PLASMA RICH IN GROWTH FACTORS FOR PERSISTENT MACULAR HOLE: A PILOT STUDY.

PURPOSE: Persistent macular hole (PMH) is a challenge for retina surgeons. There are limited surgical techniques described achieving PMH closure. For more than a decade, techniques with blood derivatives have been described without optimal outcomes. The aim of this article is to report the usefulness of the plasma rich in growth factors (PRGF) as a new way to improve PMH closure. METHODS: This is an observational study. Two patients with PMH were chosen at the FOSCAL Internacional, Floridablanca, Colombia. For each patient, a complete ophthalmological examination before and after treatment was performed. It included best-corrected visual acuity and fundus examination. Features of swept-source optical coherence tomographic angiography (Topcon) at baseline and after treatment were included. Preoperative evaluation included the following: previous vitreoretinal surgery for macular hole, macular hole measurement and classification, and dissociated optic nerve fiber layer in en-face map, confirming a prior internal limiting membrane peeling. Plasma rich in growth factors-Endoret technology is characterized by moderate platelet concentration and absence of leukocytes, which requires calcium chloride for platelet activation. It is obtained from each patient's blood sample, submitted to a series of processes to acquire a three-dimensional fibrin scaffold, rich in hundreds of proteins, which seems to have therapeutic potential. This PRGF membrane is placed into the macular hole with forceps through a pars plana vitrectomy after complete air-fluid exchange. Supernatant was placed on the macula and left it for 2 minutes. It is then aspirated, and gas or silicone oil was left as a tamponade. RESULTS: Follow-up period was of 12 months for each patient. Complete macular hole closure was achieved in both cases. Best-corrected visual acuity changed from 20/200 preoperatively to 20/100 postoperatively in Patient #1 and from 20/1,500 to 20/100 in Patient #2. CONCLUSION: Plasma rich in growth factors has been primarily investigated for ocular surface diseases. This is a pilot study using this technology for PMH treatment. The use of PRGF may be an effective and safe surgical technique with satisfactory anatomical and functional results for PMH. Because of its own biomaterials and proteins, PRGF not only allows anatomical closure but also seems to stimulate tissue regeneration.

Early microvascular changes in patients with prediabetes evaluated by optical coherence tomography angiography.

BACKGROUND: Timely detection of early microvascular changes in patients with prediabetes could help reduce the likelihood of progression of diabetes-related retinal complications. AIM: To determine early microvascular changes in patients with prediabetes using optical coherence tomography angiography (OCT-A). METHODS: In this single-center retrospective case-control study, macular OCT-A images of superficial capillary plexus (SCP) and deep capillary plexus (DCP) were analyzed in non-diabetic controls, and prediabetic and diabetic subjects. A quantitative analysis was performed using ImageJ software of the foveal avascular zone (FAZ) area, acircularity index (AI), perfusion density (PD), and vascular length density (VLD). RESULTS: A total of 94 eyes of 53 patients were included in this study. The global mean age was 57.7 years, 39.6% men and 60.4% women. In SCP, the mean PD was 0.283 ± 0.15, 0.186 ± 0.720, and 0.186 ± 0.07 in non-diabetic controls, and prediabetic and diabetic groups, respectively. The mean VLD was 8.728 ± 3.425 in non-diabetic controls, 6.147 ± 1.399 in prediabetic group, and 6.292 ± 1.997 in patients with diabetes. The comparison of prediabetic patients and controls shows statistical differences between PD and VLD in both plexus SCP (p = 0.002 and p = 0.001, respectively) and DCP (p = 0.005 and p = 0.002, respectively). The mean area of FAZ in patients with diabetes and normal individuals was 0.281 and 0.196 mm2, respectively (p < 0.001). AI was higher in the control group (0.87 ± 0.14) and prediabetic group (0.80 ± 0.17) compared to diabetic patients (0.64 ± 0.19). There were no differences in FAZ area and AI between prediabetic and non-diabetic controls. CONCLUSION: PD and VLD demonstrated to be early microvascular changes in prediabetic patients evaluated by OCT-A. No alterations of FAZ were evidenced in this group.

En face swept-source optical coherence tomography angiography choroidal vasculography (CVG) a tool to discriminate choroidal abnormalities in polypoidal choroidal vasculopathy.

BACKGROUND: Swept source optical coherence tomography angiography (SS-OCT-A) choroidal vasculography (CVG) is an imaging method which allows the evaluation of deep choroid details, being a promising too in choroidal pathologies as polypoidal choroidal vasculopathy (PCV). RESEARCH DESIGN AND METHODS: Cross-sectional study performed at FOSCAL International Clinic in Colombia. CVG features in patients with PCV were evaluated using SS-OCT CVG. RESULTS: Twenty-two eyes of 21 patients were included. The mean age was 72.7 ± 6.5 years old (range: 48.6-95.4 years old). Twelve (57.1%) patients were male. The mean number of polyps detected by SS-OCT-A CVG before treatment with anti-VEGF therapy was 2.04 ± 1.18, which decreased after treatment to 1.18 ± 0.71. This result was statistically significant (p < 0.05). All polypoidal lesions detected by B-scan were visualized using CVG. Polyp circularity and surrounding reflectivity indicated activity of disease. CONCLUSION: En face SS-OCT-A CVG is an alternative tool to evaluate choroidal structure at different depths without a contrast dye, providing information for the diagnosis and follow-up of patients with PCV. This imaging modality do not pretend to replace gold standard tests in PCV as ICGA, but rather provides choroidal imaging features of PCV, when ICGA is not available.

Differentiation of Features of Inflammatory Neovascular Membrane Versus Active Posterior Uveitis by SS-OCTA.

BACKGROUND AND OBJECTIVE: Neovascularization is a sight-threatening, uncommon complication of posterior uveitis that often goes undetected until persistent clinical findings appear, or in light of treatment failure. This could be attributed to the relative similarity of activity signs in inflammatory neovascular membranes (NVM) and active posterior uveitis. The purpose of the present study is to recognize imaging features that distinguish uveitic neovascularization from active uveitis using swept-source optical coherence tomography angiography (SS-OCTA). PATIENTS AND METHODS: Cross-sectional study. Patients with posterior uveitis with visual acuity (VA) decrease and at least one of the following findings were assessed by SS-OCTA: retinal thickening, subretinal or intraretinal fluid, and retinal hyperreflective areas. The change of VA and imaging features after treatment with anti-vascular endothelial growth factor (VEGF) therapy were analyzed in cases with inflammatory NVM. RESULTS: Forty-five eyes of 40 patients were evaluated. Twenty-four eyes (53.3%) showed signs of activity, of which eight (33.3%) presented inflammatory NVM. Imaging features that differentiate inflammatory neovascularization from active posterior uveitis included: vitreous cellularity (P = .003), outer retinal infiltration (P = .08), choroidal thickness (P = .003), posterior shadowing (P = .013), subretinal fluid (P = .04), and neovascular network (P ≤ .001). According to NVM characteristics by OCTA, multiple anastomoses and peripheral arcades were visualized at baseline in 85.7% of cases. Mean pre-operative best-corrected VA of inflammatory NVM was 20/150 (logMAR: 0.88 ± 0.60) with significant improvement to 20/40 (logMAR: 0.32 ± 0.22) after anti-VEGF treatment (P = .027). CONCLUSIONS: SS-OCTA achieves the distinction of inflammatory NVM from active posterior uveitis through specific imaging features. Inflammatory neovascularization presents a suitable response after anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:129-137.].

Psoriasis: conceptos actuales en el tratamiento sistémico: parte 1: aentes sistémicos tradicionales / Psoriasis: current concepts in the systemic treatment

La psoriasis es una dermatosis en la que intervienen múltiples factores patogénicos que interactúan de forma compleja. En la primera parte de este artículo, y a la luz de los conceptos actuales, se revisan los tratamientos sistémicos tradicionales empleados para el manejo de esta entidad.

Psoriasis: conceptos actuales en el tratamiento sistémico: parte 2: medicamentos biológicos y no tradicionales / Psoriasis: current concepts in the systemic treatment

La psoriasis es una dermatosis en la que intervienen múltiples factores patogénicos que interactúan de forma compleja. En la segunda parte de este artículo, se revisan los conceptos actuales sobre los medicamentos biológicos y los considerados no tradicionales, para el tratamiento de esta entidad.