Analysis of visual disability in Buenos Aires, Argentina. Pathologic myopia is the leading cause in working age / Análisis de discapacidad visual en Buenos Aires, Argentina. La miopía patológica es la principal causa en edad laboral

Abstract This study assessed the causes of visual impairment over a decade in Buenos Aires City. This is a retrospective case series where we reviewed the database of visual disability certificates issued by the Buenos Aires City Ministry of Health between 2009 and 2017. In Argentina, visual disability is defined as a visual acuity ≤ 20/200 in the better eye, or a corresponding visual field of less than 20 degrees in the less impaired eye. The database included the following variables: year of issue, age, gender, and cause of visual disability. Between 2009 and 2017 a total of 7656 subjects were certified as legally blind. The mean age of the sample was 57 ± 21 years and 52.1% were females. The emission was near 700 certificates per year. The age distribution showed that 62.8% of certificates were from patients older than 50 years and that only 6.6% were given to subjects under 20. The leading causes of visual disability in Buenos Aires City were age-related macular degeneration (ARMD) with a rate of 15.5%, degenerative myopia (14.4%), primary open-angle glaucoma (11.3%) and diabetic retinopathy (6.6%). In subjects younger than 50, degenerative myopia was the first cause of visual disability. Interestingly in Argentina, where the prevalence of myopia is low, degenerative myopia is found to be the major cause of visual disability in middle-aged adult subjects. Population and clinical methods to avoid this preventable disease should need to be implemented as a matter of urgency.

Resumen Este trabajo estudia las causas de la discapacidad visual durante una década en la Ciudad de Buenos Aires. Se presenta una serie de casos retrospectiva donde se revisó la base de datos de certificados de discapacidad visual emitidos por el Ministerio de Salud de la Ciudad de Buenos Aires entre 2009 y 2017. En Argentina, la discapacidad visual se define como una agudeza visual ≤ 20/200 en el mejor ojo, o un campo visual correspondiente de menos de 20 grados en el ojo menos deteriorado. La base de datos incluyó las siguientes variables: año de emisión, edad, sexo y causa de la discapacidad visual. Entre 2009 y 2017 se certificaron un total de 7656 sujetos con ceguera legal. La edad media de la muestra fue de 57 ± 21 años y el 52.1% fueron mujeres. La distribución por edades mostró que el 62.8% de los certificados fueron dados a pacientes mayores de 50 años y que solo el 6.6% se otorgó a menores de 20 años. Las principales causas de discapacidad visual fueron la degeneración macular asociada a la edad (DMAE) (15.5%), la miopía degenerativa (14.4%), el glaucoma primario de ángulo abierto (11.3%) y la retinopatía diabética (6.6%). En los menores de 50 años, la miopía degenerativa fue la primera causa de discapacidad visual. Resulta interesante que, en Argentina, donde la prevalencia de miopía es baja, la miopía degenerativa sea la principal causa de discapacidad visual en adultos de mediana edad.

Long-term Outcomes of Vitrectomy Used to Treat Myopic Traction Maculopathy

PURPOSE: We investigated the long-term outcomes of vitrectomy with internal limiting membrane (ILM) peeling as treatment for myopic traction maculopathy (MTM).METHODS: The medical records of patients who underwent vitrectomy to treat MTM were retrospectively evaluated. We excluded patients who exhibited macular holes (MHs) or retinal detachment at the time of primary surgery. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were analyzed preoperatively, at 3, 6, 12, and 24 months after surgery, and at the final visit. Complications including retinal detachment or an MH were noted during follow-up.RESULTS: Twenty-three eyes of 22 patients were enrolled. At the time of primary surgery, the mean patient age was 64.4 ± 11.1 years and the baseline mean logMAR BCVA and CFT, 0.67 ± 0.50 and 431.8 ± 159.5 µm, respectively. The mean follow-up period was 53.7 ± 19.3 months. The mean logMAR BCVAs at 3, 6, 12, and 24 months postoperatively and at the final visit were 0.42 ± 0.39 (p = 0.001), 0.41 ± 0.38 (p = 0.001), 0.39 ± 0.40 (p < 0.001), 0.42 ± 0.43 (p < 0.001), and 0.51 ± 0.47 (p = 0.016), respectively, thus significantly better than the baseline value. The mean CFT at 3, 6, 12, and 24 months postoperatively and at the final visit were 244.6 ± 72.3, 210.5 ± 79.1, 209.6 ± 91.6, 219.8 ± 93.9, and 217.7 ± 81.3 µm, respectively, thus significantly less than baseline (all p < 0.001). MTM resolved in 18 eyes (78.3%) after primary surgery, without any complication, and remained stable to the final visit.CONCLUSIONS: Vitrectomy with ILM peeling afforded favorable long-term efficacy and safety in MTM patients.

Long-term Outcomes of Macular Hole Retinal Detachment in Highly Myopic Eyes after Surgical Reattachment

PURPOSE: To evaluate visual acuity changes over 3 years following surgical reattachment of macular hole retinal detachment (MHRD) developed in high myopia.METHODS: A retrospective analysis was performed using the medical records of patients with highly myopic eyes who underwent pars plana vitrectomy with internal limiting membrane peeling or the internal limiting membrane flap technique for MHRD. Changes in best-corrected visual acuity (BCVA) were measured at baseline, 6 months, 1 year, 2 years, and 3 years.RESULTS: Of the 22 eyes analyzed, macular hole was closed in 13 and unclosed in nine. BCVA significantly improved from 1.61 ± 0.39 logarithm of the minimum angle of resolution (logMAR) at baseline to 1.17 ± 0.43 logMAR at 6 months and 1.33 ± 0.48 logMAR at 2 years after MHRD surgery. At 3 years, BCVA significantly decreased compared with that at 6 months, and visual improvement from baseline was not significant. BCVA and proportion of vision loss ≥0.3 logMAR were not different between the closed and unclosed macular hole groups.CONCLUSIONS: Visual improvement after surgical reattachment of MHRD in high myopia was not maintained, and favorable macular hole closure effects were not observed at 3-year follow-up.

Retinal Break Adjacent to the Optic Disc Causing Retinal Detachment in a Pathological Myopia

Retinal detachment is one of the common complications of pathological myopia due to presence of retinal break. However, retinal break commonly occurs in the peripheral retina. This case report illustrates the rare incidence of retinal break adjacent to the optic disc, highlights the possible causes of poor visual outcome following surgical repair as well as the possible measures to treat the complications.

La miopía degenerativa desde una perspectiva social / Degenerative myopia seen from a social perspective

La miopía degenerativa y sus consecuencias para la visión en individuos jóvenes es uno de los problemas de salud a los que se enfrenta el profesional de la oftalmología. Se redactó un ensayo en el que se valoraron los principios de la bioética como paradigmas para el oftalmólogo actual, aplicados a la enfermedad. Se tuvo en cuenta la influencia de la sociedad y el desarrollo científico-técnico en los pacientes que presentan esta afección y repercusión de la miopía en la formación de la personalidad y en sus relaciones con la familia y la sociedad.

Degenerative myopia and its consequences for the young individuals' vision is one of the health problems that the ophthalmologist faces. This paper assessed the principles of bioethics as paradigms for the current ophthalmologist and applied to the disease. The influence of the society and of the technical scientific development over the patients having this disease was taken into account together with the impact of myopia on the formation of their personality and on their relationship with the family and the society.

Tratamiento de la neovascularización coroidea miópica / Treatment of myopic choroidal neovascularization

Se realizó una revisión sobre el tratamiento de la neovascularización coroidea en la miopía degenerativa. Se consultaron fundamentalmente artículos científicos de revistas publicados e indexados en las bases de datos PubMED y Cochrane, así como textos básicos que abordan este tema. No se encontraron certezas del beneficio de la fotocoagulación con láser de las lesiones neovasculares en esta entidad, mientras que la terapia fotodinámica parece brindar estabilidad de la lesión y mejoría visual, al menos a los 3 años de seguimiento. El uso de antiangiogénicos intravítreos tiene los mejores resultados en la actualidad respecto a la inactivación de la lesión y la recuperación visual pero no hay ensayos clínicos controlados que avalen su beneficio a largo plazo. Otras opciones de tratamiento se encuentran en investigación y desarrollo. No se ha concebido el protocolo ideal para tratar las membranas neovasculares miópicas

A literature review on the treatment of the choroidal neovascularization in the degenerative myopia was made. Published scientific articles of journals indexed in Pubmed and Cochrane databases, as well as basic texts that deal with this topic. No evidences of the benefits of the laser photocoagulation for neovascular lesions were found, whereas the photodynamic therapy seems to offer stability of the lesion and visual improvement after three years of follow-up. The use of intravitreous antiangiogenic drugs has currently achieved the best results in terms of lesion inactivation and visual recovery, but there are no controlled clinical trials that support their long-term benefits. Other treatment options are under research and development. The ideal protocol of treatment of neovascular myopic membranes has not yet been devised

Alteraciones del polo posterior en la miopía degenerativa / Alterations of the posterior pole in degenerative myopia patients

La miopía degenerativa constituye una de las causas fundamentales de pérdida de la visión. Esto está relacionado con las alteraciones del polo posterior, que afectan la retina neurosensorial, el epitelio pigmentario de la retina y las capas más internas de la coroides. Su curso lento y progresivo demanda una exploración integral, con seguimiento en el tiempo y constituye un reto para el oftalmólogo. Se realizó una revisión de artículos publicados e indexados en la base de datos de PubMed que se refirieran a las características clínicas del fondo de ojo en pacientes con miopía degenerativa...

Degenerative myopia is one of the main causes of visual impairment. This is related to disorders in the posterior pole, affecting the neurosensorial retina, the retinal pigmented epithelium and the inner choroidal layers. The slow and progressive course of this condition demands comprehensive assessment and long follow-up, which is a challenging task for ophthalmologists. A review of the articles indexed in PubMed regarding the clinical characteristics of the fundus in patients with degenerative myopia was made to describe the main disorders of the posterior pole of the eyeball. ..

Bevacizumab en el tratamiento de la neovascularización coroidea miópica / Bevacizumab in the treatment of myopic choroidal neovascularization

Objetivo: Determinar los efecto de bevacizumab intravítreo en el tratamiento de la membrana neovascular miópica. Métodos: Se realizó un estudio tipo cohorte retrospectiva de pacientes sometidos a inyección intravítrea de 1,25 mg de bevacizumab para el tratamiento de neovascularización coroidea miópica. Se evaluó cambios en agudeza visual (AV) mejor corregida, efectos secundarios y complicaciones. Resultados: 22 ojos fueron incluidos. La AV inicial fue de 0,17 +/- 0.15; al mes post-tratamiento de 0,28 +/- 0,15; a los 3 meses de 0,26 +/- 0,13; a los 6 meses de 0,21 +/-0,17; a los 12 meses de 0,31 +/- 0,13; a los 18 meses de 0,29 +/- 0,08; y a los 24 meses de 0,31 +/- 0,14. Hubo diferencia estadísticamente significativa entre el 1° y 12° mes en relación a la AV inicial. Conclusión: El tratamiento con bevacizumab intravítreo resultó en una significativa mejoría en la AV durante el primer año post-tratamiento.

Purpose: To determine the effects of intravitreal bevacizumab in the treatment of myopic choroidal neovascularization. Methods: A retrospective cohort study was performed by clinical history research of patients treated with 1,25 mg of intravitreal bevacizumab, with a follow up of 24 months. best corrected visual acuity (BCVA), side effects and complications were evaluated. Results: 22 eyes of 19 patients were included. Initial BCVA was 0.17 +/-0.15; at 1 month post treatment 0.28 +/- 0.15; at 3 months 0.26 +/-0.13; at 6 months 0.21 +/- 0.17; at 12 months 0.31 +/- 0.13; at 18 months 0.29 +/- 0.08; at 24 months 0.31 +/- 0.14. There was a significant statistical difference between the 1° and 12° month in contrast with the initial BCVA. Conclusions: Treatment with intravitreal bevacizumab resulted in a significant BCVA improve during the first year after treatment.

Individualización de pacientes con baja visión en el Centro Oftalmológico del Hospital General Docente Dr Juan Bruno Zayas Alfonso / Individualization of low vision patients in Dr Juan Bruno Zayas Alfonso Teaching General Hospital Ophthalmologic Center

Se efectuó un estudio descriptivo y transversal de 73 pacientes con baja visión, que asistieron a la consulta del Centro Oftalmológico del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde julio hasta diciembre del 2009, a fin de describir algunas características clínicas y demográficas. La degeneración macular asociada a la edad primó en más de 25,0 por ciento de los integrantes de la casuística, seguida por el glaucoma crónico simple y la miopía degenerativa y, según lugar de procedencia, los pertenecientes al municipio de Santiago de Cuba representaron 73,0 por ciento del total. Se logró rehabilitar a 89,0 por cientode los pacientes examinados y tratados

A descriptive and cross sectional study of 73 patients with low vision who visited the Ophthalmologic Center at Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from July to December 2009 in order to describe some clinical and demographic characteristics. Macular degeneration associated with age prevailed in more than the 25,0 per cent of the case material, followed by simple chronic glaucoma and degenerative myopia and, according to origin place, those belonging to Santiago de Cuba municipality represented 73,0 per cent of the total. It was possible to rehabilitate the 89,0 per cent of the examined and treated patients

Short-Term Effect of Intravitreal Bevacizumab Injection for Choroidal Neovascularization Associated With Degenerative Myopia

PURPOSE: To investigate the short-term effect of intravitreal bevacizumab injection for choroidal neovascularization associated with degenerative myopia. METHODS: In 15 eyes of 15 patients, one or two consecutive intravitreal bevacizumab injections were given. The best-corrected visual acuity (BCVA) and fundus examination were evaluated at baseline and monthly thereafter. Fluorescence angiography (FA) was performed at baseline, 1 month and 3 months after treatment. When the angiographic leakage persisted 1 month after the first injection, a second injection was administered. RESULTS: The mean follow-up period was 9.7 months. The mean logarithm of the minimum angle of resolution (LogMAR) BCVA was 0.81+/-0.44 at baseline, 0.64+/-0.41 at 3 months (p=0.005), and 0.60+/-0.41 (p=0.001) at the final examination. Five eyes received a single injection, while the other ten eyes had two consecutive injections. Three months after the first injection, 14 eyes (93.3%) had no angiographic leakage, and 1 eye (6.7%) showed a decrease in leakage. The mean lines of visual improvement at 3 months and at the final examination were 1.7 and 2.1 lines, respectively. No case of vision loss was observed throughout the follow-up period. CONCLUSIONS: One or two consecutive intravitreal bevacizumab injections had favorable short-term effects on visual acuity stabilization and the regression of choroidal neovascularization associated with neovascular degenerative myopia.

Indocyanine Green Angiographic Features of Myopic Subfoveal Choroidal Neovascularization as a Prognostic Factor after Photodynamic Therapy

PURPOSE: To determine the influence of clinical features and Indocyanine green (ICG) angiographic features on the visual outcome of patients with myopic sub-foveal choroidal neovascularization (CNV) who received photodynamic therapy (PDT). METHODS: Thirty-six consecutive patients (39 eyes) with myopic CNV who were followed up for more than one year after PDT were enrolled in this study. Clinical features included age, gender, refractive error, great linear dimension, and subretinal hemorrhage. ICG features included the lesion size, lacquer cracks, hypofluorescence surrounding the CNV (dark rim), peripapillary atrophy size, and visible prominent choroidal veins under the macula. Linear regression analysis was performed using the change in visual acuity (delta logMAR) as the dependent variable and the above factors as independent variables. RESULTS: At one-year follow-up after PDT, a younger age (p=0.002) and the presence of a dark rim (p=0.002) were significantly correlated with an improvement of visual acuity (decrement in logMAR) after PDT. Other factors had no significant influence on changes in visual acuity. CONCLUSIONS: Younger patients and patients with a dark rim on ICG angiography had a higher chance of visual improvement after PDT in myopic CNV.