Retinopatía del prematuro: controversias en el uso de antiangiogénicos intraoculares / Retinopathy of prematurity: controversies in the usage of intraocular antiangiogenics

El aumento en la sobrevida de los recién nacidos prematuros, las características del cuidado neonatal y la escasez de programas para la prevención, detección y tratamiento de la retinopatía del prematuro provocan que esta enfermedad sea la principal causa de ceguera infantil prevenible en México. El advenimiento de agentes antiangiogénicos de uso oncológico, y su uso -no autorizado, aunque con buenos resultados- en el tratamiento de enfermedades vaso proliferativas en la retina del paciente adulto, así como la presencia de reportes anecdóticos en la literatura y series de casos con serias fallas metodológicas han sugerido su utilización en el tratamiento de la retinopatía del prematuro. Desafortunadamente, estos agentes, utilizados indiscriminadamente, presentan absorción sistémica y causan efectos secundarios en el organismo del paciente prematuro. Además, no existen estudios de seguimiento a largo plazo que garanticen la seguridad de su uso en esta población. El presente artículo describe la situación en nuestro país y advierte sobre los riesgos de estos medicamentos en la población de pacientes prematuros.

The increase in survival rates among preterm infants, characteristics of neonatal care for such infants and a lack of suitable programs for preventing, detecting and treating retinopathy of prematurity (ROP) are factors that have made this disease the main cause of preventable blindness among children in Mexico. The advent of antiangiogenic agents in cancer treatment and their off-label use with favorable results in the treatment of proliferative vessel disease of the retina among adult patients, as well as anecdotal reports in the literature and a series of cases showing serious methodological flaws, have prompted their use in the treatment of retinopathy of prematurity. Unfortunately, these agents used indiscriminately in our country have a systemic absorption and secondary effects on the preterm patient's body. There are no long-term monitoring studies that guarantee their safe use in this segment of the population. This article describes the situation in our country and warns of the risks posed by the use of this type of drug on the preterm infant population.

Laser-ranibizumab treatment for retinopathy of prematurity in umbral-preumbral disease. Three years of experience.

BACKGROUND: The "Early Treatment for Retinopathy of Prematurity Cooperative" reported a failure rate of 55.2% using laser in zone 1 for treatment of retinopathy of prematurity (ROP). We need to offer better alternatives for those patients. We undertook this study to evaluate the efficacy of combined laser-ranibizumab therapy for ROP with threshold-prethreshold and "plus disease" and to study development of the newborn. METHODS: This is a prospective, experimental, longitudinal and open study including newborns of either <32 weeks of gestation or with a birth weight <1500 g, with threshold-prethreshold retinopathy or "plus disease." The effect of treatment was analyzed and development of the newborn was determined. RESULTS: We studied 34 eyes of 17 patients. Age at birth was 29.9 ± 2.6 weeks. Birth weight was 1,120 ± 253 g. The statistics demonstrated an important relationship between severity of retinopathy and early birth age, along with a high probability of threshold-prethreshold disease at 29.4 weeks of age or 1204 g birth weight. The Bayley scale reported normal development in 23.5% of cases, global retardation in 23.5%, psychomotor retardation but normal mental behavior in 29.4%, and mental retardation but normal psychomotor development in 23.5%. We demonstrated regression of retinopathy in all cases. Persistence of vascular tortuosity was present in 17.6% of cases without vascular dilatation, and vitreous membrane development was demonstrated in 11.7% of patients. CONCLUSIONS: Laser-ranibizumab treatment has allowed a better control of retinopathy for threshold-prethreshold and "plus disease" in this group of patients.

[Pattern dystrophies of the retinal pigment epithelium]. / Distrofias del epitelio pigmentario de la retina en patrón.

Pattern dystrophies are defined as a group of diseases genetically determined and characterized by pigment epithelium changes that are seen on fundus examination, such as various line and dot patterns. We present a review of these pathologies including a comparative table reporting the main characteristics as well as some representative figures of each one in order to facilitate diagnosis.

Distrofias del epitelio pigmentario de la retina en patrón / Pattern dystrophies of the retinal pigment epithelium

Las distrofias en patrón son patologías de la retina genéticamente determinadas que se caracterizan por anormalidades en el epitelio pigmentario que se visualizan en el fondo de ojo conformando diversos patrones de puntos o líneas. Realizamos una revisión detallada de las diversas variedades de presentación y sus características más importantes, e incluimos una secuencia fotográfica de las más representativas.

Pattern dystrophies are defined as a group of diseases genetically determined and characterized by pigment epithelium changes that are seen on fundus examination, such as various line and dot patterns. We present a review of these pathologies including a comparative table reporting the main characteristics as well as some representative figures of each one in order to facilitate diagnosis.

Asociación VACTER y teratoma / VACTER and teratoma association

Se informa de una recién nacida pretérmino de 33.5 semanas, con 12 días de vida extrauterina, quien al nacimiento presentó varias malformaciones características de la asociación VACTER: escoliosis dorsolumbar, displasia de vértebras lumbosacras, ausencia de ano y displasia renal, entre otras; además, al efectuar la autopsia, se encontró una masa pélvica que histológicamente correspondía a un teratoma maduro. La presencia de esta neoplasia en la asociación VACTER no ha sido descrita previamente