Morphofunctional evaluation of peripapillary retinoschisis associated with myopic posterior staphyloma and hyaloid traction: does it cause peripapillary vitreoretinal traction? / Avaliação morfofuncional da retinosquise peripapilar associada ao estafloma posterior miópico e à tração hialoidea: isso causa tração vitreo-retiniana peripapilar?

ABSTRACT This case report presents the details of a 33-year-old female patient who was referred to a specialized retina service because of mild vision loss in her right eye). The patient's visual acuity was 20/25 in right eye and 20/50 in the left eye (; amblyopic); the spherical equivalent was -12.75 diopters (right eye) and -14.75 diopters (left eye). Multimodal retinal imaging showed peripapillary schisis in both the inner and outer retinal layers, grade II posterior vitreous detachment, and a tessellated fundus. Using Humphrey perimetry and MP-3 microperimetry, the functional evaluation indicated macular sensitivity within normal limits and decreased sensitivity in the peripapillary region, especially in right eye. The pattern-re versal visual evoked potential was measured. The N75 and P100 latency and amplitude in right eye were within normal values for checks of 1º. However, the amplitude was low for checks of 15′. Highly myopic patients who have posterior staphyloma that involves the optic nerve are susceptible to posterior hyaloid traction, and the resulting peripapillary vitreous traction may compromise vision.

RESUMO Este relato de caso apresenta um paciente feminino de 33 anos encaminhado para um serviço especializado de retina devido à leve perda de visão em olho direito. A acuidade visual foi de 20/25 no olho direito e 20/50 no olho esquerdo, o equivalente esférico foi de -12,75 dioptrias e -14,75 dioptrias, respectivamente. Avaliações multimodais revelaram isquese peripapilar nas camadas internas e externas da retina, descolamento vítreo posterior grau II e fundo tesselado. Avaliação funcional com perimetria Humphrey e microperimetria MP-3 revelaram sensibilidade macular normais e diminuição da sensibilidade na região peripapilar, especialmente no olho direito. Potencial visual evocado de padrão reverso apresentou no olho direito latência e amplitude N75 e P100 dentro dos valores normais para verificação de 1º. Entretanto, a amplitude foi baixa para a de 15′. Pacientes alto míopes com esfiloma posterior envolvendo o nervo óptico são suscetíveis à tração da hialoide posterior. Portanto a tração vitreopapilar resultante pode causar comprometimento da visão.

Epidemiologia e prevalência da maculopatia miópica em centro de referência em oftalmologia / Epidemiology and prevalence of myopic maculopathy in an ophthalmology reference center

RESUMO Objetivo: Determinar a epidemiologia e a prevalência da maculopatia miópica e da miopia patológica e os fatores de risco associados. Métodos: Trata-se de estudo observacional transversal retrospectivo realizado em um serviço de oftalmologia, com 59 pacientes com idade entre 7 e 70 anos e equivalente esférico maior que -6 dioptrias. Suas retinografias foram laudadas segundo a classificação META-PM, por dois oftalmologistas e um retinólogo experiente. A análise estatística foi realizada conforme o Matlab R2010, com o Excel 2010 e o Statistical Package for the Social Sciences , versão 20.0, sendo utilizado o resultado da análise de regressão logística binária múltipla. Resultados: De acordo com a META-PM, a prevalência da maculopatia miópica nos cem olhos analisados foi de 19% para C0, 53% para C1,18% para C2,2% para C3 e 8% para C4. A prevalência da miopia patológica foi de 39%, sendo que 37% desses olhos possuíam maculopatia miópica C1 com lesões plus , C2 ou pior ou estafiloma posterior, e 2% apresentavam categoria menor que C2, sem lesões plus , porém com estafiloma posterior. A análise de regressão logística binária múltipla revelou associação entre idade e equivalente esférico com a presença da miopia patológica (p<0,05), evidenciando que o aumento de 1 ano na idade implicou em 1,05 vez (razão de chance de 1,05) mais chance de apresentar miopia patológica (p<0,001; intervalo de confiança de 95% de 1,02-1,08). O aumento de 1 dioptria no equivalente esférico maior que -6 dioptrias acarretou 1,19 vez (razão de chance de 1,19) maior risco de apresentar miopia patológica (p=0,001; intervalo de confiança de 95% de1,08-1,32). Por fim, não houve associação entre sexo e presença da miopia patológica (p=0,784). Conclusão: A classificação META-PM é uma ferramenta importante na padronização do estadiamento da lesão miópica, permitindo comparação entre estudos e normatização de condutas. O avançar da idade e o equivalente esféricomiópico estão relacionados à severidade da maculopatia miópica e à presença da miopia patológica.

ABSTRACT Objective: To determine the epidemiology and prevalence of myopic maculopathy and pathologic myopia and associated risk factors. Methods: This is a retrospective cross-sectional observational study performed at an ophthalmology center, including 59 patients aged 7 to 70 years, and spherical equivalent higher than -6 diopters. Their retinographies were assessed by two ophthalmologists and an experienced retina specialist, using the META-PM study classification. Statistical analysis was performed using Matlab R2010, Excel 2010 and Statistical Package for the Social Sciences version 20.0, based on the result of multiple binary logistic regression analysis. Results: According to META-PM, the prevalence of myopic maculopathy in 100 eyes analyzed was 19% C0; 53% C1; 18% C2; 2% C3; 8% C4. The prevalence of pathologic myopia was 39%, and 37% of these eyes having myopic maculopathy category C1 with lesions plus, C2 or worse, or posterior staphyloma, and 2% in category smaller than C2, without lesions plus, but with posterior staphyloma. Multiple binary logistic regression analysis revealed an association between age and spherical equivalent inpathologic myopia (p<0.05), demonstrating the increase by 1 year in age implied in 1.05-fold (odds ratio=1.05) more likelyto present pathologic myopia (p<0.001; 95%CI 1.02-1.08). The increase by 1 diopter in the spherical equivalent higherthan -6 diopters, led to 1.19-fold (odds ratio=1.19) greater risk of presenting pathologic myopia (p=0.001; 95%CI 1.08-1.32). Finally, there was no association between sex and pathologic myopia (p=0.784). Conclusion: The META-PM study classification is an important tool to standardize myopic lesion staging, allowing comparison between studies and establishing management. Advanced age and myopic spherical equivalent are related to severity of myopic maculopathy and pathologic myopia.

Analysis of visual disability in Buenos Aires, Argentina. Pathologic myopia is the leading cause in working age / Análisis de discapacidad visual en Buenos Aires, Argentina. La miopía patológica es la principal causa en edad laboral

Abstract This study assessed the causes of visual impairment over a decade in Buenos Aires City. This is a retrospective case series where we reviewed the database of visual disability certificates issued by the Buenos Aires City Ministry of Health between 2009 and 2017. In Argentina, visual disability is defined as a visual acuity ≤ 20/200 in the better eye, or a corresponding visual field of less than 20 degrees in the less impaired eye. The database included the following variables: year of issue, age, gender, and cause of visual disability. Between 2009 and 2017 a total of 7656 subjects were certified as legally blind. The mean age of the sample was 57 ± 21 years and 52.1% were females. The emission was near 700 certificates per year. The age distribution showed that 62.8% of certificates were from patients older than 50 years and that only 6.6% were given to subjects under 20. The leading causes of visual disability in Buenos Aires City were age-related macular degeneration (ARMD) with a rate of 15.5%, degenerative myopia (14.4%), primary open-angle glaucoma (11.3%) and diabetic retinopathy (6.6%). In subjects younger than 50, degenerative myopia was the first cause of visual disability. Interestingly in Argentina, where the prevalence of myopia is low, degenerative myopia is found to be the major cause of visual disability in middle-aged adult subjects. Population and clinical methods to avoid this preventable disease should need to be implemented as a matter of urgency.

Resumen Este trabajo estudia las causas de la discapacidad visual durante una década en la Ciudad de Buenos Aires. Se presenta una serie de casos retrospectiva donde se revisó la base de datos de certificados de discapacidad visual emitidos por el Ministerio de Salud de la Ciudad de Buenos Aires entre 2009 y 2017. En Argentina, la discapacidad visual se define como una agudeza visual ≤ 20/200 en el mejor ojo, o un campo visual correspondiente de menos de 20 grados en el ojo menos deteriorado. La base de datos incluyó las siguientes variables: año de emisión, edad, sexo y causa de la discapacidad visual. Entre 2009 y 2017 se certificaron un total de 7656 sujetos con ceguera legal. La edad media de la muestra fue de 57 ± 21 años y el 52.1% fueron mujeres. La distribución por edades mostró que el 62.8% de los certificados fueron dados a pacientes mayores de 50 años y que solo el 6.6% se otorgó a menores de 20 años. Las principales causas de discapacidad visual fueron la degeneración macular asociada a la edad (DMAE) (15.5%), la miopía degenerativa (14.4%), el glaucoma primario de ángulo abierto (11.3%) y la retinopatía diabética (6.6%). En los menores de 50 años, la miopía degenerativa fue la primera causa de discapacidad visual. Resulta interesante que, en Argentina, donde la prevalencia de miopía es baja, la miopía degenerativa sea la principal causa de discapacidad visual en adultos de mediana edad.

Recurrent myopic foveoschisis: resolution after internal limiting membrane removal / Isquise miópica recorrente: resolução após remoção da membrana limitante interna

We report a case of a 66-year-old man with a history of high myopia and who was referred for acute decreased visual acuity of the right eye. Fundus examination and optical coherence tomography (OCT) showed a mild epiretinal membrane (ERM) and splitting of retinal layers. Pars plana vitrectomy was performed with intravitreous triamcinolone injection, posterior hyaloid and ERM peeling, and 12% perfluoropropane (C3F8) gas tamponade. After remaining asymptomatic for 17 months, the patient reported a new episode of sudden decreased visual acuity in his right eye, and OCT showed recurrent myopic foveoschisis (MF). He underwent vitrectomy and internal limiting membrane (ILM) peeling. Six months later, the patient’s best corrected visual acuity had improved to 20/25. Optical coherence tomography showed a remarkably improved macular anatomy, with residual traction along the inferotemporal arcade, which was attributed to the vessel stiffness itself. We conclude that removing the internal limiting membrane is a challenging maneuver in myopic foveoschisis, even with staining approaches. Although myopic foveoschisis may be resolved without peeling the internal limiting membrane, its removal should be considered if the condition recurs.

Relatamos caso de um homem de 66 anos, com antecedente de alta miopia, que referiu baixa de acuidade visual aguda no olho direito. O mapeamento de retina e o exame de tomografia de coerência óptica (OCT) mostraram discreta membrana epirretiniana (ERM) e isquise retiniana. Foi realizada vitrectomia via pars plana com injeção intravítrea de triancinolona, retirada da hialóide posterior, peeling da membrana epirretiniana e tamponamento com gás perfluorpropano (C3F8) a 12%. O paciente permaneceu assintomático por 17 meses, quando queixou-se de novo episódio de baixa de acuidade visual súbita no olho direito e o tomografia de coerência óptica mostrou recorrência da isquise miópica. Ele foi submetido a nova vitrectomia com peeling da membrana limitante interna (ILM). Após 6 meses, a acuidade visual corrigida era de 20/25. A tomografia de coerência óptica mostrou melhora importante da anatomia macular, com área de tração residual observada na arcada inferotemporal, que foi atribuída à rigidez do próprio vaso. A retirada da membrana limitante interna é uma manobra desafiadora em olhos alto míopes, mesmo estando corada. A resolução da isquise miópica pode ser atingida sem o peeling da membrana limitante interna, mas sua remoção deve ser considerada em casos de recorrência.

La miopía degenerativa desde una perspectiva social / Degenerative myopia seen from a social perspective

La miopía degenerativa y sus consecuencias para la visión en individuos jóvenes es uno de los problemas de salud a los que se enfrenta el profesional de la oftalmología. Se redactó un ensayo en el que se valoraron los principios de la bioética como paradigmas para el oftalmólogo actual, aplicados a la enfermedad. Se tuvo en cuenta la influencia de la sociedad y el desarrollo científico-técnico en los pacientes que presentan esta afección y repercusión de la miopía en la formación de la personalidad y en sus relaciones con la familia y la sociedad.

Degenerative myopia and its consequences for the young individuals' vision is one of the health problems that the ophthalmologist faces. This paper assessed the principles of bioethics as paradigms for the current ophthalmologist and applied to the disease. The influence of the society and of the technical scientific development over the patients having this disease was taken into account together with the impact of myopia on the formation of their personality and on their relationship with the family and the society.

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

Alteraciones del polo posterior en la miopía degenerativa / Alterations of the posterior pole in degenerative myopia patients

La miopía degenerativa constituye una de las causas fundamentales de pérdida de la visión. Esto está relacionado con las alteraciones del polo posterior, que afectan la retina neurosensorial, el epitelio pigmentario de la retina y las capas más internas de la coroides. Su curso lento y progresivo demanda una exploración integral, con seguimiento en el tiempo y constituye un reto para el oftalmólogo. Se realizó una revisión de artículos publicados e indexados en la base de datos de PubMed que se refirieran a las características clínicas del fondo de ojo en pacientes con miopía degenerativa...

Degenerative myopia is one of the main causes of visual impairment. This is related to disorders in the posterior pole, affecting the neurosensorial retina, the retinal pigmented epithelium and the inner choroidal layers. The slow and progressive course of this condition demands comprehensive assessment and long follow-up, which is a challenging task for ophthalmologists. A review of the articles indexed in PubMed regarding the clinical characteristics of the fundus in patients with degenerative myopia was made to describe the main disorders of the posterior pole of the eyeball. ..

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.

Individualización de pacientes con baja visión en el Centro Oftalmológico del Hospital General Docente Dr Juan Bruno Zayas Alfonso / Individualization of low vision patients in Dr Juan Bruno Zayas Alfonso Teaching General Hospital Ophthalmologic Center

Se efectuó un estudio descriptivo y transversal de 73 pacientes con baja visión, que asistieron a la consulta del Centro Oftalmológico del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde julio hasta diciembre del 2009, a fin de describir algunas características clínicas y demográficas. La degeneración macular asociada a la edad primó en más de 25,0 por ciento de los integrantes de la casuística, seguida por el glaucoma crónico simple y la miopía degenerativa y, según lugar de procedencia, los pertenecientes al municipio de Santiago de Cuba representaron 73,0 por ciento del total. Se logró rehabilitar a 89,0 por cientode los pacientes examinados y tratados

A descriptive and cross sectional study of 73 patients with low vision who visited the Ophthalmologic Center at Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from July to December 2009 in order to describe some clinical and demographic characteristics. Macular degeneration associated with age prevailed in more than the 25,0 per cent of the case material, followed by simple chronic glaucoma and degenerative myopia and, according to origin place, those belonging to Santiago de Cuba municipality represented 73,0 per cent of the total. It was possible to rehabilitate the 89,0 per cent of the examined and treated patients