Endophthalmitis after intravitreal injections. Incidence, management and prognosis. / Endoftalmitis tras inyecciones intravítreas. Incidencia, manejo y pronóstico.

OBJECTIVE: To assess the rate of endophthalmitis after intravitreal injection (IVI) in a «clean room¼ of a single health centre, following the guidelines of the Spanish Vitreo-Retinal Society (SERV). An analysis was performed on the culture specimens, response to treatment, and final outcomes (guidelines). MATERIAL AND METHODS: A retrospective, observational study was conducted on a consecutive case series of patients diagnosed with infectious endophthalmitis after IVI in a single health centre between 2010 and 2015. Intravitreal and systemic treatment was given following the SERV guidelines. The patients were followed up the case was resolved. RESULTS: There were 5 cases of endophthalmitis out of 9467 IVI (incidence 0.053%). Positive cultures were obtained in aqueous and/or vitreous fluid in all cases, with Staphylococcus epidermidis being involved in 4 out of 5 cases. In 2 cases, final visual acuity was non-light perception due to intractable retinal detachments after resolution of the infectious process. CONCLUSIONS: IVI performed in a «clean room¼ have a low incidence of endophthalmitis. The most common infectious agent was Staphylococcus species. In 2 cases the functional prognosis was poor.

Study of association of CTLA4 gene variants to non-anterior uveitis.

This study was undertaken to investigate the possible genetic association of functional CTLA4 polymorphisms with susceptibility to non-anterior uveitis. Four hundred and seventeen patients with endogenous non-anterior uveitis and 1517 healthy controls of Spanish Caucasian origin were genotyped for the CTLA4 polymorphisms rs733618, rs5742909 and rs231775, using predesigned TaqMan(©) allele discrimination assays. PLINK software was used for the statistical analyses. No significant associations between the CTLA4 polymorphisms and susceptibility to global non-anterior uveitis were found. It was also the case when the potential association of these genetic variants with the anatomical localization of the disease, such as intermediate, posterior or panuveitis, was assessed. Our results do not support a relevant role of these CTLA4 polymorphisms in the non-anterior uveitis genetic predisposition.

[Characteristics of patients with wet age-related macular degeneration and low intake of lutein and zeaxanthin]. / Características de la población con ingesta baja en luteína y zeaxantina en pacientes con degeneración macular asociada a la edad variante húmeda.

OBJECTIVE: To assess the characteristics of patients with wet AMD and low intake of lutein and zeaxanthin in our population. METHODS: A prospective, observational, cross-sectional study was conducted on patients with active wet AMD. A full blood count, a lipid and liver profile, a dietary interview (24-hour recall), and an anthropometric study were performed. Lutein-zeaxanthin (LZ) intake results split the patents in two groups.Group 1 ("sufficient" intake): patients with ≥1,400 mg/day intake in women and 1,700 mg/day in men (2/3 of the average daily intake in a normal population). Group 2: patients with daily intakes below that of group 1. A descriptive and comparative statistical study was performed. RESULTS: Fifty-two patients with a mean age of 78.9 years. Group 1: eleven patients (21% of the sample). Group 2: forty-one patients. The subjects with adequate intake of LZ had higher a body mass index and waist circumference. Between 70-80% of patients in group 1 had inadequate intake of vitamin A, C and E and zinc. CONCLUSIONS: Seventy-nine per cent of the patients with wet AMD have a deficient daily intake in lutein-zeaxanthin. The population with adequate intake is associated with an increased body mass index and waist circumference, and in addition, most of them have an insufficient intake of vitamin A, C, E and zinc.

Intravitreal pegaptanib sodium for choroidal neovascularisation secondary to age-related macular degeneration: Pan-European experience.

PURPOSE: To evaluate visual outcomes in patients with neovascular age-related macular degeneration (NV-AMD) who were treated with pegaptanib sodium in European clinical ophthalmology practices. METHODS: Thirteen centres in eight European countries participated in this retrospective study. Medical records for patients with any angiographic subtype of subfoveal choroidal neovascularisation secondary to NV-AMD with visual acuities (study eye) of 20/40-20/320 treated with 0.3 mg pegaptanib as first-line treatment and with at least 24 weeks of follow-up were identified. Anonymised data reflecting at least 24 and up to 54 weeks of follow-up were recorded. Primary end points were visual acuity outcomes at weeks 24 and 54 compared with those reported at week 54 in the vascular endothelial growth factor (VEGF) Inhibition Study in Ocular Neovascularisation (VISION) trial. RESULTS: In all, 253 patients were followed for at least 24 weeks; 62 patients completed 54 weeks of follow-up. A mean of 4.4 (SD, 1.8) pegaptanib injections were administered through 24 weeks. Compared with the VISION trial, the European experience showed that >90% of patients in the current cohort lost <15 letters from baseline at both time points compared with 70% in the VISION trial at 54 weeks. Pegaptanib was well tolerated with no reported cases of endophthalmitis, traumatic cataract, or iatrogenic retinal detachment. CONCLUSIONS: Pegaptanib was found to stabilise vision in a greater percentage of patients and produced greater overall visual improvement in this group of treatment-naive patients with NV-AMD compared with outcomes reported in the VISION trial; however, interpretation of these results should be tempered given the differences in design between this retrospective study and the prospective controlled trial.

[Treatment of retinal angiomatous proliferation (RAP). A retrospective study]. / Tratamiento de la proliferación angiomatosa retiniana (RAP). Estudio retrospectivo.

PURPOSE: To assess the follow-up and response to treatment in patients with RAP. METHODS: A retrospective follow-up study of patients with RAP diagnosed between March 2002 and August 2005. Baseline and subsequent angiograms and optical coherence tomography results were reviewed and RAP classified according to the 3 stages described by Yannuzzi. The changes observed and the best visual acuity were assessed separately for each of the 4 different treatments used: Transpupillary thermotherapy (TTT), Photodynamic therapy (PDT), combined treatment with PDT and Intravitreal triamcinolone (IVT), and combined treatment with PDT, IVT and direct laser photocoagulation of the vascular intraretinal lesion (DLPh.). RESULTS: Fifteen eyes of 14 patients with RAP were studied (mean age, 77.5 years). The mean follow-up was 15.9 months and the mean number of treatments was 2.5. The final visual acuity was worse in 7 (46.7%), stable in 7 (46.7%) and better in 1 (6.6%). Visual acuity improvement, in regard to the treatment used, was: TTT group: 2 out of 14 (14.2%): PDT group: 1 out of 5 (20%); PDT + IVT group: 2 out of 5 (40%) and DLPh. + PDT + IVT group: 3 out of 5 (60%). CONCLUSIONS: The final prognosis for RAP, in terms of visual acuity, was generally poor. However the best treatment was the combined treatment with DLPh + PDT + IVT, while the worst was TTT.

[Eleven years experience in the management of retinopathy of prematurity in the Balearic Islands]. / Once años de experiencia en el manejo de la retinopatía del prematuro en las Islas Baleares.

PURPOSE: To evaluate the incidence and effectiveness of the treatment of Retinopathy of Prematurity (ROP) in preterm births in the Balearic Islands. MATERIALS AND METHODS: Protocol of prospective and consecutive study. We included preterm infants whose birth weights were under 1,501 g, or heavier infants requiring assisted oxygen therapy. Data for the 12 years between January 1992 and December 2003 were analyzed. We evaluated gestational age, birth weight, ROP stage and the effect of treatment following CRYO-ROP Study indications. A descriptive study was undertaken. RESULTS: We evaluated 446 babies. Average age and weight were 30.4 weeks and 1,178.4 g respectively. ROP was found in 93 infants (63.1%) weighing less than 1,000 g, in 50 (19.6%) weighing 1,000-1,500 g and in 5 (11.4%) weighing > 1,500 g. In regard to gestation, ROP was found in 27 (86.2%) babies born at < 27 weeks of gestation, in 87 (35.6%) born at 27-30 weeks of gestation and in 19 infants (12.7%) born at > 30 weeks gestation. There were 75 babies with stage III disease and 73.3% needed treatment. Retinal ablation was performed at 62.9 days. CONCLUSIONS: ROP incidence is inversely related to birth weight and gestational age. Three out of four babies who reached stage III disease needed treatment. The effectiveness of photocoagulation was over 90% when performed at 2 months of age.

[A new device for vitreous biopsy]. / Nuevo dispositivo para biopsias vítreas.

PURPOSE/METHODS: Description of a simply-made device for obtaining vitreous biopsies. RESULTS/CONCLUSIONS: This new device allows the surgeon to control aspiration, thereby enabling the obtention of many vitreous biopsies both diluted and undiluted.

[Triple-blind clinical trial with placebo control to evaluate the efficacy of a heparin of low molecular weight (bemiparin) for treating slow-responding ulcers in diabetic foot in primary care]. / Ensayo clínico, controlado con placebo, triple ciego, para evaluar la eficacia de una heparina de bajo peso molecular (bemiparina) en el tratamiento de las úlceras tórpidas del pie diabético, en atención primaria.

OBJECTIVES: To establish the degree of efficacy of bemiparin treatment over 3 months in the improvement of slow-responding ulcers in diabetic foot. Also, to evaluate the safety of bemiparin and quality of life and to compare the evolution of retinopathy and nephropathy against placebo. DESIGN: Stage III clinical trial to evaluate efficacy and safety in a new indication of a medicine already on the market, parallel in two branches, randomised, triple-blind, and controlled with placebo. SETTING: Health care centres in Mallorca, Spain. PARTICIPANTS: 42 patients per branch, over 18, with type-1 or 2 DM of over 3 years evolution, and one or more first or second-degree ulcers on the Wagner scale, distal to the knee, that did not heal in three months of health care. Randomised allocation in blocks of four.Interventions. The experimental drug was bemiparin (heparin of low molecular weight), injected subcutaneously at 3500 IU/day for the first 10 days and 2500 IU/day up to 90 days. As control, physiological serum was injected sub-cutaneously in a similar volume for masking. MAIN MEASUREMENTS: An "effect"was defined as a reduction of at least 50% in its surface area and/or a favourable evolution in status to a degree between the control at the start of treatment and at three months. Other measurements included proteinuria, retinography and quality of life (SF-36). Analysis of efficacy through principle of intention to treat.

[Intravitreal ganciclovir in cytomegalovirus retinitis in AIDS]. / Ganciclovir intravítreo en la retinitis por citomegalovirus en SIDA.

A retrospective study was made of 26 patients with AIDS who initially presented with retinitis as the only clinical manifestation of cytomegalovirus infection (39 eyes). Sixty-five induction or re-induction therapeutic courses were administered with intravitreal ganciclovir. The efficiency rate of therapy was 93.8%. Thirty-eight maintenance therapeutic courses (200 micrograms/week) were evaluated. The non-compliance rate was 23%. Bilateral retinitis occurred in 44.4% of cases. The systemic administration of therapy had to be substituted for the intravitreal administration in 32% of patients during the clinical course of their conditions. The mean survival rate was 9.5 months. Both retinal detachment and vitreal hemorrhage occurred in 5% of patients. When retinitis is the first clinical manifestation of cytomegalovirus infection, therapy with intravitreal ganciclovir is efficacious to inactivate lesions. Although bilateral retinitis and extraocular dissemination are common, the mean survival rate is high.

Frequency of congenital hypertrophy of the retinal pigment epithelium in familial adenomatous polyposis.

Congenital hypertrophy of the retinal pigment epithelium is a recognized clinical marker in familial adenomatous polyposis as an expression of the altered gene in this autosomal dominant disease. Ocular lesions could be discovered years before the development of intestinal polyposis. We studied 29 diagnosed patients, 38 relatives (first degree) of familial adenomatous polyposis kindreds and 26 controls (general population). Number, size and bilaterality of pigmented lesions were analysed in order to separate members affected and non affected by intestinal polyposis in familial adenomatous polyposis kindreds. Three of 26 families (23%) had patients with polyposis and normal fundus. Bilaterality and more than 4 lesions improved specificity or sensibility of the fundus examination. However, the best efficacy of the test was obtained with large lesions (sensibility 0.82 and specificity 0.97).