[Treatment of exudative age-related macular degeneration: Consensus of French experts for first-line treatment selection and the importance of long-term risk/benefit ratio]. / Consensus d'experts français sur les critères de choix d'un traitement de 1re intention dans la DMLA néovasculaire et importance du ratio bénéfice/risque à long terme.

Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.

Tratamiento del desprendimiento de retina causado por roturas del polo posterior / Treatment of retinal detachment caused by posterior break

El desprendimiento de retina por dehiscencia posterior es una entidad rara. Veintidós casos de DR por rotura del polo posterior han sido operados en el Centro Hospitalario de Rowen, Francia, entre 1979 y 1989. Se utilizaron solamente técnicas de tamponamiento interno con aire, gas (SF6) y silicona. Siempre se practicó una vitrectomía. Una retinopexia (láser argón) se realizó en primera intención, sólo en los casos de roturas extramaculares o utilización de silicona. El éxito anatómico con vitrectomía + SF6 alcanza 73%, y es inferior a otras series debido al alto número de roturas parapapilares y en borde de estafiloma de difícil retinopexia. Cincuenta por ciento de nuestras observaciones obtienen una agudeza visual calculable en postop. Esto se explica por la existencia de un número importante de roturas extramaculares. Los nuevos métodos de examen del cuerpo vítreo y sus relaciones con la retina, nos permiten separar las roturas del polo posterior en dos tipos. Aquellas con DPV completo, sin REM y que habitualmente son los agujeros maculares. En este caso una simple punción-aspiración del líquido retrohialoidio + SF6 bastaría. El otro grupo lo forman las roturas con DPV incompleto y que habitualmente son las roturas extramaculares. En estos casos una vitrectomía se impone