Changes in the Hyperreflective Bands of Outer Retinal Layers after Idiopathic Epiretinal Membrane Surgical Removal.

Purpose: The purpose of this study was to describe the relationship between the outer retinal hyperreflective bands and visual acuity recovery after idiopathic epiretinal macular membrane (ERM) surgical removal.Methods: A prospective longitudinal non-comparative study was conducted that included a total of 68 patients with idiopathic ERM, who underwent consecutive 23 G pars plana vitrectomy (PPV) at San Juan University Hospital (Alicante, Spain) from January 2019 to January 2021. All patients underwent a complete preoperative standard ophthalmic examination, including measurement of best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) examination. This protocol was repeated at 1 and 3 months after surgery.Results: Mean preoperative decimal BCVA was 0.30 ± 0.13 and disruption of the first, second, third and fourth outer retinal hyperreflective bands was observed by SD-OCT in 9 (27.9%), 27 (39.7%), 33 (48.5%) and 17 patients (25%), respectively. BCVA improved after ERM peeling at 1 and 3 months in all patients, regardless of the presence of disruption in any hyperreflective band. Significantly larger improvement of BCVA was found at 3 months after surgery in patients not showing disruption of hyperreflective bands 1 and 4 (p = 0.048 and 0.001, respectively).Conclusions: The integrity of the outer retinal hyperreflective bands by SD-OCT in patients with idiopathic ERM is a valuable tool to determine the visual prognosis of the surgical treatment of this condition. A successful recovery of hyperreflective bands 1 and 4 with ERM surgery may be a potential biomarker of the visual improvement achieved due to their important anatomical relation with cone photoreceptors at the foveal level.

Oxidative Stress and Microvascular Alterations in Diabetic Retinopathy: Future Therapies.

Diabetes is a disease that can be treated with oral antidiabetic agents and/or insulin. However, patients' metabolic control is inadequate in a high percentage of them and a major cause of chronic diseases like diabetic retinopathy. Approximately 15% of patients have some degree of diabetic retinopathy when diabetes is first diagnosed, and most will have developed this microvascular complication after 20 years. Early diagnosis of the disease is the best tool to prevent or delay vision loss and reduce the involved costs. However, diabetic retinopathy is an asymptomatic disease and its development to advanced stages reduces the effectiveness of treatments. Today, the recommended treatment for severe nonproliferative and proliferative diabetic retinopathy is photocoagulation with an argon laser and intravitreal injections of anti-VEGF associated with, or not, focal laser for diabetic macular oedema. The use of these therapeutic approaches is severely limited, such as uncomfortable administration for patients, long-term side effects, the costs they incur, and the therapeutic effectiveness of the employed management protocols. Hence, diabetic retinopathy is the widespread diabetic eye disease and a leading cause of blindness in adults in developed countries. The growing interest in using polyphenols, e.g., resveratrol, in treatments related to oxidative stress diseases has spread to diabetic retinopathy. This review focuses on analysing the sources and effects of oxidative stress and inflammation on vascular alterations and diabetic retinopathy development. Furthermore, current and antioxidant therapies, together with new molecular targets, are postulated for diabetic retinopathy treatment.

Combined therapy: photodynamic therapy and bevacizumab to treat myopic neovascular membranes. One-year follow-up.

PURPOSE: The purpose of this study was to evaluate whether combined customized photodynamic therapy (PDT) and bevacizumab in myopic choroidal neovascularization can improve vision and whether it is possible to decrease the frequency and number of intravitreal antiangiogenic injections. METHODS: A prospective, consecutive, noncomparative, interventional case series of 36 patients with myopic choroidal neovascularization, treated with an initial dose of PDT and intravitreal bevacizumab 48 hours to 60 hours afterward. Retreatments were carried out as required with monthly bevacizumab and PDT every 3 months if there were relapses. Follow-up lasted 1 year in all cases. RESULTS: The mean best-corrected visual acuity increased from 44 letters before the initial treatment to 59.5 letters at the 12-month follow-up (P < 0.01). Compared with initial vision, 94.5% of the eyes had the same or better vision and 5.5% lost fewer than 6 lines of vision. The mean number of PDT treatments was 1.1 per patient, and the mean number of bevacizumab injections was 1.5 per patient. Only 1 initial treatment with PDT + bevacizumab was necessary in 28 cases (77.8%). CONCLUSION: Combined personalized PDT + bevacizumab therapy makes it possible to obtain visual results similar to those obtained in monotherapy studies but with fewer intravitreal injections. It appears to be an interesting option for this type of patient.

Photodynamic therapy for age-related macular degeneration treatment: epidemiological and clinical analysis of a long-term study.

BACKGROUND AND OBJECTIVE: The aim of this article was to analyze the long-term results of patients with exudative age-related macular degeneration treated with photodynamic therapy (PDT). PATIENTS AND METHODS: This prospective nonrandomized clinical trial included 262 patients with exudative age-related macular degeneration who were treated with PDT in accordance with the Protocol of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study. The followup lasted 48 months. RESULTS: There was a significant loss of visual acuity 3 months after the first PDT treatment, a slow, progressive decrease of vision until month 12, and then visual acuity remained stable from months 24 to 48. The choroidal neovascularization size increased noticeably during the first 12 months, particularly the first 3 months after PDT. The higher the classic component of choroidal neovascularization, the better it responded to PDT. The evolution of juxtafoveal choroidal neovascularization was worse than that of subfoveal choroidal neovascularization after PDT because it grew quickly toward the fovea and visual acuity loss was greater. CONCLUSION: PDT is a safe, long-term treatment for exudative age-related macular degeneration, but it is not definitive because this treatment cannot stop the initial growth of the choroidal neovascularization lesion.

One-year follow-up of combined customized therapy. Photodynamic therapy and bevacizumab for exudative age-related macular degeneration.

PURPOSE: To evaluate whether combined, personalised photodynamic therapy (PDT) and Bevacizumab in choroidal neovascularization associated with age-related macular degeneration can improve vision, and whether it is possible to decrease the frequency and number of intravitreal antiangiogenics. METHODS: A prospective, noncomparative, interventional study of a case series of 63 patients with exudative age-related macular degeneration, treated with an initial dose of PDT and intravitreal Bevacizumab 24 to 48 hours afterwards. Retreatments were carried out as required with monthly Bevacizumab and PDT every 3 months if there were relapses. Follow-up lasted 1 year in all cases. RESULTS: After the first month of treatment, the mean best-corrected visual acuity increased by 4.85 letters, reaching 5.65 letters at the 12-month follow-up (P < 0.05). Compared with initial vision, 79.3% of the eyes had the same or better vision and 95.2% lost fewer than 15 letters. The total number of PDT treatments was 92 (a mean of 1.46 treatments per patient). The mean number of Bevacizumab injections was two per patient. In 29 cases (46%), only one initial treatment with PDT + Bevacizumab was necessary. In 15 cases (23.8%), more than two combined treatments per patient were necessary. CONCLUSIONS: Combined, customized PDT + Bevacizumab therapy makes it possible to obtain visual results similar to those obtained in monotherapy, but with fewer intravitreal injections. It appears to be an interesting option for this type of patients.