Predictors of stoppage and recurrence of choroidal neovascularization with a Treat- Extend-Stop protocol: 4-year follow-up.

OBJECTIVE: To analyze the long-term results of treatment of active age-related macular degeneration (AMD) with anti-vascular endothelial growth factor (VEGF) agents using the treat-extend-stop (TES) approach, defining predictive factors for stoppage of the treatment and recurrences in a real-world setting. METHODS: Data from 191 eyes treated with intravitreal injections for choroidal neovascularization due to AMD were retrospectively reviewed. Changes in best-corrected visual acuity (BCVA) and membrane activity (optical coherence tomography) were recorded and evaluated over a 48-month follow-up. Logistic regression analysis was used to determine predictors of treatment stoppage and recurrences after stoppage. RESULTS: BCVA improvement was found in 70.5% of eyes at 48 months, and remaining signs of activity in 27.9%. Disease inactivity was achieved in 69 eyes (31.9%), with a relapse of the membrane in 29 of these eyes (42.0%). Significant independent predictors of treatment stoppage were found: no foveal membrane, inactive membrane at 12, 24, 36 and 48 months, extension interval>8 weeks at 12 and 24 months,>15 injections at 24 months, and baseline BCVA>61 letters. Concerning recurrent membranes, only the presence of membrane activity at 36 months and baseline BCVA>61 letters were independent predictors. CONCLUSIONS: Anti-VEGF treatment of AMD using the TES protocol allows for successful visual restoration in most patients, with more likely disease inactivity in those eyes with better baseline BCVA, maintaining signs of membrane inactivity during the first two years of follow-up and requiring fewer injections.

Cost-utility model of new intravitreous units vs. current patient journey model in Spain.

AIM: To compare the effectiveness and costs of the implementation of the Intravitreal Therapy Unit Model, endorsed by the SERV, SECA, SEO and SEDISA, compared to the usual procedure. METHOD: Analytical decision model that compares an UTI-type healthcare organization with 4 usual practice scenarios in Spain, in terms of quality-of-life results due to loss of visual acuity and the use of resources. The probability, cost, and quality-adjusted life years (QALYs) were estimated for each scenario proposed. A univariate sensitivity analysis was performed for each of the parameters used in the model. RESULT: The model showed that from any of the initial scenarios of the usual practice, transitioning to the UTI-type implementation improves the quality of life of patients and requires lower cost. UTI-type is dominant respect usual practice. The sensitivity analysis showed that the results would not change sign with the variation of any starting variable. CONCLUSIONS: Shorten suspicion-needle times is key to maintaining functional vision in patients requiring intravitreal treatment. The UTI-type model seeks the efficiency of ophthalmology services and can produce savings that vary between Є175 and Є85 per patient attended per year.

Risk factors for predicted refractive error after cataract surgery in clinical practice. Retrospective observational study.

OBJECTIVES: To describe the preoperative characteristics of patients undergoing cataract surgery in our hospital, to determine the final visual and refractive results and to determine the preoperative characteristics that conditioned the presence of a residual refractive error (RRE) greater than one diopter. METHODS: Retrospective analysis of cataract surgeries performed at Araba University Hospital between February 2017 and December 2019. Sociodemographic, eye comorbidity, biometric, surgical and post-surgical characteristics were collected. RESULTS: A total of 1419 patients and 1578 surgeries were included for analysis. Of these, 9.07% had preoperative legal blindness, 31.69% eye comorbidity and 4.18% had previous surgery. Overall, 95.82% of patients achieved a corrected final visual acuity (VA) ≥ 0.5 Snellen decimal and 63.12% ≥ 1, and 96.70% of patients improved VA after surgery. RRE was between ±0.5 diopters in 77.82% of patients and between ±1 diopter in 94.74%. The most prominent risk factors that conditioned the presence of RRE greater than 1 diopter were the use of ultrasonic contact biometer, a history of glaucoma surgery, the presence of white or hard cataract, and prior legal blindness. CONCLUSIONS: The visual results of cataract surgery were excellent, with 63.12% of patients obtaining corrected VA ≥ 1 and an RRE of ±1 diopter in 94.74%. Different risk factors influenced the achievement of poor refractive outcomes: preoperative conditions (previous surgeries, white/hard cataract, previous VA) and biometrics.

Recommendations for eye care during the alarm state by the coronavirus disease pandemic COVID-19. / Recomendaciones para la atención oftalmológica durante el estado de alarma por la pandemia de enfermedad por coronavirus COVID-19.

OBJECTIVE: Minimize exposure to the SARS-CoV-2, reduce the chances of cross-transmission between patients and healthcare personnel, and prevent the development of postoperative complications from the management of patients with eye diseases during the 2019 coronavirus disease pandemic (COVID-19). METHODS: COVID-19 literature review and consensus establishment between different Spanish ophthalmology societies in order to provide guidelines and recommendations of maximum resources primarily conditioned by the state of alert, confinement and social distancing that occurs in Spain since March 16, 2020. RESULTS: The recommendations will promote the adoption of action and protection measures for eye care in outpatient clinics, surgical areas and hospitalization, for unconfirmed (asymptomatic and symptomatic) and confirmed COVID-19 patients. Measures must be adapted to the circumstances and availability of personal protective equipment in each of the centers and Autonomous Communities, which will be updated according to the pandemic phases and the measures adopted by the Spanish Government. CONCLUSIONS: During the COVID-19 pandemic, attention to the potential health risks to the population caused by coronavirus should prevail over the possible progression of the common eye diseases. Ophthalmologists and other eye care professionals must assume a possible progression of these diseases due to the impossibility of adequate patient follow-up.

[Spontaneous bleeding to vitreous cavity during fluorescein angiography]. / Sangrado espontáneo a cavidad vítrea durante angiografía fluoresceínica.

CASE REPORT: We report a case in which active bleeding from a posterior pole intraretinal microvascular anomaly (IRMA) occurred in a diabetic patient. DISCUSSION: Documentation of active bleeding during the performance of fluorescein angiography is extremely rare. We discuss the origin of the bleeding.

[A scleral buckle intrusion 19 years after its use in retinal detachment surgery]. / Intrusión de cerclaje escleral 19 años después.

CASE REPORT: Intrusion is defined as erosion and protrusion of the scleral implant into the vitreous cavity. This condition may occur as a retinal detachment, vitreous hemorrhage, endophthalmitis or be without symptoms. We performed a vitrectomy alone in a patient with relapsing vitreous hemorrhage secondary to the intrusion of a scleral buckle implanted 19 years previously and left intact the intruding buckle. DISCUSSION: Intrusion of the scleral buckle is an uncommon complication of retinal detachment surgery. We discuss the management of scleral buckle intrusion.

[Spontaneous resolution of an idiopathic epiretinal membrane in a young patient]. / Resolución espontánea de membrana epirretiniana idiopática en un paciente joven.

CASE REPORT: Idiopathic epiretinal membranes are uncommon in young patients. The characteristics and evolution of these membranes are different from those in adults. We present the case of a young patient with an idiopathic epiretinal membrane, that several months later, showed spontaneous resolution with an associated posterior vitreous detachment. DISCUSSION: Idiopathic epiretinal membranes in young patients resolve spontaneously more frequently than in adults; however in many cases are associated with posterior vitreous detachment. We discuss the evolution of these membranes.

[A case of triamcinolone-induced pseudo-endophthalmitis after vitrectomy]. / Un caso de pseudoendoftalmitis por triamcinolona tras vitrectomía.

CASE REPORT: Vitrectomy with vitreous injection of triamcinolone in a patient suffering cystoid macular edema, secondary to a lens fragment luxation after subluxated cataract phacoemulsification, was performed. Four days after the surgery she presented because of discomfort and visual loss in the operated eye, and was found to have a 3.4 mm hypopyon. DISCUSSION: We describe the differences between infectious endophthalmitis, toxic endophthalmitis and pseudo-endophthalmitis.

[Multiple evanescent white-dot syndrome: bilateralization four years later]. / Síndrome múltiples puntos blancos evanescentes: bilateralización cuatro años después.

PURPOSE/METHOD: To report a clinical case of a 26-year old woman with Multiple Evanescent White-dot Syndrome (MEWDS) in left eye with recurrence in the fellow eye four year later, therefore bilateral and asynchronous. We review the clinical findings and the results of ancillary diagnostic techniques in both eyes. CLINICAL CASE/CONCLUSIONS: MEWDS is an uncommon inflammatory disorder with a benign course. The recurrences and the bilaterality are not usual. The affectation pattern in the fellow eye is similar to initial lesions seen four years earlier.