Tratamiento de la neovascularización coroidea miópica / Treatment of myopic choroidal neovascularization

Se realizó una revisión sobre el tratamiento de la neovascularización coroidea en la miopía degenerativa. Se consultaron fundamentalmente artículos científicos de revistas publicados e indexados en las bases de datos PubMED y Cochrane, así como textos básicos que abordan este tema. No se encontraron certezas del beneficio de la fotocoagulación con láser de las lesiones neovasculares en esta entidad, mientras que la terapia fotodinámica parece brindar estabilidad de la lesión y mejoría visual, al menos a los 3 años de seguimiento. El uso de antiangiogénicos intravítreos tiene los mejores resultados en la actualidad respecto a la inactivación de la lesión y la recuperación visual pero no hay ensayos clínicos controlados que avalen su beneficio a largo plazo. Otras opciones de tratamiento se encuentran en investigación y desarrollo. No se ha concebido el protocolo ideal para tratar las membranas neovasculares miópicas

A literature review on the treatment of the choroidal neovascularization in the degenerative myopia was made. Published scientific articles of journals indexed in Pubmed and Cochrane databases, as well as basic texts that deal with this topic. No evidences of the benefits of the laser photocoagulation for neovascular lesions were found, whereas the photodynamic therapy seems to offer stability of the lesion and visual improvement after three years of follow-up. The use of intravitreous antiangiogenic drugs has currently achieved the best results in terms of lesion inactivation and visual recovery, but there are no controlled clinical trials that support their long-term benefits. Other treatment options are under research and development. The ideal protocol of treatment of neovascular myopic membranes has not yet been devised

Surgical outcomes of macular buckling techniques for macular retinoschisis in highly myopic eyes

To report the anatomic and visual results following macular buckling for patients with macular retinoschisis related to high myopia. Thirty-nine highly myopic eyes [mean refractive error -16.7 D; range, -9 to -24 D] of 36 patients [mean age 59 years; range, 35-79 years] presenting with macular retinoschisis associated with a posterior staphyloma, who underwent combined vitrectomy and macular buckling were evaluated. Main outcome measures included best-corrected visual acuity [BCVA] and optical coherence tomography [OCT] findings. Three cases were excluded due to short follow-up [less than 3 months]. The mean followup was 16 months. The mean BCVA increased from 0.76 to 0.43 LogMAR [p = 0.001]. Visual acuity improved in 30 eyes [83.3%], remained stable in three eyes [8.3%] and decreased in three eyes [8.3%]. OCT showed resolution of foveoschisis with foveal reattachment in all eyes. None of the evaluated patients developed a macular hole during follow-up. Macular buckling associated with vitrectomy results in good anatomic and visual outcomes in patients with myopic foveoschisis.

Photodynamic monotherapy or combination treatment with intravitreal triamcinolone acetonide, bevacizumab or ranibizumab for choroidal neovascularization associated with pathological myopia.

This retrospective, interventional case series analyses treatment outcomes in eyes with choroidal neovascularization (CNV) secondary to pathological myopia, managed with photodynamic therapy, (PDT), (Group 1, N = 11), PDT and intravitreal triamcinolone acetonide (4 mg/0.1ml) (Group 2, N = 3), PDT and intravitreal anti-vascular endothelial growth factor (anti-VEGF) bevacizumab 1.25 mg/0.05 ml, ranibizumab 0.5 mg/0.05 ml and reduced-fluence PDT and intravitreal ranibizumab 0.5 mg/0.05 ml (Group 3, N=12). All the patients underwent PDT. Intravitreal injections were repeated as required. SPSS 14 software was used to evaluate the data. Wilcoxon signed ranks test was used to evaluate pre- and post-treatment vision. The Kruskal-Wallis test was used for comparison between the groups. All the groups were statistically comparable. All the eyes showed complete regression of CNV, with a minimum follow-up of six months. All groups had visual improvement; significantly in Group 3 (P = 0.003). Combination PDT with anti-VEGF agents appeared to be efficacious in eyes with myopic CNV. However, a larger study with a longer follow-up is required to validate these results.

Macular Gradient Measurement in Myopic Posterior Staphyloma Using Optical Coherence Tomography

PURPOSE: To evaluate clinical characteristics and the macular gradient in myopic posterior staphyloma with time domain (TD) optical coherence tomography (OCT). METHODS: Sixty-four staphyloma eyes of 40 patients were examined. Macular gradient (tangent theta) and the location of staphyloma were assessed with OCT imaging. The macular gradient was measured at points 1 mm and 2 mm distant from the fovea. The relationships of the macular gradient with age, axial length, and spherical equivalent were analyzed. RESULTS: In 8 eyes (12.5%), the bottoms of the staphylomas were in the fovea, and there was no macular gradient. However, in the other 56 eyes (87.5%), the bottoms of the staphylomas were not in the foveal area, and macular gradients existed. Staphylomas were commonly located in the infero-nasal retinal area. The mean macular gradient (tangent theta) was 0.26 +/- 0.08 at 1 mm distance from the fovea and 0.28 +/- 0.10 at 2 mm. No significant relationships were observed between macular gradient and axial length, patient age, or spherical equivalent. CONCLUSIONS: TD OCT reveals staphyloma location. If the location is outside of the fovea, a macular gradient exists and can be measured by OCT. Axial length measurement error may occur in eyes with poor visual fixation and steep macular gradients.

Bevacizumab en el tratamiento de la neovascularización coroidea miópica / Bevacizumab in the treatment of myopic choroidal neovascularization

Objetivo: Determinar los efecto de bevacizumab intravítreo en el tratamiento de la membrana neovascular miópica. Métodos: Se realizó un estudio tipo cohorte retrospectiva de pacientes sometidos a inyección intravítrea de 1,25 mg de bevacizumab para el tratamiento de neovascularización coroidea miópica. Se evaluó cambios en agudeza visual (AV) mejor corregida, efectos secundarios y complicaciones. Resultados: 22 ojos fueron incluidos. La AV inicial fue de 0,17 +/- 0.15; al mes post-tratamiento de 0,28 +/- 0,15; a los 3 meses de 0,26 +/- 0,13; a los 6 meses de 0,21 +/-0,17; a los 12 meses de 0,31 +/- 0,13; a los 18 meses de 0,29 +/- 0,08; y a los 24 meses de 0,31 +/- 0,14. Hubo diferencia estadísticamente significativa entre el 1° y 12° mes en relación a la AV inicial. Conclusión: El tratamiento con bevacizumab intravítreo resultó en una significativa mejoría en la AV durante el primer año post-tratamiento.

Purpose: To determine the effects of intravitreal bevacizumab in the treatment of myopic choroidal neovascularization. Methods: A retrospective cohort study was performed by clinical history research of patients treated with 1,25 mg of intravitreal bevacizumab, with a follow up of 24 months. best corrected visual acuity (BCVA), side effects and complications were evaluated. Results: 22 eyes of 19 patients were included. Initial BCVA was 0.17 +/-0.15; at 1 month post treatment 0.28 +/- 0.15; at 3 months 0.26 +/-0.13; at 6 months 0.21 +/- 0.17; at 12 months 0.31 +/- 0.13; at 18 months 0.29 +/- 0.08; at 24 months 0.31 +/- 0.14. There was a significant statistical difference between the 1° and 12° month in contrast with the initial BCVA. Conclusions: Treatment with intravitreal bevacizumab resulted in a significant BCVA improve during the first year after treatment.

Eficacia y seguridad del bevacizumab (avastín) intravítreo en la neovascularización coroídea en miopía patológica / Efficacy and safety of intravitreal bevacizumab for myopic choroidal neovascularization

Resumen: Evaluar seguridad y eficacia a corto plazo del bevacizumab intravítreo en pacientes con neovascularización coroídea (NVC) en miopía patológica sin tratamiento previo. Diseño: Serie clínica consecutiva intervencional retrospectiva. Métodos: Siete pacientes recibieron bevacizumab intravítreo (1,5 mg). Se evaluaron los efectos secundarios, cambios en agudeza visual de Snellen (AV), características angiográficas y tomografía de coherencia óptica (OCT) al mes, tres y/o último mes de control post inyección. Resultados: No se encontraron efectos adversos. Al mes todos los pacientes presentaron desaparición de la filtración angiográfica y resolución del líquido subretinal en el OCT, con disminución media del grosor central de 73,3 um(p=0,01). La AV media mejoró de 0,2 a 0,4 (p=0,02) y de 0,2 a 0,5 (p=0,02) al primer y tercer mes respectivamente. Ningún paciente requirió retratamiento. Conclusiones: El bevacizumab intravítreo es bien tolerado y se asocia con mejoría de la AV en concomitancia con regresión de los signos angiográficos y al OCT de actividad de la NVC en miopía patológica.

Objective: To assess the short term efficacy and safety of intravitreal bevacizumab for myopic choroidal neovascularization (mCNV) without previous treatment. Methods: Intravitreal bevacizumab (1.5 mg) was injected into seven eyes of seven patients with mCNV in this non randomized, retrospective interventional case series. Changes in Snellen visual acuity (VA), optical coherence tomography (OCT) and fluorescein angiography (FA) were measured at 1,3 and/or last follow up month after treatment. Results: At one month all patients showed resolution of leakage from the mCNV in the FA and the mean foveal thickness on OCT images decreased 73.3 um (p=0.01). Mean VA improved from 20/100 to 20/50 (p=0.02) and from 20/100 to 20/40 (p=0.02) at 1 and 3 months post injection respectively. No retreatments were required. No major complications developed. Conclusion: Intravitreal injection of bevacizumab is well tolerated and in this small series seems to be safe and efficacious in eyes with mCNV.

Avaliação das alterações fundoscópicas na miopia degenerativa / Fundus changes evaluation in degenerative myopia

OBJETIVO: Avaliar a presença de alterações fundoscópicas em pacientes portadores de miopia degenerativa. MÉTODOS: Quarenta pacientes com erro refrativo de pelo menos -6,00 dioptrias foram selecionados para exame oftalmológico, complementado por retinografia do pólo posterior e ecobiometria. RESULTADOS: Foram estudados 57 olhos de 37 pacientes com erro refrativo de -6,25 a -28,50 dioptrias, com média de -14,05, e comprimento axial de 26,06 a 32,86 mm, com média de 28,01. Encontramos crescente temporal em 36,5 por cento e circunferencial em 21 por cento dos olhos. Vasos da coróide foram visualizados em 35 por cento dos olhos. As alterações do pólo posterior foram as seguintes: estafiloma posterior em 10,5 por cento, mancha de Fuchs em 3,5 por cento e "lacquer cracks" em 1,5 por cento. O exame da periferia retiniana evidenciou atrofia corio-retiniana tipo pavimentosa em 17,5 por cento, branco sem pressão em 10,5 por cento, degeneração "lattice" em 5 por cento, ruptura retiniana em 3,5 por cento e retinosquise em 1,5 por cento dos olhos examinados. CONCLUSÕES: Alterações fundoscópicas que levam à baixa visual são freqüentes em pacientes com miopia degenerativa. O exame da periferia retiniana é muito importante nestes pacientes devido ao risco aumentado de descolamento de retina.

Effect of Internal Limiting Membrane Removal in Treatment of Retinal Detachment Caused by Myopic Macular Hole

The purpose of this study was to evaluate the anatomical outcomes of vitrectomy with internal limiting membrane removal in highly myopic eyes with retinal detachment caused by a macular hole. Nineteen, consecutive, highly myopic eyes with full thickness macular hole with retinal detachment were treated by vitrectomy with internal limiting membrane removal, endolaser photocoagulation on the center of the hole and fluid gas exchange. In five eyes with other peripheral breaks, scleral buckling (3 cases), encircling (1 case) and barrier laser (1 case) were combined. In 15 eyes (79.0%) the macular hole was closed after the initial surgery. In 4 eyes (21%) the macular hole was reopened, but these were successfully treated with fluid gas exchange (1 case) or macular buckling (3 cases). The visual acuity was improved in 15 eyes (79.0%). In conclusion, these results suggest that the removal of the perifoveal internal limiting membrane may be an important adjuvant in the treatment of the myopic macular hole with retinal detachment.