Implante de dexametasona antes de tratamiento anti-VEGF en desprendimientos del epitelio pigmentario secundarios a degeneración macular asociada a la edad con características de alto riesgo de rotura / Dexamethasone implant prior to anti-VEGF therapy in pigment epithelium detachments with high-risk rupture characteristics secondary to neovascular age-related macular degeneration

Objetivo Evaluar la incidencia de desgarro del epitelio pigmentario cuando se administra un implante intravítreo de dexametasona de liberación retardada (uso off-label) previo al tratamiento antiangiogénico en desprendimientos del epitelio pigmentario (DEP) secundarios a degeneración macular neovascular asociada a la edad (DMAEn) con características de alto riesgo de rotura e investigar si provoca una disminución del tamaño del DEP. Métodos Se incluyeron pacientes con DMAEn, altura del DEP >500micras e implante de Ozurdex previo a la terapia antiangiogénica. Se registró la presencia de rotura del epitelio pigmentario en tomografías de coherencia óptica, agudeza visual mejor corregida (AVMC) y medidas del DEP (altura y diámetro máximos). Resultados El estudio incluyó a 14 ojos de 14 pacientes: edad media 77±7 años, 11 (79%) mujeres. 25±13 días después del Ozurdex los pacientes comenzaron con al menos 3 inyecciones mensuales de anti-VEGF. La AVMC mejoró de 64±14 a 69±11 letras después de la terapia anti-VEGF (p>0,05). La altura media inicial del DEP fue de 817±269μm, siendo 639±268μm después de Ozurdex y 370±260μm después de las inyecciones de anti-VEGF (p=0,035 y p=0,009). Se produjo un desgarro del epitelio pigmentario de la retina (7%). No se hallaron otros efectos adversos. Conclusione El implante de dexametasona antes de la terapia anti-VEGF puede representar una modalidad terapéutica prometedora para los DEP grandes en la DMAEn, reduciendo las dimensiones del DEP y el riesgo de desgarros del epitelio pigmentario antes de la terapia anti-VEGF (AU)

Objective Evaluate the incidence of pigment epithelial tear when intravitreal delayed-release dexamethasone implant is administered (off-label use) prior to antiangiogenic treatment in pigment epithelium detachments (PED) secondary to neovascular age-related macular degeneration (nAMD) with high-risk rupture characteristics and investigate if it causes a decrease in the PED size. Methods Patients with nAMD, PED height >500microns and Ozurdex implant prior to the antiangiogenic therapy were included. The presence of pigment epithelium rupture in optical coherence tomography scans, best-corrected visual acuity (BCVA) and PED measurements (maximum height and diameter) were registered. Results The study included 14 eyes of 14 patients: mean age 77±7 years, 11 (79%) females. 25±13 days after the Ozurdex, patients started with at least 3 anti-VEGF monthly injections. BCVA improved from 64±14 to 69±11 letters after anti-VEGF therapy (P>.05). Mean baseline PED height was 817±269μm, being 639±268μm after Ozurdex and 370±260μm after anti-VEGF injections (P=.035 and P=.009). One retinal pigment epithelium tear occurred (7%). No other adverse effects were reported. Conclusions Dexamethasone implant prior to anti-VEGF therapy may represent a promising therapeutic modality for large PED in nAMD, reducing PED dimensions and the risk of pigment epithelium tears prior to anti VEGF therapy (AU)

Dexamethasone implant prior to anti-VEGF therapy in pigment epithelium detachments with high-risk rupture characteristics secondary to neovascular age-related macular degeneration.

OBJECTIVE: Evaluate the incidence of pigment epithelial tear when intravitreal delayed-release dexamethasone implant is administered (off-label use) prior to antiangiogenic treatment in pigment epithelium detachments (PED) secondary to neovascular age-related macular degeneration (nAMD) with high-risk rupture characteristics and investigate if it causes a decrease in the PED size. METHODS: Patients with nAMD, PED height >500 microns and Ozurdex implant prior to the antiangiogenic therapy were included. The presence of pigment epithelium rupture in optical coherence tomography scans, best-corrected visual acuity (BCVA) and PED measurements (maximum height and diameter) were registered. RESULTS: The study included 14 eyes of 14 patients: mean age 77 ±â€¯7 years, 11 (79%) females. 25 ±â€¯13 days after the Ozurdex, patients started with at least 3 anti-VEGF monthly injections. BCVA improved from 64 ±â€¯14-69 ±â€¯11 letters after anti-VEGF therapy (p > 0.05). Mean baseline PED height was 817 ±â€¯269 µm, being 639 ±â€¯268 µm after Ozurdex and 370 ±â€¯260 µm after anti-VEGF injections (p = 0.035 and p = 0.009). One retinal pigment epithelium tear occurred (7%). No other adverse effects were reported. CONCLUSIONS: Dexamethasone implant prior to anti-VEGF therapy may represent a promising therapeutic modality for large PED in nAMD, reducing PED dimensions and the risk of pigment epithelium tears prior to anti VEGF therapy.

Fundus autofluorescence in the evaluation of diabetic macular edema treatment response.

INTRODUCTION: Fundus autofluorescence (FAF) has shown sensitivity in the detection of macular edema. OBJECTIVES: To evaluate indices formed with FAF and retinal anatomical-functional variables in patients with diabetic macular edema (DME) treated with ziv-aflibercept (ziv-AFL). METHODS: Twenty-nine eyes of 15 DME patients who received ziv-AFL intravitreal injections were included in the study. Best-corrected visual acuity (BCVA), contrast sensitivity (CS), optical coherence tomography (OCT) and FAF were evaluated before treatment and at one and two months. OCT variables were central subfield thickness (CST), macular volume (MV) and macular cube average thickness (MCAT). FAF/BCVA, FAF/CS, FAF/CST, FAF/MV and AF/MCAT indices baseline values were obtained. Analysis was performed with Spearman's rank correlation coefficient and linear regression analysis. RESULTS: There was a significant correlation between baseline FAF/BCVA index and BCVA at second month (rs = - 0.78, p = 0.000), between baseline FAF/CS index and BCVA at second month (rs = -0.68, p = 0.0009) and between baseline FAF/CS index and MV at first month of follow-up (rs = 0.64, p = 0.002). CONCLUSIONS: In DME, composite indices with baseline FAF predict variables such as BCVA in the follow-up of patients receiving ziv-AFL.

INTRODUCCIÓN: La autofluorescencia retiniana (AF) ha mostrado sensibilidad en la detección del edema macular. OBJETIVOS: Evaluar índices formados con la AF y variables anatomofuncionales retinianas en pacientes con edema macular diabético (EMD) tratados con ziv-aflibercept (ziv-AFL). MÉTODOS: Fueron incluidos 29 ojos de 15 pacientes con EMD que recibieron inyecciones intravítreas de ziv-AFL. Se evaluó agudeza visual mejor corregida (AVMC), sensibilidad al contraste (SC), tomografía de coherencia óptica (TCO) y AF, antes del tratamiento, así como al primer y segundo mes de iniciado este. Las variables de la TCO fueron grosor foveal central (GFC), volumen macular (VM) y grosor promedio macular (GPM). Se obtuvieron los valores basales de AF/AVMC, AF/SC, AF/GFC, AF/VM y AF/GPM. Se realizó análisis con el coeficiente de correlación de rangos de Spearman y análisis de regresión lineal. RESULTADOS: Hubo una correlación significativa entre el índice AF/AVMC basal y la AVMC en el segundo mes (rs = −0.78, p = 0.000), entre el índice AF/SC basal y la AVMC en el segundo mes (rs = −0.68, p = 0.0009) y entre AF/SC basal y el VM en el primer mes de seguimiento (rs = 0.64, p = 0.002). CONCLUSIONES: En el EMD, los índices compuestos con AF basales predicen variables como AVMC en el seguimiento de pacientes que reciben ziv-AFL.