Biomarcadores de OCT-angiografía en la neovascularización coroidea tipo1 tras tratamiento con aflibercept durante 1 año / OCT angiography biomarkers in type1 choroidal neovascularisation after one year of aflibercept treatment

Objetivos: Evaluar la actividad de los biomarcadores, mediante OCT-angiografía (OCTA), en la neovascularización coroidea (NVC) secundaria a degeneración macular asociada a la edad (DMAE) tratada con aflibercept. Como objetivos secundarios se estudiaron la agudeza visual (AV) y la relación existente entre biomarcadores y pronóstico visual. Material y métodos: Estudio prospectivo en el que se estudiaron 33 ojos de 40 pacientes naïve diagnosticados de NVC tipo1 secundaria a DMAE y que habían sido tratados con aflibercept, según ficha técnica, durante 1año. Los pacientes fueron evaluados en el momento del diagnóstico, a los 4, a los 8 y a los 12meses. Resultados: La ganancia media de AV a los 12meses fue de 15,2±3,3 letras. El área de lesión disminuyó 1,2±1,0mm2 en el cuarto mes (p<0,0001), permaneciendo estable después. La presencia de capilares finos, anastomosis y halo hipointenso perilesional se redujo en el 85, el 70 y el 25%, respectivamente, a los 12meses de seguimiento. La arcada vascular periférica cambió de morfología, pasando de tener un aspecto frondoso a tener un aspecto afilado en el 90% de los casos. El tamaño de la lesión y la presencia/ausencia de halo hipointenso perilesional se asociaron, de manera independiente, a la AV final, de tal forma que las lesiones de mayor tamaño y la ausencia de halo hipointenso perilesional en la visita basal se asociaron a menor ganancia de AV. Conclusiones: La OCTA se trata de una herramienta útil, no invasiva, que nos aporta información cuantitativa y cualitativa del remodelado de la red vascular de la NVC tras terapia antiangiogénica. (AU)

Objective: To assess the activity of biomarkers, through OCT angiography (OCTA), of choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD) treated with aflibercept. As secondary endpoints, visual acuity (VA) and the relationship between biomarkers and visual prognosis were also studied. Material and methods: Prospective study that examined 33 eyes of 40 naïve patients with type1 CNV secondary to AMD, who had been treated with aflibercept, according to summary of product characteristics, for one year. The patients were evaluated at the time of diagnosis, and at 4, 8 and 12months. Results: The mean VA gain at 12months was 15.2±3.3 letters. The area of lesion decreased 1.2±1.0mm2 in the 4th month (P<.0001), remaining stable afterwards. The presence of tiny capillaries, anastomosis and perilesional hypointense halo was reduced by 85%, 70% and 25%, respectively, at 12 months of follow-up. The peripheral vascular arcade changed morphology, from having a leafy appearance to having a sharp appearance in 90% of cases. The size of the lesion and the presence/absence of perilesional hypointense halo were independently associated with the final VA, in such a way that larger lesions and the absence of a perilesional hypointense halo at the baseline visit were associated with less VA gain. Conclusions: The OCTA is a useful, non-invasive tool that provides quantitative and qualitative information on the remodelling of the CNV vascular network after antiangiogenic therapy. (AU)

Eficacia del implante de dexametasona intravítreo en el manejo del «síndrome de Vogt-Koyanagi-Harada-like» secundario a la inhibición de la vía MAP quinasa / Usefulness of intravitreal dexamethasone implant in the management of «Vogt-Koyanagi-Harada-like syndrome» secondary to map kinase pathway inhibition

Mujer de 58 años, con antecedentes personales de melanoma metastásico en tratamiento con trametinib y dabrafenib, que presentaba disminución de agudeza visual bilateral. En la exploración se podía observar uveítis anterior, vitritis, desprendimiento de retina seroso, vasculitis y edema de disco en ambos ojos; se la diagnosticó de síndrome de Vogt-Koyanagi-Harada-like secundario a inhibición de la vía MAP quinasa. Además de la retirada de los fármacos oncológicos, se pautaron corticoides sistémicos y tópicos, pero este tratamiento consiguió solo una mejoría parcial del cuadro cuando se reintrodujo la terapia biológica; se añadió, por tanto, un implante de dexametasona intravítreo bilateral que consiguió una evolución favorable en su sintomatología y en los hallazgos de las pruebas complementarias. La inflamación intraocular es una complicación descrita tras el tratamiento con trametinib y dabrafenib. Un diagnóstico preciso unido al tratamiento corticoideo, tanto sistémico como intravítreo, nos llevó a obtener óptimos resultados

The case is presented of a 58-year-old woman with a personal history of metastatic melanoma under treatment with trametinib and dabrafenib, as well as a decrease in bilateral visual acuity. On examination, it was observed that she had an anterior uveitis, vitritis, serous retinal detachment, vasculitis and disc oedema in both eyes. She was diagnosed with a Vogt-Koyanagi-Harada-like syndrome secondary to MAP kinase pathway inhibition. In addition to the withdrawal of the oncology drugs, systemic and topical corticosteroids were prescribed, but this treatment only achieved a partial improvement of the disease when biological therapy was re-introduced. Therefore, a bilateral intravitreal dexamethasone implant was added, which led to a favourable progression in her symptomatology, as well as in the findings of complementary tests. Intraocular inflammation is a complication described after treatment with trametinib and dabrafenib. An accurate diagnosis, added to corticosteroid treatment, systemic and intravitreal, led us to obtain optimal results

Usefulness of intravitreal dexamethasone implant in the management of «Vogt-Koyanagi-Harada-like syndrome¼ secondary to map kinase pathway inhibition. / Eficacia del implante de dexametasona intravítreo en el manejo del «síndrome de Vogt-Koyanagi-Harada-like¼ secundario a la inhibición de la vía MAP quinasa.

The case is presented of a 58-year-old woman with a personal history of metastatic melanoma under treatment with trametinib and dabrafenib, as well as a decrease in bilateral visual acuity. On examination, it was observed that she had an anterior uveitis, vitritis, serous retinal detachment, vasculitis and disc oedema in both eyes. She was diagnosed with a Vogt-Koyanagi-Harada-like syndrome secondary to MAP kinase pathway inhibition. In addition to the withdrawal of the oncology drugs, systemic and topical corticosteroids were prescribed, but this treatment only achieved a partial improvement of the disease when biological therapy was re-introduced. Therefore, a bilateral intravitreal dexamethasone implant was added, which led to a favourable progression in her symptomatology, as well as in the findings of complementary tests. Intraocular inflammation is a complication described after treatment with trametinib and dabrafenib. An accurate diagnosis, added to corticosteroid treatment, systemic and intravitreal, led us to obtain optimal results.

Linfoma y proliferación melanocítica uveal difusa unilateral: cuando ambas entidades coexisten en el ojo / Lymphoma and unilateral diffuse uveal melanocytic proliferation: when both conditions co-exist in the eye

Varón de 60 años que presenta disminución de agudeza visual rápida y progresiva en su ojo izquierdo (OI). En la exploración funduscópica se pueden observar alteraciones pigmentarias asociadas a placas anaranjadas subretinianas que, mediante autofluorescencia, aparecen como múltiples puntos hipoautofluorescentes en el polo posterior. A los 3 meses, el paciente desarrolla una importante vitritis asociada a grandes placas blanco-amarillentas subretinianas en el polo posterior del OI; el ojo derecho no presenta alteraciones. El coeficiente intravítreo IL-10/IL-6 fue de 0,87 y la resonancia nuclear magnética cerebral evidenció una lesión densa en el lóbulo frontal, sugestiva de linfoma. Se diagnosticó al paciente un linfoma primario del sistema nervioso central, con afectación ocular de su OI, que se asoció a una proliferación melanocítica uveal difusa del mismo ojo. La proliferación melanocítica uveal difusa se trata de un proceso paraneoplásico bilateral que ocurre como consecuencia de procesos tumorales carcinomatosos, aunque no siempre cumple estas características

The case is presented of a 60 year-old male with decreased visual acuity in his left eye (LE). In the funduscopic examination, pigmentary alterations associated with sub-retinal orange plaques could be observed that, in autofluorescence, manifested as hypoautofluorescent spots. Subsequently, the patient subsequently developed significant vitritis with large white sub-retinal plaques on the posterior pole of his LE, with no alterations in the right eye. The IL-10/IL-6 coefficient was 0.87, and a lesion suggestive of a lymphoma in the frontal lobe could be seen on brain magnetic resonance scan. The patient was diagnosed with primary lymphoma of the central nervous system with ocular involvement of the LE and associated unilateral diffuse uveal melanocytic proliferation of the same eye. Diffuse uveal melanocytic proliferation is a bilateral para-neoplastic process that occurs as a consequence of carcinomatous tumour processes, although it does not always meet these characteristics

Lymphoma and unilateral diffuse uveal melanocytic proliferation: when both conditions co-exist in the eye. / Linfoma y proliferación melanocítica uveal difusa unilateral: cuando ambas entidades coexisten en el ojo.

The case is presented of a 60 year-old male with decreased visual acuity in his left eye (LE). In the funduscopic examination, pigmentary alterations associated with sub-retinal orange plaques could be observed that, in autofluorescence, manifested as hypoautofluorescent spots. Subsequently, the patient subsequently developed significant vitritis with large white sub-retinal plaques on the posterior pole of his LE, with no alterations in the right eye. The IL-10/IL-6 coefficient was 0.87, and a lesion suggestive of a lymphoma in the frontal lobe could be seen on brain magnetic resonance scan. The patient was diagnosed with primary lymphoma of the central nervous system with ocular involvement of the LE and associated unilateral diffuse uveal melanocytic proliferation of the same eye. Diffuse uveal melanocytic proliferation is a bilateral para-neoplastic process that occurs as a consequence of carcinomatous tumour processes, although it does not always meet these characteristics.

Neovascularización coroidea secundaria a coroiditis serpiginosa: valor de la OCT-angiografía en el diagnóstico y en la respuesta al tratamiento con aflibercept / Choroidal neovascularisation secondary to serpiginous choroiditis: The value of OCT-angiography in diagnosis and response to therapy with aflibercept

Varón de 61 años, con antecedentes personales de coroiditis serpiginosa (CS), que presentó metamorfopsia y disminución de agudeza visual (AV) en su ojo derecho (OD). En la exploración, mediante Swept-Source OCT-angiografía (SS OCT-A), se pudo observar una hemorragia peripapilar secundaria a una neovascularización coroidea (NVC). El paciente fue tratado mediante aflibercept intravítreo, presentando una evolución favorable en su sintomatología y en los hallazgos de la SS OCT-A. La NVC es una complicación que puede aparecer hasta en el 25% de los casos tras CS. Un diagnóstico preciso, mediante SS OCT-A, unido al tratamiento precoz con aflibercept, nos llevó a obtener unos óptimos resultados, tanto clínicos como anatómicos

A case is presented of a 61 year-old man with a personal history of serpiginous choroiditis (SC), who presented with metamorphopsia and decreased visual acuity (VA) in his right eye (RE). In the examination, using Swept Source OCT-angiography (SS OCT-A), peripapillary haemorrhage secondary to a choroidal neovascularisation (CNV) was observed. The patient was treated with intravitreal aflibercept, having a favourable outcome on his symptomatology and in the SS OCT-A findings. CNV is a complication that can appear in up to 25% of cases after SC. An accurate diagnosis using SS OCT-A, with early treatment with aflibercept, led us to obtain optimal clinical and anatomical results

Choroidal neovascularisation secondary to serpiginous choroiditis: The value of OCT-angiography in diagnosis and response to therapy with aflibercept. / Neovascularización coroidea secundaria a coroiditis serpiginosa: valor de la OCT-angiografía en el diagnóstico y en la respuesta al tratamiento con aflibercept.

A case is presented of a 61 year-old man with a personal history of serpiginous choroiditis (SC), who presented with metamorphopsia and decreased visual acuity (VA) in his right eye (RE). In the examination, using Swept Source OCT-angiography (SS OCT-A), peripapillary haemorrhage secondary to a choroidal neovascularisation (CNV) was observed. The patient was treated with intravitreal aflibercept, having a favourable outcome on his symptomatology and in the SS OCT-A findings. CNV is a complication that can appear in up to 25% of cases after SC. An accurate diagnosis using SS OCT-A, with early treatment with aflibercept, led us to obtain optimal clinical and anatomical results.

Eplerenona, un nuevo tratamiento para un viejo problema: retinosis pigmentaria asociada a edema macular recalcitrante / Eplerenone, a new treatment for an old problem: Retinitis pigmentosa with recalcitrant macular edema

CASO CLÍNICO: Varón de 35 años, con antecedentes personales de retinosis pigmentaria, que presentó un edema macular quístico bilateral asociado a membrana epirretiniana bilateral resistente a tratamiento con acetazolamida oral y bevacizumab intravítreo. El tratamiento con eplerenona oral fue capaz de mejorar la agudeza visual y el grosor macular de este paciente. DISCUSIÓN: Se han propuesto numerosos tratamientos para el manejo del edema macular quístico asociado a retinosis pigmentaria, con resultados variables. El tratamiento con eplerenona oral podría ser una buena opción para el control de esta entidad

CASE REPORT: The case involves a 35-year-old man, with a history of retinitis pigmentosa, who presented with a bilateral cystoid macular oedema associated with bilateral epiretinal membrane, which was resistant to treatment with oral acetazolamide and intravitreal bevacizumab. The treatment with oral eplerenone was able to improve the visual acuity and macular thickness of this patient. DISCUSSION: A variety of treatments have been proposed for the management of cystoid macular oedema, associated with retinitis pigmentosa, with variable results. The treatment with oral eplerenone might be a good option for the control of this condition

Eplerenone, a new treatment for an old problem: Retinitis pigmentosa with recalcitrant macular edema. / Eplerenona, un nuevo tratamiento para un viejo problema: retinosis pigmentaria asociada a edema macular recalcitrante.

CASE REPORT: The case involves a 35-year-old man, with a history of retinitis pigmentosa, who presented with a bilateral cystoid macular oedema associated with bilateral epiretinal membrane, which was resistant to treatment with oral acetazolamide and intravitreal bevacizumab. The treatment with oral eplerenone was able to improve the visual acuity and macular thickness of this patient. DISCUSSION: A variety of treatments have been proposed for the management of cystoid macular oedema, associated with retinitis pigmentosa, with variable results. The treatment with oral eplerenone might be a good option for the control of this condition.

Hemangioma capilar retiniano yuxtapapilar bilateral: utilidad de aflibercept en el manejo de sus complicaciones / Bilateral juxtapapillary retinal capillary haemangioma: Usefulness of aflibercept in the management of its complications

Caso clínico: Varón de 45 años, con antecedentes personales de feocromocitoma suprarrenal, que presenta una hemorragia subretiniana yuxtapapilar en el ojo izquierdo y un pequeño tumor vascular asintomático en el ojo contralateral. Con los hallazgos mencionados, el paciente fue diagnosticado de hemangioma capilar retiniano bilateral en el contexto de una enfermedad de von Hippel Lindau y se pautó aflibercept intravítreo, con una buena evolución del cuadro. Discusión: Se han propuesto múltiples tratamientos para el manejo del hemangioma capilar retiniano yuxtapapilar, con unos resultados variables. El aflibercept intravítreo puede ser un tratamiento de utilidad, con un buen perfil de seguridad (AU)

Case report: A 45 year-old man with a history of adrenal phaeochromocytoma presented with a subretinal juxtapapillary haemorrhage on his left eye and a small asymptomatic vascular tumour in the contralateral eye. With the mentioned findings, the patient was diagnosed with bilateral retinal capillary haemangioma in the context of a von Hippel Lindau disease. Intravitreal aflibercept was prescribed, with a good outcome of the disease. Discussion: Many treatments have been proposed for the management of juxtapapillary retinal capillary haemangioma with variable results. Intravitreal aflibercept can be a useful treatment with a good safety profile (AU)

BIlateral juxtapapillary retinal capillary haemangioma: Usefulness of aflibercept in the management of its complications. / Hemangioma capilar retiniano yuxtapapilar bilateral: utilidad de aflibercept en el manejo de sus complicaciones.

CASE REPORT: A 45 year-old man with a history of adrenal phaeochromocytoma presented with a subretinal juxtapapillary haemorrhage on his left eye and a small asymptomatic vascular tumour in the contralateral eye. With the mentioned findings, the patient was diagnosed with bilateral retinal capillary haemangioma in the context of a von Hippel Lindau disease. Intravitreal aflibercept was prescribed, with a good outcome of the disease. DISCUSSION: Many treatments have been proposed for the management of juxtapapillary retinal capillary haemangioma with variable results. Intravitreal aflibercept can be a useful treatment with a good safety profile.

Anti-VEGF y sus consecuencias sobre la retina externa: rotura del epitelio pigmentario tras inyección de aflibercept en ojo contralateral / Anti-VEGF and its impact on the outer retina: retinal pigment epithelium tear after an injection of aflibercept in contralateral eye

CASO CLÍNICO: Mujer de 62 años con antecedentes personales de desprendimiento del epitelio pigmentario (DEP) de la retina bilateral, secundario a degeneración macular, que presenta una rotura del mismo en su ojo izquierdo (OI) tras inyección de aflibercept en el ojo contralateral un mes antes. DISCUSIÓN: La rotura del epitelio pigmentario de la retina (EPR) es la principal complicación cuando se utiliza la terapia anti-VEGF para el manejo de los DEP. Por otro lado, se debe tener en cuenta que la absorción sistémica del fármaco puede inducir algún efecto en el ojo no tratado

CASE REPORT: A 62-year-old woman with a history of bilateral retinal pigment epithelium detachment (PED), secondary of age-related macular degeneration (AMD), who presented with a retinal pigment epithelium (RPE) tear on her left eye after an aflibercept injection in the contralateral eye one month earlier. DISCUSSION: A RPE tear is the main complication when the anti-VEGF therapy is used for the management of the PED. Furthermore, it should be noted that systemic absorption of the drug can induce an effect on the untreated eye

Anti-VEGF and its impact on the outer retina: retinal pigment epithelium tear after an injection of aflibercept in contralateral eye. / Anti-VEGF y sus consecuencias sobre la retina externa: rotura del epitelio pigmentario tras inyección de aflibercept en ojo contralateral.

CASE REPORT: A 62-year-old woman with a history of bilateral retinal pigment epithelium detachment (PED), secondary of age-related macular degeneration (AMD), who presented with a retinal pigment epithelium (RPE) tear on her left eye after an aflibercept injection in the contralateral eye one month earlier. DISCUSSION: A RPE tear is the main complication when the anti-VEGF therapy is used for the management of the PED. Furthermore, it should be noted that systemic absorption of the drug can induce an effect on the untreated eye.

Manejo del hydrops corneal mediante aire y micropunciones / Management of corneal hydrops using air and micro-punctures

CASO CLÍNICO: Mujer de 22 años con hydrops corneal agudo y rotura de la membrana de Descemet. Se trató mediante una inyección de aire intracamerular combinada con múltiples incisiones intraestromales para conseguir el drenaje del líquido intraestromal. No hubo complicaciones intraoperatorias y el líquido intraestromal desapareció a las 2 semanas. DISCUSIÓN: El hydrops corneal agudo es una importante complicación del queratocono. Sin tratamiento, se puede resolver en un período de 2 a 4 meses. El edema persistente puede causar complicaciones tales como neovascularización corneal, infección y perforación

CASE REPORT: A 22-year- old woman with an acute hydrops and Descemet membrane detachment was managed by intracameral air injection combined with multiple corneal stromal venting incisions for the drainage of intrastromal fluid. No intraoperative complications were encountered, and the intrastromal fluid was resolved over 2 weeks. DISCUSSION: Acute corneal hydrops is a significant complication of keratoconus. If not treated, resolution usually occurs over a period of 2-4 months. The persistent oedema can cause complications, such as corneal neovascularisation, infection and corneal perforation

[Management of corneal hydrops using air and micro-punctures]. / Manejo del hydrops corneal mediante aire y micropunciones.

CASE REPORT: A 22-year- old woman with an acute hydrops and Descemet membrane detachment was managed by intracameral air injection combined with multiple corneal stromal venting incisions for the drainage of intrastromal fluid. No intraoperative complications were encountered, and the intrastromal fluid was resolved over 2 weeks. DISCUSSION: Acute corneal hydrops is a significant complication of keratoconus. If not treated, resolution usually occurs over a period of 2-4 months. The persistent oedema can cause complications, such as corneal neovascularisation, infection and corneal perforation.