Implante de dexametasona antes de tratamiento anti-VEGF en desprendimientos del epitelio pigmentario secundarios a degeneración macular asociada a la edad con características de alto riesgo de rotura / Dexamethasone implant prior to anti-VEGF therapy in pigment epithelium detachments with high-risk rupture characteristics secondary to neovascular age-related macular degeneration

Objetivo Evaluar la incidencia de desgarro del epitelio pigmentario cuando se administra un implante intravítreo de dexametasona de liberación retardada (uso off-label) previo al tratamiento antiangiogénico en desprendimientos del epitelio pigmentario (DEP) secundarios a degeneración macular neovascular asociada a la edad (DMAEn) con características de alto riesgo de rotura e investigar si provoca una disminución del tamaño del DEP. Métodos Se incluyeron pacientes con DMAEn, altura del DEP >500micras e implante de Ozurdex previo a la terapia antiangiogénica. Se registró la presencia de rotura del epitelio pigmentario en tomografías de coherencia óptica, agudeza visual mejor corregida (AVMC) y medidas del DEP (altura y diámetro máximos). Resultados El estudio incluyó a 14 ojos de 14 pacientes: edad media 77±7 años, 11 (79%) mujeres. 25±13 días después del Ozurdex los pacientes comenzaron con al menos 3 inyecciones mensuales de anti-VEGF. La AVMC mejoró de 64±14 a 69±11 letras después de la terapia anti-VEGF (p>0,05). La altura media inicial del DEP fue de 817±269μm, siendo 639±268μm después de Ozurdex y 370±260μm después de las inyecciones de anti-VEGF (p=0,035 y p=0,009). Se produjo un desgarro del epitelio pigmentario de la retina (7%). No se hallaron otros efectos adversos. Conclusione El implante de dexametasona antes de la terapia anti-VEGF puede representar una modalidad terapéutica prometedora para los DEP grandes en la DMAEn, reduciendo las dimensiones del DEP y el riesgo de desgarros del epitelio pigmentario antes de la terapia anti-VEGF (AU)

Objective Evaluate the incidence of pigment epithelial tear when intravitreal delayed-release dexamethasone implant is administered (off-label use) prior to antiangiogenic treatment in pigment epithelium detachments (PED) secondary to neovascular age-related macular degeneration (nAMD) with high-risk rupture characteristics and investigate if it causes a decrease in the PED size. Methods Patients with nAMD, PED height >500microns and Ozurdex implant prior to the antiangiogenic therapy were included. The presence of pigment epithelium rupture in optical coherence tomography scans, best-corrected visual acuity (BCVA) and PED measurements (maximum height and diameter) were registered. Results The study included 14 eyes of 14 patients: mean age 77±7 years, 11 (79%) females. 25±13 days after the Ozurdex, patients started with at least 3 anti-VEGF monthly injections. BCVA improved from 64±14 to 69±11 letters after anti-VEGF therapy (P>.05). Mean baseline PED height was 817±269μm, being 639±268μm after Ozurdex and 370±260μm after anti-VEGF injections (P=.035 and P=.009). One retinal pigment epithelium tear occurred (7%). No other adverse effects were reported. Conclusions Dexamethasone implant prior to anti-VEGF therapy may represent a promising therapeutic modality for large PED in nAMD, reducing PED dimensions and the risk of pigment epithelium tears prior to anti VEGF therapy (AU)

Update on the utility of en face optical coherence tomography in the assessment of vitreoretinal diseases.

En face optical coherence tomography (EF-OCT) is a rapid, non-invasive, high-resolution imaging technique that has evolved in recent years to be a routine examination for the assessment and follow-up of various vitreoretinal diseases. With the introduction of swept-source OCT (SS-OCT), which can achieve up to 100,000 A-scans per second and better-quality imaging of deeper structures using a longer wavelength (1050nm), EF-OCT reconstruction can produce high-resolution frontal images of the retina and choroid (C-Scans) that give an overview of disease extent. These images allow a more accurate study of vitreoretinal interface pathologies such as epiretinal membranes, macular holes, and vitreomacular traction. They also provide key information in the study of various retinal vascular diseases and the differential diagnosis of cystic macular edema. EF-OCT provides valuable information about the severity of vitreoretinal interface alterations and precisely assesses the choriocapillaris and choroidal vasculature in pachychoroid disorders. Finally, this technique provides valuable information about atrophic and neovascular age-related macular degeneration and various uveitic entities. This review aims to describe the current clinical applications of EF-OCT in various vitreoretinal diseases as well as the latest findings and future perspectives.

Dexamethasone implant prior to anti-VEGF therapy in pigment epithelium detachments with high-risk rupture characteristics secondary to neovascular age-related macular degeneration.

OBJECTIVE: Evaluate the incidence of pigment epithelial tear when intravitreal delayed-release dexamethasone implant is administered (off-label use) prior to antiangiogenic treatment in pigment epithelium detachments (PED) secondary to neovascular age-related macular degeneration (nAMD) with high-risk rupture characteristics and investigate if it causes a decrease in the PED size. METHODS: Patients with nAMD, PED height >500 microns and Ozurdex implant prior to the antiangiogenic therapy were included. The presence of pigment epithelium rupture in optical coherence tomography scans, best-corrected visual acuity (BCVA) and PED measurements (maximum height and diameter) were registered. RESULTS: The study included 14 eyes of 14 patients: mean age 77 ±â€¯7 years, 11 (79%) females. 25 ±â€¯13 days after the Ozurdex, patients started with at least 3 anti-VEGF monthly injections. BCVA improved from 64 ±â€¯14-69 ±â€¯11 letters after anti-VEGF therapy (p > 0.05). Mean baseline PED height was 817 ±â€¯269 µm, being 639 ±â€¯268 µm after Ozurdex and 370 ±â€¯260 µm after anti-VEGF injections (p = 0.035 and p = 0.009). One retinal pigment epithelium tear occurred (7%). No other adverse effects were reported. CONCLUSIONS: Dexamethasone implant prior to anti-VEGF therapy may represent a promising therapeutic modality for large PED in nAMD, reducing PED dimensions and the risk of pigment epithelium tears prior to anti VEGF therapy.

Assessment of the perception of healthcare barriers and the impact of intravitreal injections on neovascular age-related macular degeneration.

AIM: To evaluate the perception of barriers in healthcare and the impact of intravitreal injections in patients with neovascular age-related macular degeneration (nAMD). METHODS: Cross-sectional study including 108 patients with nAMD in treatment with intravitreal injections. The patients answered a questionnaire with 26 questions (score from 1 to 5) divided in three sections: 1) the disease and its treatment with injections, 2) healthcare barriers and 3) new technologies. RESULTS: The mean age was 80.4 ±â€¯7.0 years and visual acuity (VA) was 75.2 ±â€¯12.4 letters. The main barriers in healthcare were long waiting times (72%), followed by other comorbidities (10%). Some 63% of patients have to wait between 3 and 5 h to attend their clinical visit. Significant anxiety due to the injections (2.8 ±â€¯1.3) was observed, being present in 71% of the cases the day before. A great fear of blindness and losing independence was observed (4.4 ±â€¯0.9 and 4.3 ±â€¯1.1), with no differences in relation to VA, age or sex (p ≥ 0.135). Moreover, 28% of the patients reported that it was quite or very difficult for them to attend the clinical visit, with 69% of the total showing great interest in having a diagnostic device at home. CONCLUSION: The nAMD and its treatment represent a significant burden on patients, among whom there is a great fear of blindness and of losing their independence, the main barrier being the long waiting time for the clinical visit.

Evaluación de la percepción de las barreras en la asistencia sanitaria y del impacto de las inyecciones intravítreas en la degeneración macular asociada a la edad neovascular / AEvaluación de la percepción de las barreras en la asistencia sanitaria y del impacto de las inyecciones intravítreas en la degeneración macular asociada a la edad neovascular

Propósito Evaluar la percepción de las barreras en la asistencia sanitaria y del impacto de las inyecciones intravítreas en los pacientes con degeneración macular asociada a la edad neovascular (DMAEn). Métodos Estudio transversal de 108 pacientes con DMAEn en tratamiento con inyecciones intravítreas mediante un cuestionario de 26 preguntas (puntuación del 1 al 5) divididas en 3 bloques: 1)enfermedad y su tratamiento con inyecciones; 2)barreras en la asistencia sanitaria, y 3)nuevas tecnologías. Resultados La edad media fue 80,4±7,0 años y la agudeza visual (AV) de 75,2±12,4 letras. Las principales barreras en la asistencia sanitaria fueron los largos tiempos de espera en consulta (72%), seguida por otras comorbilidades (10%). El 63% de los pacientes dedican entre 3 y 5h para acudir a la consulta. Se apreció una ansiedad notable debida a las inyecciones (2,8±1,3), estando presente en el 71% el día antes. Se observó un gran miedo a la ceguera y a dejar de ser independientes (4,4±0,9 y 4,3±1,1), sin existir diferencias en relación con la AV, la edad o el sexo (p≥0,135). El 28% de los pacientes refieren que les cuesta bastante o mucho la asistencia a consulta, presentando el 69% del total un gran interés en tener un aparato diagnóstico en el domicilio. Conclusiones La DMAEn y su tratamiento suponen una importante carga asistencial para los pacientes, existiendo un gran miedo a la ceguera y a perder su independencia, siendo la principal barrera el largo tiempo de espera en consulta (AU)

Aim To evaluate the perception of barriers in healthcare and the impact of intravitreal injections in patients with neovascular age-related macular degeneration (nAMD). Methods Cross-sectional study including 108 patients with nAMD in treatment with intravitreal injections. The patients answered a questionnaire with 26 questions (score from 1 to 5) divided in three sections: 1)the disease and its treatment with injections; 2)healthcare barriers, and 3)new technologies. Result The mean age was 80.4±7.0 years and visual acuity (VA) was 75.2±12.4 letters. The main barriers in healthcare were long waiting times (72%), followed by other comorbidities (10%). Some 63% of patients have to wait between 3 and 5hours to attend their clinical visit. Significant anxiety due to the injections (2.8±1.3) was observed, being present in 71% of the cases the day before. A great fear of blindness and losing independence was observed (4.4±0.9 and 4.3±1.1), with no differences in relation to VA, age or sex (P≥.135). Moreover, 28% of the patients reported that it was quite or very difficult for them to attend the clinical visit, with 69% of the total showing great interest in having a diagnostic device at home.Conclusion The nAMD and its treatment represent a significant burden on patients, among whom there is a great fear of blindness and of losing their independence, the main barrier being the long waiting time for the clinical visit (AU)

Assessment of vision-related quality of life and depression and anxiety rates in patients with neovascular age-related macular degeneration.

PURPOSE: To assess the vision-related quality of life and the depression and anxiety rates in patients with neovascular Age-Related Macular Degeneration (nAMD). METHODS: A cross-sectional study of patients with nAMD treated with intravitreal injections was performed. The patients completed two validated questionnaires: the Visual Functioning Questionnaire (VFQ-25, score from 0 to 100), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Age, gender and visual acuity (VA) in the Early Treatment Diabetic Retinopathy Study (ETDRS) scale was registered. RESULTS: Fifty-five patients with nAMD participated with a mean age of 80.9 ± 6.6 years-old (range 67-93) and a mean VA in the best eye of 73.5 ± 12.7 letters (range 44-95). The global VFQ-25 mean score was 57.4 ± 21.9 being 38.9 ± 13.2 for the general vision and 42.0 ± 19.5 for the general health. VA in the best eye was associated with the global score of the VFQ-25 scale (R = 0.608; P < .001), but no correlation was observed with general health (P = .936). In the HADS scale, 26.9% and 25.5% of patients had symptoms of depression and anxiety respectively. A negative correlation was found between the HADS and VFQ-25 scales for the general vision score (R = -0.438). CONCLUSION: This study elucidates the impact of vision impairment and the visual functioning in nAMD, describing an important rate of depression and anxiety symptoms.

Evaluación de la calidad de vida y la presencia de síntomas de depresión y ansiedad en pacientes con degeneración macular asociada a la edad neovascular / Assessment of vision-related quality of life and depression and anxiety rates in patients with neovascular age-related macular degeneration

Propósito Evaluar la calidad de vida relacionada con la visión, así como la presecia de síntomas de depresión y ansiedad en los pacientes con degeneración macular asociada a la edad neovascular (DMAEn). Métodos Se realizó un estudio transversal de pacientes con DMAEn en tratamiento con inyecciones intravítreas de antiangiogénicos. Los pacientes realizaron 2 cuestionarios validados: el cuestionario de función visual (VFQ-25, cuya puntuación varía de 0 a 100) y la Escala hospitalaria de ansiedad y depresión (HADS). Se registraron la edad, el sexo y la agudeza visual (AV) en la escala Early Treatment Diabetic Retinopathy Study. Resultado Se incluyeron 55 pacientes con DMAEn con una edad de 80,9±6,6 años (rango 67 a 93) y una AV en el mejor ojo de 73,5±12,7 letras (rango 44 a 95). La puntuación global media en el VFQ-25 fue de 57,4±21,9, siendo 38,9±13,2 para la visión general y 42,0±19,5 para la salud general. La AV se correlacionó con la puntuación global de la escala VFQ-25 (R=0,608; p<0,001), pero no con la salud general (p=0,936). Mediante la escala HADS se detectó un 27,2% y un 25,5% de pacientes con síntomas de depresión y ansiedad respectivamente. Se observó una correlación negativa entre las puntuaciones del HADS y VFQ-25 para el dominio de visión general (R=–0,438). Conclusiones Este estudio muestra el impacto en la calidad de vida y función visual en los pacientes con DMAE neovascular, presentando en un porcentaje considerable de los casos síntomas de depresión y ansiedad (AU)

Purpose To assess the vision-related quality of life and the depression and anxiety rates in patients with neovascular Age-Related Macular Degeneration (nAMD). Method A cross-sectional study of patients with nAMD treated with intravitreal injections was performed. The patients completed two validated questionnaires: the Visual Functioning Questionnaire (VFQ-25, score from 0 to 100), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Age, gender and visual acuity (VA) in the Early Treatment Diabetic Retinopathy Study (ETDRS) scale was registered. Result Fifty-five patients with nAMD participated with a mean age of 80.9±6.6 years-old (range 67 to 93) and a mean VA in the best eye of 73.5±12.7 letters (range 44 to 95). The global VFQ-25 mean score was 57.4±21.9 being 38.9±13.2 for the general vision and 42.0±19.5 for the general health. VA in the best eye was associated with the global score of the VFQ-25 scale (R=.608; P<.001), but no correlation was observed with general health (P=.936). In the HADS scale, 26.9% and 25.5% of patients had symptoms of depression and anxiety respectively. A negative correlation was found between the HADS and VFQ-25 scales for the general vision score (R=–0.438). Conclusions This study elucidates the impact of vision impairment and the visual functioning in nAMD, describing an important rate of depression and anxiety symptoms (AU)

Actualización en el tratamiento de la coriorretinopatía serosa central crónica / Update on the management of chronic central serous chorioretinopathy

La coriorretinopatía serosa central (CSC) es una de las principales causas de disminución de la agudeza visual en pacientes menores de 60 años. Su fisiopatología sigue siendo parcialmente desconocida, aunque se ha postulado una hiperpermeabilidad coroidea que produce típicamente un desprendimiento neurosensorial y/o un desprendimiento del epitelio pigmentario de la retina en el polo posterior. La CSC aguda generalmente no requiere tratamiento, mientras que cuando es crónica debe ser tratada para evitar un deterioro visual. Con el desarrollo de las nuevas técnicas de imagen ha existido una mejora en el diagnóstico y se han propuesto diferentes estrategias terapéuticas. Actualmente diversos tratamientos para el manejo de la CSC crónica han demostrado ser útiles para mejorar o estabilizar la agudeza visual, la resolución del fluido subretiniano y para prevenir recurrencias. Los tratamientos más empleados en la actualidad son la terapia fotodinámica con verteporfina, el láser subumbral de micropulso, el tratamiento con antagonistas de los mineralocorticoides o los fármacos intravítreos antiangiogénicos. Pero existen otras propuestas y, además, se están desarrollando nuevos tratamientos con resultados prometedores. Esta revisión pretende ofrecer al lector una visión global de la evidencia científica actual de las diferentes opciones de tratamientos disponibles para la CSC para ayudar en la toma de decisiones en la práctica clínica (AU)

Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual acuity in patients younger than 60 years. Its pathophysiology remains partially unknown, although it has been postulated that choroidal hyper-permeability may be involved. This typically produces a neurosensory retinal detachment and/or a detachment of the retinal pigment epithelium in the posterior pole. Although acute CSC generally does not require treatment, when chronic it must be treated to avoid visual impairment. With the development of new imaging techniques, there has been an improvement in diagnosis, and different therapeutic strategies have been proposed. Various treatments for the management of chronic CSC have currently been shown to be useful to improve or stabilise visual acuity, the resolution of subretinal fluid, and to prevent recurrences. The most commonly used treatments today are photodynamic therapy, micropulse subthreshold laser, mineralocorticoid antagonists, or anti-vascular endothelial growth factor drugs. There are also other proposals and new treatments being developed, with promising results. This review aims to provide the reader with an overview of the current scientific evidence of the different treatment options available for CSC in order to help decision-making in clinical practice (AU)

Update on the management of chronic central serous chorioretinopathy. / Actualización en el tratamiento de la coriorretinopatía serosa central crónica.

Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual acuity in patients younger than 60 years. Its pathophysiology remains partially unknown, although it has been postulated that choroidal hyper-permeability may be involved. This typically produces a neurosensory retinal detachment and/or a detachment of the retinal pigment epithelium in the posterior pole. Although acute CSC generally does not require treatment, when chronic it must be treated to avoid visual impairment. With the development of new imaging techniques, there has been an improvement in diagnosis, and different therapeutic strategies have been proposed. Various treatments for the management of chronic CSC have currently been shown to be useful to improve or stabilise visual acuity, the resolution of subretinal fluid, and to prevent recurrences. The most commonly used treatments today are photodynamic therapy, micropulse subthreshold laser, mineralocorticoid antagonists, or anti-vascular endothelial growth factor drugs. There are also other proposals and new treatments being developed, with promising results. This review aims to provide the reader with an overview of the current scientific evidence of the different treatment options available for CSC in order to help decision-making in clinical practice.

Angiografía mediante tomografía de coherencia óptica: ¿presente o futuro en la práctica clínica diaria? / Optical coherence tomography angiography: Present or future in daily clinical practice?

No disponible

Resultados de una encuesta nacional sobre la gestión de pacientes con enfermedad macular / Results of a national survey on the management of patients with macular disease

No disponible

Retinopatía hemorrágica asociada a leishmaniasis visceral en el contexto de infección por el virus de inmunodeficiencia humana / Haemorrhagic retinopathy in visceral leishmaniasis complicating human inmunodeficiency virus infection

No disponible