Análisis coste-utilidad del modelo de unidad de terapia intravítrea (UTI) frente a la administración tradicional de terapia intravítrea / Cost-utility model of new intravítreous units vs. current patient journey model in Spain

Objetivo Comparar la efectividad y los costes de la implantación del Modelo de Unidad de Terapia Intravítrea (UTI), avalado por la Sociedad Española de Retina y Vítreo (SERV), Sociedad Española de Calidad Asistencial (SECA), Sociedad Española de Oftalmología (SEO) y Sociedad Española de Directivos Sanitarios (SEDISA) vs. el procedimiento habitual. Método Modelo de decisión analítico que compara una organización asistencial tipo UTI con cuatro escenarios de práctica habitual en España, en cuanto al resultado en la calidad de vida por pérdida de agudeza visual y la utilización de recursos. Se estimó la probabilidad, el coste y los años de vida ajustados por calidad (AVAC) para cada escenario planteado. Se realizó un análisis de sensibilidad univariante para cada uno de los parámetros empleados. Resultado Se observó que la implantación del modelo UTI mejora la calidad de vida de los pacientes y presenta un menor coste frente a la práctica habitual. Se produjo ahorro de costes y ganancia de AVAC. El análisis de sensibilidad mostró que el resultado no cambiaría de signo con la modificación de ninguna variable de partida. Conclusiones En las patologías oculares con indicación de tratamiento intravítreo, cualquier reducción en el tiempo que transcurre desde la sospecha diagnóstica hasta la primera inyección intravítrea disminuye la pérdida de agudeza visual. Así, actuar para acortar los tiempos sospecha-aguja es clave para mantener la visión funcional de los pacientes. La mejora de la eficiencia de los servicios de oftalmología que se organizan siguiendo el modelo UTI puede generar ahorros que varían entre los 175 € y 85 € por paciente atendido y año (AU)

Aim To compare the effectiveness and costs of the implementation of the intravitreal therapy unit model, endorsed by the SERV, SECA, SEO and SEDISA, compared to the usual procedure. Method Analytical decision model that compares an UTI-type healthcare organization with four usual practice scenarios in Spain, in terms of quality-of-life results due to loss of visual acuity and the use of resources. The probability, cost, and quality-adjusted life years (QALYs) were estimated for each scenario proposed. A univariate sensitivity analysis was performed for each of the parameters used in the model. Result The model showed that from any of the initial scenarios of the usual practice, transitioning to the UTI-type implementation improves the quality of life of patients and requires lower cost. UTI-type is dominant respect usual practice. The sensitivity analysis showed that the results would not change sign with the variation of any starting variable. Conclusions Shorten suspicion-needle times is key to maintaining functional vision in patients requiring intravitreal treatment. The UTI-type model seeks the efficiency of ophthalmology services and can produce savings that vary between €175 and €85 per patient attended per year (AU)

Cost-utility model of new intravitreous units vs. current patient journey model in Spain.

AIM: To compare the effectiveness and costs of the implementation of the Intravitreal Therapy Unit Model, endorsed by the SERV, SECA, SEO and SEDISA, compared to the usual procedure. METHOD: Analytical decision model that compares an UTI-type healthcare organization with 4 usual practice scenarios in Spain, in terms of quality-of-life results due to loss of visual acuity and the use of resources. The probability, cost, and quality-adjusted life years (QALYs) were estimated for each scenario proposed. A univariate sensitivity analysis was performed for each of the parameters used in the model. RESULT: The model showed that from any of the initial scenarios of the usual practice, transitioning to the UTI-type implementation improves the quality of life of patients and requires lower cost. UTI-type is dominant respect usual practice. The sensitivity analysis showed that the results would not change sign with the variation of any starting variable. CONCLUSIONS: Shorten suspicion-needle times is key to maintaining functional vision in patients requiring intravitreal treatment. The UTI-type model seeks the efficiency of ophthalmology services and can produce savings that vary between Є175 and Є85 per patient attended per year.

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.

Risk factors for predicted refractive error after cataract surgery in clinical practice. Retrospective observational study.

OBJECTIVES: To describe the preoperative characteristics of patients undergoing cataract surgery in our hospital, to determine the final visual and refractive results and to determine the preoperative characteristics that conditioned the presence of a residual refractive error (RRE) greater than one diopter. METHODS: Retrospective analysis of cataract surgeries performed at Araba University Hospital between February 2017 and December 2019. Sociodemographic, eye comorbidity, biometric, surgical and post-surgical characteristics were collected. RESULTS: A total of 1419 patients and 1578 surgeries were included for analysis. Of these, 9.07% had preoperative legal blindness, 31.69% eye comorbidity and 4.18% had previous surgery. Overall, 95.82% of patients achieved a corrected final visual acuity (VA) ≥ 0.5 Snellen decimal and 63.12% ≥ 1, and 96.70% of patients improved VA after surgery. RRE was between ±0.5 diopters in 77.82% of patients and between ±1 diopter in 94.74%. The most prominent risk factors that conditioned the presence of RRE greater than 1 diopter were the use of ultrasonic contact biometer, a history of glaucoma surgery, the presence of white or hard cataract, and prior legal blindness. CONCLUSIONS: The visual results of cataract surgery were excellent, with 63.12% of patients obtaining corrected VA ≥ 1 and an RRE of ±1 diopter in 94.74%. Different risk factors influenced the achievement of poor refractive outcomes: preoperative conditions (previous surgeries, white/hard cataract, previous VA) and biometrics.

Factores de riesgo asociados al error refractivo residual tras cirugía de catarata en práctica clínica. Estudio observacional retrospectivo / Risk factors for predicted refractive error after cataract surgery in clinical practice. Retrospective observational study

Objectives: To describe the preoperative characteristics of patients undergoing cataract surgery in our hospital, to determine the final visual and refractive results and to determine the preoperative characteristics that conditioned the presence of a residual refractive error (RRE) greater than one diopter.MethodsRetrospective analysis of cataract surgeries performed at Araba University Hospital between February 2017 and December 2019. Sociodemographic, eye comorbidity, biometric, surgical and post-surgical characteristics were collected.ResultsA total of 1,419 patients and 1,578 surgeries were included for analysis. Of these, 9.07% had preoperative legal blindness, 31.69% eye comorbidity and 4.18% had previous surgery. Overall, 95.82% of patients achieved a corrected final visual acuity (VA) ≥ 0.5 Snellen decimal and 63.12% ≥ 1, and 96.70% of patients improved VA after surgery. RRE was between ± 0.5 diopters in 77.82% of patients and between ± 1 diopter in 94.74%. The most prominent risk factors that conditioned the presence of RRE greater than 1 diopter were the use of ultrasonic contact biometer, a history of glaucoma surgery, the presence of white or hard cataract, and prior legal blindness.ConclusionsThe visual results of cataract surgery were excellent, with 63.12% of patients obtaining corrected VA ≥ 1 and an RRE of ± 1 diopter in 94.74%. Different risk factors influenced the achievement of poor refractive outcomes: preoperative conditions (previous surgeries, white/hard cataract, previous VA) and biometrics (AU)

Objetivos: Describir las características preoperatorias de la población intervenida de cataratas en nuestro hospital, determinar los resultados visuales y refractivos finales y determinar las características previas a la intervención que condicionan la presencia de un error refractivo residual (ERR) mayor de una dioptría.MétodosEstudio retrospectivo de cirugías de catarata realizadas en el Hospital Universitario Araba, entre febrero de 2017 y diciembre de 2019. Se recogieron características sociodemográficas, de comorbilidad ocular, biométricas, quirúrgicas y postquirúrgicas.ResultadosSe incluyeron 1.419 pacientes y 1.578 cirugías para su análisis. El 9,07% presentaron ceguera legal preoperatoria, el 31,69% comorbilidad ocular y el 4,18% había sido previamente intervenido. El 95,82% de los pacientes alcanzaron una agudeza visual (AV) final corregida ≥ 0,5 Snellen decimal y el 63,12% ≥ 1. El 96,70% de los pacientes mejoraron la agudeza visual (AV) tras la intervención. El ERR estuvo entre ± 0,5 dioptrías en el 77,82% de los pacientes y entre ± 1 dioptría en el 94,74%. Los factores de riesgo más destacados que condicionan la presencia de ERR mayor de una dioptría fueron la utilización de biómetro ultrasónico de contacto, el antecedente de cirugía de glaucoma, la presencia de catarata blanca o dura y una AV previa de ceguera legal.ConclusionesLos resultados visuales de la cirugía de cataratas fueron excelentes, alcanzando el 63,12% de los pacientes una AV corregida ≥ 1 y quedando un ERR entre ± 1 dioptría en el 94,74%. Diferentes factores de riesgo influyen en la consecución de peores resultados refractivos: condiciones preoperatorias (intervención previa, catarata blanca/dura, AV previa) y biométricas (AU)

Recommendations for eye care during the alarm state by the coronavirus disease pandemic COVID-19. / Recomendaciones para la atención oftalmológica durante el estado de alarma por la pandemia de enfermedad por coronavirus COVID-19.

OBJECTIVE: Minimize exposure to the SARS-CoV-2, reduce the chances of cross-transmission between patients and healthcare personnel, and prevent the development of postoperative complications from the management of patients with eye diseases during the 2019 coronavirus disease pandemic (COVID-19). METHODS: COVID-19 literature review and consensus establishment between different Spanish ophthalmology societies in order to provide guidelines and recommendations of maximum resources primarily conditioned by the state of alert, confinement and social distancing that occurs in Spain since March 16, 2020. RESULTS: The recommendations will promote the adoption of action and protection measures for eye care in outpatient clinics, surgical areas and hospitalization, for unconfirmed (asymptomatic and symptomatic) and confirmed COVID-19 patients. Measures must be adapted to the circumstances and availability of personal protective equipment in each of the centers and Autonomous Communities, which will be updated according to the pandemic phases and the measures adopted by the Spanish Government. CONCLUSIONS: During the COVID-19 pandemic, attention to the potential health risks to the population caused by coronavirus should prevail over the possible progression of the common eye diseases. Ophthalmologists and other eye care professionals must assume a possible progression of these diseases due to the impossibility of adequate patient follow-up.

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

[Multiple evanescent white-dot syndrome: bilateralization four years later]. / Síndrome múltiples puntos blancos evanescentes: bilateralización cuatro años después.

PURPOSE/METHOD: To report a clinical case of a 26-year old woman with Multiple Evanescent White-dot Syndrome (MEWDS) in left eye with recurrence in the fellow eye four year later, therefore bilateral and asynchronous. We review the clinical findings and the results of ancillary diagnostic techniques in both eyes. CLINICAL CASE/CONCLUSIONS: MEWDS is an uncommon inflammatory disorder with a benign course. The recurrences and the bilaterality are not usual. The affectation pattern in the fellow eye is similar to initial lesions seen four years earlier.

Síndrome múltiples puntos blancos evanescentes: bilateralización cuatro años después / Multiple evanescent white-dot syndrome: bilateralization four years later

Objetivo/Métodos: Presentar un caso clínico de una paciente mujer de 26 años con síndrome de múltiples puntos blancos evanescentes (SMPBE) en el ojo izquierdo que recurrió en el ojo adelfo a los cuatro años, por tanto bilateral y asincrónico. Hacemos una revisión de los hallazgos clínicos y de los resultados de las exploraciones diagnósticas complementarias en ambos ojos. Resultados/Conclusiones: El SMPBE es una patología inflamatoria infrecuente de curso benigno. Las recurrencias y la bilateralidad no son frecuentes. El patrón de afectación en el ojo congénere es similar a las lesiones iniciales constatadas en el primer ojo hace cuatro años (AU)