The prelaminar region of the optic nerve and adjacent retina was fixed and flatmounted or frozen and cryosectioned and examined with the confocal laser microscope. Samples were also prepared for conventional transmission electron microscopy. RESULTS: The surface of the vitreous surface of the optic nerve is covered by a cobblestone-like pavement made of astrocytic projections. Intensely stained passages of different thickness indicate the presence of wide interconnected intercellular spaces in the covering of Elschnig's astrocytes. Those passages are absent in the intervascular areas occupied by axons and axon-linked astrocytes. CONCLUSIONS: Delineation of the astrocytic pavement and the preferred flow routes formed by wide extracellular spaces are conspicuous features of the prelaminar region when examined with the confocal laser microscope and the help of sticky fluorescent tracer. This suggests that excess extracellular fluid can be interchanged with the vitreous by a network of interconnected extracellular spaces or preferred flow routes. Some pathogenic mechanisms can be related to fluid interchange in the optic nerve head.

Accidental foveal photocoagulation secondary to alexandrite laser.

PURPOSE: In recent years, we have seen an increase in the use of laser systems in the field of aesthetics (mainly depigmentation and hair removal). Alexandrite laser is the most widely used.Case report. METHODS: Case report. RESULTS: We describe a case of retinal injury (foveal photocoagulation) directly related to an alexandrite laser hair removal procedure. CONCLUSIONS: Hair removal by laser systems is a fast and efficient method. The use of lasers without adequate protective measures or by unqualified personnel increases the risk of ocular adverse effects.