Predictors of stoppage and recurrence of choroidal neovascularization with a Treat- Extend-Stop protocol: 4-year follow-up.

OBJECTIVE: To analyze the long-term results of treatment of active age-related macular degeneration (AMD) with anti-vascular endothelial growth factor (VEGF) agents using the treat-extend-stop (TES) approach, defining predictive factors for stoppage of the treatment and recurrences in a real-world setting. METHODS: Data from 191 eyes treated with intravitreal injections for choroidal neovascularization due to AMD were retrospectively reviewed. Changes in best-corrected visual acuity (BCVA) and membrane activity (optical coherence tomography) were recorded and evaluated over a 48-month follow-up. Logistic regression analysis was used to determine predictors of treatment stoppage and recurrences after stoppage. RESULTS: BCVA improvement was found in 70.5% of eyes at 48 months, and remaining signs of activity in 27.9%. Disease inactivity was achieved in 69 eyes (31.9%), with a relapse of the membrane in 29 of these eyes (42.0%). Significant independent predictors of treatment stoppage were found: no foveal membrane, inactive membrane at 12, 24, 36 and 48 months, extension interval>8 weeks at 12 and 24 months,>15 injections at 24 months, and baseline BCVA>61 letters. Concerning recurrent membranes, only the presence of membrane activity at 36 months and baseline BCVA>61 letters were independent predictors. CONCLUSIONS: Anti-VEGF treatment of AMD using the TES protocol allows for successful visual restoration in most patients, with more likely disease inactivity in those eyes with better baseline BCVA, maintaining signs of membrane inactivity during the first two years of follow-up and requiring fewer injections.

Sangrado espontáneo a cavidad vítrea durante angiografía fluoresceínica / Spontaneous bleeding to vetreous cavity during fluorescein angiography

Caso clínico: Se presenta un caso de sangrado activo desde una anomalía microvascular intrarretiniana (AMIR) en un paciente diabético. Discusión: La documentación de un sangrado activo durante la realización de una angiografía fluoresceínica es extremadamente infrecuente. Se discute el origen del sangrado

Case report: We report a case in which active bleeding from a posterior pole intraretinal microvascular anomaly (IRMA) occurred in a diabetic patient. Discussion: Documentation of active bleeding during the performance of fluorescein angiography is extremely rare. We discuss the origin of the bleeding

[Spontaneous bleeding to vitreous cavity during fluorescein angiography]. / Sangrado espontáneo a cavidad vítrea durante angiografía fluoresceínica.

CASE REPORT: We report a case in which active bleeding from a posterior pole intraretinal microvascular anomaly (IRMA) occurred in a diabetic patient. DISCUSSION: Documentation of active bleeding during the performance of fluorescein angiography is extremely rare. We discuss the origin of the bleeding.

[A scleral buckle intrusion 19 years after its use in retinal detachment surgery]. / Intrusión de cerclaje escleral 19 años después.

CASE REPORT: Intrusion is defined as erosion and protrusion of the scleral implant into the vitreous cavity. This condition may occur as a retinal detachment, vitreous hemorrhage, endophthalmitis or be without symptoms. We performed a vitrectomy alone in a patient with relapsing vitreous hemorrhage secondary to the intrusion of a scleral buckle implanted 19 years previously and left intact the intruding buckle. DISCUSSION: Intrusion of the scleral buckle is an uncommon complication of retinal detachment surgery. We discuss the management of scleral buckle intrusion.

Intrusión de cerclaje escleral 19 años después / A sclerar bucle intrusion 19 years after its use in retinal detachment surgery

Caso clínico: Se define intrusión como la erosión y protrusión del implante escleral en la cavidad vítrea. Esta condición puede presentarse como desprendimiento de retina, hemorragias vítreas, endoftalmitis o de manera asintomática. Realizamos vitrectomía a una paciente con hemorragias vítreas de repetición secundarias a intrusión del cerclaje escleral implantado 19 años antes y dejamos intacto el cerclaje intraocular. Discusión: La intrusión del cerclaje escleral es una complicación infrecuente de la cirugía del desprendimiento de retina. Discutimos el manejo de esta patología

Case report: Intrusion is defined as erosion and protrusion of the scleral implant into the vitreous cavity. This condition may occur as a retinal detachment, vitreous hemorrhage, endophthalmitis or be without symptoms. We performed a vitrectomy alone in a patient with relapsing vitreous hemorrhage secondary to the intrusion of a scleral buckle implanted 19 years previously and left intact the intruding buckle. Discussion: Intrusion of the scleral buckle is an uncommon complication of retinal detachment surgery. We discuss the management of scleral buckle intrusion

[Spontaneous resolution of an idiopathic epiretinal membrane in a young patient]. / Resolución espontánea de membrana epirretiniana idiopática en un paciente joven.

CASE REPORT: Idiopathic epiretinal membranes are uncommon in young patients. The characteristics and evolution of these membranes are different from those in adults. We present the case of a young patient with an idiopathic epiretinal membrane, that several months later, showed spontaneous resolution with an associated posterior vitreous detachment. DISCUSSION: Idiopathic epiretinal membranes in young patients resolve spontaneously more frequently than in adults; however in many cases are associated with posterior vitreous detachment. We discuss the evolution of these membranes.

Resolución espontánea de membrane epirretiniana idiomática en un paciente joven / Spontaneous resolution of an idiopathic epiretinal membrana in a young patient

Caso clinico: Las membranas epirretinianas (MER) idiopáticas en los pacientes jóvenes son infrecuentes. Las características y la evolución de estas membranas son diferentes a las de los adultos. Presentamos el caso de paciente joven con membrana epirretiniana idiopática que tras varios meses de evolución presenta una resolución espontánea asociada a un desprendimiento posterior del vítreo (DPV).Discusion: Los pacientes jóvenes con membranas epirretinianas presentan una mayor frecuencia de resolución espontánea en muchos casos asociada a desprendimiento posterior de vítreo. Discutimos la evolución de estas membranas

Case report: Idiopathic epiretinal membranes are uncommon in young patients. The characteristics and evolution of these membranes are different from those in adults. We present the case of a young patient with an idiopathic epiretinal membrane, that several months later, showed spontaneous resolution with an associated posterior vitreous detachment. Discussion: Idiopathic epiretinal membranes in young patients resolve spontaneously more frequently than in adults; however in many cases are associated with posterior vitreous detachment. We discuss the evolution of these membranes

[A case of triamcinolone-induced pseudo-endophthalmitis after vitrectomy]. / Un caso de pseudoendoftalmitis por triamcinolona tras vitrectomía.

CASE REPORT: Vitrectomy with vitreous injection of triamcinolone in a patient suffering cystoid macular edema, secondary to a lens fragment luxation after subluxated cataract phacoemulsification, was performed. Four days after the surgery she presented because of discomfort and visual loss in the operated eye, and was found to have a 3.4 mm hypopyon. DISCUSSION: We describe the differences between infectious endophthalmitis, toxic endophthalmitis and pseudo-endophthalmitis.

Un caso de pseudoendoftalmitis por triamcinolona tras vitrectomía / A case of triamcinolone-induced pseudo-endophthalmitis after vitrectomy

Caso clínico: Se realizó una vitrectomía con inyección de triamcinolona a una paciente que padecía un edema macular quístico secundario a la luxación de un fragmento de cristalino tras facoemulsificación de una catarata subluxada. A los cuatro días tras la cirugía acudió a la consulta con pérdida de agudeza visual y sensación de cuerpo extraño en el ojo operado. La paciente presentaba un hipopión de 3,4 mm.Discusión: Se discutieron las diferencias entre la endoftalmitis infecciosa, tóxica y la pseudoendoftalmitis

Case report: Vitrectomy with vitreous injection of triamcinolone in a patient suffering cystoid macular edema, secondary to a lens fragment luxation after subluxated cataract phacoemulsification, was performed. Four days after the surgery she presented because of discomfort and visual loss in the operated eye, and was found to have a 3.4 mm hypopyon. Discussion: We describe the differences between infectious endophthalmitis, toxic endophthalmitis and pseudo-endophthalmitis

Coroideremia: manifestaciones en varón afectado y mujer portadora / Choroideremia: manifestations in affected male and female carrier

Caso clínico: Se describen los fenotipos oculares de un varón afectado y una mujer portadora de coroideremia.Discusión: La coroideremia es una enfermedad degenerativa de la retina que se caracteriza por una atrofia casi total de la coriocapilar, el epitelio pigmentario retiniano y la retina neurosensorial. Su herencia es recesiva ligada al sexo, afectando a los varones y actuando las mujeres como transmisoras. Sus manifestaciones clínicas son disminución de la visión nocturna, alteración en fases tardías de la visión central, constricción periférica en los campos visuales y electrorretinograma anómalo desde las fases precoces (AU)

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[Choroideremia: manifestations in affected male and female carrier]. / Coroideremia: manifestaciones en varón afectado y mujer portadora.

CASE REPORT: Ocular phenotypes in an affected male and a female carrier with choroideremia are described. COMMENT: Choroideremia is a degenerative retinal disease recognized in the late stages by a near total absence of the choriocapillaris, retinal pigment epithelium and neurosensory retina. Inheritance is X-linked recessive, with males being affected and females acting as carriers. Clinical manifestations include decreased night vision, central vision affected in late stages, peripheral constriction in the visual field and abnormal electroretinogram early in the course of the disease.