Impacto presupuestario de XEN®63 en el tratamiento del glaucoma primario de ángulo abierto en España / Budget impact analysis of the XEN®63 for the treatment of primary open angle glaucoma in Spain

Antecedentes y objetivo Evaluar el impacto económico en España derivado de la introducción del implante XEN®63 como alternativa quirúrgica en el manejo del glaucoma primario de ángulo abierto (GPAA) con o sin cataratas en pacientes refractarios. Materiales y métodos Se diseñó un análisis de impacto presupuestario para estimar los costes del tratamiento quirúrgico del GPAA desde la perspectiva del Sistema Nacional de Salud (SNS) español, en un horizonte temporal de1 año. Los comparadores considerados (trabeculectomía, esclerectomía profunda no perforante, válvula de Ahmed, iStent inject®, Preserflo® microshunt y XEN®45) se corresponden a los empleados en la práctica clínica pública española. Para el cálculo de la población diana, cuotas de mercado y uso de recursos en términos de visitas de seguimiento, procedimientos adicionales y complicaciones poscirugía, se emplearon datos de la literatura y se validaron con un panel de cuatro expertos. Los costes unitarios (€de2021) se obtuvieron de la base de datos ESALUD Resultados la inclusión de XEN®63 podría generar un ahorro de 2.569.737€ tras un año desde su introducción, derivado del ahorro en el coste del implante y del procedimiento (−423.120; −0,7%), de las visitas de seguimiento (−777.407€; −4,5%), de los procedimientos adicionales (−1.048.145€, −20,6%) y de las complicaciones poscirugía (−321.065€, −14,2%). Conclusiones La incorporación de XEN®63 en el arsenal quirúrgico para el tratamiento del GPAA refractario con y sin cataratas podría generar ahorros para el SNS (AU)

Background and objective To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. Materials and methods A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1year. The comparators considered (trabeculectomy, deep non-perforating sclerectomy, Ahmed valve, iStent inject®, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€2021) were obtained from the ESALUD database. Result The inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (−€423,120; −0.7%), follow-up visits (−€777,407; −4.5%), additional procedures (−1,048,145; −20.6%) and post-surgery complications (−€321,065; −14.2%). Conclusion The incorporation of XEN®63 in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS (AU)

Budget impact analysis of the XEN®63 for the treatment of primary openangle glaucoma in Spain.

BACKGROUND AND OBJECTIVE: To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. MATERIALS AND METHODS: A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1 year. The comparators considered (trabeculectomy, deep non-penetrating sclerectomy, Ahmed valve, iStent inject, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€ 2021) were obtained from the ESALUD database. RESULTS: The inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (-€423,120; -0.7%), follow-up visits (-€777,407; -4.5%), additional procedures (-€1,048,145; -20.6%) and post-surgery complications (-€321,065; -14.2%). CONCLUSIONS: The incorporation of XEN63®in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS.

Espolonectomía: una nueva modificación de la esclerectomía profunda no perforante / Spurectomy: A novel modification of non-penetrating deep sclerectomy

Objetivos Evaluar los resultados de una nueva modificación de la esclerectomía profunda no perforante (EPNP) denominada espolonectomía. Métodos Estudio retrospectivo no aleatorizado y comparativo que incluyó 98 ojos (grupoA) operados con espolonectomía, que consiste en la combinación de la escisión del espolón escleral con EPNP. El grupo control (B) incluyó 53 ojos operados con EPNP clásica. Durante 12meses se estudiaron la presión intraocular (PIO), los medicamentos antiglaucomatosos que requirieron y las complicaciones. Resultados La PIO media disminuyó de 25,69±8,11 preoperatoria a 15,73±4,16mmHg después de la cirugía en el grupoA (p<0,001). En el grupoB disminuyó de 26,66±5,93 preoperatoria a 18,19±5,93mmHg postoperatoria (p<0,001). Las diferencias entre grupos de la PIO postoperatoria fue estadísticamente significativa (p<0,001). A los 12meses después de la cirugía, el 13,27 y el 52,83% de ojos en los gruposA yB requirieron tratamiento antihipertensivo tópico (p<0,001). La tasa de éxito absoluto después de la cirugía fue del 87,5 y del 47,17% en los gruposA yB, con una tasa significativamente mayor de éxito relativo en el grupoB (p<0,001). No hubo diferencias significativas entre los grupos en la tasa de complicaciones (p=0,960). La complicación postoperatoria más frecuente fue la microperforación de la membrana trabeculo-descemética en ambos grupos. Conclusiones La espolonectomía es una técnica segura y eficaz en comparación con la EPNP convencional y parece una alternativa prometedora en el tratamiento quirúrgico del glaucoma, optimizando la eficacia del tratamiento y minimizando las complicaciones (AU)

Purpose To evaluate the outcomes of a novel modification of the non-penetrating deep sclerectomy (NPDS) approach for glaucoma management called spurectomy. Methods Observational comparative non-randomized retrospective study including 98 glaucomatous eyes of 76 patients operated on with the spurectomy technique consisting of the combination of the excision of the scleral spur with NPDS (groupA). A control group (groupB) including 53 glaucomatous eyes of 43 patients operated on with classical NPDS was also included. Changes in intraocular pressure (IOP) and medications required as well as complications were recorded in a 12-month follow-up. Results Mean IOP decreased from 25.69±8.11 preoperatively to 15.73±4.16mm Hg postoperatively in groupA (p<0.001). In groupB, mean IOP decreased from 26.66±5.93 preoperatively to 18.19±5.93mm Hg postoperatively (P<.001). Differences between groups in postoperative IOP was statistically significant (P<.001). At 12months after surgery, 13.27% and 52.83% of eyes in groupsA andB required topical antihypertensive therapy (P<.001). The rate of absolute success after surgery was 87.5% and 47.17% in groupsA andB, with significantly higher rate of relative success in groupB (P<.001). No significant differences among groups were found in the complication rate (P=.960). The most common postoperative complication was microperforation of the trabeculo-descemetic membrane in both groups. Conclusions Spurectomy is a safe and effective technique when compared with conventional NPDS and seems a promising alternative in the surgical management of glaucoma, optimizing the efficacy of the treatment and minimizing complications (AU)

Spurectomy: A novel modification of non-penetrating deep sclerectomy. / Espolonectomía: una nueva modificación de la esclerectomía profunda no perforante.

PURPOSE: To evaluate the outcomes of a novel modification of the non-penetrating deep sclerectomy (NPDS) approach for glaucoma management called spurectomy. METHODS: Observational comparative non-randomized retrospective study including 98 glaucomatous eyes of 76 patients operated on with the spurectomy technique consisting of the combination of the excision of the scleral spur with NPDS (groupA). A control group (groupB) including 53 glaucomatous eyes of 43 patients operated on with classical NPDS was also included. Changes in intraocular pressure (IOP) and medications required as well as complications were recorded in a 12-month follow-up. RESULTS: Mean IOP decreased from 25.69±8.11 preoperatively to 15.73±4.16mm Hg postoperatively in groupA (p<0.001). In groupB, mean IOP decreased from 26.66±5.93 preoperatively to 18.19±5.93mm Hg postoperatively (P<.001). Differences between groups in postoperative IOP was statistically significant (P<.001). At 12months after surgery, 13.27% and 52.83% of eyes in groupsA andB required topical antihypertensive therapy (P<.001). The rate of absolute success after surgery was 87.5% and 47.17% in groupsA andB, with significantly higher rate of relative success in groupB (P<.001). No significant differences among groups were found in the complication rate (P=.960). The most common postoperative complication was microperforation of the trabeculo-descemetic membrane in both groups. CONCLUSIONS: Spurectomy is a safe and effective technique when compared with conventional NPDS and seems a promising alternative in the surgical management of glaucoma, optimizing the efficacy of the treatment and minimizing complications.

Uso de sustituto semisintético de duramadre como injerto tras extrusión de prótesis en una cavidad anoftálmica / Use of semisynthetic dura mater substitute as a patch graft for prosthesis extrusion in anophthalmic socket

Presentamos un caso de una paciente de 3 años de edad con diagnóstico de retinoblastoma en el ojo izquierdo. El curso de la enfermedad obligó a la enucleación de dicho ojo e implantación de una prótesis. Dos años tras la cirugía, se produjo una extrusión parcial de la prótesis en la cavidad anoftálmica y se decidió emplear un sustituto semisintético de duramadre para cubrir el defecto. El uso de un sustituto semisintético de duramadre en este escenario específico no ha sido comunicado previamente

We present a case report of a three-year old patient diagnosed with retinoblastoma in her left eye. The course of the disease made enucleation of the latter eye and a prosthesis implant necessary. Two years after surgery, partial prosthesis extrusion occurred and a semisynthetic dura mater substitute was used as a patch graft to cover the defect. To our knowledge, semisynthetic dura mater substitutes' use in this scenario has not been previously reported

Use of semisynthetic dura mater substitute as a patch graft for prosthesis extrusion in anophthalmic socket. / Uso de sustituto semisintético de duramadre como injerto tras extrusión de prótesis en una cavidad anoftálmica.

We present a case report of a three-year old patient diagnosed with retinoblastoma in her left eye. The course of the disease made enucleation of the latter eye and a prosthesis implant necessary. Two years after surgery, partial prosthesis extrusion occurred and a semisynthetic dura mater substitute was used as a patch graft to cover the defect. To our knowledge, semisynthetic dura mater substitutes' use in this scenario has not been previously reported.

Actualización de la utilidad de la tomografía de coherencia óptica para el estudio del ángulo iridocorneal / Update on the usefulness of optical coherence tomography in assessing the iridocorneal angle

El ángulo iridocorneal por sus implicaciones en la fisiopatología del drenaje del humor acuoso es una estructura fundamental de la cámara anterior. La tomografía de coherencia óptica de segmento anterior es una técnica rápida y no invasiva que obtiene imágenes de los tejidos vivos con una alta resolución permitiendo conocer la anatomía normal del ángulo, sus alteraciones y los cambios que se producen en el mismo tras diferentes intervenciones terapéuticas. La tecnología de la tomografía de coherencia óptica de segmento anterior ha ido evolucionando hasta ofrecer imágenes que permiten identificar y cuantificar estructuras angulares claves en sujetos sanos y en pacientes con glaucoma, especialmente la malla trabecular y el canal de Schlemm, lo que puede contribuir a ampliar el conocimiento de la fisiopatología del glaucoma. Además, permite cuantificar la abertura angular con unos parámetros objetivos descritos en los últimos años, entre los que destacan el ángulo iridotrabecular, la distancia de abertura angular y el área iridotrabecular. La tomografía de coherencia óptica de segmento anterior presenta múltiples utilidades en el estudio de los distintos mecanismos del cierre angular, la evaluación de los cambios angulares tras la realización de una iridotomía láser o iridoplastia, cirugía de la catarata o el implante de lentes fáquicas

The iridocorneal angle, due to its implications in the physiopathology of aqueous humour drainage, is a fundamental structure of the anterior chamber. Anterior segment optical coherence tomography is a rapid and non-invasive technique that obtains images in vivo. The high resolution allows it to analyse the normal anatomy of the angle, any alterations, and the changes that occur after different therapeutic interventions. Anterior segment optical coherence tomography technology has evolved to provide images that allow the identification and quantification of the angular structures in healthy subjects and in glaucoma patients, and especially the trabecular meshwork and the Schlemm's canal. It also enables the angle width to be quantified, with some objective parameters that have been standardised in recent years, such as the trabecular-iris angle, the angle opening distance, and the trabecular-iris area. This technique has multiple uses in the study of the different mechanisms of angle closure, the evaluation of changes after a laser peripheral iridotomy or iridoplasty after cataract surgery, as well as after the implantation of phakic lenses

Update on the usefulness of optical coherence tomography in assessing the iridocorneal angle. / Actualización de la utilidad de la tomografía de coherencia óptica para el estudio del ángulo iridocorneal.

The iridocorneal angle, due to its implications in the physiopathology of aqueous humour drainage, is a fundamental structure of the anterior chamber. Anterior segment optical coherence tomography is a rapid and non-invasive technique that obtains images in vivo. The high resolution allows it to analyse the normal anatomy of the angle, any alterations, and the changes that occur after different therapeutic interventions. Anterior segment optical coherence tomography technology has evolved to provide images that allow the identification and quantification of the angular structures in healthy subjects and in glaucoma patients, and especially the trabecular meshwork and the Schlemm's canal. It also enables the angle width to be quantified, with some objective parameters that have been standardised in recent years, such as the trabecular-iris angle, the angle opening distance, and the trabecular-iris area. This technique has multiple uses in the study of the different mechanisms of angle closure, the evaluation of changes after a laser peripheral iridotomy or iridoplasty after cataract surgery, as well as after the implantation of phakic lenses.

Tomografía de coherencia óptica de segmento anterior en el seguimiento de hendidura de ciclodiálisis / Anterior segment optical coherence tomography in the follow up of cyclodialysis cleft

No disponible

Iridoplastia periférica con láser argón y tomografía de coherencia óptica de segmento anterior en el manejo del cierre angular agudo del siglo XXI / Argon laser peripheral iridoplasty and anterior segment optical coherence tomography in the management of acute angle closure in the 21st century

No disponible

Obstrucción de la arteria ciliorretiniana durante el embarazo / Cilioretinal obstruction during pregnancy

Objetivos: Conocer la incidencia de obstrucción aislada de la arteria ciliorretiniana (OACR) en nuestra serie, a lo largo de 5 años, y describir la incidencia, evolución y secuelas oftalmológicas de esta entidad en el embarazo. Métodos: Estudio retrospectivo, descriptivo, observacional de serie de casos. Resultados: De los 135 pacientes diagnosticados de oclusión arterial retiniana del total de nuestra serie, 20 (14,8%) presentaban OACR, de los cuales 2 (1,48%) eran mujeres embarazadas. Caso 1: mujer embarazada de 34 años, con escotoma centrocecal y agudeza visual de 1 en ojo derecho. Fondo de ojo: exudado algodonoso en el haz papilomacular con edema retiniano y émbolos en una de las ramas de la arteria ciliorretiniana. A las 5 semanas el exudado y el edema habían desaparecido, con reducción del escotoma. Caso 2: mujer embarazada de 30 años, que presenta de forma brusca escotoma centrocecal en el ojo derecho con agudeza visual de 1. Fondo de ojo: exudación lipídica y mancha algodonosa en haz interpapilomacular secundarias a la OACR. A las 4 semanas habían desaparecido los hallazgos en fondo de ojo, con resolución completa de la sintomatología. Conclusiones: La etiología de la OACR suele estar relacionada con enfermedad carotídea u otros procesos tromboembólicos relacionados con estados de hipercoagulabilidad y autoinmunidad. El embarazo es considerado un estado de hipercoagulación, sin embargo, no se ha podido demostrar que se trate de un factor de riesgo per se para desarrollar embolia arterial. Por tanto, se necesitan estudios adicionales para conocer la correlación entre embarazo y OACR (AU)

Purpose: To determine the number of patients diagnosed over a 5-year period with isolated occlusion of the cilioretinal artery (CRAO) whilst pregnant, as well as to describe the outcomes and ophthalmological sequelae of this condition in pregnant woman. Methods: A retrospective study of the medical records. Results: From the 135 patients diagnosed with retinal arterial occlusion of all of our series, 20 (14.8%) had CRAO, and 2 (1.48%) of these were pregnant. Case 1: A 34 year-old pregnant woman with a centrocaecal scotoma and visual acuity of 20/20 in right eye. Fundus examination: A soft exudate in the papillomacular bundle with retinal oedema and embolism on a cilioretinal artery branch. The exudate and oedema disappeared after 5 weeks, and the scotoma was reduced. Case 2: A 30 year-old pregnant woman, with normal visual acuity in right eye, and a centrocaecal scotoma. Fundoscopy: An area of retinal interpapillomacular infarction due to cilioretinal artery occlusion. The fundus returned to normal in 4 weeks, with an improvement of the scotoma. Conclusions: The aetiology of CRAO is usually associated with carotid disease or other thromboembolic events related to hypercoagulable states and autoimmunity. Pregnancy is considered a hypercoagulable state, and it is not known if it is a risk factor for arterial embolism. Further studies are required to determine the correlation between pregnancy and CRAO (AU)

Cilioretinal obstruction during pregnancy. / Obstrucción de la arteria ciliorretiniana durante el embarazo.

PURPOSE: To determine the number of patients diagnosed over a 5-year period with isolated occlusion of the cilioretinal artery (CRAO) whilst pregnant, as well as to describe the outcomes and ophthalmological sequelae of this condition in pregnant woman. METHODS: A retrospective study of the medical records. RESULTS: From the 135 patients diagnosed with retinal arterial occlusion of all of our series, 20 (14.8%) had CRAO, and 2 (1.48%) of these were pregnant. Case 1: A 34 year-old pregnant woman with a centrocaecal scotoma and visual acuity of 20/20 in right eye. Fundus examination: A soft exudate in the papillomacular bundle with retinal oedema and embolism on a cilioretinal artery branch. The exudate and oedema disappeared after 5 weeks, and the scotoma was reduced. Case 2: A 30 year-old pregnant woman, with normal visual acuity in right eye, and a centrocaecal scotoma. Fundoscopy: An area of retinal interpapillomacular infarction due to cilioretinal artery occlusion. The fundus returned to normal in 4 weeks, with an improvement of the scotoma. CONCLUSIONS: The aetiology of CRAO is usually associated with carotid disease or other thromboembolic events related to hypercoagulable states and autoimmunity. Pregnancy is considered a hypercoagulable state, and it is not known if it is a risk factor for arterial embolism. Further studies are required to determine the correlation between pregnancy and CRAO.

Melanocitoma de nervio óptico / Optic nerve melanocytoma

No disponible

La isla mínima / The minimun island

No disponible

¿Sirve para algo la lente de Goldman en el glaucoma por cierre angular? / Is the Goldman lens any good in angle-closure glaucoma?

No disponible