[Enzymatic vitrectomy by intravitreal autologous plasmin injection, as initial treatment for diffuse diabetic macular edema]. / Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial del edema macular diabético difuso.

PURPOSE: To determine whether intravitreal injection of plasmin is effective in treating diffuse diabetic macular edema (DDME). DESIGN: A prospective, comparative, interventional case study. PATIENTS: Eighteen patients with bilateral DDME received, as their primary therapeutic treatment, an intravitreal injection of plasmin in one eye, with their contralateral untreated eye serving as a control. INTERVENTION: Intravitreal 0.2 ml of autologous plasmin injected under topical anesthesia. The plasmin was obtained by a simplified method. MAIN OUTCOME MEASURES: Central macular thickness (CMT), determined by optical coherence tomography (OCT), and Best Corrected Visual Acuity (LogMAR), assessed at one and three months of follow-up. RESULTS: All patients completed the 3-month follow-up assessments. Before the injection, the CMT was 525.22 SD 80.12 microm [mean +/- standard deviation (SD)] in the eyes to be injected, compared to 525.44 SD 78.13 microm in the control eyes. One month after the injection, the CMT was 323.72 SD 44.87 microm in the injected eyes and 518.44 SD 78.54 microm in the control eyes (P < 0.001, bilateral Wilcoxon test for paired samples). Three months after the injection, the CMT was 310.55 SD 35.38 microm in the injected eyes and 517.66 SD 80 microm in the control eyes (P < 0.001). Macular edema improved in all injected eyes (100%), with a reduction of at least 50% in every treated eye, but no changes occurred in the control group. Nine of the 18 treated eyes (50%) improved their BCVA by at least two vision lines. No adverse effects were observed in any of the patients. CONCLUSION: Intravitreal plasmin injection, as primary treatment, effectively reduces macular thickening due to DDME and improves visual acuity. Further studies are warranted to assess long-term efficacy and safety.

[Acute macular neuroretinopathy]. / Neurorretinopatía macular aguda.

CLINICAL CASE: A 22-year-old woman complained of symptoms consistent with the sudden onset of central scotomas in both eyes after a flu-like illness. The typical reddish brown macular lesions of acute macular neuroretinopathy were evident in the parafoveal area of both eyes. Visual field examination revealed central scotomas in both eyes that corresponded in location to the retinal injuries. DISCUSSION: Acute macular neuroretinopathy is a rare idiopathic posterior uveitis for which no effective treatment is available. Several pathogenic theories are postulated.

Methotrexate as a treatment in ocular cicatricial moderate pemphigoid.

CLINICAL CASE: A 73 year-old woman presented with a history of non-specific symptoms and photophobia in both eyes of 1 year progression. The examination revealed a bilateral symblepharon and fornix shortening. Immunohistochemical analysis confirmed the presence of linear deposits of IgG, IgM and C3 along the conjunctival basement membrane. With the diagnosis of Ocular Cicatricial Pemphigoid, systemic treatment with subcutaneous methotrexate was prescribed. DISCUSSION: We consider such treatment a very effective initial immunosuppressive alternative in patients with moderate conjunctival inflammation and in cases of rapid progression.

[Intraocular levels of pigment epithelium-derived factor in patients with active uveitis]. / Niveles intraoculares del factor derivado del epitelio pigmentario en pacientes con uveítis activa.

OBJECTIVE: Pigment epithelium-derived factor (PEDF) is an antiangiogenic/neurotrophic dual functional factor, and recently it was also shown to mediate antioxidative and anti-inflammatory action. The purpose of this study was to evaluate the levels of PEDF in the aqueous humor in eyes with idiopathic acute anterior uveitis (IAAU). METHODS: A comparative control study. Aqueous humor was collected from 20 eyes of 20 patients with IAAU. The control group included 20 aqueous humor samples from 20 patients who underwent a cataract surgery and without any other ocular or systemic diseases. Levels of PEDF were determined with the ELISA test. RESULTS: Concentration of PEDF in aqueous humor was remarkably higher in patients with IAAU than in control subjects (Mann-Whitney U test, P<.001). Levels of PEDF were 6,291,637.70±8,564,836.48 pg/ml (mean±SD) in eyes with IAAU and 449,178.10±158,670.19 pg/ml in the eyes of the control group. CONCLUSION: The aqueous humor PEDF levels are increased in eyes with IAAU and may be increased as self-protection against inflammation.

Q fever: a new ocular manifestation.

Q Fever is a zoonosis caused by Coxiella burnetii. Ocular manifestations are rare in this infection. We describe the case of a man complaining of an intense retro-orbital headache, fever, arthralgia, and bilateral loss of vision, who showed an anterior uveitis accompanied by exudative bilateral inferior retinal detachment and optic disk edema. At the beginning, a Vogt-Koyanagi-Harada (VKH) syndrome was suspected, but the patient was diagnosed with Q fever and treatment with doxycycline was initiated, with complete resolution after 2 weeks. We wondered if Q fever could unleash VKH syndrome or simulate a VKH syndrome by a similar immunological process.

[Enzymatic vitrectomy by intravitreal autologous plasmin injection as initial treatment for macular epiretinal membranes and vitreomacular traction syndrome]. / Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial de las membranas epirretinianas maculares y el síndrome de tracción vitreomacular.

PURPOSE: To determine the effectiveness of intravitreal plasmin injection in the treatment of macular epiretinal membranes (MEM) and vitreomacular traction syndrome (VMTS) without associated pars plana vitrectomy. DESIGN: Interventional, prospective, case series pilot study. PATIENTS: Seven patients were enrolled in the study, 4 with MEM and 3 with VMTS. TREATMENT: 0.2 ml of autologous plasmin intravitreally injected under topical anesthesia was administered to all patients. The plasmin was obtained by a simplified method with urokinase. MAIN OUTCOME MEASURES: Degree of detachment of the MEM and the VMTS measured by optical coherence tomography (OCT), and the best corrected visual acuity (Snellen scale) before and one month after the plasmin injection. RESULTS: The follow-up period was completed by all the patients. The MEM remained attached to the retina in all cases, as measured either by biomicroscopy or OCT. The VMTS was completely detached from the foveal area in all cases, with the disappearance of secondary tractional retinal folds and recovery of the normal macular anatomic architecture as measured by OCT. Visual acuity was not modified in any of the MEM patients, and improved in all VMTS patients. No adverse effects were observed. CONCLUSION: In our case series, intravitreally injected autologous plasmin was not effective in the treatment of MEM, but resolved VMTS successfully, improving the visual acuity and releasing the retinal traction without the need for associated pars plana vitrectomy. Larger studies to confirm the efficacy of this technique and the possibility of success after repeated injections are warranted.

Monitorización de la escleritis posterior mediante tomografía de coherencia óptica Swept-Source / Posterior scleritis follow-up by Swept-Source optical coherence tomography

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