The role of retinal fluid location in atrophy and fibrosis evolution of patients with neovascular age-related macular degeneration long-term treated in real world.

PURPOSE: To assess the effect of clinical factors on the development and progression of atrophy and fibrosis in patients with neovascular age-related macular degeneration (nAMD) receiving long-term treatment in the real world. METHODS: An ambispective 36-month multicentre study, involving 359 nAMD patients from 17 Spanish hospitals treated according to the Spanish Vitreoretinal Society guidelines, was designed. The influence of demographic and clinical factors, including the presence and location of retinal fluid, on best-corrected visual acuity (BCVA) and progression to atrophy and/or fibrosis were analysed. RESULTS: After 36 months of follow-up and an average of 13.8 anti-VEGF intravitreal injections, the average BCVA gain was +1.5 letters, and atrophy and/or fibrosis were present in 54.8% of nAMD patients (OR = 8.54, 95% CI = 5.85-12.47, compared to baseline). Atrophy was associated with basal intraretinal fluid (IRF) (OR = 1.87, 95% CI = 1.09-3.20), whereas basal subretinal fluid (SRF) was associated with a lower rate of atrophy (OR = 0.40, 95% CI = 0.23-0.71) and its progression (OR = 0.44, 95% CI = 0.26-0.75), leading to a slow progression rate (OR = 0.34, 95% CI = 0.14-0.83). Fibrosis development and progression were related to IRF at any visit (p < 0.001). In contrast, 36-month SRF was related to a lower rate of fibrosis (OR = 0.49, 95% CI = 0.29-0.81) and its progression (OR = 0.50, 95% CI = 0.31-0.81). CONCLUSION: Atrophy and/or fibrosis were present in 1 of 2 nAMD patients treated for 3 years. Both, especially fibrosis, lead to vision loss. Subretinal fluid (SRF) was associated with good visual outcomes and lower rates of atrophy and fibrosis, whereas IRF yields worse visual results and a higher risk of atrophy and especially fibrosis in routine clinical practice.

Coordinated Intervention of Microglial and Müller Cells in Light-Induced Retinal Degeneration.

Purpose: To analyze the role of microglial and Müller cells in the formation of rings of photoreceptor degeneration caused by phototoxicity. Methods: Two-month-old Sprague-Dawley rats were exposed to light and processed 1, 2, or 3 months later. Retinas were dissected as whole-mounts, immunodetected for microglial cells, Müller cells, and S- and L/M-cones and analyzed using fluorescence, thunder imaging, and confocal microscopy. Cone populations were automatically counted and isodensity maps constructed to document cone topography. Results: Phototoxicity causes a significant progressive loss of S- and L/M-cones of up to 68% and 44%, respectively, at 3 months after light exposure (ALE). One month ALE, we observed rings of cone degeneration in the photosensitive area of the superior retina. Two and 3 months ALE, these rings had extended to the central and inferior retina. Within the rings of cone degeneration, there were degenerating cones, often activated microglial cells, and numerous radially oriented processes of Müller cells that showed increased expression of intermediate filaments. Between 1 and 3 months ALE, the rings coalesced, and at the same time the microglial cells resumed a mosaic-like distribution, and there was a decrease of Müller cell gliosis at the areas devoid of cones. Conclusions: Light-induced photoreceptor degeneration proceeds with rings of cone degeneration, as observed in inherited retinal degenerations in which cone death is secondary to rod degeneration. The spatiotemporal relationship of cone death microglial cell activation and Müller cell gliosis within the rings of cone degeneration suggests that, although both glial cells are involved in the formation of the rings, they may have coordinated actions and, while microglial cells may be more involved in photoreceptor phagocytosis, Müller cells may be more involved in cone and microglial cell migration, retinal remodeling and glial seal formation.

Patient-reported outcomes in Spanish patients diagnosed with bilateral age-related macular degeneration.

PURPOSE: To evaluate the patient-reported outcomes (PRO) in age-related macular degeneration (AMD) patients by using instruments for eliciting health status and vision specific issues. METHODS: PRO were assessed using the 25-item National Eye Institute Visual Function Questionnaire (NEIVFQ-25) and the Short-Form General Health Survey (SF-12). RESULTS: The mean age and corrected distance visual acuity (CDVA) in the better eye of the AMD patients were 82.53 ± 5.17 years and 0.82 ± 0.43 logMAR, respectively. The overall NEIVFQ-25 composite score was 57.89. SF-12 physical and mental component summary scores were 37.28 and 57.25, respectively. There were significant correlations (p ≤ 0.05) between CDVA and the following NEIVFQ-25 subscales: general (r = -0.73), near (r = -0.40) and distance vision (r = -0.60), role limitations (r = -0.40), social function (r = -0.48) and mental health (r = -0.38). CONCLUSIONS: Visual function is severely affected in AMD patients. It hampers their daily living without, however, deeply disturbing their social function. This may help them retain adequate mental health despite their poor physical status.

Frequency of high-grade prostatic intraepithelial neoplasia in Mexican population.

BACKGROUND: High-grade intraepithelial neoplasia (HGPIN) is the only lesion regarded as precursor of prostatic carcinoma, though its frequency is unknown in many countries. Here we studied the frequency of HGPIN in a population with high grade frequency of prostatic carcinoma. MATERIAL AND METHODS: A total of 486 cases of sextant prostatic biopsies performed from January 2001 to January 2006 were reviewed. These included 280 biopsies from patients belonging to an urban population, with medium or high socioeconomic status, from two hospitals in Mexico City. For comparison, 206 cases from the Regional Hospital of Tabasco located in the tropical zone of the country were included. This hospital receives patients from a rural population with low income and socioeconomic status. RESULTS: Of the total 486 cases, 162 (33.33%) cases were diagnosed as prostatic carcinoma and 319 (65.64%) as benign conditions. Only in five (1.03%) biopsies was HGPIN found. Three of these patients were from Mexico City, and two from the Regional Hospital of Tabasco. CONCLUSIONS: Even when our results were obtained only in three hospitals, they suggest that a low frequency of HGPIN on needle prostate biopsies does not necessarily mean a low frequency of prostatic carcinoma in the same population. The reason for such a disparity could be related to a reduced extension of HGPIN areas in the prostate gland. In populations with low frequency of HGPIN and high incidence of prostatic carcinoma, perhaps more biopsy cores should be obtained in order to minimize false negative results for premalignant lesions or early adenocarcinoma.