Resultados de la cirugía de agujero macular grande empleando distintas técnicas de interposición macular. Serie de 9 casos / Results of large macular hole surgery using different interposition techniques. A report on 9 cases

Objetivo Describir la restauración anatómica y funcional observada a largo plazo en pacientes intervenidos por agujero macular (AM) grande empleando distintas técnicas de interposición macular. Método Análisis retrospectivo de los resultados obtenidos en una serie de 9 pacientes sometidos a cirugía de AM grande (≥450μm) realizando 4 técnicas de interposición macular distintas: flap invertido de membrana limitante interna en 4 casos, plegado de membrana limitante interna en 2, injerto de membrana amniótica en 2 e injerto autógeno de cápsula anterior en uno. El tiempo de seguimiento medio fue de 11 meses. Anatómicamente las medidas de resultados exploradas fueron la restauración de las capas externas de la retina y el patrón de cierre macular. Funcionalmente se valoró la agudeza visual final y la calidad visual. Resultados La restauración de las capas externas fue parcial en 6 casos. La tasa de cierre macular fue del 100%, apreciándose un patrón incompleto en 4 casos. La agudeza visual mejoró en 7 pacientes, manteniéndose estable en 2. Tres casos mostraron un patrón de fijación excéntrico y/o metamorfopsias. Conclusiones El desarrollo de nuevas técnicas quirúrgicas ha incrementado la tasa de cierre macular en AM grandes. Sin embargo, la restauración anatómica y funcional sigue siendo impredecible. En este trabajo se logró el cierre macular en todos los pacientes y una mayor tasa de cierre completo empleando flap invertido de membrana limitante interna. La restauración de las capas externas fue más favorable en los grupos en los que se había empleado membrana limitante interna. La recuperación funcional fue independiente de la técnica empleada (AU)

Objective To describe the long-term anatomical and functional restoration observed in patients operated on for a large macular hole (MH) using different macular interposition techniques. Method Retrospective analysis of the results obtained in a series of 9 patients undergoing large MH surgery (≥450μm) performing 4 different macular interposition techniques: inverted internal limiting membrane flap in 4 cases, autotransplantation of internal limiting membrane in 2, amniotic membrane graft in 2, and autologous anterior capsule graft in one. The mean follow-up time was 11 months. Anatomically, the outcome measures explored were the restoration of the outer layers of the retina and the pattern of MH closure. The final visual acuity and visual quality were functionally assessed. Results The restoration of the outer layers was partial in 6 cases. The macular closure rate was 100%, showing an incomplete pattern in 4 cases. Visual acuity improved in 7 patients, remaining stable in 2. Three cases showed an eccentric fixation pattern and/or metamorphopsia. Conclusion The development of new surgical techniques has increased the rate of macular closure in large MHs. However, the anatomical and functional restoration remains unpredictable. In this work, macular closure was achieved in all patients and a higher rate of complete closure using inverted internal limiting membrane flap. The restoration of the outer layers was more favorable in the groups in which internal limiting membrane had been used. Functional recovery was independent of the technique used (AU)

Real-life results in treating neovascular age-related macular degeneration with anti-VEGF therapy. Analysis of 122 patients from a single centre.

BACKGROUND: The prognosis of age-related macular degeneration (AMD) has improved significantly since the advent of antiangiogenic treatments. However, several «real life¼ studies have shown lower number of injections and a markedly worse visual prognosis than pivotal clinical trials. OBJECTIVE: To assess the effectiveness and safety of the treatment of neovascular AMD and analyse clinical factors related to the functional and structural prognosis in routine clinical practice. MATERIAL AND METHODS: Retrospective, observational, single-centre study that included 143 eyes of 122 patients diagnosed with neovascular AMD between the years 2015 and 2016, who received treatment with antiangiogenic drugs and were followed up for two or more years. RESULTS: Visual acuity improved in 45% of patients after two years of treatment. The mean decrease in central macular thickness was 85 µm (p < 0.001) and the mean number of injections was 13. Retinal pigment epithelium rupture was present in 3.5%. Ranibizumab was the drug most used as a first option, although 79 patients (55.2%) required a change in treatment, most being switched to aflibercept. A greater number of visits (p < 0.001) and a lower number of injections (p < 0.01) were predictors of worse structural outcome. The number of visits was associated with better visual acuity (p < 0.001). CONCLUSIONS: The treatment has demonstrated its efficacy by improving visual acuity and central macular thickness. However, the number of injections performed has generally been higher than in other real-life studies.

Resultados de vida real en el tratamiento de la degeneración macular asociada a la edad neovascular con terapia anti-VEGF. Análisis de 122 pacientes de un solo centro / Real-life results in treating neovascular age-related macular degeneration with anti-VEGF therapy. Analysis of 122 patients from a single centre

Antecedentes El pronóstico de la degeneración macular asociada a la edad (DMAE) ha mejorado significativamente desde la aparición de los tratamientos antiangiogénicos. Sin embargo, diversos estudios realizados en «vida real» han demostrado un número de inyecciones inferior y un pronóstico visual notablemente peor de los ensayos clínicos pivotales. Objetivo Valorar la efectividad y seguridad del tratamiento de la DMAE neovascular y analizar factores clínicos relacionados con el pronóstico funcional y estructural en la práctica clínica habitual. Materiales y métodos Estudio retrospectivo, observacional y unicéntrico. Se incluyeron 143 ojos de 122 pacientes diagnosticados de DMAE neovascular entre los años 2015 y 2016, que recibieron tratamiento con antiangiogénicos y con un seguimiento de dos o más años. Resultados La agudeza visual mejoró en el 45% de pacientes tras dos años de tratamiento. La disminución media de grosor macular central fue de 85 μm (p < 0,001) y el número medio de inyecciones fue de 13. Un 3,5% presentó una rotura del epitelio pigmentario. Ranibizumab fue el más utilizado como primera opción, aunque 79 pacientes (55,2%) requirieron un cambio de fármaco, pasando la mayoría a ser tratados con aflibercept. Fueron predictores de peor resultado estructural un mayor número de visitas (p < 0,001) y un menor número de inyecciones (p < 0,01). El número de visitas se asoció a mejor agudeza visual (p < 0,001). Conclusiones El tratamiento ha demostrado su eficacia mejorando la agudeza visual y el grosor macular central. Sin embargo, el número de inyecciones realizado ha sido en general superior al de otros estudios de vida real (AU)

Background The prognosis of age-related macular degeneration (AMD) has improved significantly since the advent of antiangiogenic treatments. However, several «real life» studies have shown lower number of injections and a markedly worse visual prognosis than pivotal clinical trials. Objective To assess the effectiveness and safety of the treatment of neovascular AMD and analyse clinical factors related to the functional and structural prognosis in routine clinical practice. Material and method Retrospective, observational, single-centre study that included 143 eyes of 122 patients diagnosed with neovascular AMD between the years 2015 and 2016, who received treatment with antiangiogenic drugs and were followed up for two or more years. Result Visual acuity improved in 45% of patients after two years of treatment. The mean decrease in central macular thickness was 85 microns (p < 0.001) and the mean number of injections was 13. Retinal pigment epithelium rupture was present in 3.5%. Ranibizumab was the drug most used as a first option, although 79 patients (55.2%) required a change in treatment, most being switched to aflibercept. A greater number of visits (p < 0.001) and a lower number of injections (p < 0.01) were predictors of worse structural outcome. The number of visits was associated with better visual acuity (p < 0.001). Conclusions The treatment has demonstrated its efficacy by improving visual acuity and central macular thickness. However, the number of injections performed has generally been higher than in other real-life studies (AU)

Results of large macular hole surgery using different interposition techniques. A report on 9 cases.

OBJECTIVE: To describe the long-term anatomical and functional restoration observed in patients operated on for a large macular hole (MH) using different macular interposition techniques. METHOD: Retrospective analysis of the results obtained in a series of 9 patients undergoing large MH surgery (≥450µm) performing 4 different macular interposition techniques: inverted internal limiting membrane flap in 4 cases, autotransplantation of internal limiting membrane in 2, amniotic membrane graft in 2, and autologous anterior capsule graft in one. The mean follow-up time was 11 months. Anatomically, the outcome measures explored were the restoration of the outer layers of the retina and the pattern of MH closure. The final visual acuity and visual quality were functionally assessed. RESULTS: The restoration of the outer layers was partial in 6 cases. The macular closure rate was 100%, showing an incomplete pattern in 4 cases. Visual acuity improved in 7 patients, remaining stable in 2. Three cases showed an eccentric fixation pattern and/or metamorphopsia. CONCLUSIONS: The development of new surgical techniques has increased the rate of macular closure in large MHs. However, the anatomical and functional restoration remains unpredictable. In this work, macular closure was achieved in all patients and a higher rate of complete closure using inverted internal limiting membrane flap. The restoration of the outer layers was more favorable in the groups in which internal limiting membrane had been used. Functional recovery was independent of the technique used.

Diferencias en la visión intermedia: lente intraocular monofocal vs. lente intraocular monofocal de rango extendido / Differences in intermediate vision: monofocal intraocular lenses vs. monofocal extended depth of focus intraocular lenses

OBJETIVO: El objetivo de este estudio es analizar si una lente intraocular (LIO) monofocal (TECNIS Eyhance®, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) de foco extendido proporciona una mejor agudeza visual (AV) intermedia que otras LIO monofocales (TECNIS 1-pieza®, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) de la misma plataforma. MÉTODOS: Se realizó un estudio observacional prospectivo y aleatorizado con pacientes que necesitaban cirugía de cataratas en ambos ojos. Un grupo de pacientes recibió el implante con la LIO TECNIS 1-pieza y otro grupo recibió la LIO Eyhance de foco extendido monofocal. Un mes desde la cirugía en el segundo ojo se evaluó la AV intermedia corregida (66 cm) y se obtuvieron las curvas de desenfoque. También se exploró la correlación de aberraciones de orden elevado y esféricas con AV intermedia, tamaño pupilar con AV intermedia y edad con AV intermedia. RESULTADOS: El estudio analizó a 30 pacientes (60 ojos), 15 de ellos en el grupo TECNIS 1-pieza y 15 en el grupo Eyhance. Ambos grupos consiguieron una AV lejana de 0,00 logMAR. En contraste, para la visión intermedia la AV fue mejor con las LIO Eyhance de foco extendido monofocal (0,16 ± 0,12 LogMAR), siendo la diferencia estadísticamente significativa (p < 0,001). Además, se observó que la AV intermedia binocular guardaba una correlación significativa con las aberraciones corneales (6 mm) RMS de alto orden (ρ 0,476) y Z40 (ρ 0,483) con la LIO Eyhance. CONCLUSIONES: La nueva LIO monofocal de foco extendido (Eyhance) ofrece suficiente profundidad de foco para proporcionar a los pacientes una visión confortable sin afectar la visión lejana

PURPOSE: The purpose of this study was to analyse whether an extended depth of focus (EDOF) monofocal intraocular lens (IOL) (TECNIS Eyhance™, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) provides better intermediate visual acuity (VA) than another monofocal IOL (TECNIS 1-piece™, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) from the same platform. METHODS: Randomised prospective observational study. Patients who required cataract surgery in both eyes were included. Patients in one group were implanted with Tecnis 1-piece IOL and those in the other group with Eyhance EDOF monofocal IOL. One month after surgery in the second eye, we assessed the corrected intermediate VA (66 cm) and obtained defocus curves. We also explored the correlation of: high-order and spherical aberrations with intermediate VA, pupil size with intermediate VA and age with intermediate VA. RESULTS: We analysed 30 patients (60 eyes), 15 patients in the TECNIS 1-piece group and 15 in the Eyhance group. Both groups achieved a far VA of 0.00 logMAR. In contrast, for intermediate vision, VA was better with the Eyhance EDOF monofocal IOLs (0.16 ± 0.12 LogMAR), the difference being statistically significant (p < 0.001). In addition, binocular intermediate VA was found to be significantly correlated with corneal (6 mm) RMS high-order aberrations (ρ 0.476) and Z40 (ρ 0.483) with the Eyhance IOL. CONCLUSIONS: The new EDOF monofocal IOL (Eyhance) offers sufficient depth of focus to provide patients with comfortable vision without impairing far vision

Differences in intermediate vision: monofocal intraocular lenses vs. monofocal extended depth of focus intraocular lenses. / Diferencias en la visión intermedia: lente intraocular monofocal vs. lente intraocular monofocal de rango extendido.

PURPOSE: The purpose of this study was to analyse whether an extended depth of focus (EDOF) monofocal intraocular lens (IOL) (TECNIS Eyhance™, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) provides better intermediate visual acuity (VA) than another monofocal IOL (TECNIS 1-piece™, Johnson&Johnson Surgical Vision, Inc., Santa Ana, CA) from the same platform. METHODS: Randomised prospective observational study. Patients who required cataract surgery in both eyes were included. Patients in one group were implanted with Tecnis 1-piece IOL and those in the other group with Eyhance EDOF monofocal IOL. One month after surgery in the second eye, we assessed the corrected intermediate VA (66 cm) and obtained defocus curves. We also explored the correlation of: high-order and spherical aberrations with intermediate VA, pupil size with intermediate VA and age with intermediate VA. RESULTS: We analysed 30 patients (60 eyes), 15 patients in the TECNIS 1-piece group and 15 in the Eyhance group. Both groups achieved a far VA of 0.00 logMAR. In contrast, for intermediate vision, VA was better with the Eyhance EDOF monofocal IOLs (0.16 ± 0.12 LogMAR), the difference being statistically significant (p < 0.001). In addition, binocular intermediate VA was found to be significantly correlated with corneal (6 mm) RMS high-order aberrations (ρ 0.476) and Z40 (ρ 0.483) with the Eyhance IOL. CONCLUSIONS: The new EDOF monofocal IOL (Eyhance) offers sufficient depth of focus to provide patients with comfortable vision without impairing far vision.

Vitreous levels of somatostatin in patients with chronic uveitic macular oedema.

PURPOSE: Intravitreal somatostatin (SST) levels are decreased in patients with diabetic macular oedema. This deficit may be involved in the pathogenesis of this condition. The aim of the present study was to determine SST concentration in the vitreous fluid of patients with chronic uveitic macular oedema (CUMO) and quiescent intraocular inflammation. METHODS: Plasma and vitreous fluid samples were obtained during vitrectomy from 11 eyes of patients with CUMO and from 42 eyes of control subjects (idiopathic epiretinal membrane, macular hole). SST concentration was measured by radioimmunoassay. STATISTICS: χ(2)-square test, Mann-Whitney U-test, Wilcoxon test, Spearman's rank correlation coefficient, and multivariant linear regression models. RESULTS: Plasma SST concentrations were similar in uveitic patients and controls (28.25 pg/ml (21.3-31) vs 28.7 pg/ml (22-29.5); P=0.869). A higher vitreous concentration of proteins was found in uveitic patients (1.59±0.38 mg/ml vs 0.73±0.32 mg/ml, P<0.0001). Vitreous SST was markedly lower in uveitic patients, both in absolute terms and after adjusting for total intravitreous protein concentration (39.37 pg/ml (6.16-172) vs 486.73 pg/ml (4.7-1833), P<0.0001; 33.1 pg/mg (3.9-215.74) vs 629.75 pg/mg (6.91-2024), P<0.0001). No correlations were found between plasma and vitreous concentration of SST in either group (ρ=0.191, P=0.57 and ρ=0.49, P=0.66). There were no correlations between vitreous SST concentration and visual acuity or macular thickness in uveitic patients (ρ=0.302, P=0.31 and ρ=0.45, P=0.13). CONCLUSIONS: Intravitreous SST is decreased in patients with CUMO and quiescent intraocular inflammation. The deficit of SST may have a role in the pathogenesis of this condition.

Exitoso tratamiento con queratoprótesis de Boston en un paciente con síndrome de Lyell / Successful Boston keratoprrosthesis in a patient with Lyell's syndrome

Caso clínico: Presentamos el caso de una pacienteque acude a nuestro servicio remitida por presentarun síndrome de Lyell con severa participación ocular.La intensa afectación de la superficie ocular y lainsuficiencia límbica sientan la indicación paraimplantar una queratoprótesis de Boston tipo 1,logrando un resultado funcional estable y muysatisfactorio.Discusión: Como se puede ver en este caso clínico,la queratoprótesis de Boston tipo 1 parece ser unaopción viable después de múltiples trasplantes cornealesfallidos o en algunas situaciones con pobrepronóstico para una queratoplastia penetrante primariapor presentar insuficiencia límbica, como elsíndrome de Lyell(AU)

Case report: We present the case of a woman readmittedto our service to receive treatment for severeophthalmic manifestations due to Lyell’s syndrome.This intense affectation of the ocular surface alongwith limbal stem cell deficiency are grounds for treatmentwith Boston type 1 keratoprosthesis, whichprovided a stable and very satisfactory functionalresult.Discussion: As noted in this case report, the BostonType 1 keratoprosthesis seems to be a viable optionafter multiple failed corneal grafts or in situationswith a poor prognosis for primary penetrating keratoplastybecause of limbal stem cell deficiency,such as Lyell’s syndrome(AU)

[Successful Boston keratoprosthesis in a patient with Lyell's syndrome]. / Exitoso tratamiento con queratoprótesis de Boston en un paciente con síndrome de Lyell.

CASE REPORT: We present the case of a woman readmitted to our service to receive treatment for severe ophthalmic manifestations due to Lyell's syndrome. This intense affectation of the ocular surface along with limbal stem cell deficiency are grounds for treatment with Boston type 1 keratoprosthesis, which provided a stable and very satisfactory functional result. DISCUSSION: As noted in this case report, the Boston Type 1 keratoprosthesis seems to be a viable option after multiple failed corneal grafts or in situations with a poor prognosis for primary penetrating keratoplasty because of limbal stem cell deficiency, such as Lyell's syndrome.

Phacoemulsification cataract surgery in vitrectomized eyes.

PURPOSE: To determine the problems, safety, and results of phacoemulsification cataract surgery in previously vitrectomized eyes. SETTING: Department of Ophthalmology of Galdácano Hospital, Galdacano, Spain. METHODS: In this prospective study, phacoemulsification was performed in 23 eyes that had had vitrectomy between February 1992 and May 1994. Surgical and postsurgical difficulties and complications and visual acuity results were analyzed. Follow-up ranged from 12 to 24 months. RESULTS: The incidence of surgical problems and complications was higher than usual: 7 eyes presented small pupil size (< 3.0 mm); sudden changes in anterior chamber depth and pupil size during surgery occurred in 6 eyes; unusual mobility and flaccidity of the posterior capsule was observed in 6 cases, which was associated with posterior subcapsular cataract and young age (< 50 years); posterior capsule tear occurred in 2 eyes, 1 of which required anterior vitrectomy. Postoperatively, best visual acuity improved two Snellen lines or more in 17 eyes (73.91%), did not change in 3 (13.04%), and worsened in 3. CONCLUSION: Phacoemulsification in vitrectomized eyes presented more problems and complications than usual. However, it seems to be safer than manual extracapsular surgery because it minimized the risk of intraoperative eye hypotony or collapse.