Bevacizumab intravítreo en neovascularización coroidea asociada a enfermedad de Best / Intravitreal bevacizumab for choroidal neovascularization associated with Best's disease

CASO CLÍNICO: Mujer de 27 años que presentaba disminución de visión en ojo derecho (20/200). El examen funduscópico reveló una hemorragia intrarretiniana macular con desprendimiento neurosensorial en ojo derecho, y un depósito de material viteliforme en el ojo izquierdo. La angiografía fluoresceínica y el electrooculograma confirmaron el diagnóstico de neovascularización coroidea asociada a enfermedad de Best. Cuatro semanas después de una única inyección de bevacizumab intravítreo, la agudeza visual a la normalidad (20/25) y se mantuvo estable tras 12 meses de seguimiento. DISCUSIÓN: El bevacizumab intravítreo puede ser una opción terapéutica eficaz en la neovascularización coroidea secundaria a enfermedad de Best

CASE REPORT: A 27-year old woman presented with loss of vision in the right eye (20/200). Ophthalmoscopic examination showed intrarretinal hemorrhage in the macular region with neurosensory detachment in the right eye, and viteliform deposit on the left eye. Fluorescein angiography and the electrooculogram confirmed the diagnosis of choroidal neovascularization associated with Best's disease. Four weeks after a single bevacizumab intravitreal injection, visual acuity was restored (20/25) and remained stable after a 12 month follow-up. DISCUSSION: Intravitreal bevacizumab appears to be an effective treatment for choroidal neovascularization associated to Best's disease

[Intravitreal bevacizumab for choroidal neovascularization associated with Best's disease]. / Bevacizumab intravítreo en neovascularización coroidea asociada a enfermedad de Best.

CASE REPORT: A 27-year old woman presented with loss of vision in the right eye (20/200). Ophthalmoscopic examination showed intrarretinal hemorrhage in the macular region with neurosensory detachment in the right eye, and viteliform deposit on the left eye. Fluorescein angiography and the electrooculogram confirmed the diagnosis of choroidal neovascularization associated with Best's disease. Four weeks after a single bevacizumab intravitreal injection, visual acuity was restored (20/25) and remained stable after a 12 month follow-up. DISCUSSION: Intravitreal bevacizumab appears to be an effective treatment for choroidal neovascularization associated to Best's disease.

Rhegmatogenous retinal detachment treatment guidelines.

This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons' experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience.

Guías de tratamiento del desprendimiento de retina rhegmatógeno / Rhegmatogenous retinal detachment treatment guidelines

El objetivo de esta guía es describir unas directrices generales del proceso seguido por el cirujano oftalmólogo desde el diagnóstico del desprendimiento de retina, pasando por su evaluación preoperatoria, hasta su tratamiento, complicaciones intra y postoperatorias, fracaso o recidiva del desprendimiento de retina rhegmatógeno, y las posibles alternativas terapéuticas en cada caso. También describiremos el tratamiento del desprendimiento de retina traumático por su importancia y peculiaridades. Se sugieren líneas de tratamiento o profilaxis para las diferentes situaciones del desprendimiento de retina en base a la variables encontradas, a la experiencia de los cirujanos oftalmólogos de la comisión que las ha redactado, y a la revisión bibliográfica con los distintos niveles de evidencia, pero no pretende establecer criterios de obligado cumplimiento, sobre todo considerando que el desprendimiento de retina tiene amplias posibilidades de tratamiento, y que la experiencia del cirujano en una u otra técnica va a ser fundamental en la obtención del mejor resultado quirúrgico. Como guías que son, solamente pretenden asesorar al cirujano en la práctica diaria, dejando en sus manos y en su experiencia la mejor opción terapéutica(AU)

This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons’ experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience(AU)

Vitreous levels of interleukine-8 and monocyte chemoattractant protein-1 in macular oedema with branch retinal vein occlusion.

PURPOSE: To investigate whether interleukine-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) are related with macular oedema in patients with branch retinal vein occlusions (BRVOs). DESIGN: Retrospective case-control study. PARTICIPANTS: Nineteen patients who had macular oedema due to BRVO and nine patients with non-ischaemic ocular diseases (control group). METHODS: Macular oedema was examined by optical coherence tomography. Both venous blood and vitreous samples were obtained at the time of vitreoretinal surgery. IL-8 and MCP-1 levels in vitreous fluid and plasma were determined with enzyme-linked immunosorbent assay kits. Variables were compared with the Mann-Whitney U-test, Wilcoxon's signed-ranked test, and the chi2-test, when appropriate. To examine correlations, Spearman's rank-order correlation coefficients were calculated. Statistical significance was set at P<0.05. RESULTS: The vitreous fluid levels of IL-8 (median: 63.5 pg/ml) and MCP-1 (median: 1522.4 pg/ml) were significantly higher in the patients with BRVO than in the control group (median: 5.1 and 746.5 pg/ml respectively; P<0.001 and <0.001 respectively). Vitreous IL-8 and MCP-1 were significantly correlated in patients with BRVO (P=0.009). CONCLUSIONS: Both IL-8 and MCP-1 were elevated in the vitreous fluid of patients with BRVO and macular oedema. Both chemokines may contribute to the pathogenesis of macular oedema in patients with BRVO.

Vitreous levels of erythropoietin in patients with macular oedema secondary to retinal vein occlusions: a comparative study with diabetic macular oedema.

OBJECTIVE: In a recent study, we found high levels of erythropoietin (EPO) in patients with diabetic macular oedema (DME), suggesting a role of EPO in the pathogenesis of this condition. To investigate a possible relationship between EPO and other diseases causing macular oedema, we determined vitreous levels of this peptide in patients with macular oedema secondary to retinal vein occlusion (RVO) and compared them with levels in patients with DME and control patients. METHODS: Vitreous and serum samples were obtained from patients with macular oedema secondary to RVO, DME, epiretinal membrane, and macular hole (controls). EPO was measured by radioimmunoassay. RESULTS: No differences were found in median vitreous EPO levels between patients with RVO and controls: RVO, 76 mU/ml (30-806) vs controls, 25 mU/ml (10-75) (P=0.105). Median EPO concentration was higher in DME patients than in patients with RVO or controls: DME, 430 mU/ml (41-3000) vs RVO, 76 mU/ml (30-806) (P<0.0001) vs controls, 25 mU/ml (10-75) (P<0.0001). CONCLUSIONS: EPO levels are not elevated in patients with macular oedema secondary to RVO. Patients with DME have high levels of EPO. These results suggest that EPO could be involved in the pathogenesis of diabetic retinopathy, but not in macular oedema secondary to RVO.

Removal of retained subretinal perfluorocarbon liquid.

AIM: To report a case series in which a modified technique was used to remove retained subretinal perfluorocarbon liquid. METHOD: In three patients with retained subretinal perfluorocarbon liquid, a three-port pars plana vitrectomy approach was used to perform a small self-sealing retinotomy adjacent to the perfluorocarbon liquid bubble. The tip of a 50-G glass micropipette connected to an active suction system was inserted in the bubble, and the liquid was aspirated. RESULTS: Successful removal of subretinal perfluorocarbon liquid was achieved in all cases with no complications. Visual acuity improved in all patients. CONCLUSION: With the technique presented, retained subretinal perfluorocarbon liquid can be successfully removed with minimal trauma to adjacent tissues.

Endoresection in high posterior choroidal melanomas: long-term outcome.

BACKGROUND: Eyes with high posterior choroidal melanomas are frequently enucleated because of the potential complications of radiotherapy. The aim of this study was to evaluate the safety and efficacy of endoresection at long-term follow-up. METHODS: Retrospective, non-randomised, interventional case series. Thirty-eight patients underwent endoresection. For primary procedures, inclusion criteria were tumour thickness >or=8 mm, base <15 mm, tumours not exceeding the equatorial area. Endoresection was also undertaken as the salvage procedure in four patients. Main outcomes measured were metastatic disease, survival, local recurrences, visual acuity, enucleation rate, and surgical complications. RESULTS: Follow-up time ranged from 23 to 129 months (mean 70.63 months). Preoperative visual acuity ranged from "hand-movements" to 20/20 (mean, 20/60). In primary cases, mean tumour thickness was 10.1 mm and mean base diameter 9.9 mm. At the latest visit, 92.1% patients still retained the eye. Final visual acuity ranged from "no light perception" to 20/30 (mean 20/300). Two patients experienced local recurrence before 3 years of follow-up. Melanoma metastatic disease was found in two patients at 5 years of follow-up. Kaplan-Meier survival analysis for all causes was 88.2% at 5 years. Specific survival was 90.9% at 5 years. CONCLUSIONS: At long-term follow-up, the risk of metastasis or local recurrence, and survival rates were similar to other techniques, although comparisons are difficult because of the unusual presentation of this type of melanoma. Further studies and longer follow-up are needed.

Non-complicated retinal detachment management: variations in 4 years. Retina 1 project; report 1.

AIMS: To assess variations in the characteristics and management of two series of non-complicated rhegmatogenous retinal detachments (RD) carried out 4 years apart in Spain. METHODS: Prospective, multicentric, non-randomised comparative study. 339 consecutive cases of RD treated in five hospitals were included. Group 1 (G1) (n = 186) included cases operated on from 1999 to 2001; group 2 (G2) (n = 153) included cases from 2004 to 2006. 83 variables related to preoperative characteristics of RD, surgical management and postoperative evolution were recorded. Surgeons were allowed to treat patients following their personal criteria. Differences in preoperative characteristics, rate of vitrectomy and anatomical outcome were studied. Quantitative variables were compared by Mann-Whitney U test and qualitative variables by standard contingency tables. Multivariate analysis was carried out by logistic regression analysis. RESULTS: G1 showed a significantly longer delay in performing surgery, since the first symptoms appeared (G1: 29 (SD 50) days; G2: 22 (55); p<0.001) and more RD without visible retinal break than G2 (G1: 17.4%; G2: 9.2%; p = 0.028). In G2, cases with multiple retinal breaks (G1: 31.6%; G2: 44.6%) were more frequent (p = 0.022). No significant differences in other preoperative variables were observed. Vitrectomy was performed in 30.1% in G1 and in 78.4% in G2 as a primary surgical approach (p<0.001). Regardless of the characteristics of the RD, the rate of vitrectomy was higher in G2. The reattachment rate was over 94% in both groups (p = 0.833). Pseudophakic RD showed better anatomical outcomes in G2 (G1: 83.9%; G2: 96.4%; p = 0.028). CONCLUSION: There is an increasing tendency to treat RD with primary vitrectomy, which is related to neither a higher complexity of cases nor better anatomical results.

Surgical embolus removal in retinal artery occlusion.

AIMS: To evaluate the anatomical outcomes, safety and functional effectiveness of surgical embolus removal in retinal artery occlusion (RAO). METHODS: Prospective study of seven patients with RAO of <36 h duration. All eyes underwent pars plana vitrectomy and a longitudinal incision of the anterior wall of the occluded arteriole in an attempt to remove the embolus. Outcome measures included visual acuity and arteriolar reperfusion, as evaluated with fluorescein angiography. RESULTS: Surgical removal of the embolus was achieved in six of the seven (87.5%) patients, visual acuity improved from a median of 20/400 (range: hand movements 20/25) to 20/40 (range: hand movements 20/25), and reperfusion of the occluded vessel was angiographically confirmed in four of the six patients in whom the embolus was successfully removed. CONCLUSION: Surgical removal of retinal arterial emboli seems to be an effective and safe treatment for RAO, but a randomised and controlled clinical trial will be necessary to establish an evidence base for the role, if any, of this intervention.

Comparison of different techniques for purification of triamcinolone acetonide suspension for intravitreal use.

BACKGROUND: Intravitreal triamcinolone has increasingly been used for the treatment of oedematous and neovascular diseases and purification of triamcinolone suspension may be important in order to avoid the potential toxic effects of the vehicle. The aim was to evaluate different techniques used to reduce the solvent agent benzyl alcohol (9.9 mg/ml) from a commercially prepared triamcinolone acetonide suspension. METHODS: Different techniques were used to reduce the solvent agent benzyl alcohol: filter techniques using 0.22 mum or 5 mum pore size, and non-filter techniques using sedimentation or centrifugation. Quantification of triamcinolone acetonide and benzyl alcohol was performed by high pressure liquid chromatography (HPLC). RESULTS: Benzyl alcohol concentration was decreased significantly in all the techniques used compared with the original commercial suspension (p<0.05), with no significant differences among them. The reduction was approximately one tenth of its original concentration. However, triamcinolone acetonide concentration differed significantly depending on the method used. Centrifugation method showed no differences versus the original commercial solution; sedimentation technique reduced the expected dose only 25%; the filter technique using a 5 mum pore size membrane reduced the expected dose to one fourth, while the filter technique using a 0.22 mum pore size membrane reduced the expected dose to 45%. CONCLUSIONS: All the different techniques employed effectively reduced the concentration of benzyl alcohol. However, the final concentration of triamcinolone was much lower than expected using the filter techniques. The pore size membrane inversely influenced the final concentration, with part of the triamcinolone crystals probably being entrapped in the filter. Centrifugation is recommended as the best way of administering the drug.