Correlación entre la sensibilidad al contraste y las características morfológicas obtenidas por OCT en pacientes con degeneración macular relacionada con la edad avanzada tratados con dosis de carga de inhibidores del factor de crecimiento endotelial vascular / Correlation between contrast sensitivity and morphological features obtained by OCT in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors

Objetivo Determinar la correlación entre la sensibilidad al contraste y las características morfológicas obtenidas por tomografía de coherencia óptica en pacientes con degeneración macular relacionada con la edad avanzada tratados con dosis de carga de inhibidores del factor de crecimiento endotelial vascular (anti-VEGF). Diseño Se trata de un estudio ambispectivo (prospectivo+retrospectivo) observacional y analítico. Participantes Todos los pacientes de 55 años o más con degeneración macular relacionada con la edad que acudieron al departamento de Retina del servicio de Oftalmología y cumplieron con los criterios de inclusión entre marzo-mayo de 2022. Métodos Se recolectaron los datos por medio de la revisión de expedientes. Se analizaron los estudios de tomografía de coherencia óptica previa a la aplicación de inyecciones intravítreas de los pacientes que se encontraban en el mes posterior a la última dosis. Se incluyeron un total de 33 sujetos y un total de 30 continuaron seguimiento. Se realizaron pruebas de normalidad (Shapiro y Bartlett) entre los grupos de estudio, dando como resultado grupos no normales no homocedásticos. Los sujetos fueron sometidos a una nueva evaluación oftalmológica y nueva toma de mediciones retinianas. Resultados Se realizó un análisis de regresión lineal comparando los valores logarítmicos de la agudeza visual y la sensibilidad al contraste, obteniendo una relación significativa entre ambos valores posterior a la aplicación del tratamiento (p<0,0001). Asimismo, se demostró una correlación entre la disminución de los valores de la sensibilidad al contraste y todas las características evaluadas en el tomografía de coherencia óptica. Conclusiones Las estrategias de antiangiogénesis pueden conducir a mejores resultados en la función visual global, impactando positivamente en la sensibilidad al contraste (AU)

Objective To determine the correlation between contrast sensitivity and morphological characteristics obtained by optical coherence tomography in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors (anti-VEGF). Design This is an ambispective (prospective+retrospective) observational, cross-sectional, and analytical study. Participants All patients over 55 years of age with age-related macular degeneration who attended the Retina service of the Ophthalmology department and met the inclusion criteria between March-May 2022. Methods Data collection was carried out by reviewing the records of patients.Optical coherence tomography studies prior to the application of intravitreal injections of patients who were currently in the first month after the last dose of anti-VEGF were analyzed. A total of 33 subjects were included, of which 30 continued follow-ups. Normality tests (Shapiro and Bartlett) were performed where a nonparametric data distribution was demonstrated. The subjects underwent a new ophthalmological evaluation and new retinal measurements of the affected eye. Results A linear regression analysis was performed comparing the logarithmic values of both visual acuity and contrast sensitivity, obtaining a significant relationship between both values after the application of treatment (P<.0001). Likewise, correlation was demonstrated between the decrease in contrast sensitivity values and all the characteristics evaluated in the patients’ optical coherence tomography. Conclusions Antiangiogenesis strategies can lead to better results in global visual function, positively impacting contrast sensitivity (AU)

Evaluación de signos tomográficos no exudativos en casos de degeneración macular asociada a la edad de tipo exudativo / Evaluation of non-exudative tomographic signs in cases of exudative age-related macular degeneration

Objetivo Analizar la prevalencia de signos tomográficos no exudativos (signo de cebolla, seudoedema, tubulación de la retina externa, seudoquistes, hendiduras subretinianas y atrofia macular) en pacientes con degeneración macular asociada a la edad neovascular. Material y métodos Un total de 174 ojos de pacientes con degeneración macular asociada a la edad neovascular que no habían recibido tratamiento previo fueron incluidos en el estudio. Se valoró la agudeza visual, la actividad de la neovascularización y la aparición o no de los distintos signos objeto de estudio en los tiempos 0 (visita inicial), 4 meses, un año, año y medio y a los 2 y 3 años de seguimiento. Se evaluaron también: la edad, el sexo, el ojo afecto y el tipo de neovascularización (1, 2, 3, polipoidea o mixta). Los análisis se han realizado mediante el software estadístico R (versión 3.3.2) y el paquete glmmADMB (versión 0.8.3.3). Resultados La presencia de seudoquistes y tubulación de la retina externa va en aumento a lo largo del seguimiento. El signo de cebolla comienza con una frecuencia ascendente hasta los 12 meses, posteriormente desciende a los 18 meses y vuelve a incrementarse a los 24 meses. En cuanto al seudoedema, mantiene un incremento hasta los 18 meses para finalmente descender. Las hendiduras subretinianas son el signo más raro, presentándose en el 1,1% en la primera visita. Finalmente, la atrofia macular, presente en el 12,6% de los ojos inicialmente, se encuentra en el 25% a los 2 años. Conclusión Los seudoquistes, la tubulación de la retina externa y la atrofia macular fueron los signos más prevalentes, mientras que las hendiduras subretinianas fueron los más infrecuentes (AU)

Objective To analyze the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration. Material and methods A total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3). Results The presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years. Conclusion Pseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent (AU)

Evaluation of non-exudative tomographic signs in cases of exudative age-related macular degeneration.

OBJECTIVE: To analyse the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration. MATERIAL AND METHODS: A total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3). RESULTS: The presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years. CONCLUSION: Pseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent.

Correlation between contrast sensitivity and morphological features obtained by OCT in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors.

OBJECTIVE: To determine the correlation between contrast sensitivity and morphological characteristics obtained by Optical Coherence Tomography (OCT) in patients with Age-Related Macular Degeneration treated with a loading dose of vascular endothelial growth factor inhibitors (anti-VEGF). DESIGN: This is an ambispective (prospective + retrospective) observational, cross-sectional, and analytical study. PARTICIPANTS: All patients over 55 years of age with Age-Related Macular Degeneration who attended the Retina service of the Ophthalmology department and met the inclusion criteria between March-May 2022. METHODS: Data collection was carried out by reviewing the records of patients diagnosed with Age-Related Macular Degeneration of the neovascular variety treated with the loading dose of anti-VEGF. OCT studies obtained by Optovue® iVue80 prior to the application of intravitreal injections of patients who met the inclusion criteria and were currently in the first month after the last dose of anti-VEGF were analyzed. A total of 33 subjects were included, of which 30 continued follow-ups. The subjects underwent a new ophthalmological evaluation and new retinal measurements of the affected eye. Normality tests (Shapiro‒Wilk) were performed where a nonparametric data distribution was demonstrated. RESULTS: A linear regression analysis was performed comparing the logarithmic values of both visual acuity and contrast sensitivity, obtaining a significant relationship between both values after the application of treatment (P = <.0001***). Likewise, correlation was demonstrated between the decrease in contrast sensitivity values and all the characteristics evaluated in the patients' OCT. CONCLUSIONS: Antiangiogenesis strategies can lead to better results in global visual function, positively impacting contrast sensitivity.

Biomarcadores de OCT-angiografía en la neovascularización coroidea tipo1 tras tratamiento con aflibercept durante 1 año / OCT angiography biomarkers in type1 choroidal neovascularisation after one year of aflibercept treatment

Objetivos: Evaluar la actividad de los biomarcadores, mediante OCT-angiografía (OCTA), en la neovascularización coroidea (NVC) secundaria a degeneración macular asociada a la edad (DMAE) tratada con aflibercept. Como objetivos secundarios se estudiaron la agudeza visual (AV) y la relación existente entre biomarcadores y pronóstico visual. Material y métodos: Estudio prospectivo en el que se estudiaron 33 ojos de 40 pacientes naïve diagnosticados de NVC tipo1 secundaria a DMAE y que habían sido tratados con aflibercept, según ficha técnica, durante 1año. Los pacientes fueron evaluados en el momento del diagnóstico, a los 4, a los 8 y a los 12meses. Resultados: La ganancia media de AV a los 12meses fue de 15,2±3,3 letras. El área de lesión disminuyó 1,2±1,0mm2 en el cuarto mes (p<0,0001), permaneciendo estable después. La presencia de capilares finos, anastomosis y halo hipointenso perilesional se redujo en el 85, el 70 y el 25%, respectivamente, a los 12meses de seguimiento. La arcada vascular periférica cambió de morfología, pasando de tener un aspecto frondoso a tener un aspecto afilado en el 90% de los casos. El tamaño de la lesión y la presencia/ausencia de halo hipointenso perilesional se asociaron, de manera independiente, a la AV final, de tal forma que las lesiones de mayor tamaño y la ausencia de halo hipointenso perilesional en la visita basal se asociaron a menor ganancia de AV. Conclusiones: La OCTA se trata de una herramienta útil, no invasiva, que nos aporta información cuantitativa y cualitativa del remodelado de la red vascular de la NVC tras terapia antiangiogénica. (AU)

Objective: To assess the activity of biomarkers, through OCT angiography (OCTA), of choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD) treated with aflibercept. As secondary endpoints, visual acuity (VA) and the relationship between biomarkers and visual prognosis were also studied. Material and methods: Prospective study that examined 33 eyes of 40 naïve patients with type1 CNV secondary to AMD, who had been treated with aflibercept, according to summary of product characteristics, for one year. The patients were evaluated at the time of diagnosis, and at 4, 8 and 12months. Results: The mean VA gain at 12months was 15.2±3.3 letters. The area of lesion decreased 1.2±1.0mm2 in the 4th month (P<.0001), remaining stable afterwards. The presence of tiny capillaries, anastomosis and perilesional hypointense halo was reduced by 85%, 70% and 25%, respectively, at 12 months of follow-up. The peripheral vascular arcade changed morphology, from having a leafy appearance to having a sharp appearance in 90% of cases. The size of the lesion and the presence/absence of perilesional hypointense halo were independently associated with the final VA, in such a way that larger lesions and the absence of a perilesional hypointense halo at the baseline visit were associated with less VA gain. Conclusions: The OCTA is a useful, non-invasive tool that provides quantitative and qualitative information on the remodelling of the CNV vascular network after antiangiogenic therapy. (AU)

Papel de los exosomas en la angiogénesis, revascularización y respuesta inmune / Role of exosomes in angiogenesis, revascularization and immune response

Introducción: Los exosomas son vesículas extracelulares de tamaño nanométrico, que se generan cuando los endosomas multivesiculares se fusionan con la membrana plasmática y el contenido de las vesículas intraluminales se libera en el espacio extracelular. Son producidos por casi todos los tipos de células, en condiciones fisiológicas y patológicas. Transportan proteínas, lípidos y ácido ribonucleico (ARN) no codificante, desde la célula madre hasta la célula receptora, estos son considerados un punto clave en la regeneración de tejidos, lo que se ha demostrado en una serie de estudios, con diferentes tejidos corporales, como piel, cartílago, pancreático y tejidos cardiovasculares. Objetivo: Explicar los aspectos generales y posibles usos de los exosomas en el campo médico. Métodos: Se realizó una búsqueda de información mediante consulta en las bases de datos SciELO PubMed, Science Direct y Lilacs, en los idiomas español e inglés, con diferentes combinaciones de palabras claves y términos MESH como: exosomes, neovascularization, wound healing, immunity, micro RNA, immunology, therapy, classification. Se efectuó un análisis y resumen de la información revisada. Conclusiones: En la actualidad, los exosomas se han convertido en objeto de investigación para diversos tratamientos, medicamentos y uso como marcadores moleculares. Se destacan en terapias contra el cáncer, la inmunomodulación, la estimulación o supresión de la angiogénesis, regeneración cutánea, cicatrización y curación de heridas; por lo que de forma general resultan prometedores en el ámbito de las ciencias médicas(AU)

Introduction: Exosomes are nano-sized extracellular vesicles, which are generated when multivesicular endosomes fuse with the plasma membrane and the content of intraluminal vesicles released into the extracellular space. Are produced by almost all types of cells, under physiological and pathological conditions and they transport proteins, lipids and non-coding RNA (ribonucleic acid), from the stem cell to the recipient cell, these are considered a key point in tissue regeneration, which has been shown in a series of studies, with different body tissues, such as skin, cartilage, pancreatic and cardiovascular tissues. Objective: To explain the general aspects and possible uses of exosomes in the medical field. Methods: A search for information was carried out by consulting the Scielo, PubMed, ScienceDirect and Lilacs databases, in Spanish and English, with different combinations of keywords and MESH terms such as: exosomes, neovascularization, wound healing, immunity, microRNA, immunology, therapy, classification. Then, an analysis and summary of the reviewed information was carried out. Conclusions: Currently, exosomes have become the object of research for various treatments, drugs, and their use as molecular markers. They stand out in cancer therapies, immunomodulation, stimulation or suppression of angiogenesis, skin regeneration, and wound healing, which is why they are generally promising in the field of medical sciences(AU)

OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2.

Idiopathic macular telangiectasia type 2 (MacTel 2) is a slow and progressive bilateral condition that affects middle-aged and elderly individuals. Vision loss is generally mild and occurs over the course of many years. The development of sub-retinal neovascularisation (SRNV) can occur late in the disease process, and lead to more dramatic vision loss. A report is presented of 2 cases of MacTel 2 in which optical coherence tomography angiography (OCTA) was essential for the diagnosis of secondary SRNV. The commercially available OCTA Cirrus AngioPlex 5000 platform (Zeiss, Jena, Germany) was used. Subretinal neovascularization was detectable in both cases in OCTA at the level of the deep capillary plexus and the avascular layer. OCTA also allowed us to monitor disease progression and monitor response to anti-VEGF therapy.

Angiografía-OCT para diagnóstico y respuesta al tratamiento de la neovascularización subretiniana secundaria a telangiectasia macular idiopática tipo 2 / OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2

La telangiectasia macular idiopática tipo 2 (MacTel 2) es una afección bilateral, lenta y progresiva que afecta a individuos de mediana edad y ancianos. La pérdida de visión es generalmente leve y ocurre en el transcurso de muchos años. El desarrollo de neovascularización subretiniana (NVSR) puede ocurrir tarde en el proceso de la enfermedad y conducir a una pérdida de visión más dramática. Presentamos 2casos de MacTel 2 donde la angiografía por tomografía de coherencia óptica (OCTA) fue fundamental para el diagnóstico de NVSR secundaria. Se utilizó la plataforma comercialmente disponible OCTA Cirrus AngioPlex 5000 (Zeiss, Jena, Alemania). La NVSR fue detectable en ambos casos con OCTA a nivel del plexo capilar profundo y en la capa avascular. La OCTA también nos permitió controlar la progresión de la enfermedad y monitorizar la respuesta a la terapia anti-VEGF (AU)

Idiopathic macular telangiectasia type 2 (MacTel 2) is a slow and progressive bilateral condition that affects middle-aged and elderly individuals. Vision loss is generally mild and occurs over the course of many years. The development of sub-retinal neovascularisation (SRNV) can occur late in the disease process, and lead to more dramatic vision loss. A report is presented of 2cases of MacTel 2 in which optical coherence tomography angiography (OCTA) was essential for the diagnosis of secondary SRNV. The commercially available OCTA Cirrus AngioPlex 5000 platform (Zeiss, Jena, Germany) was used. Subretinal neovascularization was detectable in both cases in OCTA at the level of the deep capillary plexus and the avascular layer. OCTA also allowed us to monitor disease progression and monitor response to anti-VEGF therapy (AU)

Neovascularización coroidea en pacientes con uveítis / Choroidal neovascularization in patients with uveitis

Objetivo: Determinar las características clínicas y epidemiológicas de la neovascularización coroidea en los pacientes con uveítis. Métodos: Se realizó un estudio observacional, descriptivo y transversal en pacientes con diagnóstico de neovascularización coroidea asociada a uveítis, atendidos en el Servicio de Uveítis e Inflamaciones Oculares del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Resultados: Esta entidad predominó en el sexo femenino, en edad pediátrica y en jóvenes. Se asoció con mayor frecuencia a enfermedades infecciosas, como la toxoplasmosis ocular, y un pequeño número de pacientes desarrolló membrana neovascular coroidea bilateral. Las membranas localizadas con mayor frecuencia fueron las subfoveales. Por angiografía fluoresceínica predominaron las clásicas, mientras el grosor de la membrana neovascular coroidea fue mayor que el grosor foveal central. La agudeza visual mejor corregida en la mayoría de nuestros pacientes fue menor de 85 VAR. Conclusión: La membrana neovascular coroidea asociada a las uveítis es reconocida como una complicación infrecuente, pero compromete de forma severa la visión en estos pacientes(AU)

Objective. To determine the clinical-epidemiological characteristics of choroidal neovascularization in patients with uveitis. Method. An observational, descriptive, cross-sectional study was carried out in patients with a diagnosis of choroidal neovascularization associated with uveitis, attended in the Uveitis and Ocular Inflammations Service of the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". Results. This entity predominated in the female sex, in pediatric age and youth. It was more frequently associated with infectious diseases, such as ocular toxoplasmosis, and a small number of patients developed bilateral choroidal neovascular membrane. The most frequent location of the membranes were the subfoveal ones, by fluorescein angiography the predominantly classic ones and the thickness of the choroidal neovascular membrane was greater than the central foveal thickness. The best corrected visual acuity in most of our patients was less than 85 VAR. Conclusion. CNVM associated with uveitis is recognized as an uncommon complication but one that severely compromises vision in these patients(AU)

Nuevas evidencias sobre el efecto protector de la ganancia de peso en la retinopatía del prematuro / New evidence on the protector effect of weight gain in retinopathy of prematurity

Introducción: La retinopatía del prematuro (ROP) se caracteriza por el desarrollo vascular insuficiente en la retina que, en los casos severos precisa tratamiento precoz para evitar secuelas visuales. Es actualmente la segunda causa mundial de ceguera infantil prevenible.Pacientes y métodos: Estudio observacional, retrospectivo, de casos-controles sobre 233 recién nacidos prematuros explorados entre 1999-2019.Resultados: La ganancia de peso posnatal en las primeras 4 semanas, el peso al nacer, la edad gestacional, la ventilación mecánica, las transfusiones recibidas y la presencia de sepsis, ductus arteriovenoso persistente, enterocolitis necrosante, hemorragia intraventricular o leucomalacia periventricular, mostraron diferencias significativas entre el grupo de ROP no susceptible de tratamiento frente al grupo candidato a tratamiento. La ganancia ponderal media fue 12,75±5,99g/día en el grupo no susceptible de tratamiento y 9,50±5,45g/día en el susceptible de tratamiento. El riesgo de ROP candidata a tratamiento se redujo progresivamente con el aumento de ganancia ponderal. La reducción del riesgo fue de 2,76 - 8,35% en ganancias de 10g/día, y alcanza el 7,17 - 12,76% en ganancias de 20g/día.Conclusiones: El riesgo de presentar ROP severa candidata a tratamiento disminuye con el aumento de la ganancia de peso posnatal en las primeras 4 semanas. Esta relación se mantiene en ganancias de peso >14g/día. Sin embargo, se deben tener en cuenta la edad gestacional y peso al nacer del recién nacido, la duración de la ventilación mecánica y su comorbilidad para la evaluación global del riesgo de ROP que precisa tratamiento. (AU)

Introduction: Retinopathy of prematurity (ROP) is characterised by insufficient vascular development in the retina, and requires early treatment to avoid visual disability in severe cases. ROP is currently the second leading cause of preventable child blindness in the world.Patients and methods: This was an observational, retrospective, case-control study including 233 preterm infants examined between 1999 and 2019.Results: Postnatal weight gain in the first 4 weeks of life, birth weight, gestational age, mechanical ventilation, transfusion, presence of sepsis, persistence of arterial ductus, necrotising enterocolitis, intraventricular haemorrhage, or periventricular leukomalacia were found to be significantly different between the ROP groups requiring and not requiring treatment. The mean postnatal weight gain in the ROP group not requiring treatment was 12.75±5.99g/day, whereas it was 9.50±5.45g/day in the ROP group requiring treatment. The risk of developing ROP that required treatment decreased with an increase in weight gain. The risk reduction was 2.76 - 8.35% in preterm infants gaining 10g/day, and 7.17 - 12.76% in infants gaining 20g/day.Conclusions: The risk of developing ROP requiring treatment decreased with increasing weight gain in the first 4 weeks of life. This was applicable in infants with postnatal weight gain ≥ 14g/day. However, gestational age, birth weight, time of mechanical ventilation, and comorbidity should be taken into account when evaluating the risk of ROP requiring treatment. (AU)

New evidence on the protector effect of weight gain in retinopathy of prematurity.

INTRODUCTION: Retinopathy of prematurity (ROP) is characterised by insufficient vascular development in the retina, and requires early treatment to avoid visual disability in severe cases. ROP is currently the second leading cause of preventable child blindness in the world. PATIENTS AND METHODS: This was an observational, retrospective, case-control study including 233 preterm infants examined between 1999 and 2019. RESULTS: Postnatal weight gain in the first 4 weeks of life, birth weight, gestational age, mechanical ventilation, transfusion, presence of sepsis, persistence of arterial ductus, necrotising enterocolitis, intraventricular haemorrhage, or periventricular leukomalacia were found to be significantly different between the ROP groups requiring and not requiring treatment. The mean postnatal weight gain in the ROP group not requiring treatment was 12.75 ±â€¯5.99 g/day, whereas it was 9.50 ±â€¯5.45 g/day in the ROP group requiring treatment. The risk of developing ROP that required treatment decreased with an increase in weight gain. The risk reduction was 2.76%-8.35% in preterm infants gaining 10 g/day, and 7.17%-12.76% in infants gaining 20 g/day. CONCLUSIONS: The risk of developing ROP requiring treatment decreased with increasing weight gain in the first 4 weeks of life. This was applicable in infants with postnatal weight gain ≥14 g/day. However, gestational age, birth weight, time of mechanical ventilation, and comorbidity should be taken into account when evaluating the risk of ROP requiring treatment.

OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2. / Angiografía-OCT para diagnóstico y respuesta al tratamiento de la neovascularización subretiniana secundaria a telangiectasia macular idiopática tipo 2.

Idiopathic macular telangiectasia type 2 (MacTel 2) is a slow and progressive bilateral condition that affects middle-aged and elderly individuals. Vision loss is generally mild and occurs over the course of many years. The development of sub-retinal neovascularisation (SRNV) can occur late in the disease process, and lead to more dramatic vision loss. A report is presented of 2cases of MacTel 2 in which optical coherence tomography angiography (OCTA) was essential for the diagnosis of secondary SRNV. The commercially available OCTA Cirrus AngioPlex 5000 platform (Zeiss, Jena, Germany) was used. Subretinal neovascularization was detectable in both cases in OCTA at the level of the deep capillary plexus and the avascular layer. OCTA also allowed us to monitor disease progression and monitor response to anti-VEGF therapy.

Peripapillary pachychoroidopathy. / Paquicoroidopatía peripapilar.

A study was made on 8 eyes of 5 patients between 47 and 65 years of age with peripapillary pachychoroidopathy. They all presented with a serous detachment of the neuroepithelium or retinal pigment epithelium in the nasal macular region that extended to the optic disc, with an increase in choroidal thickness at that level. An analysis was made of the choroidal thickness using high penetration optical coherence tomography, as well as their outcome in a period between 12 and 48 months. Peripapillary pachychoroidopathy is a distinct variant of the pachychoroid disease spectrum. It must be distinguished from other disorders, such as inflammatory or neuro-ophthalmological conditions, that may manifest in the vicinity of the optic disc. When faced with a patient with suspected pachychoroidopathy, a specific study of the papillary area should be considered using high penetration optical coherence tomography.

Malformación arteriovenosa de alto flujo en un adulto joven: reporte de caso / High flow arteriovenous malformation in a young adult: case report / Malformação arteriovenosa de alto fluxo em um adulto jovem: relato de caso

Introducción. Las malformaciones arteriovenosas son lesiones relativamente raras e infrecuentes. Se caracterizan por presentar un aumento anormal en el número de vasos sanguíneos como consecuencia de un defecto en el desarrollo vascular. Constituyen un desafío diagnóstico y terapéutico para el médico tratante. Su incidencia es de alrededor el 1.5% de la población general. Dentro de las opciones terapéuticas se incluye la embolización selectiva, la resección quirúrgica o ambas. El objetivo del presente artículo es reportar un caso de una patología poco frecuente y hacer una revisión literaria del tema para arrojar luz sobre su diagnóstico. Reporte de caso. Se presenta el caso de un paciente adulto joven que consulta por presentar una masa en glúteo derecho de 6 años de evolución. Esta es diagnosticada erróneamente como lipoma, por lo que se lleva al paciente a cirugía sin la realización de imágenes diagnósticas previas. En la cirugía, el paciente presenta choque hipovolémico. Posteriormente, se documenta la masa como malformación arteriovenosa profunda. Discusión. Es poco usual la ubicación de dichas malformaciones en los miembros inferiores, como en el paciente del actual caso. El diagnóstico de estas lesiones puede ser clínico, pero requiere del conocimiento o sospecha de esta entidad, ya que pueden ser lesiones clínicamente no visibles, lo que lleva a que pasen inadvertidas o se diagnostiquen de forma errónea. Conclusión. Aunque se trata de una patología poco frecuente, esta puede generar repercusiones clínicas, físicas, psicológicas y estéticas importantes, por lo que es indispensable realizar adecuados métodos por imágenes que permitan establecer su correcto diagnóstico y manejo. Cómo citar. Rodriguez-Londoño NH. Malformación arteriovenosa de alto flujo en un adulto joven. MedUNAB. 2021;24(1): 72-79. doi: https://doi.org/10.29375/01237047.3785

Introduction. Arteriovenous malformations are relative rare and infrequent injuries. Their main characteristic is an abnormal increase in the number of blood vessels as a result of defective vascular development. They represent a diagnostic and therapeutic challenge for the treating physician. Their incidence in the general population is around 1.5%. Some therapeutic options include selective embolization, surgical resection, or both. The purpose of this article is to report a case of an infrequent pathology and to perform a literature review on the topic to shed light on its diagnosis. Case report. The case involves a young adult patient who inquired about the presence of a mass in the right buttock with six years of evolution. It was erroneously diagnosed as a lipoma, as a result of which the patient was taken to surgery without performing preliminary diagnostic images. During surgery, the patient went into hypovolemic shock. Afterwards, the mass was documented as a profound arteriovenous malformation. Discussion. Such malformations are rarely found in the lower limbs, as in this case. These injuries may be clinically diagnosed, but knowledge or suspicion on the existence of this entity is required, because such injuries might not be clinically visible, which implies that they may go unnoticed or be erroneously diagnosed. Conclusion. Even though it is an infrequent pathology, it may have substantial clinical, physical, psychological and aesthetic implications, which implies that it is indispensable to perform adequate imaging-based procedures to enable its adequate diagnosis and management. Cómo citar. Rodriguez-Londoño NH. Malformación arteriovenosa de alto flujo en un adulto joven. MedUNAB. 2021;24(1): 72-79. doi: https://doi.org/10.29375/01237047.3785

Introdução. As malformações arteriovenosas são lesões relativamente raras e infrequentes. São caracterizadas por apresentarem um aumento anormal do número de vasos sanguíneos como consequência de um defeito no desenvolvimento vascular. Constituem um desafio diagnóstico e terapêutico para o médico que trata. Sua incidência gira em torno de 1.5% da população geral. As opções de tratamento incluem embolização seletiva, ressecção cirúrgica ou ambas. O objetivo deste artigo é relatar um caso de patologia pouco frequente e fazer uma revisão bibliográfica sobre o assunto para lançar luz sobre seu diagnóstico. Relato de caso. Apresentamos o caso de um paciente adulto jovem que consultou por apresentar uma massa na nádega direita, de 6 anos de evolução. Isso é diagnosticado erroneamente como um lipoma, então o paciente é levado para cirurgia sem imagens diagnósticas prévias. Na cirurgia, o paciente apresenta um choque hipovolêmico. Posteriormente, a massa é documentada como uma malformação arteriovenosa profunda. Discussão. A localização dessas malformações nos membros inferiores é incomum, como no caso deste paciente. O diagnóstico dessas lesões pode ser clínico, mas requer conhecimento ou suspeita dessa entidade, pois podem ser lesões clinicamente invisíveis, o que as leva a passar despercebidas ou mal diagnosticadas. Conclusão. Embora seja uma patologia pouco frequente, pode gerar importantes repercussões clínicas, físicas, psicológicas e estéticas, pelo que é imprescindível a realização de métodos de imagem adequados para estabelecer seu correto diagnóstico e tratamento. Cómo citar. Rodriguez-Londoño NH. Malformación arteriovenosa de alto flujo en un adulto joven. MedUNAB. 2021;24(1): 72-79. doi: https://doi.org/10.29375/01237047.3785

Amplitud de distribución eritrocitaria un biomarcador inflamatorio relacionado a retinopatía diabética proliferativa / Red Blood Cell Distribution Width An Inflammatory Biomarker Related To Proliferative Diabetic Retinopathy

Objetivo: El objetivo de este estudio fue determinar la asociación entre el ancho de distribución de glóbulos rojos y la retinopatía diabética proliferativa en pacientes con diabetes tipo 2. Métodos: Realizamos un estudio de casos y controles en un hospital. Pacientes adultos (≥ 18 años) con diagnóstico de Retinopatía Diabética que fueron sometidos a controles médicos en el servicio de Oftalmología donde se inscribieron en nuestro estudio. Seleccionamos un tamaño de muestra total de 262 pacientes, de los cuales 131 casos tenían retinopatía diabética proliferativa y 131 controles tenían retinopatía diabética no proliferativa. Se registraron datos sobre edad, sexo, índice de masa corporal, antecedentes de hipertensión, nefropatía diabética, insuficiencia cardíaca congestiva, hemoglobina y HbA1c para las personas que cumplieron con los criterios de inclusión. Se utilizó un modelo de razón de probabilidades para probar la relación entre el ancho de distribución de glóbulos rojos y la retinopatía diabética proliferativa. Resultados: El ancho medio de distribución de glóbulos rojos +/- DE de los casos fue 14,41 +/- 0,84 y los controles fue 13,49 +/- 1,26. De acuerdo con el análisis bivariado, se encontró una asociación entre el ancho de distribución de los glóbulos rojos y la retinopatía diabética proliferativa (OR 3,79, P = 0,000, IC = 2,12-6,78). El análisis de regresión logística multivariante indicó que el ancho de distribución de glóbulos rojos (OR 2,15, P = 0,037, IC = 1,05-4,43) era un factor de riesgo independiente para el desarrollo de retinopatía diabética proliferativa. Conclusión: Los valores elevados del ancho de distribución de glóbulos rojos se relacionaron con la retinopatía diabética proliferativa, lo que sugiere la posible aplicación del ancho de distribución de glóbulos rojos como un biomarcador predictivo accesible de la progresión de la enfermedad en pacientes con retinopatía diabética.

Objective: The aim of this study was to determine the association between Red Blood cell Distribution width and Proliferative Diabetic Retinopathy in patients with type 2 diabetes. Methods: We conducted a hospital-based case-control study. Adult patients (≥ 18 years old) with the diagnosis of Diabetic Retinopathy who underwent medical check-ups at the ophthalmology department where enrolled in our study. We selected a total sample size of 262 patients, of which 131 cases had Proliferative Diabetic Retinopathy and 131 controls had Non Proliferative Diabetic Retinopathy. Data about age, gender, body mass index, history of hypertension, diabetic nephropathy, Congestive heart failure, Hemoglobin and HbA1c were registered for individuals who met inclusion criteria. Odds ratio model was used to test the relationship between Red Blood Cell Distribution Width and Proliferative Diabetic Retinopathy. Results: Mean Red Blood cell Distribution width +/- SD of the cases was 14.41+/-0.84 and the controls was 13.49+/-1.26. According to bivariate analysis, an association was found between Red Blood cell Distribution width and Proliferative Diabetic Retinopathy (OR 3.79, P=0.000, IC=2.12-6.78). Multivariate logistic regression analysis indicated that Red Blood cell Distribution width (OR 2.15, P=0.037, IC= 1.05-4.43) was an independent risk factors for the development of Proliferative Diabetic Retinopathy. Conclusion: Elevated values of Red Blood cell Distribution width were related to Proliferative Diabetic Retinopathy, suggesting the potential application of Red Blood cell Distribution width as an accessible predictive biomarker of disease progression in patients with diabetic retinopathy.

Takayasu's arteritis: Ischaemic retinal arterial occlusion as a possible initial presentation. / Arteritis de Takayasu: obstrucción arterial retiniana isquémica como posible presentación inicial.

Ocular manifestations are observed in 25% of patients with Takayasu's arteritis. Its signs and symptoms can be very variable. The case is presented of a 41-year-old woman with progressive vision loss in her right eye secondary to ischaemic retinal arterial occlusion. After a systematic study, a protein purified derivative (PPD) skin test compatible with tuberculosis was found to be the only alteration. After ruling out other causes, and based on the initial suspicion of tuberculous retinal vasculitis, treatment was started with antimicrobial agents and systemic corticosteroids, without any therapeutic response. Eighteen months later, the patient developed acute kidney failure, secondary to right renal artery stenosis. The CT-angiography revealed a thickening of the aortic arch and its branches, and Takayasús arteritis was finally diagnosed. Therefore, emphasis is made on the importance of the ophthalmologist in the diagnosis of Takayasús arteritis, in which its ophthalmological manifestations can be an early sign of the disease.

Effectiveness of treat-and-extend versus pro re nata regimens in the treatment of Neovascular Age Macular Degeneration: A Real World Comparison. / Efectividad de los regímenes tratar y extender vs. pro re nata para el tratamiento de degeneración macular neovascular vinculada a la edad: una comparación en un entorno real.

PURPOSE: Evaluate and compare the visual and morphological results of Pro re nata (PRN) and treat-and-extend (T&E) treatment regimens at 3 years in real world clinical practice. METHODS: Retrospective study of patients with neovascular age macular degeneration (AMD) treated with anti-VEGF with 3 years of continuous follow-up and no previous anti-VEGF treatment. Best corrected visual acuity (BCVA), central foveal thickness (CFT) and number of intravitreal injections outcomes were tested for statistical differences between the two groups at baseline and during follow-up. RESULTS: A total of 240 eyes were included in the study, 170 in the PRN group and 70 in the T&E group. At 12 months, mean BCVA (ETDRS letters) gain from baseline was at its highest point in the T&E group (+6.38±13.32; p=0.25). In the PRN group, BCVA peaked at 3 months and slowly decreased until end of follow-up. With both regimens, from baseline, CFT continued to decrease until the second year (PRN -138.81 [-846.7 to +162.77] and T&E -81 [-604 to +100] µm, p=0.06). After that, T&E group maintained this tendency, reaching the lowest CFT value at 36 months, whereas PRN group showed an increased in CFT values (PRN -104 [-807.7 to +297] µm and T&E -103 [-575 to +244], µm p=0.63). Patients treated with T&E regimen received a significantly higher number of injections (PRN 16.3±7.6 vs T&E 23.9 ±9.4, p<0.01). CONCLUSION: Our results demonstrated a trend towards for T&E to achieve higher marks in BCVA, peaking at 12 months, and lower CFT thickness at the end of three years. Despite the higher number of injections performed in the T&E group the mean BCVA reverts to baseline values at 3 years.

Bevacizumab as a treatment option in gastrointestinal bleeding associated to hereditary hemorrhagic telangiectasia. Case Report / Bevacizumab como opción terapéutica en sangrado gastrointestinal asociado a telangiectasia hemorrágica hereditaria. Reporte de caso

Abstract Introduction: Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant genetic disease characterized by the presence of arteriovenous malformations in the nasal mucosa, the tips of fingers, and sometimes in the lungs, the gastrointestinal tract, the liver, the pancreas, the marrow and the brain. Its treatment is based on symptomatic control measures, but recently, the administration of anti-vascular endothelial growth factor (VEGF) molecules has been proposed as a treatment alternative, especially in patients with recurrent bleeding. Case presentation: The case of a 67-year-old man diagnosed with HHT and suffering from potentially life-threatening gastrointestinal GI bleeding is presented. The patient underwent several esophagogastric cauterization procedures but not positive outcomes were obtained, so he had to go to the Emergency Service of the hospital multiple times due to having low levels of hemoglobin (as low as 3.5g/dL). A bevacizumab based treatment was started by using a novel dosage regimen consisting of the administration of 6 5mg/kg bevacizumab dosages every 14 days. During the first week of treatment, hemoglobin levels increased to 14g/dL and the condition was stabilized. Conclusions: The findings reported here suggest that bevacizumab may be a therapeutic choice to be considered when treating patients with recurrent and refractory GI bleeding caused by HHT. However, a larger sample is required to determine if administering this medication is safe for these patients, as well as the appropriate dosage.

Resumen Introducción. La telangiectasia hemorrágica hereditaria (HHT) es una enfermedad genética autosómica dominante que se caracteriza por la presencia de malformaciones arteriovenosas en mucosa nasal, dedos y, algunas veces, pulmones, tracto gastrointestinal, hígado, páncreas, médula ósea y cerebro. El tratamiento se basa en el control sintomático, pero recientemente se ha propuesto la administración de moléculas anti-factor de crecimiento de endotelio vascular (VEGF), en especial en pacientes que presentan sangrado recurrente. Presentación del caso. Paciente masculino de 67 años con diagnóstico de telangiectasia hemorrágica hereditaria (HHT) y hemorragia gastrointestinal severa potencialmente mortal. El paciente recibió múltiples cauterizaciones esofagogástricas sin obtener respuesta, por lo que ingresó en múltiples oportunidades al servicio de urgencias con niveles de hemoglobina incluso tan bajos como 3.5g/dL. Se inició tratamiento con bevacizumab con un novedoso esquema de 6 dosis de 5mg/k cada 14 días, lográndose aumentar los niveles de hemoglobina a 14g/dL durante la primera semana de tratamiento y estabilizando la enfermedad. Conclusiones. Los hallazgos sugieren que el bevacizumab puede ser una opción terapéutica en sangrado gastrointestinal recurrente y refractario secundario a HHT. Sin embargo, se requiere incluir una cohorte de pacientes más amplia para establecer la seguridad del medicamento y la dosificación apropiada para este tipo de pacientes.

Distrofia macular viteliforme de Best asociada a membrana neovascular coroidea en edad pediátrica / Vitelliform macular dystrophy and its association with choroidal neovascular membrane in pediatric age

Resumen La enfermedad de Best, también llamada distrofia macular viteliforme es una maculopatía autosómica dominante que se presenta por mutaciones en el gen BEST 1, localizado en el epitelio pigmentario de la retina. Clínicamente, hace parte de las cinco enfermedades degenerativas de la retina distinguidas como bestrofinopatías. En etapas iniciales de la enfermedad puede presentarse agudeza visual normal; sin embargo, en la mayoría de los pacientes hay pérdida progresiva de la misma debido al depósito subfoveal de material amarillo. Algunos pacientes también pueden presentar neovascularización coroidea, siendo esta una complicación poco común. En población pediátrica el tratamiento temprano con ranibizumab de la enfermedad asociada a neovascularización coroidea ha evidenciado mejoría del pronóstico. Aunque son necesarios más estudios que valoren su eficacia y se ha registrado buena respuesta al tratamiento con otros medicamentos, este sigue siendo la primera elección. Se presenta el caso de una paciente quien a los trece años fue diagnosticada con distrofia macular viteliforme y fue tratada exitosamente con ranibizumab durante dos años.

Abstract Best's disease, also called vitelliform macular dystrophy is an autosomal dominant maculopathy, which is caused by mutations in the BEST 1 gene, located in the retina pigment epithelium. Is part of the five retina degenerative diseases clinically distinguished as bestrophinopathies. Affected individuals, in the early disease stages may present normal visual acuity; however, in most patients there is a progressive loss of this material in the deposit of subfoveal yellow material. Some patients may also present choroidal neovascularization, an uncommon complication. In pediatric population, early disease treatment associated with choroidal neovascularization with ranibizumab has shown a prognosis improvement. Although more studies are needed to assess its efficacy in this condition and good response to treatment with other medications, this still being the first choice. We present a patient who at thirteen years was diagnosed with VMD and was successfully treated with ranibizumab for two years.

Choroidal neovascularisation secondary to serpiginous choroiditis: The value of OCT-angiography in diagnosis and response to therapy with aflibercept. / Neovascularización coroidea secundaria a coroiditis serpiginosa: valor de la OCT-angiografía en el diagnóstico y en la respuesta al tratamiento con aflibercept.

A case is presented of a 61 year-old man with a personal history of serpiginous choroiditis (SC), who presented with metamorphopsia and decreased visual acuity (VA) in his right eye (RE). In the examination, using Swept Source OCT-angiography (SS OCT-A), peripapillary haemorrhage secondary to a choroidal neovascularisation (CNV) was observed. The patient was treated with intravitreal aflibercept, having a favourable outcome on his symptomatology and in the SS OCT-A findings. CNV is a complication that can appear in up to 25% of cases after SC. An accurate diagnosis using SS OCT-A, with early treatment with aflibercept, led us to obtain optimal clinical and anatomical results.