Choroidal macrovessel and persistent metamorphopsia after epiretinal membrane surgery.

We report the case of a 59-year-old man with decreased visual acuity and metamorphopsia in both eyes in the context of bilateral epiretinal membrane (ERM) who underwent retinovitreal surgery (chromovitrectomy plus peeling of internal limiting membrane). He recovered visual acuity in his left eye. However, the visual results of his right eye were not satisfactory, with persistence of metamorphopsia in that eye. The multimodal imaging study that included color and red filter retinographies, enhanced depth imaging optical coherence tomography (EDI-OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), OCT angiography (OCTA) and OCT en face, were useful to diagnose a choroidal macrovessel. This ran from the fovea to the temporal macula. EDI-OCT revealed that the choroidal macrovessel generated a foveal deformation of both the ellipsoid zone (EZ) and the retinal pigment epithelium (RPE). This paper discusses whether structural changes in the fovea generated by the choroidal macrovessel are related to persistent metamorfopsia in the affected eye.

Macrovaso coroideo y metamorfopsia persistente después de cirugía de membrana epirretiniana / Choroidal macrovessel and persistent metamorphopsia after epiretinal membrane surgery

Presentamos el caso de un hombre de 59 años con disminución de agudeza visual y metamorfopsia en ambos ojos en el contexto de membrana epirretiniana bilateral (MER) que fue intervenido con cirugía retinovítrea (cromovitrectomía más pelado de membrana limitante interna). Presentó recuperación de agudeza visual en su ojo izquierdo. Sin embargo, los resultados visuales de su ojo derecho no fueron satisfactorios, con persistencia de metamorfopsia en dicho ojo. El estudio con imagen multimodal que incluyó retinografía en color y filtro rojo, tomografía de coherencia óptica con imagen de profundidad mejorada (OCT-EDI), angiografía fluoresceínica (AF), angiografía verde de indocianina (ICGA), OCT-angiografía (OCTA) y OCT en-face fue útil para diagnosticar un macrovaso coroideo. Este recorría desde la fóvea hasta la mácula temporal. La OCT-EDI reveló que el macrovaso coroideo generaba una deformación foveal tanto de la zona elipsoide (ZE) como del epitelio pigmentario de retina (EPR). En este trabajo se discute si los cambios estructurales en la fóvea generados por el macrovaso coroideo están relacionados con la metamorfopsia persistente en el ojo afectado (AU)

We report the case of a 59-year-old man with decreased visual acuity and metamorphopsia in both eyes in the context of bilateral epiretinal membrane (ERM) who underwent retinovitreal surgery (chromovitrectomy plus peeling of internal limiting membrane). He recovered visual acuity in his left eye. However, the visual results of his right eye were not satisfactory, with persistence of metamorphopsia in that eye. The multimodal imaging study that included colour and red filter retinographies, enhanced depth imaging optical coherence tomography (EDI-OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), OCT angiography (OCTA) and OCT en face, were useful to diagnose a choroidal macrovessel. This ran from the fovea to the temporal macula. EDI-OCT revealed that the choroidal macrovessel generated a foveal deformation of both the ellipsoid zone (EZ) and the retinal pigment epithelium (RPE). This paper discusses whether structural changes in the fovea generated by the choroidal macrovessel are related to persistent metamorfopsia in the affected eye (AU)

OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2.

Idiopathic macular telangiectasia type 2 (MacTel 2) is a slow and progressive bilateral condition that affects middle-aged and elderly individuals. Vision loss is generally mild and occurs over the course of many years. The development of sub-retinal neovascularisation (SRNV) can occur late in the disease process, and lead to more dramatic vision loss. A report is presented of 2 cases of MacTel 2 in which optical coherence tomography angiography (OCTA) was essential for the diagnosis of secondary SRNV. The commercially available OCTA Cirrus AngioPlex 5000 platform (Zeiss, Jena, Germany) was used. Subretinal neovascularization was detectable in both cases in OCTA at the level of the deep capillary plexus and the avascular layer. OCTA also allowed us to monitor disease progression and monitor response to anti-VEGF therapy.

Angiografía-OCT para diagnóstico y respuesta al tratamiento de la neovascularización subretiniana secundaria a telangiectasia macular idiopática tipo 2 / OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2

La telangiectasia macular idiopática tipo 2 (MacTel 2) es una afección bilateral, lenta y progresiva que afecta a individuos de mediana edad y ancianos. La pérdida de visión es generalmente leve y ocurre en el transcurso de muchos años. El desarrollo de neovascularización subretiniana (NVSR) puede ocurrir tarde en el proceso de la enfermedad y conducir a una pérdida de visión más dramática. Presentamos 2casos de MacTel 2 donde la angiografía por tomografía de coherencia óptica (OCTA) fue fundamental para el diagnóstico de NVSR secundaria. Se utilizó la plataforma comercialmente disponible OCTA Cirrus AngioPlex 5000 (Zeiss, Jena, Alemania). La NVSR fue detectable en ambos casos con OCTA a nivel del plexo capilar profundo y en la capa avascular. La OCTA también nos permitió controlar la progresión de la enfermedad y monitorizar la respuesta a la terapia anti-VEGF (AU)

Idiopathic macular telangiectasia type 2 (MacTel 2) is a slow and progressive bilateral condition that affects middle-aged and elderly individuals. Vision loss is generally mild and occurs over the course of many years. The development of sub-retinal neovascularisation (SRNV) can occur late in the disease process, and lead to more dramatic vision loss. A report is presented of 2cases of MacTel 2 in which optical coherence tomography angiography (OCTA) was essential for the diagnosis of secondary SRNV. The commercially available OCTA Cirrus AngioPlex 5000 platform (Zeiss, Jena, Germany) was used. Subretinal neovascularization was detectable in both cases in OCTA at the level of the deep capillary plexus and the avascular layer. OCTA also allowed us to monitor disease progression and monitor response to anti-VEGF therapy (AU)

Atypical bilateral presentation in idiopathic macular telangiectasia type 1.

Idiopathic macular telangiectasia type 1 (MacTel 1) almost always occurs unilaterally. In this article, we report the case of a 73-year-old man with no significant history diagnosed with MacTel 1 but with atypical bilateral presentation, something very rare in this disease. The usefulness of multimodal imaging studies, including optical coherence tomography angiography (OCTA), is highlighted to differentiate it from macular telangectasia type 2 (MacTel 2). The patient's condition was characterized by cystoid macular edema (CME) with discreet results with treatment with a dexamethasone implant. However, aflibercept therapy showed favorable results, but with recurrences when extending the doses.

Presentación bilateral atípica en telangiectasia macular idiopática tipo 1 / Atypical bilateral presentation in idiopathic macular telangiectasia type 1

La telangiectasia macular idiopática tipo 1 (MacTel 1) se presenta casi siempre de forma unilateral. En este artículo publicamos el caso de un varón de 73 años, sin antecedentes de importancia, diagnosticado de MacTel 1, pero de presentación atípica bilateral, algo muy infrecuente en esta enfermedad. Se resalta la utilidad de estudio con imagen multimodal, incluyendo la angiografía por tomografía de coherencia óptica (OCTA) para diferenciarla de la telangiectasia macular tipo 2 (MacTel 2). El cuadro del paciente se caracterizó por edema macular cistoideo (EMC), con discreta respuesta al tratamiento con implante de dexametasona. Sin embargo, la terapia con aflibercept mostró resultados favorables, pero con recurrencias al extender las dosis (AU)

Idiopathic macular telangiectasia type 1 (MacTel 1) almost always occurs unilaterally. In this article, we report the case of a 73-year-old man with no significant history diagnosed with MacTel 1 but with atypical bilateral presentation, something very rare in this disease. The usefulness of multimodal imaging studies, including optical coherence tomography angiography (OCTA), is highlighted to differentiate it from macular telangectasia type 2 (MacTel 2). The patient's condition was characterized by cystoid macular edema (CME) with discreet results with treatment with a dexamethasone implant. However, aflibercept therapy showed favorable results, but with recurrences when extending the doses (AU)

Nepafenac for cystoid macular oedema secondary to paclitaxel.

Paclitaxel is used to treat a wide range of malignant tumours. This type of drug is known to cause ocular adverse effects, with cystoid macular oedema being a known, but rare complication, of this therapy. Although most cases resolve after discontinuation of the drug, several authors have attempted various treatments to accelerate resolution, or when paclitaxel therapy cannot be discontinued. A case is presented of a 62 year-old man who presented with decreased visual acuity due to bilateral cystoid macular oedema after administration of paclitaxel for oesophageal cancer. As part of the study, optical coherence tomography angiography (OCTA) was performed at the time of diagnosis, and later when the symptoms subsided. Nepafenac eye drops were prescribed as treatment.

Nepafenaco para edema macular cistoideo secundario a paclitaxel / Nepafenac for cystoid macular oedema secondary to paclitaxel

El paclitaxel es utilizado para tratar una amplia gama de tumores malignos. Se sabe que estos fármacos causan efectos adversos oculares, siendo el edema macular cistoide una complicación conocida pero rara de esta terapia. Aunque la mayoría de los casos se resuelven después de la interrupción del fármaco, varios autores han intentado diversos tratamientos para acelerar la resolución o cuando la terapia con paclitaxel no puede suspenderse. Presentamos un caso de un varón de 62 años que presentó disminución de la agudeza visual debido a edema macular cistoideo bilateral después de la administración de paclitaxel para cáncer de esófago; como parte del estudio se realizó angiografía por tomografía de coherencia óptica en el momento del diagnóstico y posteriormente cuando el cuadro remitió. Como tratamiento se prescribió colirio de nepafenaco (AU)

Paclitaxel is used to treat a wide range of malignant tumours. This type of drug is known to cause ocular adverse effects, with cystoid macular oedema being a known, but rare complication, of this therapy. Although most cases resolve after discontinuation of the drug, several authors have attempted various treatments to accelerate resolution, or when paclitaxel therapy cannot be discontinued. A case is presented of a 62 year-old man who presented with decreased visual acuity due to bilateral cystoid macular oedema after administration of paclitaxel for oesophageal cancer. As part of the study, optical coherence tomography angiography (OCTA) was performed at the time of diagnosis, and later when the symptoms subsided. Nepafenac eye drops were prescribed as treatment (AU)

[Infections in patients colonized with carbapenem-resistant Gram-negative bacteria in a medium Spanish city]. / Infecciones en pacientes colonizados con bacterias gramnegativas resistentes a carbapenémicos en una ciudad media española.

OBJECTIVE: Because there are few studies on the clinical implications of colonization by carbapenem-resistant gram-negative bacteria (CRB) this was analyzed in rectal smears (RS) and pharyngeals (PS) and its ability to predict infection/colonization. METHODS: A cross-sectional, retrospective study from adult inpatients between January 2016 and December 2019 was conducted. The isolates were characterized by MicroScan and spectrometry of masses applying EUCAST 2018 cutoff points. The detection of carbapenemases was performed by PCR and Sanger sequencing; sequencies was assigned by MLST. The genetic relationship between the clinical isolates was made by pulsed field electrophoresis using the enzymes Xbal, Spel or Apal. RESULTS: A total of 308 (86.03%) RS and 50 (13.97%) positive PS were detected, the RS had a 85% sensibility, 100% specificity, 100% positive predictive value and 97% negative predictive value. In RS, the following were isolated: 44% (n=135) Acinetobacter baumannii, 26% (n =80) Enterobacterales (20 KPC, 29 OXA-48, 22 VIM, 2 IMP, 7 NDM), 17% (n=53) Pseudomonas aeruginosa and 13% (n=40) Stenotrophomonas maltophilia. In the PS were isolated 44% (n=22) S. maltophilia, 40% (n = 20) A. baumannii, 8% (n=4) P. aeruginosa and 8% (n=4) Enterobacterales (3 VIM, 1 OXA). From the patients with simultaneous RS and PS, 41 (40.6%) had positivity in both smears, 45 (44.6%) only in RS and 15 (14.9%) only in PS. Colonization preceded infection in 81.3% (n=13) of the isolates; association between infection and colonization was found (p<0.001; χ2); and the episodes where the information was found all the isolates from the clinical samples and from the smears were similar. CONCLUSIONS: The probability of predicting infection through the CRB colonized in different clinical samples is feasible. The RS has a major sensibility to detect colonization.

OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2. / Angiografía-OCT para diagnóstico y respuesta al tratamiento de la neovascularización subretiniana secundaria a telangiectasia macular idiopática tipo 2.

Idiopathic macular telangiectasia type 2 (MacTel 2) is a slow and progressive bilateral condition that affects middle-aged and elderly individuals. Vision loss is generally mild and occurs over the course of many years. The development of sub-retinal neovascularisation (SRNV) can occur late in the disease process, and lead to more dramatic vision loss. A report is presented of 2cases of MacTel 2 in which optical coherence tomography angiography (OCTA) was essential for the diagnosis of secondary SRNV. The commercially available OCTA Cirrus AngioPlex 5000 platform (Zeiss, Jena, Germany) was used. Subretinal neovascularization was detectable in both cases in OCTA at the level of the deep capillary plexus and the avascular layer. OCTA also allowed us to monitor disease progression and monitor response to anti-VEGF therapy.

Focal laser for idiopathic macular telangectasia type 1 refractory to ozurdex, ranibizumab and aflibercept. / Láser focal para telangectasia macular idiopática tipo 1 refractario a ozurdex, ranibizumab y aflibercept.

We present a case of a woman with idiopathic macular telangiectasia type 1, characterized by the presence of a capillary macroanaeurysm associated with macular edema with a macular star pattern. Several differential diagnoses were proposed, in which the study with a multimodal image was key to clarify the diagnosis. In addition, the various treatments used and their effectiveness are discussed.

Atypical bilateral presentation in idiopathic macular telangiectasia type 1. / Presentación bilateral atípica en telangiectasia macular idiopática tipo 1.

Idiopathic macular telangiectasia type 1 (MacTel 1) almost always occurs unilaterally. In this article, we report the case of a 73-year-old man with no significant history diagnosed with MacTel 1 but with atypical bilateral presentation, something very rare in this disease. The usefulness of multimodal imaging studies, including optical coherence tomography angiography (OCTA), is highlighted to differentiate it from macular telangectasia type 2 (MacTel 2). The patient's condition was characterized by cystoid macular edema (CME) with discreet results with treatment with a dexamethasone implant. However, aflibercept therapy showed favorable results, but with recurrences when extending the doses.

Genetic variant of Stickler's syndrome. / Variante genética del síndrome de Stickler.

CASES REPORTS: Three myopic components of a same family came for study because presented severely degraded vitreous, equatorial membranes, retinal pigment epithelium hyperplasia, vascular sheathed and sclerosis of peripheral predominance. A genetic study confirmed the diagnosis of Stickler syndrome with a variant in the mutation of the COL2A1 gene. DISCUSSION: Stickler's syndrome should be suspected in families with a characteristic phenotype with vitreous syneresis and alterations in the retina, but there may be genetic variants that do not express the classic phenotype.

Teleoftalmología para el cribado de la retinopatía diabética: experiencia de 8 años / Tele-ophthalmology for diabetic retinopathy screening: 8 years of experience

OBJETIVO: Mostrar los resultados de un programa de cribado de la retinopatía diabética desde el ámbito de la atención primaria. MÉTODOS: Se realizó un estudio retrospectivo de los datos recogidos mediante registro informático automatizado desde el 1 de enero de 2007, hasta el 31 de diciembre de 2015. RESULTADOS: El número de pacientes cribados aumentó progresivamente desde 7.173 en 2007 hasta 42.339 en 2015. Asimismo, la habilidad de los médicos de familia en la interpretación de retinografías mejoró progresivamente, clasificando como normales un 55% de las retinografías en 2007, llegando a un 68% en 2015. El número de retinografías consideradas no valorables disminuyó a lo largo del programa, registrándose picos de hasta el 15% y situándose en un 7% en 2015, en parte gracias a un cambio en la normativa, que permitió dilatar la pupila. Se detectaron cada vez menos casos graves, pasándose de un 14% de retinopatías diabéticas no proliferativas severas y proliferativas al inicio del programa a un 3% en 2015. CONCLUSIONES: El cribado de la oftalmopatía diabética mediante teleoftalmología se reveló como un método muy valioso en una población en crecimiento como es la diabética, facilitando las revisiones al usuario, ayudando a descongestionar los servicios de atención especializada y detectando los casos tratables con mayor precocidad. Sin embargo, los efectos de la implantación no fueron inmediatos, obteniéndose unos resultados modestos en los primeros años del proyecto, que mejoraron en los años subsiguienteS

PURPOSE: To describe the results of a diabetic retinopathy screening program implemented in a primary care area. METHODS: A retrospective study was conducted using data automatically collected since the program began on 1 January 2007 until 31 December 2015. RESULTS: The number of screened diabetic patients has progressively increased, from 7,173 patients in 2007 to 42,339 diabetic patients in 2015. Furthermore, the ability of family doctors to correctly interpret retinographies has improved, with the proportion of retinal images classified as normal having increased from 55% in 2007 to 68% at the end of the study period. The proportion of non-evaluable retinographies decreased to 7% in 2015, having peaked at 15% during the program. This was partly due to a change in the screening program policy that allowed the use of tropicamide. The number of severe cases detected has declined, from 14% with severe non-proliferative and proliferativediabetic retinopathy in the initial phase of the program to 3% in 2015. CONCLUSIONS: Diabetic eye disease screening by tele-ophthalmology has shown to be a valuable method in a growing population of diabetics. It leads to a regular medical examination of patients, helps ease the workload of specialised care services and favours the early detection of treatable cases. However, the results of implementing a program of this type are not immediate, achieving only modest results in the early years of the project that have improved over subsequent years

Dome shaped macula associated with myopic retinochoroidosis. Use of spironolactone. / Mácula en cúpula asociada a la retinocoroidosis miópica. Utilidad de la espironolactona.

CASES REPORTS: The cases are presented of three women of 22, 36 and 55 years old with bilateral myopic retinochoroidosis. They had unilateral decreased visual acuity, normal bilateral tonometry, and biomicroscopy. Funduscopy showed bilateral and unilateral myopic maculopathy, and Optical Coherence Tomography (OCT) showed a dome shaped macula with neurosensory detachment. Treatment was started with spironolactone and an improvement by OCT was shown in all cases. DISCUSSION: The etiopathogenic mechanism of the dome shaped macula is discussed. OCT demonstrated to be the fundamental test in the follow-up of this condition. After the evidence shown, initial treatment with spironolactone is suggested.

Tele-ophthalmology for diabetic retinopathy screening: 8 years of experience. / Teleoftalmología para el cribado de la retinopatía diabética: experiencia de 8 años.

PURPOSE: To describe the results of a diabetic retinopathy screening program implemented in a primary care area. METHODS: A retrospective study was conducted using data automatically collected since the program began on 1 January 2007 until 31 December 2015. RESULTS: The number of screened diabetic patients has progressively increased, from 7,173 patients in 2007 to 42,339 diabetic patients in 2015. Furthermore, the ability of family doctors to correctly interpret retinographies has improved, with the proportion of retinal images classified as normal having increased from 55% in 2007 to 68% at the end of the study period. The proportion of non-evaluable retinographies decreased to 7% in 2015, having peaked at 15% during the program. This was partly due to a change in the screening program policy that allowed the use of tropicamide. The number of severe cases detected has declined, from 14% with severe non-proliferative and proliferativediabetic retinopathy in the initial phase of the program to 3% in 2015. CONCLUSIONS: Diabetic eye disease screening by tele-ophthalmology has shown to be a valuable method in a growing population of diabetics. It leads to a regular medical examination of patients, helps ease the workload of specialised care services and favours the early detection of treatable cases. However, the results of implementing a program of this type are not immediate, achieving only modest results in the early years of the project that have improved over subsequent years.

Sarcoidosis. Debut as orbital pseudotumour.

CASE REPORT: 78 year-old female patient being investigated for a left orbital pseudotumour of 17 days onset. She had proptosis, pain, with no limitation of eye movements, periorbital oedema, and upper eyelid ptosis, compatible with an orbital pseudotumour. The MRI showed an upper outer left orbital mass adjacent to the side of eyeball and an increase in soft tissue at the level of lacrimal gland. The histopathology study of an eyelid lesion demonstrated the presence of non-caseating granulomas. DISCUSSION: A definitive diagnosis of orbital sarcoidosis was made. Oral treatment with corticosteroids and methotrexate achieved gradual control of the disease.

Resultados coste-efectividad del implante de dexametasona en edema macular / A cost-effectiveness study of dexamethasone implants in macular edema

OBJETIVO: Analizar el beneficio coste-efectividad del implante intravítreo de dexametasona (Ozurdex®, Allergan, Irvine, CA, EE. UU.) en sus aplicaciones clínicamente relevantes. MATERIAL Y MÉTODOS: Un total de 88 ojos de 86 pacientes con edema macular de > 300 μm medido mediante tomografía de coherencia óptica (Zeiss Cirrus, Dublín, CA, EE. UU.) fueron incluidos en este trabajo retrospectivo de 2 años, con un seguimiento mínimo de 6 meses. Se incluyeron 3 grupos de pacientes: el grupo 1 con edema macular en oclusión venosa retiniana, el grupo 2 con uveítis posterior no infecciosa y el grupo 3 con edema macular diabético, estando este fuera de indicación pero avalado por la literatura médica. Antes del implante y los días 1, 30, 60, 90 y 180 se evaluó la agudeza visual corregida (Snellen), espesor retiniano central, presión intraocular y biomicroscopia. Los análisis de coste-beneficio se tabularon por línea de visión ganada, comparando las principales alternativas terapéuticas, y se valoró el perfil de seguridad del implante intravítreo de dexametasona (Ozurdex®; Allergan, Irvine, CA, EE. UU.). RESULTADOS: Los resultados de este estudio no difirieron de los publicados por otros, en términos de mejoría de la agudeza visual en el 63,3% y del espesor macular central en el 97%. En los casos de recidiva, se produjo a los 120 días de media; la necesidad de retratamiento fue del 40,9%. Entre los efectos secundarios, el incremento de presión intraocular > 23 mm Hg se produjo en el 29,54%, controlándose con tratamiento tópico, excepto un 1,13% de los casos que requirieron tratamiento quirúrgico. El desarrollo de catarata fue del 44,7%, requiriendo cirugía un 10,6%. Los resultados del tratamiento mostraron una menor necesidad en la frecuencia del uso de Ozurdex® frente a otros tratamientos para el control de la enfermedad, convirtiéndose en una opción que permite el ahorro de costes. DISCUSIÓN: Los análisis coste-efectividad son clínicamente relevantes cuando se aplican estrategias terapéuticas en pacientes con edema macular. El implante de dexametasona intravítrea es una opción terapéutica segura y eficiente

OBJECTIVE: To analyze the cost-effectiveness and benefits of a dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA.) in its clinically relevant applications. MATERIAL AND METHODS: A total of 88 eyes of 86 patients with macular edema of > 300 μm measured by optical coherence tomography (Cirrus Zeiss, Dublin, CA, USA) were included in this two-year retrospective study, with a minimum of 6 months follow-up. The patients were divide into 3 groups: group 1 with macular edema in retinal vein occlusion, group 2 with non-infectious posterior uveitis, and group 3 with diabetic macular edema. The treatment was off-label but supported by the literature. Before implantation, and on days 1, 30, 60, 90 and 180, corrected visual acuity (Snellen), central retinal thickness, intraocular pressure and biomicroscopy were evaluated. The cost-benefit analysis was tabulated by line of visual acuity gained, comparing the main therapeutic alternatives and assessment of the safety profile of the dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA). RESULTS: The results of this study did not differ from the published studies, in terms of visual acuity improvement in 63.3% of cases, and with central macular thickness improvement in 97% of cases. There were relapses, which occurred after 120 days on average, and the need for retreatment was 40.9%. Increased intraocular pressure >23 mm Hg was among the side effects in 29.54%, and was controlled with topical treatment, except in 1.13% requiring surgical treatment. The development of cataract was 44.7%, and 10.6% required surgery. Treatment results showed less frequent use of Ozurdex® than other treatments for disease control, being a cost saving option. DISCUSSION: Cost-effectiveness analyses are clinically relevant when applying treatment strategies in patients with macular edema. Dexamethasone intravitreal implant appears to be a safe and efficient therapy