Utilidad de la tomografía de coherencia óptica en el edema macular diabético traccional

Case report: We report the case of a 66-year-old man with non-proliferating diabetic retinopathy in both eyes and tractional diabetic macular edema (DME) in his right eye, as confirmed by Optical Coherence Tomography (OCT). We also present the results after pars plana vitrectomy and dissection of the posterior hyalod. Discussion: OCT is a useful tool for the diagnosis, follow-up and design of the surgical treatment of patients with tractional DME. It allows us to examine the evolution of the edema in a non-invasive way.Caso clínico: Se presenta el caso de un paciente varón de 66 años afecto de retinopatía diabética no proliferativa en ambos ojos y edema macular diabético (EMD) con componente traccional en el ojo derecho confirmado por Tomografía de Coherencia Óptica (OCT), así como el resultado después de realizar tratamiento quirúrgico mediante vitrectomía via pars plana y delaminación de la hialoides posterior. Discusión: La Tomografía de Coherencia Óptica es de utilidad para el diagnóstico, seguimiento y diseño del protocolo quirúrgico en los pacientes afectos de EMD traccional, puesto que nos permite cuantificar la evolución del mismo de una manera no invasiv

Factores de riesgo de recidiva postquirúrgica en las membranas neovasculares de etiología miópica

Purpose: To determine risk factors of postsurgical relapse before myopic neovascular membranes extraction (NVM). Methods: A retrospective study was made on 30 myopic patients younger than 50 years old who needed surgery. All the patients presented type 2 membranes (above RPE) and were operated by the same surgeon. Following variables were analyzed: age, gender, number of diopters, visual acuity (VA) before and after surgery, membrane location, postsurgical complications, and time between surgery and relapse when presented. VA improvement after reintervention was also analyzed, in case of relapse. Mean time follow up was 15,24 months (range between 3 and 51 months). We divided them on three groups dependin on the number of diopters: I ( 12 diopters), rejecting patients with less than 6 diopters. Results: Relapse index was 16.66% (5 cases) being the mean time 4.5 months (range between 2 and 7 months). VA improvement post-op was demonstrated with a high level of signification (p=0.002) by student t for paired data. We also studied the relation between sex and relapse incidence and no significative statistical differences were found (p=0.561). We compared relapse incidence between the three groups of patients and found that most of relapses appeared on the II group (10-12 D) (p=0.045). The main post-op complications were: asseptic endophtalmitis (3), retinal detachment (1), choroidal detachment (1). Conclusions: Myopic NVM excission is an effective surgical technique on VA improvement in this patients. We observed a major number of post-op relapses on 10-12 myopic diopters. Low diopters patients have less RPE alteration and so, a lower relapse index. On the other hand, high diopters patients have more choroidal atrophy and less vascularization, what reduces relapsing chance. Median myopia seems to be post op relapse risk factor on myopic NVM.Objetivo: Determinar los factores de riesgo de recidiva postquirúrgica tras la extracción de membranas neovasculares (MNV) miópicas. Material y Métodos: Se realizó un estudio retrospectivo sobre 30 pacientes miopes menores de 50 años con MNV que precisaron cirugía. Todos los pacientes presentaban membranas tipo 2 (por encima del EPR) y fueron intervenidos por el mismo cirujano. Se analizaron las siguientes variables: edad, sexo, número de dioptrías, agudeza visual antes y después de la cirugía, localización de la membrana, complicaciones postquirúrgicas, y período de tiempo entre la cirugía y la recidiva si ésta se producía. También se analizó la ganancia de agudeza visual tras reintervención en los casos de recidiva. El tiempo medio de seguimiento fue de 15,24 meses (rango entre 3 meses y 51 meses). Se dividió en 3 grupos según el número de dioptrías: I ( 12 dioptrías), descartando los pacientes con menos de 6 dioptrías. Resultados: El índice de recidiva fue del 16,66% (5 casos) y el tiempo medio de aparición fue de 4,5 meses (rango entre 2 y 7 meses). Se comprobó la mejoría de AV tras cirugía con un alto nivel de significación (p=0,0002) mediante la t de student para datos apareados. Se estudió la relación entre el sexo y la incidencia de recidiva no hallándose diferencias estadísticamente significativas (p=0,561). Se comparó la incidencia de recidiva en los 3 grupos de pacientes según número de dioptrías y se encontró que la mayoría de las recidivas se producían en los pacientes entre 10 y 12 dioptrías (p=0,045). Éstas fueron las principales complicaciones postquirúrgicas: endoftalmitis asépticas 3, desprendimiento de retina (DR) 1, desprendimiento de coroides (DC) 1. Conclusiones: La excisión de MNV de etiología miópica es una técnica eficaz en la mejora de la AV en estos pacientes Se ha observado que los pacientes con mayor índice de recidiva postquirúrgica son los comprendidos entre 10 y 12 dioptrías. Los pacientes con menor número de dioptrías tienen a su vez una menor alteración del EPR y por lo tanto un menor índice de recurrencia. Por otro lado, los pacientes con un elevado número de dioptrías tienen una mayor atrofia coroidea y disminución de la circulación coroidea, lo cual también reduce la posibilidad de recidiva. La miopía media parece ser un factor de riesgo de recidiva postquirúrgica de las MNV miópicas

Membrana neovascular asociada a rotura retiniana en el polo posterior

Case report: We present the case of a 75-year-old man who refers visual loss in his left eye. There is a detachment in the posterior pole associated to a retinal break. Ancillary tests allow us to achieve the diagnosis of choroidal neovascular membrane. Discussion: The presence of a retinal break makes the initial diagnosis difficult in this case. Although hemorrhage usually confirms the presence of neovascular membrane activity, in many cases this hemorrhage may be scarce or absent, and only subretinal fluid may be seen.Caso clínico: Varón de 75 años de edad que refiere disminución de agudeza visual en ojo izquierdo. Presenta un levantamiento del polo posterior asociado a una rotura retiniana. Se presentan las pruebas complementarias que permiten llegar al diagnóstico de membrana neovascular coroidea. Discusión: La presencia de una rotura retiniana dificulta el diagnóstico inicial del paciente. Aunque clásicamente se considera que la presencia de hemorragias confirma la actividad de una membrana neovascular, en muchos casos este componente hemorrágico puede ser escaso o incluso estar ausente, siendo el fluido subretiniano el único signo clínico presente

Queratitis por acanthamoeba: estudio retrospectivo

Purpose: To analize the diagnosis and treatment¿s evolution of acanthamoeba keratitis (AK) in our center in recent years. Methods: We have studied 21 cases of AK in which the diagnosis was confirmed by anatomopathological tests. We¿ve studied these variables: age, gender, job, diagnosis date, visual acuity when diagnosed, period of time between starting the symptomatology and specific treatment, contact lenses (CL) wearer and swiming with them, clinical signs, treatment applied and illness evolution. Results: We found that of 21 patients we studied, 17 were CL wearers, 14 of them were soft. The most frequent presumption diagnosis the patient came to our center with was herpetic keratitis in 15 cases. Diagnosis was made in all cases by anatomopathological tests, 9 cases by corneal biopsy and 13 cases by recipient¿s cornea studies in pacients who requiered penetrating keratoplasty. Conclusion: To have the knowledge of this entity and its suspicion in CL wearers is very important to avoid an unfavourably evolution. Early diagnosis and an appropiated treatment can avoid it. Contact lenses wearers should know disinfectant measures in order to avoid risky situations.Objetivo: Analizar la evolución sufrida en el diagnóstico y tratamiento de la queratitis por acanthamoeba en nuestro centro en los últimos 13 años. Métodos: Hemos estudiado 21 casos de dicha patología en los cuales el examen anatomopatológico confirmó el diagnóstico. Se analizan variables como la edad, sexo, ocupación laboral, fecha del diagnóstico, AV en el momento del diagnóstico y AV final, tiempo entre el inicio del cuadro y tratamiento específico, uso de lentes de contacto (LC) y baño con ellas, signos clínicos, tratamiento empleado y evolución del cuadro. Resultados: Hallamos que de 21 pacientes, 17 eran portadores de LC, 14 de las cuales eran hidrofílicas. El diagnóstico de presunción más frecuente con el que el paciente acudió a nuestro servicio fue el de queratitis herpética en 15 casos. El diagnóstico se estableció en todos los casos por estudio anatomopatológico, tanto por biopsia corneal (9 casos) como por estudio del botón corneal en aquellos que requirieron queratoplastia penetrante (QP) (13 casos). Conclusiones: El conocimiento de esta patología y su sospecha en pacientes portadores de LC es fundamental para evitar una evolución desfavorable. El diagnóstico precoz y un tratamiento adecuado pueden evitarlo. El conocimiento por parte de los usuarios de las medidas de desinfección y evitar situaciones de riesgo es básico en la prevención de dicha entidad

Efficacy, durability, and safety of intravitreal faricimab with extended dosing up to every 16 weeks in patients with diabetic macular oedema (YOSEMITE and RHINE): two randomised, double-masked, phase 3 trials

Background: To reduce treatment burden and optimise patient outcomes in diabetic macular oedema, we present 1-year results from two phase 3 trials of faricimab, a novel angiopoietin-2 and vascular endothelial growth factor-A bispecific antibody. Methods: YOSEMITE and RHINE were randomised, double-masked, non-inferiority trials across 353 sites worldwide. Adults with vision loss due to centre-involving diabetic macular oedema were randomly assigned (1:1:1) to intravitreal faricimab 6·0 mg every 8 weeks, faricimab 6·0 mg per personalised treatment interval (PTI), or aflibercept 2·0 mg every 8 weeks up to week 100. PTI dosing intervals were extended, maintained, or reduced (every 4 weeks up to every 16 weeks) based on disease activity at active dosing visits. The primary endpoint was mean change in best-corrected visual acuity at 1 year, averaged over weeks 48, 52, and 56. Efficacy analyses included the intention-to-treat population (non-inferiority margin 4 Early Treatment Diabetic Retinopathy Study [ETDRS] letters); safety analyses included patients with at least one dose of study treatment. These trials are registered with ClinicalTrials.gov (YOSEMITE NCT03622580 and RHINE NCT03622593). Findings: 3247 patients were screened for eligibility in YOSEMITE (n=1532) and RHINE (n=1715). After exclusions, 940 patients were enrolled into YOSEMITE between Sept 5, 2018, and Sept 19, 2019, and 951 patients were enrolled into RHINE between Oct 9, 2018, and Sept 20, 2019. These 1891 patients were randomly assigned to faricimab every 8 weeks (YOSEMITE n=315, RHINE n=317), faricimab PTI (n=313, n=319), or aflibercept every 8 weeks (n=312, n=315). Non-inferiority for the primary endpoint was achieved with faricimab every 8 weeks (adjusted mean vs aflibercept every 8 weeks in YOSEMITE 10·7 ETDRS letters [97·52% CI 9·4 to 12·0] vs 10·9 ETDRS letters [9·6 to 12·2], difference −0·2 ETDRS letters [−2·0 to 1·6]; RHINE 11·8 ETDRS letters [10·6 to 13·0] vs 10·3 ETDRS letters [9·1 to 11·4] letters, difference 1·5 ETDRS letters [−0·1 to 3·2]) and faricimab PTI (YOSEMITE 11·6 ETDRS letters [10·3 to 12·9], difference 0·7 ETDRS letters [−1·1 to 2·5]; RHINE 10·8 ETDRS letters [9·6 to 11·9], difference 0·5 ETDRS letters [−1·1 to 2·1]). Incidence of ocular adverse events was comparable between faricimab every 8 weeks (YOSEMITE n=98 [31%], RHINE n=137 [43%]), faricimab PTI (n=106 [34%], n=119 [37%]), and aflibercept every 8 weeks (n=102 [33%], n=113 [36%]). Interpretation: Robust vision gains and anatomical improvements with faricimab were achieved with adjustable dosing up to every 16 weeks, demonstrating the potential for faricimab to extend the durability of treatment for patients with diabetic macular oedema. Funding: F Hoffmann-La Roche.</p

Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial

Background Geographic atrophy is an advanced form of dry age-related macular degeneration that can lead to irreversible vision loss and high burden of disease. We aimed to assess efficacy and safety of avacincaptad pegol 2 mg in reducing geographic atrophy lesion growth.Methods GATHER2 is a randomised, double-masked, sham-controlled, 24-month, phase 3 trial across 205 retina clinics, research hospitals, and academic institutions globally. To be eligible, patients had to be aged 50 years or older with non-centrepoint-involving geographic atrophy and best corrected visual acuity between 20/25 and 20/320 in the study eye. Eligible patients were randomly assigned (1:1) to monthly avacincaptad pegol 2 mg administered as a 100 mu L intravitreal injection or sham for the first 12 months. Randomisation was performed using an interactive response technology system with stratification by factors known to be of prognostic importance in age-related macular degeneration. Patients, investigators, study centre staff, sponsor personnel, and data analysts were masked to treatment allocation. The primary endpoint was geographic atrophy lesion size measured by fundus autofluorescence at baseline, month 6, and month 12. Efficacy and safety analyses were done in the modified intention-to-treat and safety populations, respectively. This trial is registered with ClinicalTrials.gov, NCT04435366.Findings Between June 22, 2020, and July 23, 2021, 1422 patients were screened for eligibility, of whom 448 were enrolled and randomly assigned to avacincaptad pegol 2 mg (n=225) or sham (n=223). One patient in the sham group did not receive study treatment and was excluded from analyses. There were 154 (68%) female patients and 71 (32%) male patients in the avacincaptad pegol 2 mg group, and 156 (70%) female patients and 66 (30%) male patients in the sham group. From baseline to month 12, the mean rate of square-root-transformed geographic atrophy area growth was 0 center dot 336 mm/year (SE 0 center dot 032) with avacincaptad pegol 2 mg and 0 center dot 392 mm/year (0 center dot 033) with sham, a difference in growth of 0 center dot 056 mm/year (95% CI 0 center dot 016-0 center dot 096; p=0 center dot 0064), representing a 14% difference between the avacincaptad pegol 2 mg group and the sham group. Ocular treatment-emergent adverse events in the study eye occurred in 110 (49%) patients in the avacincaptad pegol 2 mg group and 83 (37%) in the sham group. There were no endophthalmitis, intraocular inflammation, or ischaemic optic neuropathy events over 12 months. To month 12, macular neovascularisation in the study eye occurred in 15 (7%) patients in the avacincaptad pegol 2 mg group and nine (4%) in the sham group, with exudative macular neovascularisation occurring in 11 (5%) in the avacincaptad pegol 2 mg group and seven (3%) in the sham group.Interpretation Monthly avacincaptad pegol 2 mg was well tolerated and showed significantly slower geographic atrophy growth over 12 months than sham treatment, suggesting that avacincaptad pegol might slow disease progression and potentially change the trajectory of disease for patients with geographic atrophy.Funding Iveric Bio, An Astellas Company.Copyright (c) 2023 Elsevier Ltd. All rights reserved