Study of the choroid of healthy population using swept-source optical coherence tomography

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Oftalmología y Otorrinolaringología, leída el 28-04-2017Empleando la tomografía de coherencia óptica Swept-Source (SS-OCT): - Evaluar el grosor coroideo (GC) en la población infantil. - Determinar el perfil del GC en población sana. - Analizar las características morfológicas de la interfase coroides-esclerótica. - Determinar la diferencia interocular en el perfil del GC macular. - Estudiar el GC y sus variaciones con la edad, así como la morfología y cambios de las tres capas anatómicas de la coroides. - Analizar la densidad de la coroides de la población sana. Material y Métodos: Los criterios de inclusión fueron: mejor agudeza visual corregida entre 20/20 y 20/25, equivalente esférico (EE) entre ±3 dioptrías (D) y ausencia de enfermedades sistémicas u oculares. Las medidas y determinaciones fueron realizadas por dos o tres investigadores independientes y enmascarados según el caso, con un prototipo SS-OCT (Topcon Co., Japón). Para el estudio de la población infantil se realizó un estudio comparativo transversal no intervencionista del área macular de 83 ojos de 43 pacientes pediátricos (<18 años). El GC macular se determinó independientemente por 3 observadores manualmente a intervalos de 750 μm midiendo la distancia desde el borde posterior del epitelio pigmentario de la retina (EPR) hasta la unión coroidesesclerótica, a lo largo de una línea de 4500 μm centrada en la fóvea. El GC pediátrico se comparó con el de 75 ojos de 50 voluntarios adultos sanos (≥18 años)...While using Swept-Source optical coherence tomography (SS-OCT): - Study choroidal thickness of healthy pediatric population. - Study the choroidal thickness profile of healthy population. - Study the morphologic characteristics of the choroid-sclera interface. - Study interocular differences regarding the macular choroidal thickness profile. - Study choroidal thickness, its variations with age and the changes that appear within its three layers. - To analyse the vascular density of the choroid in a healthy population. Material y Methods: Inclusion criteria were: Best corrected visual acuity between 20/20 and 20/25, spherical equivalent (SE) between ±3 diopters (D) and absence of systemic or ocular diseases. Measures were performed by 2 or 3 independent, masked observers using a SS-OCT prototype (Topcon Co. Japan). A cross-sectional, non-interventional study of 276 eyes was performed to analyse the choroidal thickness profile and the morphology of the choroid-sclera interface. Two independent, masked observers studied these characteristics and classified the shape into concave (bowl-shaped) or inflection (S-shaped), manually measuring choroidal thickness from the posterior edge of the RPE and the choroidsclera junction under the fovea. They performed 8 more measures every 1000 μm towards temporal and nasal sectors. Analised subjects were stratified into 5 age groups...Depto. de Inmunología, Oftalmología y ORLFac. de MedicinaTRUEunpu

Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN)

Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area—defined as myopic maculopathy—are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>−6 to −8 diopters) in the context of eye elongation (26–26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)—with and without retinal detachment—and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable—but erroneous—use of the terms high and pathologic myopia in genetic researc

Systemic effects of repeated intraocular dexamethasone Intravitreal implant in diabetic patients: a retrospective study

Introduction: The objective of this study is to evaluate the influence of repeated intraocular dexamethasone implant (Ozurdex) injections on metabolic control in type 2 diabetic patients. Methods: Retrospective study of 165 type 2 diabetic patients starting Ozurdex treatment who received no less than three consecutive injections. Glycated hemoglobin (HbA1c), serum creatinine, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TGs) were evaluated during 15 months of follow-up after Ozurdex treatment onset. Results: Fifty-seven patients met inclusion criteria. Mean baseline values for HbA1c, creatinine, total cholesterol, HDL cholesterol, and TGs before treatment (7.1%, 1.3, 176.7, 51.1, and 125.6 mg/ dl, respectively) were similar to mean values after Ozurdex onset (Wilcoxon test p values were 0.68, 0.41, 0.06, 0.87, and 0.33, respectively) and remained stable during the follow-up period. Mean LDL cholesterol levels increased slightly after Ozurdex treatment onset (90.1 vs 88.2 mg/ dl, p = 0.04) but after 15 months of follow-up they had returned to baseline values. Transient increase in LDL cholesterol was remarkable in the group of 24 bilaterally treated patients (96.8 vs 88.4 mg/dl, p = 0.03). A third of these patients increased their baseline LDL values by more than 20%. Even with continuous injections of Ozurdex, LDL cholesterol levels also declined back to baseline by month 15. Conclusion: Ozurdex injections had no influence on HbA1c or renal function. Lipid profile changes were mild and transient. However, a significant temporary increase has been found in LDL cholesterol levels in patients receiving simultaneous bilateral injections. Lipid levels should be monitored in patients starting with bilateral Ozurdex injections especially in those with recent history of acute myocardial infarction

Effect of pharmacological pupil dilation on measurements and iol power calculation made using the new swept-source optical coherence tomography-based optical biometer

Purpose: to determine whether pupil dilation affects biometric measurements and intraocular lens (IOL) power calculation made using the new swept-source optical coherence tomography-based optical biometer (IOLMaster 700©; Carl Zeiss Meditec, Jena, Germany). Procedures: eighty-one eyes of 81 patients evaluated for cataract surgery were prospectively examined using the IOLMaster 700© before and after pupil dilation with tropicamide 1%. The measurements made were: axial length (AL), central corneal thickness (CCT), aqueous chamber depth (ACD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW) and pupil diameter (PD). Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between measurement modes (with and without dilation) was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots. Results: mean patient age was 75.17 ± 7.54 years (range: 57–92). Of the variables determined, CCT, ACD, LT and WTW varied significantly according to pupil dilation. Excellent intraobserver correlation was observed between measurements made before and after pupil dilation. Mean IOL power calculation using the Holladay 2 and SRK/T formulas were unmodified by pupil dilation. Conclusions: the use of pupil dilation produces statistical yet not clinically significant differences in some IOLMaster 700© measurements. However, it does not affect mean IOL power calculation

Genetic and environmental factors related to the development of myopic maculopathy in Spanish patients

High myopia and the subsequent degenerative changes of the retina, choroid, and sclera, known as myopic maculopathy (MM), are a serious visual problem in many Asian countries, and are beginning to be so in the south of Europe, especially in the Mediterranean. It is therefore necessary to carry out genetic and environmental studies to determine the possible causes of this disease. This study aims to verify if the genetic factors that have been most related to Asian populations are also associated in two Spanish cohorts. Eight SNPs from six genes (PAX6,SCO2,CCDC102B,BLID,chromosome 15q14, andCOL8A1) along with demographic, ophthalmic and environmental factors were analysed in two cohorts from a total of 365 highly myopic subjects and 177 control subjects. The genetic analysis showed thatCOL8A1SNP rs13095226 was associated with the development of choroidal neovascularization (CNV) and also seems to play an important role in the increase of axial length. The SNP rs634990 ofchromosome 15q14also showed a significant association with MM, although this was lost after the Bonferroni correction. Additional demographic and environmental factors, namely age, sex, smoking status, and pregnancy history, were also found to be associated with MM and CNV in this population

Reflexiones universitarias. San Pedro Valencia: renovación urbana, saneamiento ambiental y emprendimientos turísticos. Otoño 2015

Los trabajos que aquí se presentan se elaboraron por las y los estudiantes como parte de las actividades del Proyecto de Aplicación Profesional (PAP) “San Pedro Valencia: renovación urbana, saneamiento ambiental y emprendimientos turísticos”, durante el periodo de Otoño de 2015. A lo largo del periodo los autores compartieron sus reflexiones en torno a su percepción sobre el contexto en el que actúa el PAP; sobre las alternativas posibles a la problemática detectada y lo que significa pensar una alternativa; sobre los sujetos con los que se ha interactuado a lo largo de la experiencia de trabajo y sobre el papel del profesionista y del ciudadano en un mundo como el que nos tocó vivir. La obra está compuesta por reflexiones personales de las y los estudiantes que, explorando estas temáticas, comparten sus aprendizajes y observaciones de forma vívida.ITESO, A.C

Real-world experience with bezlotoxumab for prevention of recurrence of Clostridioides difficile infection

Bezlotoxumab is marketed for the prevention of recurrent Clostridioides difficile infection (rCDI). Its high cost could be determining its prescription to a different population than that represented in clinical trials. The objective of the study was to verify the effectiveness and safety of bezlotoxumab in preventing rCDI and to investigate factors related to bezlotoxumab failure in the real world. A retrospective, multicentre cohort study of patients treated with bezlotoxumab in Spain was conducted. We compared the characteristics of cohort patients with those of patients treated with bezlotoxumab in the pivotal MODIFY trials. We assessed recurrence rates 12 weeks after completion of treatment against C. difficile, and we analysed the factors associated with bezlotoxumab failure. Ninety-one patients were included in the study. The cohort presented with more risk factors for rCDI than the patients included in the MODIFY trials. Thirteen (14.2%) developed rCDI at 12 weeks of follow-up, and rCDI rates were numerically higher in patients with two or more previous episodes (25%) than in those who had fewer than two previous episodes of C. difficile infection (CDI) (10.4%); p = 0.09. There were no adverse effects attributable to bezlotoxumab. Despite being used in a more compromised population than that represented in clinical trials, we confirm the effectiveness of bezlotoxumab for the prevention of rCDI

Comparison of Bioelectrical Impedance Analysis, Slaughter Skinfold-Thickness Equations, and Dual-Energy X-ray Absorptiometry for Estimating Body Fat Percentage in Colombian Children and Adolescents with Excess of Adiposity

Dual-energy X-ray absorptiometry (DXA) has been considered a reference method for measuring body fat percentage (BF%) in children and adolescents with an excess of adiposity. However, given that the DXA technique is impractical for routine field use, there is a need to investigate other methods that can accurately determine BF%. We studied the accuracy of bioelectrical impedance analysis (BIA) technology, including foot-to-foot and hand-to-foot impedance, and Slaughter skinfold-thickness equations in the measurement of BF%, compared with DXA, in a population of Latin American children and adolescents with an excess of adiposity. A total of 127 children and adolescents (11–17 years of age; 70% girls) from the HEPAFIT (Exercise Training and Hepatic Metabolism in Overweight/Obese Adolescent) study were included in the present work. BF% was measured on the same day using two BIA analysers (Seca® 206, Allers Hamburg, Germany and Model Tanita® BC-418®, TANITA Corporation, Sportlife Tokyo, Japan), skinfold measurements (Slaughter equation), and DXA (Hologic Horizon DXA System®, Quirugil, Bogotá, Columbia). Agreement between measurements was analysed using t-tests, Bland–Altman plots, and Lin’s concordance correlation coefficient (ρc). There was a significant correlation between DXA and the other BF% measurement methods (r > 0.430). According to paired t-tests, in both sexes, BF% assessed by BIA analysers or Slaughter equations differ from BF% assessed by DXA (ρ < 0.001). The lower and upper limits of the differences compared with DXA were 6.3–22.9, 2.2–2.8, and -3.2–21.3 (95% CI) in boys and 2.3–14.8, 2.4–20.1, and 3.9–18.3 (95% CI) in girls for Seca® mBCA, Tanita® BC 420MA, and Slaughter equations, respectively. Concordance was poor between DXA and the other methods of measuring BF% (ρc < 0.5). BIA analysers and Slaughter equations underestimated BF% measurements compared to DXA, so they are not interchangeable methods for assessing BF% in Latin American children and adolescents with excess of adiposity.The author C.A.A.S was given a doctoral scholarship from Brazilian government by CAPES (Coordination of Improvement of Higher Education Personnel) (Proc: 9588-13-2). MM is supported by grants from the Spanish Ministry of Education, Culture, and Sport FPU14/03329 (predoctoral grant) and EST17/00210 (short stay grant). KG-R received a scholarship from Universidad del Rosario, Colombia, Escuela de Medicina y Ciencias de la Salud, to do a Doctorate. The HEPAFIT Study was carried out with the financial support of Instituto Colombiano para el Desarrollo de la Ciencia y la Tecnología “Francisco José de Caldas” COLCIENCIAS (contract code 59700 and no. 122277757900). The content of this paper reflects the authors’ views alone, and the Colombian Community and COLCIENCIAS are not liable for any use that may be made of the information contained herein