Modification of the inverted flap technique compared to conventional internal limiting membrane peeling in complete macular hole surgery.

AIM: To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM). METHODS: Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed. RESULTS: A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957). CONCLUSIONS: The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.

Técnica modificada del flap invertido superior con vitrectomía versus vitrectomía con pelado de membrana limitante interna para el desprendimiento de retina con agujero macular miópico / Modified superior inverted internal limiting membrane flap technique with vitrectomy versus vitrectomy with internal limiting membrane peeling for retinal detachment with myopic macular hole

Objetivo Evaluar la eficacia de la técnica del flap invertido superior de membrana limitante interna (MLI) modificada para el tratamiento del desprendimiento de retina (DR) por agujero macular (AM), comparada con el pelado clásico de la MLI. Materiales y métodos Análisis retrospectivo de 10 pacientes que requirieron vitrectomía pars plana por DR con AM. Se dividieron en dos grupos, según la técnica quirúrgica realizada: grupo del flap (5 pacientes) y de pelado de MLI (5 pacientes). Se comparó la agudeza visual mejor corregida (AVMC) pre y posquirúrgica, la resolución del DR, la tasa de cierre del AM y la restauración de las capas externas de la retina entre los grupos. Resultado La AVMC poscirugía mejoró en ambos grupos, sin diferencias significativas (p=0,9). La tasa de cierre del AM fue del 100% en el grupo del flap y del 80% del grupo de pelado de la MLI, sin diferencias significativas entre los grupos. La retina se reaplicó en el 100% de los casos en ambos grupos. Solo se restauraron las capas externas de la retina en 2 pacientes del grupo del flap invertido (40%) y en ninguno del grupo de pelado de la MLI (p=0,62). Conclusiones Las técnicas de pelado de MLI y del flap invertido superior modificada son útiles para el tratamiento del DR con agujero macular en ojos miopes (AU)

Purpose To evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling. Methods Retrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups. Results There were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12months after surgery (P=.9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (P=.62). Conclusions ILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes (AU)

Modified superior inverted internal limiting membrane flap technique with vitrectomy versus vitrectomy with internal limiting membrane peeling for retinal detachment with myopic macular hole.

PURPOSE: To evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling. METHODS: Retrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups. RESULTS: There were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (p=0.9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (p=0.62). CONCLUSIONS: ILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.

Predictors of good visual outcomes in patients with neovascular age-related macular degeneration in daily practice.

PURPOSE: To report predictive factors for therapeutic response to anti-VEGF in patients with neovascular age-related macular degeneration (nAMD) in daily clinical practice in our patient population. METHODS: Retrospective cohort study including 56 patients (69 eyes) with nAMD treated with anti-VEGF, followed for at least two years between February 2012 and April 2018. Patients received three intravitreal anti-VEGF (bevacizumab) injections (loading dose) and were monitored and treated according to a PRN regimen. We analysed whether a gain in visual acuity of 15 or more ETDRS letters at the final visit was associated with demographic characteristics, presence of systemic comorbidities, fundus lesions or measurable improvement on Cirrus optical coherence tomography (OCT) between the first and last visit. RESULTS: After a mean follow-up of 15.5 months (4.7-27.8 interquartile range), central retinal thickness (CRT) (RR: 1.004; IC 95%: 1.001-1.007; P=0.011) and macular hemorrhage (RR: 0.30; IC 95%: 0.10-0.90, P=0.032) at baseline were found to be useful predictive factors for visual acuity improvement (≥15 letters) in patients treated for nAMD by anti-VEGF in a real world clinical setting. CONCLUSION: In the present series of patients with nAMD receiving a loading dose of bevacizumab and followed according to a PRN regimen for 24 months, the only predictable factors for a ≥15 letter gain in visual acuity were anatomical response as measured by OCT and macular hemorrhage at baseline.

Retinal pigment epithelial tears.

A retinal pigment epithelial (RPE) tear is a well-known complication of retinal pigment epithelial detachments (PED) and may cause a significant visual impairment. The most common cause is a vascularized PED in patients with exudative age-related macular degeneration (AMD). The development of diagnostic imaging techniques brings us closer to the etiology and pathophysiological mechanisms of this entity, offering us new strategies for treatment and follow-up. The advent of intravitreal antiangiogenic treatment (anti-VEGF) has led to an increase in the number of reported cases of RPE tears, which are an important vision-limiting factor during treatment. However, RPE tears may occur spontaneously or as a consequence of thermal laser treatment, photodynamic therapy or anti-VEGF therapy. It is accepted that the mechanism of RPE tears is multifactorial. The optimization of the functional outcome of this complication has been described with continuous treatment with antiangiogenic drugs. The goal of the present review is to evaluate the incidence, risk factors and treatment of RPE tears.

Atrofia geográfica: etiopatogenia y terapias actuales / Geographic atrophy: Etiopathogenesis and current therapies

La atrofia geográfica se caracteriza por un déficit visual severo cuya etiología y fisiopatología aún están por dilucidar. Como hipótesis de trabajo, el daño oxidativo desencadenaría una inflamación crónica en el complejo membrana de Bruch-EPR-coriocapilar, cobrando protagonismo la activación del complemento. Algunos sujetos con mutaciones en el sistema del complemento y otros factores tienen menor capacidad en la modulación de la respuesta inflamatoria, lo que se traduce en daño celular y acumulación de desechos. Esta acumulación de desechos intracelulares y extracelulares se manifiesta como drusas y alteraciones pigmentarias que preceden a la atrofia de fotorreceptores, EPR y coriocapilar, existiendo un proceso isquémico de base con disminución del flujo coroideo. Todos estos procesos se objetivan como hallazgos tomográficos y signos de la autofluorescencia que son útiles en la evaluación de los pacientes con DMAE atrófica, pudiendo establecer un pronóstico individualizado. Terapias antiinflamatorias, antioxidantes y reductora de la acumulación de toxinas para la preservación de células del EPR y fotorreceptores están siendo investigadas para disminuir el avance de esta enfermedad

Geographic atrophy is characterized by severe visual deficit whose etiology and pathophysiology are yet to be elucidated. As a working hypothesis, oxidative damage could trigger a chronic inflammation in Bruch's membrane-RPE-choriocapillaris complex, mostly due to complement pathway overactivation. Some individuals with mutations in the complement system and other factors have diminished capacity in the modulation of the inflammatory response, which results in cell damage and waste accumulation. This accumulation of intracellular and extracellular waste products manifests as drusen and pigmentary changes that precede the atrophy of photoreceptors, RPE, choriocapillaris with an ischemic process with decreased choroid flow. All these processes can be detected as tomographic findings and autofluorescence signals that are useful in the evaluation of patients with atrophic AMD, which helps to establish an individualized prognosis. Anti-inflammatory, antioxidant and therapies that decrease the accumulation of toxins for the preservation of the RPE cells and photoreceptors are being investigated in order to slow down the progression of this disease

Geographic atrophy: Etiopathogenesis and current therapies. / Atrofia geográfica: etiopatogenia y terapias actuales.

Geographic atrophy is characterized by severe visual deficit whose etiology and pathophysiology are yet to be elucidated. As a working hypothesis, oxidative damage could trigger a chronic inflammation in Bruch's membrane-RPE-choriocapillaris complex, mostly due to complement pathway overactivation. Some individuals with mutations in the complement system and other factors have diminished capacity in the modulation of the inflammatory response, which results in cell damage and waste accumulation. This accumulation of intracellular and extracellular waste products manifests as drusen and pigmentary changes that precede the atrophy of photoreceptors, RPE, choriocapillaris with an ischemic process with decreased choroid flow. All these processes can be detected as tomographic findings and autofluorescence signals that are useful in the evaluation of patients with atrophic AMD, which helps to establish an individualized prognosis. Anti-inflammatory, antioxidant and therapies that decrease the accumulation of toxins for the preservation of the RPE cells and photoreceptors are being investigated in order to slow down the progression of this disease.

Breve historia de los anteojos / A short history of glasses

No disponible

Nieve visual. ¿Del síntoma al síndrome? / Visual snow. From a symptom to a syndrome?

No disponible