RESUMEN
IMPORTANCE: Identification of the genetic risk factors that contribute to geographic atrophy (GA) could lead to advancements in interventional trials and/or therapeutic approaches for combating vision loss. OBJECTIVE: To investigate whether single-nucleotide polymorphisms (SNPs) are associated with the presence and progression of established GA in age-related macular degeneration (AMD). DESIGN, SETTING, AND PARTICIPANTS: Prospective, controlled, multicenter study of 154 patients with GA/AMD and 141 age-matched control participants at 8 Spanish hospitals. MAIN OUTCOMES AND MEASURES: Samples of DNA were collected to analyze SNPs within AMD-related genes (CFH, CFB, C3, FHR1-3, and ARMS2). Fundus autofluorescence imaging was used to evaluate GA progression during a 2-year period in 73 patients with GA/AMD. Finally, logistic regression was used to analyze the associations of SNPs, age, body mass index, and cigarette smoking with the rate of progression and relative growth of GA. RESULTS: This case-control analysis revealed a significant (P < .05) association between the presence of GA and SNPs within CFH, ARMS2, and FHR1-3. Moreover, logistic regression analysis identified significant associations of the rate of progression with genetic polymorphisms (CFH-402His [P = .04] and CFH-62Ile [P = .04]) and demographic factors (sex [P = .02] and age [P = .02]), whereas relative growth was associated with 1 polymorphism (CFB-32Gln [P = .04]).Conclusions and Relevance Taken together, our findings confirm that genetic risk factors related to the presence of GA are not identical to those associated with GA progression. In fact, we demonstrate that gene variants of CFH and CFB, as well as demographic risk factors, confer significant risk for GA progression (both rate of progression and relative growth) within a Spanish population.
Asunto(s)
Complemento C3/genética , Factor B del Complemento/genética , Factor H de Complemento/genética , Atrofia Geográfica/genética , Imagen Óptica/métodos , Polimorfismo Genético , Proteínas/genética , Anciano , Proteínas Sanguíneas/genética , Proteínas Sanguíneas/metabolismo , Complemento C3/metabolismo , Proteínas Inactivadoras del Complemento C3b/genética , Proteínas Inactivadoras del Complemento C3b/metabolismo , Factor B del Complemento/metabolismo , Factor H de Complemento/metabolismo , ADN/genética , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Predisposición Genética a la Enfermedad , Genotipo , Atrofia Geográfica/patología , Humanos , Mácula Lútea/patología , Degeneración Macular/genética , Masculino , Estudios Prospectivos , Proteínas/metabolismoRESUMEN
AIM: To compare the mydriatic efficacy of an ophthalmic insert (Mydriasert, MY) versus phenylephrine and tropicamide (PT) eye drops. METHODS: Two controlled, prospective, randomized, single-blind studies were performed. In the first study, a total of 80 eyes from 40 outpatient-clinic patients were analyzed. PT drops were applied to the right eye, and a MY device was inserted in the left eye for 30min. Time until maximal pupil dilation for each eye was then assessed. In the second study, 80 eyes from 80 patients undergoing cataract surgery were analyzed. Pupil dilation was achieved using either PT drops three-times for one hour prior to surgery (40 patients), or a MY device was inserted one hour prior to surgery (40 patients). RESULTS: In the first study, MY achieved superior mydriasis compared to PT eye drops at 90min (9.04±1.33mm vs 8.78±1.37mm, P=0.012). However MY took longer than PT drops to achieve maximal dilation, and mydriasis was inferior in eyes with MY compared to PT drops at 30min (7.21±1.73mm vs 8.22±1.43mm, P<0.001), the two groups only becoming similar by 60min (8.85±1.44mm vs 8.71±1.27mm, P=0.236). In the second study, both MY and PT achieved similar levels of mydriasis at the beginning of surgery (8.75±0.76mm with MY vs 8.77±0.63mm with PT), and also at the end of surgery (7.96±1.06mm with MY vs 8.32±0.72mm with PT), with no significant difference between groups (P=0.08). MY was well tolerated and cardiovascular effects were not influenced by dilation method. CONCLUSION: MY could be a safe and efficacious alternative for mydriasis. The mydriatic effect of MY is as good as conventional PT eye drops after 60min, and is superior after 90min. MY also maintains good pupil dilation during cataract surgery.
Asunto(s)
Enfermedades del Iris/etiología , Facoemulsificación , Complicaciones Posoperatorias , Implantación de Prótesis , Pupila , Suturas , Adolescente , Humanos , Implantación de Lentes Intraoculares , Subluxación del Cristalino/etiología , Subluxación del Cristalino/cirugía , Masculino , Síndrome de Marfan/complicaciones , Polipropilenos , Rotura Espontánea/etiologíaRESUMEN
An 82-year-old man had uneventful phacoemulsification with bilateral implantation of a hydrophilic acrylic, single-piece intraocular lens (IOL) (ACR6D SE, Laboratoires Cornéal). Five years later, simultaneous and bilateral IOL subluxations occurred. In both eyes, the subluxation was situated on the side of one haptic that had moved forward (temporal area in the right eye and superior area in the left eye). In the right eye, the haptic-capsular bag was entrapped by the pupil and produced endothelial damage. A transscleral suture was placed over and under the subluxated haptic through the anterior and posterior capsules to capture the haptic. The haptic was then sutured to the sclera. No postoperative complications developed. We hypothesize that 10-degree angulated and broad haptic junctions can lead to zonular damage and IOL subluxation.
