Analysis of the Recurrence of Plus Disease after Intravitreal Ranibizumab as a Primary Monotherapy for Severe Retinopathy of Prematurity.

PURPOSE: To assess the outcomes of severe retinopathy of prematurity (ROP) in zone I or posterior zone II, and of aggressive posterior ROP treated with a single dose of intravitreal ranibizumab (IVR) as monotherapy. DESIGN: Retrospective study. PARTICIPANTS: The study included premature babies diagnosed with aggressive posterior ROP or ROP 3+ in zone I or posterior zone II. METHODS: Intravitreal injection of 0.25 mg (0.025 mL) ranibizumab was performed in the operating room. A disposable 1-mL syringe with a 30-gauge needle was used. MAIN OUTCOME MEASURES: Favorable outcome was considered regression of ROP after treatment (meaning regression of the retinal neovascularization and plus disease). Unfavorable outcome was progression to stages 4 and 5 of ROP. RESULTS: The study included 43 infants (85 eyes). The mean birth weight and gestational age were 1276±302 g and 29.7±2.0 weeks, respectively. The mean postmenstrual age at ROP diagnosis was 36±2.7 weeks and at treatment was 37.2±2.2 weeks. All 85 eyes demonstrated total regression of plus disease after a single dose of IVR. Twelve infants (29.2%) developed full vascularization of the peripheral retina in both eyes. Twenty-two infants (43 eyes [53.6%]) developed ROP reactivation at a mean interval of 7.1±3 weeks (range, 3-15 weeks) after IVR and needed rescue laser treatment of the peripheral avascular retina. The mean postmenstrual age at rescue laser was 43±3.2 weeks (range, 35.5-54.5 weeks). Six patients (11.6%) had persistent peripheral avascular retina in zone II for >6 months (or 24 weeks) after IVR treatment. CONCLUSIONS: Although there was complete regression of plus disease in all treated eyes, only 29.2% of the patients reached complete peripheral retinal vascularization. There was a disease reactivation in 53.6% of the patients and they needed additional laser therapy. The results of IVR treatment in severe ROP, even when initial control of the disease was achieved, did not eliminate the risk of late reactivation of the disease by retinal neovascularization. Some of the treated patients may achieve a permanent interruption in the development of the peripheral retinal vascularization.

Intravitreal ranibizumab as a primary or a combined treatment for severe retinopathy of prematurity.

PURPOSE: The aim of the study was to assess the outcomes of severe retinopathy of prematurity (ROP) in zone I or posterior zone II treated with intravitreal ranibizumab (IVR) as monotherapy or combined treatment with laser photocoagulation. METHODS: This is a retrospective study analyzing clinical records of the included patients. Patients were divided into two groups: group 1 included patients who received only IVR treatment; and group 2 was subdivided into group 2A - including patients with IVR as initial treatment and complementary laser photocoagulation if retinal neovascularization or plus disease did not regress, and group 2B - including patients with initial laser photocoagulation and IVR as rescue therapy. Favorable outcomes were regression of the retinal neovascularization and plus disease, meaning control of the disease. Unfavorable outcomes were progression to stages 4 and 5 of ROP. RESULTS: Fifty-seven eyes were included in the study. Mean birth weight and gestational age were 1,281±254 g and 29.5±2.1 weeks, respectively. Group 1 comprised of 16 eyes, with favorable outcomes in 14 eyes (87.5%). Group 2 comprised of 41 eyes, with favorable outcomes in 29 eyes (70.7%), in a mean follow-up period of 12.8 months. CONCLUSION: IVR was effective to treat severe cases of ROP as a primary or a combined treatment. Forty-three of the 57 treated eyes (75.4%) achieved regression of ROP and favorable outcomes.

Implantes de lentes intraoculares en niños con cataratas bilaterales / Intraocular lens implants in bilateral cataracts in children

Determinar los resultados del uso de lentes intraoculares bilaterales en niños. Se incluyeron 20 niños entre 7 meses y 11 años con cataratas congénitas o del desarrollo. Los pacientes se dividieron según la edad. A los pacientes del grupo A y B se les practicó facoaspiración de catarata, más capsulorexis posterior, virectomía anterior y colocación de un LIO, en el grupo C no se practicó capsulorexis posterior ni vitrectomía. Sin complicaciones intraoperatorias. En el grupo A la incidencia de complicaciones postoperatorias fue mayor. Hubo una diferencia significativa entre la refracción esperada y la resultante al tercer mes en los grupos A y B. La mejoría de la AV fue significativa en todos los grupos, así como la mejoría del nistagmo. Aunque la AV visual y el nistagmo mejoraron, la mayor incidencia de complicaciones en el grupo A determina precaución en la indicación de LIO en menores de dos años

Evaluación oftalmológica de pacientes con enfermedades la fosforilación oxidativa / Opthalmological evaluation of patients with oxidative phosphorilation

Se estudian 12 pacientes referidos de la Unidad de Genética del Hospital Universitario de Maracaibo, portadores de enfermedades de la fosforilación oxidativa. Se realizó evaluación oftalmológica externa, de segmento anterior y posterior así como test de visión de colores, fluororetinografía, campimetría computarizada y electrorretinografía. El 50 por ciento presentó afectación ocular, de los cuales 3 pacientes presentaron blefaroptosis, oftalmoplejía progresiva crónica externa en 3 e insuficiencia de convergencia en 1. La manifestación clínica inicial de enfermedad de fosforilación oxidativa fue blefaroptosis y disminución de AV. La AVsc/cc promedio fue de 0,43ñ0,40 y 0,76ñ0,33 respectivamente. El error refractivo fue de esfera de -1,0 hasta -5,5 y cilindro de -0,5 hasta -4,0 con presión intraocular promedio de 13,63 mmHgñ3,83. En retina se evidenciaron discretos cambios pigmentarios en 2 pacientes, retinopatía en "sal y pimienta" en 3 pacientes, atenuación vascular en 5, palidez con atrofia de disco óptico y epitelio pigmentario de la retina en 5 pacientes y acúmulos pigmentarios difusos en retina periférica en 1. Se observó hiper e hipofluorescencia por atrofia del epitelio pigmentario de la retina y atenuación arterior, escotomas absolutos y relativos con tendencia anular en 50 por ciento de los afectados. El oftalmologo debe conocer este grupo recientemente descrito de enfermedades cuyas manifestaciones oftalmológicas deben alertar al médico sobre su posible diagnóstico y manejo temprano