Charles Bonnet syndrome in a young patient with a history of epilepsy

Unidad Docente de Inmunología, Oftalmología y ORLFac. de Óptica y OptometríaTRUEpu

Retinal nerve fiber layer thickness in children with primary congenital glaucoma measured by spectral domain optical coherence tomography

Purpose: To evaluate retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD-OCT) in a population of children diagnosed with primary congenital glaucoma (PCG). Methods: In this cross-sectional study, 59 eyes of 59 children diagnosed with PCG and 87 eyes of 87 healthy children were evaluated by SD-OCT to measure the RNFL. The global average peripapillary RNFL thickness and sectional RNFL thickness were evaluated in both groups. Differences in global average and sectional thickness were analyzed. Results: Mean age in the PCG group was 9.61 ± 3.23 years; in the control group, 8.47 ± 2.99 years (P = 0.0516). There were statistically significant differences (P < 0.007) in all sectors between both groups. Conclusions: SD-OCT is a promising tool for evaluating the eyes of children diagnosed with PCG. Future research should examine the test–retest variability of SD-OCT parameters and their ability to diagnose progression in these children

Evaluation of a Novel Αb Εxterno MicroShunt for the Treatment of Glaucoma

The surgical management of glaucoma has been revolutionized by the introduction of minimally invasive glaucoma surgery (MIGS). The various MIGS options aim to meaningfully lower intraocular pressure with a better safety profile than traditional glaucoma surgery. The key clinical attributes and the emerging potential of an ab externo MicroShunt (PreserFlo™) are reviewed in the context of published evidence and clinical experience. This novel MicroShunt consists of an 8.5-mm-long tube that is implanted in the eye via an ab externo approach enabling aqueous humor drainage into the sub-Tenon's space through the formation of a bleb, similar in appearance to that created by trabeculectomy. The efficacy and safety of this procedure, the concomitant use of antimetabolites, the impact of tube positioning, and its future value in clinical practice are critically reviewed. Recent evidence has demonstrated the MicroShunt to be less effective than traditional filtration surgery, but with a significant improvement in safety. Cumulative data suggest that the new implant provides tangible clinical benefits to selected patients with glaucoma in need of further intraocular pressure (IOP) lowering. Future research should delineate the precise role of this and other MIGS options in the rapidly evolving glaucoma treatment algorithm.Unidad Docente de Inmunología, Oftalmología y ORLDepto. de Inmunología, Oftalmología y ORLFac. de Óptica y OptometríaFac. de MedicinaTRUEpu

Current Perspectives on the Use of Anti-VEGF Drugs as Adjuvant Therapy in Glaucoma

The approval of one of the first anti-vascular endothelial growth factor (VEGF) agents for the treatment of neovascular age-related macular degeneration one decade ago marked the beginning of a new era in the management of several sight-threatening retinal diseases. Since then, emerging evidence has demonstrated the utility of these therapies for the treatment of other ocular conditions characterized by elevated VEGF levels. In this article we review current perspectives on the use of anti-VEGF drugs as adjuvant therapy in the management of neovascular glaucoma (NVG). The use of anti-VEGFs for modifying wound healing in glaucoma filtration surgery (GFS) is also reviewed. Selected studies investigating the use of anti-VEGF agents or antimetabolites in GFS or the management of NVG have demonstrated that these agents can improve surgical outcomes. However, anti-VEGF agents have yet to demonstrate specific advantages over the more established agents commonly used today. Further studies are needed to evaluate the duration of action, dosing intervals, and toxicity profile of these treatments

Tear and aqueous humour cytokine profile in primary open‐angle glaucoma

Purpose: To evaluate the concentrations of pro‐inflammatory cytokines in tear and aqueous humour of patients with primary open‐angle glaucoma (POAG), relative to healthy controls. Method: Tear and aqueous humour samples were collected from 29 healthy controls and 27 POAG patients. Twenty‐seven inflammatory cytokines were analysed: interleukin (IL)‐1β, IL‐1ra, IL‐2, IL‐4, IL‐5, IL‐6, IL‐7, IL‐8, IL9, IL‐10, IL‐12, IL‐13, IL‐15, IL‐17, eotaxin, fibroblast growth factor (FGF) basic, granulocyte colony‐stimulating factor, granulocyte‐monocyte colony‐stimulating factor, interferon (IFN)‐γ, interferon gamma‐induced protein, monocyte chemo‐attractant protein‐1, macrophage inflammatory protein (MIP)‐1α, MIP‐1β, platelet‐derived growth factor, regulated on activation normal T cell expressed and secreted, tumour necrosis factor (TNF)‐α and vascular endothelial growth factor (VEGF). Results: In tear samples of glaucoma patients, an increase in IL‐4, IL‐12, IL‐15, FGF‐basic and VEGF was observed, as well as a decrease in MIP‐1a relative to the control group (p < 0.05). IL‐5, IL‐12, IL‐15, IFN‐γ and MIP‐1a were significantly higher in aqueous humour of glaucoma eyes (p < 0.05). A poor correlation between cytokine levels in tear and aqueous humour was observed. Conclusion: The different profiles of inflammatory marker expression of patients with POAG and healthy controls confirm the inflammatory activity of the pathology, indicating that some of them could be used as potential biomarkers of this disease

Changes in corneal biomechanical properties after 24 hours of continuous intraocular pressure monitoring using a contact lens sensor

Objective: This study was designed to assess changes in corneal topography and biomechanics after intraocular pressure (IOP) monitoring using the Triggerfish contact lens sensor (CLS). Methods: For this prospective study, 30 eyes of 30 subjects: 14 healthy subjects (G1) and 6 glaucoma patients (G2), were recruited for 24 hours of continuous IOP monitoring using the CLS. The following measurements were taken before CLS fitting and after lens removal: maximum keratometry (Kmax), mean keratometry (MK), and corneal astigmatism (Cyl) measured through Pentacam corneal topography, and the corneal biomechanical variables corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA). Results: Pentacam data revealed significant changes after CLS removal in Kmax (+3.14 ± 2.46 D, p = 0.002), MK (+0.52 ± 0.63 D, p = 0.02), and Cyl (+0.48 ± 0.53 D, p = 0.019) in G1; and Kmax (+1.38 ± 1.43 D, p = 0.002) in G2. The changes observed were more pronounced in G1 than in G2 but differences were not significant. The ORA results indicated higher CH (11.35 ± 2.42 vs 8.17 ± 2.09) and CRF (10.3 ± 2.03 vs 9.1 ± 1.81) before lens fitting in G1 than G2, while no significant changes were produced after CLS removal in either group. Conclusions: The use of CLS for IOP monitoring over 24 hours caused topographic changes in both healthy subjects and glaucoma patients. No changes were produced in corneal biomechanics

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Structural analysis in chilhood glaucoma

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Oftalmología y Otorrinolaringología, leída el 26-01-2017El glaucoma infantil está causado por una presión intraocular elevada. Es clasificado como primario cuando hay una anomalía del desarrollo del ángulo aislada, y como secundario cuando la obstrucción del drenaje es causada por alguna otra causa ocular o sistémica. El glaucoma congénito primario es el que presenta una mayor incidencia y entre los secundarios la anomalía de Axenfeld-Reiger, anomalía de Peters, uveitis, afaquia, aniridia, y el síndrome de Sturge-Weber son los más frecuentes. La evaluación de un niño con glaucoma o sospecha de glaucoma requiere un examen en consulta o de una exploración bajo anestesia en función de la edad y de su capacidad de colaboración. La medida de la presión intraocular junto al examen de la cabeza del nervio óptico con oftalmoscopio directo o mediante fotografías sigue siendo el estándar. La presente tesis doctoral ha sido diseñada con el objetivo de evaluar el uso de nuevos dispositivos de exploración en sujetos con glaucoma infantil. Para ello, se han llevado a cabo un grupo de estudios entre los que se incluyen el análisis de parámetros de biomecánica corneal, análisis de capa de fibras nerviosas del nervio óptico mediante tomografía de coherencia óptica, cuantificación de los niveles de hemoglobina papilar por colorimetría y anális de la topografía corneal en sujetos con glaucoma infantil. Los resultados obtenidos son expuestos de forma detallada y parece que estas nuevas tecnologías de diagnóstico estructural podrían presentarse como una herramienta de ayuda en el manejo de estos pacientes con glaucoma de la infancia.Depto. de Inmunología, Oftalmología y ORLFac. de MedicinaTRUEunpu