Protocol for the treatment of cystoid macular edema secondary to retinitis pigmentosa and other inherited retinal dystrophies.

Inherited retinal dystrophies (IRD) are the leading cause of legal blindness in the working population. Cystic macular edema (CME) is one of the treatable causes of visual loss, affecting up to 50% of the patients. A bibliographic review has been carried out combining "inherited retinal dystrophy", "retinitis pigmentosa", "macular oedema" and a diagnostic-therapeutic protocol according to the levels of evidence and recommendations of the "US Agency for Healthcare Research and Quality". This protocol has been discussed in the monthly meetings of the XAREA DHR group with the participation of more than 25 ophthalmologists, creating a consensus document. The etiology of CME is multifactorial: dysfunction of the blood-retinal barrier, retinal pigment epithelium, and Müller cells, inflammation, and vitreous traction. OCT is the test of choice for the diagnosis and follow-up of CME associated with IRD. The drugs with the highest degree of scientific evidence are carbonic anhydrase inhibitors (IAC). Intravitreal corticosteroids, anti-VEGF, and vitrectomy with peeling of the internal limiting membrane do not have sufficient evidence. A treatment scheme is proposed for the CME in IRD in adults, another for pediatric patients and another for IRD and cataract surgery. Oral and topical IACs are effective in the treatment of CME secondary to IRD. Treatment with corticosteroids, anti-VEGF, and vitrectomy are second-line options. Randomized clinical trials are required to establish the therapeutic scale in these patients.

Evaluation of non-exudative tomographic signs in cases of exudative age-related macular degeneration.

OBJECTIVE: To analyse the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration. MATERIAL AND METHODS: A total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3). RESULTS: The presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years. CONCLUSION: Pseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent.

[X-linked blue cone monochromatism. A familial case report]. / Monocromatismo de conos azules ligado a X. Una familia afecta.

CLINICAL CASE: A family affected by X-linked blue cone monochromatism is presented. There are 4 male affected individuals and 9 female carriers. DISCUSSION: The diagnosis of blue cone monochromatism is based on severely affected color vision with preserved blue function, poor visual acuity, nystagmus, nearly absent photopic ERG, and a family pedigree compatible with X-linked inheritance. The female carriers showed normal visual function and ocular motility. It is important to be familiar with non progressive cone dysgenesis in order to make a genetic diagnosis of the illnesses in this group.

[Corneal epithelial complications after vitrectomy: a retrospective study]. / Complicaciones corneales epiteliales de las vitrectomías: estudio retrospectivo.

PURPOSE: To establish the incidence, evolution and final visual outcome of corneal epithelial complications after vitrectomy in a consecutive series performed throughout a period of one year. METHODS: 195 consecutive medical records of patients vitrectomized in 2001 have been retrospectively reviewed. Patients were clinically evaluated the day after vitrectomy, during the first week, and then weekly for 3 months (minimum follow-up). Functional results have been established at the end of this period. RESULTS: 12 out of 195 eyes developed corneal epithelial complications after surgery (6.1%). Eight cases were diagnosed of persistent epithelial defect (4.1%), and four cases (2%) of necrotizing herpetic keratitis. Six out of 12 were diabetic. Corneal epithelial complications affected 10.5% of diabetic and 4.3% of non-diabetic patients (p=0.10). The majority of persistent epithelial defects healed without sequelae in less than two months. Herpetic keratitis required between 3 to 4 months to heal and caused corneal scarring in all cases. CONCLUSIONS: Persistent corneal epithelial defects after vitrectomy are a relatively frequent complication, mainly in diabetic patients. Recurrence of herpetic keratitis must also be kept in mind. This finding has not been previously reported and needs further studies.

[Iatrogenic retinal breaks during vitrectomy: retrospective study]. / Roturas retinianas iatrogénicas en las vitrectomías: estudio retrospectivo.

PURPOSE: To establish the incidence and characteristics of iatrogenic retinal breaks occurring during vitrectomy and to propose a protocol for their management. METHODS: Retrospective study of 195 consecutive vitrectomies performed in 2001. Minimum follow up was 3 months for all cases. RESULTS: 13 patients with iatrogenic retinal breaks (6.6%) have been detected. In 8 cases the breaks affected the peripheral retina, in 4 cases they were located in the posterior pole and there was one retinal dialysis. In 4 cases there were more than one retinal break. 9 patients (70%) were vitrectomized for diabetic retinal complications. In 12 cases, the breaks were detected during surgery and treated with endolaser and/or cryoretinopexy (3 cases located inferiorly). Nevertheless 7 cases (54%) developed a retinal detachment, 2 of which could be reattached. CONCLUSIONS: Among iatrogenic retinal breaks produced during vitrectomy, the peripheral ones are slightly more frequent than the breaks in the posterior pole. Iatrogenic breaks occur more frequently in diabetic patients, having a bad prognosis and often developing a retinal detachment despite endolaser or cryoretinopexy.

[Functional improvement after vision rehabilitation in low monocular vision after myopic macular degeneration and retinal detachment]. / Mejora funcional tras la rehabilitación visual en una paciente con visión monocular deficitaria debido a degeneración macular miópica y desprendimiento de retina.

PURPOSE: We present a case of a 62 year-old woman, with a single eye functional vision (VA of 0.16) who improved her vision after following a vision rehabilitation program, which included optical and non-optical devices for daily performance. CONCLUSIONS: A correct optometric evaluation and a training program are key factors to improve quality of life in low vision patients, whose ocular pathology allows no other treatment.

[First results of the IOBA low vision unit]. / Primeros resultados de la Unidad de Baja Visión del IOBA.

PURPOSE: To verify the efficacy a treatment for the rehabilitation of vision in our Unit for Clinical Low Vision in the testing of improvements in patient's efficiency for daily life activities. MATERIAL AND METHOD: 80 patients were studied. Ophthalmologic and optometric evaluation followed by a customised vision rehabilitation program were performed according to patient's immediate needs. In a second stage a telephoned questionnaire was filled in order to record efficacy of prescribed visual aids in their own environment. RESULTS: Rehabilitation training resulted in 89% of patients showing improvement in their quality of life in both fields; functional and psychological. 85% of patients showed improvement in near activities and 35% in far activities. DISCUSSION: A correct and specialised low vision refraction and a posterior vision rehabilitation training in the use of optical and non optical aids show increase in quality of life in patients with severe visual deficiencies.