Monitorización de la escleritis posterior mediante tomografía de coherencia óptica Swept-Source / Posterior scleritis follow-up by Swept-Source optical coherence tomography

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Análisis del DRCR Network sobre coste-efectividad de aflibercept, bevacizumab y ranibizumab para el tratamiento de edema macular diabético y su aplicación en España / The diabetic retinopathy clinical research network analysis of the cost-effectiveness of aflibercept, bevacizumab and ranibizumab for the treatment of diabetic macular oedema and its application in Spain

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Metotrexato como tratamiento en el penfigoide ocular cicatricial moderado / Methotrexate as a treatment in ocular cicatricial moderate pemphigoid

CASO CLÍNICO: Una mujer de 73 años se presenta con historia de molestias inespecíficas y fotofobia en ambos ojos (AO) de un año de evolución. A la exploración se observa un simbléfaron bilateral y acortamiento de fondos de saco. El análisis inmunohistoquímico (IHQ) confirma la presencia de un depósito lineal de Ig G, Ig M y C3 a lo largo de la membrana basal conjuntival. Ante el diagnóstico de penfigoide ocular cicatricial (POC) se pauta tratamiento sistémico mediante metotrexato (MTX) subcutáneo. DISCUSIÓN: Consideramos dicho tratamiento una alternativa inmunosupresora inicial muy eficaz en pacientes con inflamación conjuntival moderada y en casos de rápida progresión

CLINICAL CASE: A 73 year-old woman presented with a history of non-specific symptoms and photophobia in both eyes of 1 year progression. The examination revealed a bilateral symblepharon and fornix shortening. Immunohistochemical analysis confirmed the presence of linear deposits of IgG, IgM and C3 along the conjunctival basement membrane. With the diagnosis of Ocular Cicatricial Pemphigoid, systemic treatment with subcutaneous methotrexate was prescribed. DISCUSSION: We consider such treatment a very effective initial immunosuppressive alternative in patients with moderate conjunctival inflammation and in cases of rapid progression

Éter etílico: un viejo aliado contra la blefaritis por Demodex resistente a ivermectina oral / Ethyl ether: an old ally against oral ivermectin resistant demodex blepharitis

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Methotrexate as a treatment in ocular cicatricial moderate pemphigoid.

CLINICAL CASE: A 73 year-old woman presented with a history of non-specific symptoms and photophobia in both eyes of 1 year progression. The examination revealed a bilateral symblepharon and fornix shortening. Immunohistochemical analysis confirmed the presence of linear deposits of IgG, IgM and C3 along the conjunctival basement membrane. With the diagnosis of Ocular Cicatricial Pemphigoid, systemic treatment with subcutaneous methotrexate was prescribed. DISCUSSION: We consider such treatment a very effective initial immunosuppressive alternative in patients with moderate conjunctival inflammation and in cases of rapid progression.

Queratectomía superficial mediante láser de femtosegundo como tratamiento de la queratopatía en banda bilateral / Femtosecond laser-assisted superficial keratectomy as a treatment for bilateral band keratopathy

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Sensimed Triggerfish ® como nuevo sistema para el registro continuo de tensión intraocular durante 24 horas en pacientes con glaucoma / Sensimed Triggerfish ® as a new system for continuous recording of 24-hour intraocular pressure in glaucoma patients

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Q fever: a new ocular manifestation.

Q Fever is a zoonosis caused by Coxiella burnetii. Ocular manifestations are rare in this infection. We describe the case of a man complaining of an intense retro-orbital headache, fever, arthralgia, and bilateral loss of vision, who showed an anterior uveitis accompanied by exudative bilateral inferior retinal detachment and optic disk edema. At the beginning, a Vogt-Koyanagi-Harada (VKH) syndrome was suspected, but the patient was diagnosed with Q fever and treatment with doxycycline was initiated, with complete resolution after 2 weeks. We wondered if Q fever could unleash VKH syndrome or simulate a VKH syndrome by a similar immunological process.

[Intraocular levels of pigment epithelium-derived factor in patients with active uveitis]. / Niveles intraoculares del factor derivado del epitelio pigmentario en pacientes con uveítis activa.

OBJECTIVE: Pigment epithelium-derived factor (PEDF) is an antiangiogenic/neurotrophic dual functional factor, and recently it was also shown to mediate antioxidative and anti-inflammatory action. The purpose of this study was to evaluate the levels of PEDF in the aqueous humor in eyes with idiopathic acute anterior uveitis (IAAU). METHODS: A comparative control study. Aqueous humor was collected from 20 eyes of 20 patients with IAAU. The control group included 20 aqueous humor samples from 20 patients who underwent a cataract surgery and without any other ocular or systemic diseases. Levels of PEDF were determined with the ELISA test. RESULTS: Concentration of PEDF in aqueous humor was remarkably higher in patients with IAAU than in control subjects (Mann-Whitney U test, P<.001). Levels of PEDF were 6,291,637.70±8,564,836.48 pg/ml (mean±SD) in eyes with IAAU and 449,178.10±158,670.19 pg/ml in the eyes of the control group. CONCLUSION: The aqueous humor PEDF levels are increased in eyes with IAAU and may be increased as self-protection against inflammation.

Niveles intraoculares del factor derivado del epitelio pigmentario en pacientes con uveítis activa / Intraocular levels of pigment epithelium-derived factor in patients with active uveitis

Objetivo: El factor derivado del epitelio pigmentario (PEDF) es un factor antiangiogénico yneurotrófico que recientemente también ha demostrado tener poder antioxidante y antiinflamatorio.El objetivo de nuestro estudio fue determinar los niveles de PEDF en humoracuoso de ojos con uveítis anterior aguda idiopática (UAAI).Métodos: Se realizó un estudio comparativo con grupo control. El humor acuoso fue estudiadoen 20 ojos de 20 pacientes con UAAI. El grupo control comprendía 20 muestras de humoracuoso de 20 pacientes intervenidos de cataratas, sin ninguna otra enfermedad ocular nisistémica. Los niveles de PEDF se determinaron mediante el test de ELISA.Resultados: La concentración de PEDF en humor acuoso fue marcadamente superior en lospacientes con UAAI que en los sujetos control (test U Mann-Whitney, p < 0,001). Los nivelesde PEDF fueron 6.291.637,70±8.564.836,48 pg/ml (media±DS) en los ojos con UAAI y449.178,10±158.670,19 pg/ml en los ojos del grupo control.Conclusiones: Los niveles de PEDF en humor acuoso están aumentados en ojos con UAAI locual podría considerarse como un mecanismo de autoprotección frente a la inflamación(AU)

Objective: Pigment epithelium-derived factor (PEDF) is an antiangiogenic/neurotrophic dualfunctional factor, and recently it was also shown to mediate antioxidative and antiinflammatoryaction. The purpose of this study was to evaluate the levels of PEDF in theaqueous humor in eyes with idiopathic acute anterior uveitis (IAAU).Methods: A comparative control study. Aqueous humor was collected from 20 eyes of 20 patients with IAAU. The control group included 20 aqueous humor samples from 20 patients who underwent a cataract surgery and without any other ocular or systemic diseases. Levels of PEDF were determined with the ELISA test. Results: Concentration of PEDF in aqueous humor was remarkably higher in patientswith IAAU than in control subjects (Mann-Whitney U test, P < .001). Levels of PEDF were6,291,637.70±8,564,836.48 pg/ml (mean±SD) in eyes with IAAU and 449,178.10±158,670.19pg/ml in the eyes of the control group.Conclusion: The aqueous humor PEDF levels are increased in eyes with IAAU and may beincreased as self-protection against inflammation(AU)

[Enzymatic vitrectomy by intravitreal autologous plasmin injection as initial treatment for macular epiretinal membranes and vitreomacular traction syndrome]. / Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial de las membranas epirretinianas maculares y el síndrome de tracción vitreomacular.

PURPOSE: To determine the effectiveness of intravitreal plasmin injection in the treatment of macular epiretinal membranes (MEM) and vitreomacular traction syndrome (VMTS) without associated pars plana vitrectomy. DESIGN: Interventional, prospective, case series pilot study. PATIENTS: Seven patients were enrolled in the study, 4 with MEM and 3 with VMTS. TREATMENT: 0.2 ml of autologous plasmin intravitreally injected under topical anesthesia was administered to all patients. The plasmin was obtained by a simplified method with urokinase. MAIN OUTCOME MEASURES: Degree of detachment of the MEM and the VMTS measured by optical coherence tomography (OCT), and the best corrected visual acuity (Snellen scale) before and one month after the plasmin injection. RESULTS: The follow-up period was completed by all the patients. The MEM remained attached to the retina in all cases, as measured either by biomicroscopy or OCT. The VMTS was completely detached from the foveal area in all cases, with the disappearance of secondary tractional retinal folds and recovery of the normal macular anatomic architecture as measured by OCT. Visual acuity was not modified in any of the MEM patients, and improved in all VMTS patients. No adverse effects were observed. CONCLUSION: In our case series, intravitreally injected autologous plasmin was not effective in the treatment of MEM, but resolved VMTS successfully, improving the visual acuity and releasing the retinal traction without the need for associated pars plana vitrectomy. Larger studies to confirm the efficacy of this technique and the possibility of success after repeated injections are warranted.

Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial de las membranas epirretinianas maculares y el síndrome de tracción vitreomacular / Enzymatic vitrectomy by intravitreal autologous plasmin injection as initial treatment for macular epiretinal membranes and vitreomacular traction syndrome

Objetivo: Determinar si la inyección intravítrea de plasmina es efectiva en el tratamiento de las membranas epirretinianas maculares (MEM) y el síndrome de tracción vitreomacular (STVM), sin necesidad de asociar vitrectomía quirúrgica.Material y método: Diseño: Estudio piloto prospectivo, de intervención, serie de casos.Pacientes: Siete pacientes, cuatro con membranaepirretiniana macular y tres con síndrome de tracciónvitreomacular.Tratamiento: Inyección intravítrea de 0,2 ml de plasmina autóloga bajo anestesia tópica. La plasminafue obtenida por un método simplificado modificado por adicción de uroquinasa.Principales medidas: Grado de separación de la membrana epirretiniana de la retina medido portomografía de coherencia óptica (OCT) y la mejor agudeza visual corregida (escala Snellen), antes y almes de la inyección de plasmina.Resultados: Todos los pacientes completaron el seguimiento de 1 mes. La membrana epirretiniana(MEM) permaneció oftalmoscópicamente adherida, sin cambios ni separación del plano de la retina. Sin embargo, en los casos con síndrome de tracciónvitreomacular (STVM), la membrana se despegó del área foveal, desapareciendo los pliegues retinianostraccionales secundarios, y normalizando la mácula la estructura anatómica. La agudeza visualno se modificó en ninguno de los casos de membrana epirretiniana y mejoró en los casos de síndromede tracción vitreomacular. No se observaron efectos secundarios.Conclusión: La inyección intravítrea de plasmina autóloga como tratamiento inicial previo a la vitrectomíaquirúrgica, en la serie de casos estudiada, parece ineficaz en las membranas epirretinianasmaculares, y más eficaz en el síndrome de tracción vitreomacular, mejorando en este último la agudeza visual y consiguiendo el despegamiento al menosparcial de la membrana. Estudios más amplios son necesarios para confirmar su eficacia y la posibilidad de incrementar la misma con reinyeccionesperiódicas de plasmina(AU)

Purpose: To determine the effectiveness of intravitrealplasmin injection in the treatment of macular epiretinalmembranes (MEM) and vitreomacular traction syndrome(VMTS) without associated pars plana vitrectomy.Methods:Design: Interventional, prospective, case seriespilot study.Patients: Seven patients were enrolled in the study,4 with MEM and 3 with VMTS.Treatment: 0.2 ml of autologous plasmin intravitreallyinjected under topical anesthesia was administered to all patients. The plasmin was obtained by a simplifiedmethod with urokinase.Main outcome measures: Degree of detachment ofthe MEM and the VMTS measured by optical coherencetomography (OCT), and the best correctedvisual acuity (Snellen scale) before and one monthafter the plasmin injection.Results: The follow-up period was completed byall the patients. The MEM remained attached to theretina in all cases, as measured either by biomicroscopyor OCT. The VMTS was completely detachedfrom the foveal area in all cases, with the disappearanceof secondary tractional retinal folds and recoveryof the normal macular anatomic architecture asmeasured by OCT. Visual acuity was not modifiedin any of the MEM patients, and improved in allVMTS patients. No adverse effects were observed.Conclusion: In our case series, intravitreally injectedautologous plasmin was not effective in the treatmentof MEM, but resolved VMTS successfully, improvingthe visual acuity and releasing the retinal tractionwithout the need for associated pars planavitrectomy. Larger studies to confirm the efficacy ofthis technique and the possibility of success afterrepeated injections are warranted(AU)