Management and Systemic Implications of Diabetic Neovascular Glaucoma.

OBJECTIVES: To study the efficacy and safety of different treatments for diabetic neovascular glaucoma (NVG). We additionally attempt to determine if the presence of NVG could be a predictor of cardiovascular disease or death. METHOD: This is a retrospective, observational cohort study including patients diagnosed with diabetic NVG from 2006 to 2016 at the Hospital Clínico Universitario de Valladolid (Spain). Extracted data included clinical characteristics of the patients, glycated haemoglobin levels, and ocular treatment. Visual acuity (VA), intraocular pressure (IOP), cardiovascular events, and deaths were registered. RESULTS: 30 eyes from 23 patients were followed for a mean of 4.48 years (SD = 2.82 years). The IOP-lowering intervention groups were: Ahmed implant (11 eyes), laser cyclo-photocoagulation (CPC; 6 eyes), both (4 eyes), or none (9 eyes). IOP success was achieved in 100% of the eyes with Ahmed and/or laser CPC and in 44.4% of the eyes with no IOP-lowering procedure (p= 0.002). Most eyes with Ahmed implant (with or without CPC) maintained or improved their VA (100 and 63.6%, respectively). 33.3% of the eyes with laser CPC and 25% of those with no IOP-lowering intervention maintained or improved their VA (p = 0.028). Hypotony was the only adverse effect (after laser CPC). No statistically significant difference could be established between low VA (finger count or worse), poor IOP control, or bad metabolic control and mortality or cardiovascular event (p > 0.05), however, the four patients who died had poor VA at the time of NVG diagnosis. CONCLUSIONS: Ahmed implant surgery is a safe and effective treatment option for diabetic NVG. Medical treatment alone is not the best option for most cases. Advanced NVG could be an indicator of higher mortality risk in diabetic patients.

Efficacy and Safety of an Aflibercept Treat-and-Extend Regimen in Treatment-Naïve Patients with Macular Oedema Secondary to Central Retinal Vein Occlusion (CRVO): A Prospective 12-Month, Single-Arm, Multicentre Trial.

OBJECTIVES: To evaluate efficacy and safety of an aflibercept treat-and-extend (TAE) regimen in patients with macular oedema (MO) secondary to central retinal vein occlusion (CRVO). DESIGN SETTING AND PATIENTS: Phase IV, prospective, open-label, single-arm trial in 11 Spanish hospitals. Treatment-naïve patients with <6 month diagnosis of MO secondary to CRVO and best-corrected visual acuity (BCVA) of 73-24 ETDRS letters were included between 23 January 2015 and 17 March 2016. INTERVENTION: Intravitreal aflibercept 2 mg monthly (3 months) followed by proactive individualized dosing. MAIN OUTCOMES: Mean change in BCVA after 12 months. RESULTS: 24 eyes (24 patients) were included; mean (SD) age: 62.8 (15.0) years; 54.2% male; median (IQR) time since diagnosis: 7.6 (3.0, 15.2) days. Mean BCVA scores significantly improved between baseline (56.0 (16.5)) and Month 12 (74.1 (17.6)); mean (95% CI) change: 14.8 (8.2, 21.4); P=0.0001. Twelve (50.0%) patients gained ≥15 ETDRS letters. Foveal thickness improved between baseline (mean: 569.4 (216.8) µm) and Month 12 (mean 257.4 (48.4) µm); P < 0.0001. At Month 12, 8.3% patients had MO. The mean (SD) number of injections: 8.3 (3.0). No treatment-related AEs were reported. Five (20.8%) patients experienced ocular AEs. Two nonocular serious AEs were reported. CONCLUSIONS: An aflibercept TAE regimen improves visual acuity in patients with MO secondary to CRVO over 12 months with good tolerability.

Do nutritional supplements have a role in age macular degeneration prevention?

Purpose. To review the proposed pathogenic mechanisms of age macular degeneration (AMD), as well as the role of antioxidants (AOX) and omega-3 fatty acids ( ω -3) supplements in AMD prevention. Materials and Methods. Current knowledge on the cellular/molecular mechanisms of AMD and the epidemiologic/experimental studies on the effects of AOX and ω -3 were addressed all together with the scientific evidence and the personal opinion of professionals involved in the Retina Group of the OFTARED (Spain). Results. High dietary intakes of ω -3 and macular pigments lutein/zeaxanthin are associated with lower risk of prevalence and incidence in AMD. The Age-Related Eye Disease study (AREDS) showed a beneficial effect of high doses of vitamins C, E, beta-carotene, and zinc/copper in reducing the rate of progression to advanced AMD in patients with intermediate AMD or with one-sided late AMD. The AREDS-2 study has shown that lutein and zeaxanthin may substitute beta-carotene because of its potential relationship with increased lung cancer incidence. Conclusion. Research has proved that elder people with poor diets, especially with low AOX and ω -3 micronutrients intake and subsequently having low plasmatic levels, are more prone to developing AMD. Micronutrient supplementation enhances antioxidant defense and healthy eyes and might prevent/retard/modify AMD.

Development of predictive models of proliferative vitreoretinopathy based on genetic variables: the Retina 4 project.

PURPOSE: Machine learning techniques were used to identify which of 14 algorithms best predicts the genetic risk for development of proliferative vitreoretinopathy (PVR) in patients who are experiencing primary rhegmatogenous retinal detachment (RD). METHOD: Data from a total of 196 single nucleotide polymorphisms in 30 candidate genes were used. The genotypic profile of 138 patients with PVR following primary rhegmatogenous RD and 312 patients without PVR RD were analyzed. Machine learning techniques were used to develop statistical predictive models. Fourteen models were assessed. Their reproducibility was evaluated by an internal cross-validation method. RESULTS: The three best predictive models were the lineal kernel based on the Support Vector Machine (SMV), the radial kernel based on the SVM, and the Random Forest. Accuracy values were 78.4%, 70.3%, and 69.3%, respectively. The more accurate, although complex, algorithm uses 42 SNPs, whereas the simpler one uses only two SNPs, which makes them more suitable for routine diagnostic work. The radial kernel based on SVM uses 10 SNPs. The best individually predictor marker was rs2229094 in the tumor necrosis factor locus. CONCLUSION: Genetic variables may be useful to predict the likelihood of the development of PVR. The predictive capabilities of these models are as good as those observed with clinical approaches. These results need external validation to estimate the true predictive capability and select the most appropriate ones for clinical use.

Oral flavonoids, chromocarb diethylamine salt and cyaninosides chloride, to eliminate lipoperoxidation postvitrectomy.

This study was undertaken to determine the concentration of malondialdehyde, an end product of lipoperoxidation, in lens and retinal tissue postvitrectomy associated with oral administration of antioxidant flavonoids cyaninosides chloride and chromocarb diethylamine salt or N -acetylcysteine. Fifty adult pigmented rabbits were divided into five groups: (1) controls (normal eyes, malondialdehyde concentration in lens and retina); (2) vitrectomy with BSS Plus (malondialdehyde level measured 2hr after vitrectomy); (3) vitrectomy with BSS Plus and pretreatment with oral cyaninosides chloride 100mg kg day(-1)for 3 weeks (malondialdehyde level measured 2hr after surgery); (4) vitrectomy with BSS Plus and pretreatment with oral chromocarb diethylamine salt 100 mg kg day(-1)for 3 weeks (malondialdehyde level measured 2hr after surgery); and (5) vitrectomy with BSS Plus and pretreatment with oral N -acetylcysteine 200 mg kg day(-1)for 3 weeks (malondialdehyde level measured 2hr after surgery). Lens and retina samples were used to determine malondialdehyde levels using ion-pairing high performance liquid chromatography. Statistical analysis was done using analysis of variance (P<0.05). The content of malondialdehyde in the normal lens was 0.036 +/- 0.017 microg g(-1); in the vitrectomized groups the malondialdehyde concentrations were as follows: (2) 0.027 +/- 0.013 microg g(-1); (3) under detection limit (detection limit=1.75x e-3 microg g(-1)); (4) under detection limit; and (5) 0.020 +/- 0.006 microg g(-1). The results showed that the malondialdehyde concentration in the normal retina was 1.160 +/- 0.361 microg g(-1), while in the vitrectomized groups with or without pretreatment (cyaninosides chloride, chromocarb diethylamine salt, and N -acetylcysteine) the malondialdehyde levels were 2.091 +/- 0.982 microg g(-1), 0.069 +/- 0.024 microg g(-1), 0.082 +/- 0.027 microg g(-1), and 0.215 +/- 0.134 microg/g(-1), respectively, all significantly different from the normal eyes (P<0.05). Vitrectomy induced increased malondialdehyde levels in the retina. Oral flavonoids are an effective protective therapy for surgically induced lipoperoxidation, especially in the retina.