Long-term results of the treatment of patients with exudative age-related macular degeneration during the COVID-19 pandemic.

PURPOSE: To quantify the long-term impact (24 months) on the visual results and activity of neovascular lesions of COVID-19 confinement in patients with nAMD in our population. METHODS: A retrospective observational study of patients with nAMD who attended consultation or were treated during the 3 months before confinement was carried out. RESULTS: 144 patients (168 eyes) with nAMD were included, 51 of them (35.42%) came during confinement, and at 24 months the final cohort was 118 patients (133 eyes). The previous VA of 57.99 ±â€¯23.68 letters decreased, clinically relevant and statistically significant, by an average of 6.87 (±16.84) and 7.89 (±19.58) at 12- and 24-months follow-up. This change differs significantly from the two-year vision change observed in the national database of pretreated patients. The median number of injections and consultations is lower in our group at 12 months, compared to the pre-pandemic national database, and tends to equalize at 24 months. We did not find differences in vision when we compared patients who attended consultations during confinement or in treatment intervals greater than 8 weeks (Tq8w). CONCLUSIONS: The VA of patients with nAMD decreased significantly after confinement, probably due to the lower number of antiangiogenic injections and consultations during the first year, and did not recover during the second year despite the increase in the number of injections and visits close to those reported before confinement.

Results of the treatment of patients with exudative AMD during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVE: The SARS-CoV-2 pandemic has caused chaos in all health systems on the planet. It has been difficult to cope with COVID 19, but also to maintain the activity in other specialties. In ophthalmology, the scientific societies recommended providing urgent care, including the intravitreal treatment of patients with active neovascular age-related macular degeneration (AMD), since a delay in treatment implies a potential loss of visual acuity (VA). The main objective of this study was to measure the impact of the coronavirus lockdown on the activity and visual results in patients with neovascular AMD in Area 3 of Madrid. MATERIAL AND METHOD: A retrospective observational study was conducted of all patients with neovascular AMD who attended a consultation and/or received intravitreal treatment in the 3 months before the lockdown. RESULTS: In the 3 months before the lockdown, 144 patients with neovascular AMD were treated, of whom only 51 attended a consultation during the lockdown and, at 6 months after it, only 117 patients had resumed their follow-up. Mean VA before the lockdown was 58.0 ±â€¯23.7 letters and was statistically significantly reduced to 53.0 ±â€¯27.1 letters at 6 months after the lockdown. We also observed a significant decrease in the number of visits during the lockdown, despite the security measures implemented. CONCLUSIONS: Our study shows that patients with neovascular AMD have had a statistically significant decrease in VA due to the lockdown. A VA of almost 58 letters was reduced to 53 at 6 months after the lockdown. The percentage of patients who lost 15 or more letters doubled. We observed a 63.3% loss of temporary follow-up during the lockdown and a 14.58% loss of permanent follow-up at 6 months after the lockdown.

[Results of the treatment of patients with exudative AMD during the COVID-19 pandemic]. / Resultados del tratamiento de los pacientes con DMAE exudativa durante la pandemia por COVID-19.

Background and objective: The SARS-CoV-2 pandemic has caused chaos in all health systems on the planet. It has been difficult to cope with COVID 19, but also to maintain the activity in other specialties. In ophthalmology, the scientific societies recommended providing urgent care, including the intravitreal treatment of patients with active neovascular age-related macular degeneration (AMD), since a delay in treatment implies a potential loss of visual acuity (VA).The main objective of this study was to measure the impact of the coronavirus lockdown on the activity and visual results in patients with neovascular AMD in Area 3 of Madrid. Material and method: A retrospective observational study was conducted of all patients with neovascular AMD who attended a consultation and/or received intravitreal treatment in the 3 months before the lockdown. Results: In the 3 months before the lockdown, 144 patients with neovascular AMD were treated, of whom only 51 attended a consultation during the lockdown and, at 6 months after it, only 117 patients had resumed their follow-up. Mean VA before the lockdown was 58.0 ± 23.7 letters and was statistically significantly reduced to 53.0 ± 27.1 letters at 6 months after the lockdown. We also observed a significant decrease in the number of visits during the lockdown, despite the security measures implemented. Conclusions: Our study shows that patients with neovascular AMD have had a statistically significant decrease in VA due to the lockdown. A VA of almost 58 letters was reduced to 53 at 6 months after the lockdown. The percentage of patients who lost 15 or more letters doubled. We observed a 63.3% loss of temporary follow-up during the lockdown and a 14.58% loss of permanent follow-up at 6 months after the lockdown.

Inferior sclerotomies without subretinal fluid drainage for exudative retinal detachment in diffuse retinal pigment epitheliopathy.

PURPOSE: To evaluate the efficacy of inferior sutureless sclerotomies without subretinal fluid drainage for the treatment of bullous exudative retinal detachment secondary to diffuse retinal pigment epitheliopathy. METHODS: A retrospective interventional case series of eyes treated with two inferior postequatorial full-thickness sclerotomies without subretinal fluid drainage. Patients were placed in an upright position 24 hours after surgery. Main outcomes were visual acuity and retinal reattachment rate. RESULTS: Three eyes with recent diagnoses of diffuse retinal pigment epitheliopathy and bullous inferior retinal detachment were included in the study. In all cases, a very thick sclera was evident during surgery. The day after surgery the retina was completely attached in the three eyes. Preoperative visual acuity was light perception, 20/200, and counting fingers. After surgery, visual acuity improved to 20/200, 20/70, and 20/50, respectively. No intra- or postoperative complications occurred. CONCLUSIONS: The performance of inferior sutureless sclerotomies without a draining procedure in cases of diffuse retinal pigment epitheliopathy with inferior bullous retinal detachment is a simple and effective technique. It achieves retinal reattachment the day after surgery, allowing laser photocoagulation of the leaking lesions disclosed in fluorescein angiography.

Optociliary shunt vessels in compressive optic neuropathy by the intracranial internal carotid artery.

PURPOSE: To report a clinical case of optic nerve compression by supraclinoidal internal carotid artery associated with optociliary shunt vessels. METHODS: A 78-year-old woman with the clinical triad of left visual loss, ipsilateral optic disc pallor, and retinochoroidal (optociliary) shunt vessels is reported. She complained of loss of vision in the left eye of 2 years'' duration. RESULTS: A diffuse depression of the visual field was found in the affected eye. Magnetic resonance imaging revealed left optic nerve compression by the supraclinoidal internal carotid artery. CONCLUSIONS: The occurrence of optociliary shunt vessels, visual loss, and optic atrophy is a nonspecific sign of chronic optic nerve compression and in some instances may be falsely localized.

[Intracranial hypertension and cranial sinus stenosis]. / Hipertensión intracraneal y estenosis de los senos craneales.

CLINICAL CASE: Craneal sinuses stenosis can appear in patients with idiopathic intracranial hypertension. Neuroimaging techniques revealed a right transverse sinus stenosis. As the pressure gradient between both sides of the stenosis was small and response to conservative treatment good, angioplasty was not indicated. DISCUSSION: Lateral sinus stenosis in patients with idiopathic intracranial hypertension is prevalent. It is not clear whether these stenoses are the origin of, or secondary to, cerebrospinal fluid pressure increases. Some cases refractory to conservative treatment may respond to angioplasty with stent placement.

[Conservative surgical management of a post-traumatic iris cyst]. / Tratamiento quirúrgico conservador en un caso de quiste de iris postraumático.

CASE REPORT: A 32-year-old man with recent visual loss in his right eye, was found to have an iris cyst involving about 50% of the anterior chamber. He had been treated three years previously for a penetrating injury to that eye. The cyst was treated by aspiration, viscodissection and ab-externo photocoagulation, with this achieving a rapid recovery of vision and good anatomic results. At the six month follow-up visit the visual acuity remains stable with no signs of recurrence of the cyst. DISCUSSION: Conservative surgical treatment consisting of aspiration, viscodissection and photocoagulation appears to be an effective strategy to manage secondary anterior chamber cysts, achieving good anatomic and functional results.

[Results of nonpenetrating deep sclerectomy in inflammatory glaucoma: one year follow up]. / Resultados de la esclerectomía profunda no perforante en el tratamiento del glaucoma inflamatorio al año de seguimiento.

PURPOSE: To assess the efficacy and safety of nonpenetrating deep sclerectomy in uveitic glaucoma. METHODS: In this observational retrospective trial, 6 eyes with inflammatory glaucoma underwent a nonpenetrating deep sclerectomy and a reticulated hyaluronic acid implant. The minimal follow-up period was 12 months. RESULTS: At 12 months, the complete success rate (defined as an IOP higher than 5 and lower than 21 mmHg without medication) was 66.67% and the qualified success rate was 100%. The mean postoperative IOP at 12 months was 16.67 mmHg (SD: 3.26), and the mean IOP reduction was 23.00 mmHg (SD:13.75) (p= 0.027). The mean number of antiglaucoma medications required was reduced from 2.67 (SD: 0.52) before surgery to 0.50 (SD: 0.84) one year after surgery (p= 0.038). No change on visual acuity was observed. Complications included one case of hyphema and one case of bleb encapsulation. CONCLUSIONS: Nonpenetrating deep sclerectomy in this preliminary study, deep sclerectomy was efficacious and had few postoperative complications, so it can be an alternative in the management of uveitic glaucoma.

Ocular residual astigmatism's effect on high myopic astigmatism LASIK surgery.

PURPOSE: To analyze the effect of ocular residual astigmatism (ORA) on the effectiveness of LASIK for treating high myopic astigmatism. METHODS: This is an observational, cross-sectional study. We studied 116 consecutive myopic eyes with -3 diopters (D) or more of astigmatism that underwent LASIK surgery. The magnitude of uncorrected residual refractive astigmatism 3 months postoperatively was measured. RESULTS: The mean preoperative cylinder was -4.0±0.83 D (range, -7.5 to -3 D) and the mean preoperative ORA was 0.82±0.5 D. The mean residual refractive cylinder 3 months postoperatively was -0.78±0.83 D (range, -3 to 0 D). No correlation was found between ORA and the refractive cylinder 3 months postoperatively (P=0.6). CONCLUSION: In eyes with high myopic astigmatism undergoing LASIK, ORA was not correlated with the residual postoperative cylinder.

Results of bevacizumab as the primary treatment for retinal vein occlusions.

BACKGROUND: The purpose of this study is to evaluate the efficacy of intravitreal bevacizumab as the primary treatment of macular oedema due to retinal vein occlusions. METHODS: Patients diagnosed as having central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) with visual acuity of less than 20/40 and macular oedema with more than 300 microm central retinal thickness were recruited. Patients that had received any prior treatment were excluded. After an initial intravitreal injection of bevacizumab, re-treatment was performed if intraretinal or subretinal fluid with distortion of the foveal depression was found in optical coherence tomography. RESULTS: 18 eyes with CRVO and 28 eyes with BRVO were included. During a 6-month period, the mean number of injections per patient was 3.7 (BRVO group) and 4.6 (CRVO group). In the BRVO group, mean baseline logMAR visual acuity was 0.80 (SD 0.38) and macular thickness was 486.9 microm (SD 138.5 microm). After 6 months, mean logMAR visual acuity improved significantly to 0.44 (SD 0.34), p<0.001. Mean macular thickness decreased significantly to 268.2 microm (SD 62.5 microm), p<0.001. In the CRVO group, mean baseline logMAR visual acuity was 1.13 (SD 0.21) and macular thickness was 536.4 microm (SD 107.1 microm). Mean final logMAR visual acuity improved significantly to 0.83 (SD 0.45), p<0.001. Mean macular thickness decreased significantly to 326.17 microm (SD 96.70 microm), p<0.001. CONCLUSIONS: Intravitreal bevacizumab seems to be an effective primary treatment option for macular oedema due to retinal occlusions. Its main drawback is that multiple injections are necessary to maintain visual and anatomic improvements.

[Pars plana vitrectomy as anti-inflammatory therapy for intermediate uveitis in children]. / La vitrectomía como terapia antinflamatoria de la uveítis intermedia en niños.

PURPOSE: Intermediate uveitis represents between 2 and 26% of uveitis in children. The spectrum of the disease is highly variable, ranging between mild cases that resolve spontaneously and chronic, severe forms that develop multiple episodes and complications. The purpose of this study is to evaluate the efficacy of vitrectomy to control inflammation in children with recurrent intermediate uveitis. METHODS: Retrospective evaluation of patients with at least six months of follow-up. All patients under 16 who had undergone vitrectomy for intermediate uveitis were included. Vitrectomy was performed after at least two episodes of intermediate uveitis in children that had had no previous prophylactic systemic immunosuppressant treatment. Data recorded were visual acuity (VA), recurrences and surgical complications. RESULTS: Seven eyes of five children with intermediate uveitis who underwent vitrectomy were included. After a mean follow-up of 34 months, VA improved in all eyes after surgery. Four eyes developed mild subcapsular posterior cataracts. Post-surgical recurrences were anterior and responded to topical treatment, except for an episode of intermediate uveitis that required a periocular injection of triamcinolone. Only one patient is being treated with systemic immunosuppressants, due to the presence of repeated episodes of uveitis in the non-vitrectomised eye and since his parents were unwilling to have him undergo new surgery. CONCLUSIONS: Vitrectomy with inferior cryotheraphy controls inflammation in intermediate uveitis in children with good mid-term results avoiding the secondary side-effects of systemic immunosuppressants.

Massive exophthalmos after traumatic carotid-cavernous fistula embolization.

An 18-year-old man without previous clinical problems developed a left traumatic carotid-cavernous fistula after a traffic accident. An endovascular embolization with coils was performed without success. The drainage was derived to the superior ophthalmic vein solely and clinical worsening occurred. Left eye proptosis, chemosis and intraocular pressure increased. Complete ophthalmoplegia developed and visual acuity decreased due to a central retinal vein obstruction. After a second embolization attempt the fistula was closed successfully but proptosis, chemosis and intraocular pressure remained uncontrolled despite medical treatment. Therefore an orbital decompression surgery was performed. Ophthalmoplegia, proptosis and chemosis improved and intraocular pressure was controlled. Although retinal hemorrhages persist, no neovascularization has developed. Central retinal vein occlusion in young patients seems to have a different etiology than in the elderly. In young patients, local factors are more frequently identified than systemic vascular diseases. Early detection of central retinal vein obstruction may prevent deterioration of visual acuity.

[Study of 112 patients with septic arthritis caused by pyogenic organisms and fungi: changes in the clinical spectrum during the last 2 decades]. / Estudio de 112 pacientes con artritis séptica por piógenos y hongos: cambios en el espectro clínico durante las dos últimas décadas.

A retrospective study of 112 patients with septic arthritis (SA) caused by pyogenic organisms and fungi attended at the same Medical Service from 1975 to 1994. This SA was more common among male patients and the age at onset of disease was 42 +/- 23.2 years. Predisposing factors were identified in 53 patients, the more common being connective tissue diseases and parenteral drug abuse (PDA). The main portal of entry was bacteremia from a distant infective source. The most common causative agents were Grampositive cocci (particularly S. aureus) and the more uncommon organisms were recovered from patients with underlying diseases. The diagnostic delay was 14.1 +/- 28.1 days. Single joint SA occurred in 88% of patients. Large joints were mainly involved. On admission, 25% of patients had no fever and only 54% of them had leukocytosis; therefore, the lack of these findings in a given patient with acute arthritis should not rule out the possibility of SA. Initial therapy consisted of daily arthrocentesis and i.v. antibiotics. The mean duration of antibiotic therapy was 47 +/- 23 days; the duration of the i.v. route was 23 +/- 14 days. An eighty percent of patients recovered without functional sequelae. The 31 patients who required surgical drainage had a longer diagnostic delay and a worse evolution, thus stressing the necessity of an early diagnosis. In the last decade (1986-1994) an increase in some predisposing factors (iatrogenic SA and PDA), a shorter diagnostic delay, a more prolonged antibiotic therapy, a smaller proportion of surgical drainage and an ultimate evolution identical to that in the previous decade were observed.