Características clínicas, manejo y resultados de los pacientes con endoftalmitis estéril asociados con la inyección intravítrea de factores de crecimiento endotelial antivascular / Clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal injection of antivascular endothelial growth factor

OBJETIVO: Analizar las características clínicas, el manejo y los resultados de los pacientes con endoftalmitis estéril asociada con el factor de crecimiento endotelial antivascular intravítreo. MÉTODOS: Serie de casos de observación retrospectiva de pacientes con endoftalmitis estéril después de inyecciones intravítreas anti-VEGF. Se han revisado los datos clínicos de pacientes tratados con anti-VEGF intravítreos durante un año. Se analizan los que han presentado un episodio de endoftalmitis estéril y se estudia su causalidad y manejo. RESULTADOS: Siete pacientes tuvieron un inicio de endoftalmitis estéril en los 4días posteriores a la inyección intravítrea (aflibercept n = 5 y ranibizumab n = 2). Estos pacientes tienen alguna condición neovascular activa: degeneración macular relacionada con la edad (n = 4), neovascularización coroidea miope (n = 1) o edema macular: edema macular diabético (n = 1), oclusión de la vena retiniana ramificada (n = 1). Los signos y síntomas compartidos incluyeron pérdida de visión indolora, células en cámara anterior o vítrea y falta de hipopión. En todos los pacientes, la agudeza visual volvió a estar dentro de una línea de agudeza basal. CONCLUSIÓN: Diferenciar casos de endoftalmitis estéril de infecciosa puede ser un desafío. Es crucial diferenciar ambas entidades, ya que un buen diagnóstico determina el pronóstico visual. Debemos ser conscientes de una inflamación mínima después de repetidas inyecciones intravítreas para establecer el tratamiento adecuado

PURPOSE: Analyze clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal antivascular endothelial growth factor. METHODS: Observational retrospective case series of patients with sterile endophthalmitis following anti-VEGF intravitreal injections. Clinical data of patients treated with intravitreal anti-VEGFs during one year have been revised. Those who have presented an episode of sterile endophthalmitis are analyzed and their causality and management are studied. RESULTS: Seven patients have had a sterile endophthalmitis onset within 4days after intravitreal injection (aflibercept n = 5 and ranibizumab n = 2). These patients have some active neovascular condition: age related macular degeneration (n = 4), myopic choroidal neovascularization (n = 1) or macular edema: diabetic macular edema (n = 1), branch retinal vein occlusion (n = 1). Shared signs and symptoms included painless vision loss, anterior chamber and vitreous cell and lack of hypopyon. In all patients, visual acuity returned to within one line of baseline acuity. CONCLUSIÓN: Differentiating cases of sterile from infectious endophthalmitis may be challenging. It is crucial to differentiate both entities as a good diagnosis determines the visual prognosis. We should be aware of minimal inflammation after repeated intravitreal injections in order to establish the adequate treatment

Clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal injection of antivascular endothelial growth factor. / Características clínicas, manejo y resultados de los pacientes con endoftalmitis estéril asociados con la inyección intravítrea de factores de crecimiento endotelial antivascular.

PURPOSE: Analyze clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal antivascular endothelial growth factor. METHODS: Observational retrospective case series of patients with sterile endophthalmitis following anti-VEGF intravitreal injections. Clinical data of patients treated with intravitreal anti-VEGFs during one year have been revised. Those who have presented an episode of sterile endophthalmitis are analyzed and their causality and management are studied. RESULTS: Seven patients have had a sterile endophthalmitis onset within 4days after intravitreal injection (aflibercept n=5 and ranibizumab n=2). These patients have some active neovascular condition: age related macular degeneration (n=4), myopic choroidal neovascularization (n=1) or macular edema: diabetic macular edema (n=1), branch retinal vein occlusion (n=1). Shared signs and symptoms included painless vision loss, anterior chamber and vitreous cell and lack of hypopyon. In all patients, visual acuity returned to within one line of baseline acuity. CONCLUSION: Differentiating cases of sterile from infectious endophthalmitis may be challenging. It is crucial to differentiate both entities as a good diagnosis determines the visual prognosis. We should be aware of minimal inflammation after repeated intravitreal injections in order to establish the adequate treatment.

Longitudinal study of retinal nerve fiber layer thickness changes in a multiple sclerosis patients cohort: A long term 5 year follow-up.

PURPOSE: To analyze the changes in retinal nerve fiber layer (RNFL) in eyes with and without prior history of optic neuritis (ON) of patients with multiple sclerosis (MS) after a 5-year time period (2010-2015) using optical coherence tomography. METHODS: The RNFL thickness of 114 eyes of 57 MS patients and 40 eyes of 20 healthy subjects were measured in year 2010 and year 2015. Measurements were made separately in twelve sectors around the optic nerve head. Statistical comparisons were made with the obtained data. RESULTS: Progressive RNFL thinning occurs with time in both MS patients (regardless the eye had history of ON or not) and in normal subjects. The baseline mean RNFL thickness in ON eyes of MS patients (year 2010) was 74.2 ± 15.7µm and five years later was 68.7 ± 12.2µm. The baseline mean RNFL thickness in eyes without ON of MS patients was 90.0 ± 11.1µm and 84.7 ± 10.3µm five years later. The median RNFL thickness reduction was 3.5µm for ON eyes, 4.7µm for eyes without ON, and 2.2µm for control eyes. The RNFL thickness reduction rate was similar in eyes with history of ON that in those with no history of ON. On the contrary, the MS group had a significantly higher rate of reduction than the control group. CONCLUSIONS: MS patients have thinner RNFL than normal controls, regardless their eyes had past episodes of ON or not. Eyes of MS patients lose their axons in a similar fashion regardless they had history of ON or not. Although ON causes RNFL loss, once resolved it does not influence the rate of RNFL loss in MS patients.

Bevacizumab intravítreo como tratamiento de las telangiectasias yuxtafoveales idiopáticas tipo I / Intravitreal bevacizumab in the treatment of idiopathic juxtafoveal telangiectasis type I

CASO CLÍNICO: Se presenta el caso clínico de un paciente varón de 42 años de edad con edema macular quístico secundario a telangiectasias yuxtafoveales idiopáticas tipo I. Se inicia tratamiento con bevacizumab intravítreo (1,25 mg en 0,05 ml) cada cuatro semanas hasta un total de tres inyecciones, obteniéndose una mejoría funcional y anatómica que se mantiene durante el primer año de seguimiento. DISCUSIÓN: Actualmente no existe consenso en el tratamiento de las telangiectasias yuxtafoveales idiopáticas. Entre las opciones terapéuticas se encuentra la fotocoagulación con láser en rejilla, la corticoterapia, la terapia fotodinámica con verteforfirino (Visudyne) o la terapia antiangiogénica. En nuestro caso clínico observamos un beneficio tanto funcional como anatómico tras la inyección de bevacizumab que se mantiene durante los 12 primeros meses de seguimiento

CLINICAL CASE: We report a case of a 42 year-old male with a macular edema due to idiopathic juxtafoveal retinal telangiectasis type I, treated with 3 sequential injections of intravitreal bevacizumab (1.25 mg in 0.05 ml). Anatomical improvements were observed after one year of follow up. DISCUSSION: There is currently no general consensus regarding the treatment of unilateral idiopathic juxtafoveal telangiectasis. The therapeutic options are, grid laser photocoagulation, intravitreal triamcinolone, verteporfin photodynamic therapy, or anti-VEGF. Visual acuity and anatomical improvements were observed in this case after intravitreal bevacizumab. Thus, intravitreal bevacizumab seems to be effective to treat macular edema in idiopathic juxtafoveal telangiectasis type I

[Intravitreal bevacizumab in the treatment of idiopathic juxtafoveal telangiectasis type I]. / Bevacizumab intravítreo como tratamiento de las telangiectasias yuxtafoveales idiopáticas tipo i.

CLINICAL CASE: We report a case of a 42 year-old male with a macular edema due to idiopathic juxtafoveal retinal telangiectasis type i, treated with 3 sequential injections of intravitreal bevacizumab (1.25 mg in 0.05 ml). Anatomical improvements were observed after one year of follow up. DISCUSSION: There is currently no general consensus regarding the treatment of unilateral idiopathic juxtafoveal telangiectasis. The therapeutic options are, grid laser photocoagulation, intravitreal triamcinolone, verteporfin photodynamic therapy, or anti-VEGF. Visual acuity and anatomical improvements were observed in this case after intravitreal bevacizumab. Thus, intravitreal bevacizumab seems to be effective to treat macular edema in idiopathic juxtafoveal telangiectasis type i.

Fundus autofluorescence: applications and perspectives.

PURPOSE: To describe the findings of the study of autofluorescence of the different retinal diseases included in the study. To determine in which diseases autofluorescence may be more, or just as, useful as fluorescein angiography (FAG) in terms of diagnostic information. MATERIAL AND METHODS: We studied the retinal autofluorescence of 123 eyes of 93 patients, including various diseases of the eye fundus. In all cases we explored the fundus, retinal autofluorescence, and, if indicated, FAG was performed. Analysis of the autofluorescence was performed using the Heidelberg Retina angiography Angiograph 2 (HRA2) Heidelberg Engineering (Germany). RESULTS: The autofluorescence information provided was equal or better (than FAG) in: 68.18% of cases of macular edema, 50% of pigment epithelium detachments, 100% of pigment epithelium atrophies, 100% of central serous chorioretinopathy; 55.55% of choroidal neovascularization, 100% of retinal dystrophies with deposition of lipofuscin, 100% of hard exudates and pre-retinal hemorrhages. CONCLUSIONS: Autofluorescence is a quick and non-invasive examination method, comfortable for both patient and examiner, and with a very short learning curve. It provides diagnostic information about many eye fundus diseases. While more studies and more experience with its use are needed, its interest lies in the possibility of avoiding the performing of angiography in patients with these diseases, and in the additional information autofluorescence provides about the functional situation of cells and retinal pigments.

Autofluorescencia retiniana: aplicaciones y perspectivas / Fundus autofluorescence: applications and perspectives

Objetivos: Describir los hallazgos en el estudio de la autofluorescencia de las distintas enfermedades retinianas incluidas en el estudio. Estudiar en qué enfermedades la autofluorescencia puede ser igual o superior a la angiografía fluoresceínica (AGF) en cuanto a información diagnóstica. Material y métodos: Se estudió la autofluorescencia retiniana de 123 ojos y pacientes, incluyendo diversas enfermedades del fondo de ojo. En todos los casos se exploró el fondo de ojo, la autofluorescencia retiniana, y, en caso de estar indicado, se realizó AGF. La exploración de la autofluorescencia fue llevada a cabo usando el angiógrafo Heidelberg Retina Angiograph 2 (HRA2) de Heidelberg Engeneering (Alemania). Resultados: La autofluorescencia aportó una información igual o mejor (que la AGF) en: 68,18% de casos de edema macular; 50% de desprendimientos del epitelio pigmenario; 100% de atrofias del epitelio pigmentario; 100% de coriorretinopatías centrales serosas; 55,55% de neovascularizaciones coroideas; 100% de las distrofias retinianas con depósito de lipofucsina; 100% de los exudados duros y hemorragias prerretinianas. Conclusiones: La autofluorescencia es un método de exploración rápido, cómodo para el paciente y explorador, no invasivo y con una curva de aprendizaje muy corta, que aporta información para el diagnóstico de múltiples enfermedades con afectación del fondo de ojo. Si bien son precisos más estudios y más experiencia con su uso, su interés radica en la posibilidad de evitar la realización de angiografías en pacientes con estas enfermedades y en la información adicional que nos aporta sobre la situación funcional de las células y pigmentos retinianos(AU)

Purpose: To describe the findings of the study of autofluorescence of the different retinal diseases included in the study. To determine in which diseases autofluorescence may be more, or just as, useful as fluorescein angiography (FAG) in terms of diagnostic information. Material and methods: We studied the retinal autofluorescence of 123 eyes of 93 patients, including various diseases of the eye fundus. In all cases we explored the fundus, retinal autofluorescence, and, if indicated, FAG was performed. Analysis of the autofluorescence was performed using the Heidelberg Retina angiography Angiograph 2 (HRA2) Heidelberg Engineering (Germany) .Results: The autofluorescence information provided was equal or better (than FAG) in: 68.18% of cases of macular edema, 50% of pigment epithelium detachments, 100% of pigment epithelium atrophies, 100% of central serous chorioretinopathy; 55.55% of choroidal neovascularization, 100% of retinal dystrophies with deposition of lipofuscin, 100% of hard exudates and pre-retinal hemorrhages. Conclusions: Autofluorescence is a quick and non-invasive examination method, comfortable for both patient and examiner, and with a very short learning curve. It provides diagnostic information about many eye fundus diseases. While more studies and more experience with its use are needed, its interest lies in the possibility of avoiding the performing of angiography in patients with these diseases, and in the additional information autofluorescence provides about the functional situation of cells and retinal pigments(AU)

De la evidencia científica a la práctica clínica: pautas de tratamiento del edema macular secundario a oclusión venosa retiniana / From scientific evidence to clinical practice: treatment regimens for macular edema secondary to retinal vein occlusion

Las oclusiones venosas de la retina (OVR) son la segunda causa más frecuente de enfermedad vascular de la retina después de la retinopatía diabética. A pesar de la existencia de varias opciones terapéuticas posibles, ninguna resultó del todo satisfactoria, y muchos pacientes sufrían una pérdida visual irreversible. Como resultado de los ensayos BRAVO,CRUISE y GENEVA, ranibizumab y los implantes intravítreos biodegradables de dexametasona han sido recientemente aprobados por la Food and Drug Administration en los Estados Unidos y por la Agencia Europea del Medicamento para el tratamiento del edema macular secundario a OVR. En este trabajo comenzamos describiendo las opciones actuales de tratamiento para el edema macular secundario a oclusión venosa retiniana y continuamos con la descripción de la pauta de tratamiento con ranibizumab(AU)

Retinal vein occlusion (RVO) is the second most common cause of retinal vascular disease after diabetic retinopathy. Despite the existence of several possible treatment options, none was entirely satisfactory and many patients suffered irreversible visual loss. As a result of the BRAVO, CRUISE and GENEVA trials, ranibizumab and the intravitreal biodegradable implants of dexamethasone has recently been approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of RVO secondary edema. In this paper we begin by describing the current treatment options for RVO associated macular edema and continue with the description of the treatment regimen with ranibizumab(AU)

[From scientific evidence to clinical practice: treatment regimens for macular edema secondary to retinal vein occlusion]. / De la evidencia cientifica a la practica clinica: pautas de tratamiento del edema macular secundario a oclusion venosa retiniana.

Retinal vein occlusion (RVO) is the second most common cause of retinal vascular disease after diabetic retinopathy. Despite the existence of several possible treatment options, none was entirely satisfactory and many patients suffered irreversible visual loss. As a result of the BRAVO, CRUISE and GENEVA trials, ranibizumab and the intravitreal biodegradable implants of dexamethasone has recently been approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of RVO secondary edema. In this paper we begin by describing the current treatment options for RVO associated macular edema and continue with the description of the treatment regimen with ranibizumab.

Triamcinolone and bevacizumab as adjunctive therapies to panretinal photocoagulation for proliferative diabetic retinopathy.

Purpose. To evaluate efficacy of intravitreal triamcinolone (IVT) and bevacizumab (IVB) as adjunctive treatments to panretinal photocoagulation (PRP) in proliferative diabetic retinopathy (PDR). Methods. In 60 eyes of 45 patients with PDR, PRP (PRP group), PRP with IVT (IVT group), or PRP with IVB (IVB group) was performed. Regression of new vessels (NV), changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and contrast sensitivity at 1,2, and 6 months were evaluated. Results. Initial mean numbers of active NV and BCVA were 3.45 and 67.35 in the PRP group, 4.35 and 76.65 in the IVT group, and 4.79 and 75.53 in the IVB group. At the 6-month follow-up, numbers of active NV were 2.5 (P = 0.064), 1.11 (P = 0.000), and 1.11 (P = 0.002), and there was a mean loss of 2,6 (P = 0.055), 3.9 (P = 0.011), and 0.9 letters (P = 0.628) in the PRP, IVT, and IVB groups, respectively. Changes in CMT in the PRP and IVT groups were not significant, but significantly increased in the IVB group (P = 0.032). Contrast sensitivity remained stable in PRP and IVB groups and slightly decreased in IVT group. Conclusions. Adjunctive use of both triamcinolone and bevacizumab with PRP lead to a greater reduction of active NV than PRP alone in PDR, although no differences were seen between the two of them.

Development and validation of a computer-aided diagnostic tool to screen for age-related macular degeneration by optical coherence tomography.

BACKGROUND: To develop and assess the technical validity of new computer-aided diagnostic software (CAD) for automated analyses of optical coherence tomography (OCT) images for the purpose of screening for neovascular age-related macular degeneration. METHODS: Artificial visual techniques were used to develop the CAD in two steps: normalisation and feature vector extraction from OCT images; and training and classification by means of decision trees. Technical validation was performed by a retrospective study design based on OCT images randomly extracted from clinical charts. Images were classified as normal or abnormal to serve for screening purposes. Sensitivity, specificity, positive predictive values and negative predictive values were obtained. RESULTS: The CAD was able to quantify image information by working in the perceptually uniform hue-saturation-value colour space. Particle swarm optimisation with Haar-like features is suitable to reveal structural features in normal and abnormal OCT images. Decision trees were useful to characterise normal and abnormal images using feature vectors obtained from descriptive statistics of detected structures. The sensitivity of the CAD was 96% and the specificity 92%. CONCLUSIONS: This new CAD for automated analysis of OCT images offers adequate sensitivity and specificity to distinguish normal OCT images from those showing potential neovascular age-related macular degeneration. These results will enable its clinical validation and a subsequent cost-effectiveness assessment to be made before recommendations are made for population-screening purposes.

[SERV clinical practice guidelines: management of retinal vein occlusion. Sociedad Española de Retina y Vitreo]. / Guías de práctica clínica de la SERV: manejo de las oclusiones venosas de la retina. Sociedad Española de Retina y Vitreo.

PURPOSE: A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined. METHODS: Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries. RESULTS: Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings. CONCLUSIONS: Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion.

Guías de práctica clínica de la SERV: manejo de las oclusiones venosas de la retina / SERV clinical paractice guidelines: management of retinal vein occlusion

Propósito: Se presenta una guía de manejo de las oclusiones venosas retinianas. Esto se hace necesario en un momento en el que han aparecido varias alternativas terapéuticas cuyo papel aún no está completamente definido.MétodosSe revisa la literatura publicada hasta el momento identificando los artículos más relevantes, clasificándolos en base al nivel de evidencia.ResultadosTeniendo en cuenta las distintas opciones de tratamiento que existen en la actualidad, se sugieren varias líneas de actuación. Se discute el papel de las exploraciones complementarias y se recomiendan pautas de tratamiento en base a los hallazgos clínicos, angiográficos y tomográficos.Conclusionesaunque no existe un consenso total, esta guía promueve un estándar de buena práctica clínica y proporciona una actualización del manejo de las oclusiones venosas retinianas (AU)

Purpose: A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined.MethodsReview of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries.ResultsTaking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings.ConclusionsAlthough there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion(AU)

Sirius: a web-based system for retinal image analysis.

PURPOSE: Retinal image analysis can lead to early detection of several pathologies such as hypertension or diabetes. Screening processes require the evaluation of a high amount of visual data and, usually, the collaboration between different experts and different health care centers. These usual routines demand new fast and automatic solutions to deal with these situations. This work introduces Sirius (System for the Integration of Retinal Images Understanding Services), a web-based system for image analysis in the retinal imaging field. METHODS: Sirius provides a framework for ophthalmologists or other experts in the field to collaboratively work using retinal image-based applications in a distributed, fast and reliable environment. Sirius consists of three main components: the web client that users interact with, the web application server that processes all client requests and the service module that performs the image processing tasks. In this work, we present a service for the analysis of retinal microcirculation using a semi-automatic methodology for the computation of the arteriolar-to-venular ratio (AVR). RESULTS: Sirius has been evaluated in different real environments, involving health care systems, to test its performance. First, the AVR service was validated in terms of precision and efficiency and then, the framework was evaluated in different real scenarios of medical centers. CONCLUSIONS: Sirius is a web-based application providing a fast and reliable work environment for retinal experts. The system allows the sharing of images and processed results between remote computers and provides automated methods to diminish inter-expert variability in the analysis of the images.

[Management of intravitreal injections]. / Manejo de las inyecciones intravítreas.

PURPOSE: The intravitreal injection is a minimally invasive technique which has been proved to be an effective therapy in the management of numerous vitreoretinal diseases. Its use has been rapidly increased in the last few years due to new medications and indications. However, non-standardized performance of this procedure might cause severe complications, being of special concern intraocular infection. The aim of this Guide is to give ophthalmologists, with the information we have up to date, the guidelines needed to make this procedure safe. METHODS: 1. Reviewing the literature regarding evidence published up to date. 2. Consulting with experienced surgeons their common practice in this technique. 3. Contrasting the information from this Guide with those guides published in other countries. RESULTS: Although there is no complete consensus regarding the intravitreal injection procedure technique, the recommendations in this Guide are, up to date from our point of view, the most appropriate to prevent complications, specially infection. Of most importance are antisepsis with povidone iodine, the use of sterile material and gloves and an adequate injection technique. CONCLUSIONS: Large series published of intravitreal injections which took place in clinic settings applying a procedure technique as recommended in this Guide, presented a very low incidence of complications, specially endophthalmitis.

Manejo de las inyecciones intravítreas / Management of intravitreal injections

Objetivo: La inyección intravítrea es una técnicamínimanente invasiva de demostrada eficacia en eltratamiento de numerosas enfermedades vitreorretinianas.Su uso, gracias a nuevas medicaciones eindicaciones, se ha generalizado en los últimosaños. La práctica de esta técnica sin las precaucionesadecuadas, puede causar complicaciones graves,en especial la infección.La finalidad de esta Guía es difundir entre los oftalmólogosun compendio de recomendaciones estandarizadasque faciliten la administración de inyeccionesintravítreas, con las máximas medidas deseguridad y fiabilidad.Método: Se efectúa:1. Una revisión bibliográfica de la evidencia científicapublicada hasta la fecha.2. Consulta de práctica clínica habitual entre especialistascon experiencia acreditada.3. Contraste de nuestra información con la contenidaen las guías publicadas en otros países.Resultado: Aunque no hay un consenso absoluto,las maniobras recomendadas en esta Guía parecen,hasta el día de la fecha, las más adecuadas paraminimizar los riesgos de complicaciones, en especial la infección. Se consideran de particular importanciala antisepsis con povidona yodada, el uso deguantes y materiales estériles y una técnica adecuadade inyección.Conclusiones: Series muy grandes de inyeccionesintravitreas realizadas en consulta y aplicando lasmedidas aquí recomendadas, presentan una incidenciamuy baja de complicaciones, en especial la sospecha de infección intraocular(AU)

Purpose: The intravitreal injection is a minimallyinvasive technique which has been proved to be aneffective therapy in the management of numerousvitreoretinal diseases. Its use has been rapidlyincreased in the last few years due to new medicationsand indications. However, non-standardizedperformance of this procedure might cause severecomplications, being of special concern intraocularinfection.The aim of this Guide is to give ophthalmologists,with the information we have up to date, the guidelinesneeded to make this procedure safe.Methods: 1. Reviewing the literature regarding evidencepublished up to date.2. Consulting with experienced surgeons their commonpractice in this tecnique.3. Contrasting the information from this Guide withthose guides published in other countries.Results: Although there is no complete consensusregarding the intravitreal injection procedure technique,the recomendations in this Guide are, up todate from our point of view, the most appropriate toprevent complications, specially infection. Of mostimportance are antisepsis with povidone iodine, the use of sterile material and gloves and an adecuateinjection technique.Conclussions: Large series published of intravitrealinjections which took place in clinic settingsapplying a procedure tecnique as recomended inthis Guide, presented a very low incidente of complications,specially endophthalmitis(AU)

Intravitreous bevacizumab to treat subfoveal choroidal neovascularization in highly myopic eyes: short-term results.

AIM: To describe the anatomical and visual outcome of subfoveal and juxtafoveal choroidal neovascularization (CNV) in highly myopic eyes treated by intravitreal bevacizumab. METHODS: Prospective, nonrandomized, multicentric, interventional pilot study. Twenty-six highly myopic eyes from 25 patients with subfoveal and juxtafoveal CNV were treated by three monthly intravitreal injections with 1.25 mg bevacizumab. Patients were evaluated for best-corrected visual acuity (BCVA) and optical coherence tomography at baseline and then monthly. Fluorescein angiography was performed at baseline and at month 3. RESULTS: Patients averaged 49.5 years of age (SD 16.0, range 29-82). Five patients were male and 20 were female. BCVA at baseline averaged 20/62 (range 20/200-20/32) and 20/38 (range 20/160-20/20) at month 6. Average central foveal thickness was 282.4 microm (SD 68.3, range 168-447) at baseline and 224.0 microm (SD 46, range 132-294) at month 6. Fifteen eyes were naïve for treatment and 11 eyes had been previously treated by photodynamic therapy (PDT) (average 2.5 PDT sessions). Leakage from CNV had ceased in all eyes at month 3 and CNV was still closed at month 6. Neither ocular nor systemic safety issues appeared during the follow-up. CONCLUSIONS: Intravitreal bevacizumab seems to be an effective and safe therapeutic procedure to treat subfoveal and juxtafoveal CNV in highly myopic eyes. Further studies are required to verify the efficacy and usefulness of this therapy compared with established treatments for this condition.

Intravitreal bevacizumab to treat subfoveal choroidal neovascularisation in highly myopic eyes: 1-year outcome.

AIMS: The aim of the study was to examine the changes in visual acuity, fluorescein angiography (FA) and optical coherence tomography (OCT) macular thickness of subfoveal, and juxtafoveal choroidal neovascularisation (CNV) in highly myopic eyes treated by intravitreal bevacizumab. METHODS: The study was a prospective, non-randomised, multicentre, interventional case series. Twenty-nine highly myopic eyes from 28 patients with subfoveal and juxtafoveal CNV were treated by three monthly intravitreal injections of 1.25 mg bevacizumab. Patients were evaluated for best-corrected visual acuity (BCVA) and OCT at baseline and then monthly for 1 year. FA was performed at baseline, after 3 months, and whenever CNV activity was suspected. RESULTS: The average age was 50 (SD 15, range 29-82) years. The mean LogMAR BCVA at baseline was 0.55 (SD 0.25, range 0.2-1.0) and 0.38 (SD 0.32, range 0.0-1.2) at 1 year. Sixteen eyes were naïve for treatment and 13 eyes had been previously treated by photodynamic therapy (average 2.5 sessions). Leakage from CNV had ceased in all eyes at month 3. OCT central foveal thickness decreased significantly from 282 (SD 68) mum at baseline to 224 (SD 46) mum at month 12 (p = 0.008, Student t test for paired data). Six eyes needed one re-injection during follow-up at month 4 (one eye), month 6 (four eyes) and month 12 (one eye). Neither ocular nor systemic adverse reactions appeared during follow-up. CONCLUSIONS: The results of this case series suggest that intravitreal bevacizumab seems to be an effective therapeutic procedure to treat subfoveal and juxtafoveal CNV in highly myopic eyes at 1-year follow-up. Further studies are required to verify the efficacy and usefulness of this therapy compared with established treatments for this condition.