Optical coherence tomography angiography as predictor of visual outcomes in retinal vein occlusion treated with antiangiogenic therapy.

PURPOSE: Evaluate optical coherence tomography angiography (OCT-A) features in retinal vein occlusions (RVO) associated with visual outcomes after anti-VEGF. METHODS: Analytical observational study performed in eyes with macular edema secondary to RVO treated with anti-VEGF, with at least 6 months of follow-up. Bradley et al. classification of macular ischemia was used. Logistic regression analysis was used to investigate associations between final best-corrected visual acuity (BCVA) and OCT-A. RESULTS: A total of 62 eyes, 61 subjects, mean age of 70 ± 12,6 years were included. Median follow up time 21,2 months (IQR 24.8), 53,2% had central retinal vein occlusion (CRVO) and 46,8% branch retinal vein occlusion (BRVO). Median BCVA pre-treatment was 0,84 logMAR (IQR 0,83) and post-treatment 0,47 logMAR (IQR 0,52). BCVA improved at the end of follow-up (p = 0,01), as well as central retinal thickness (CRT) (p = 0,02). Regarding capillary densities (CD), there was a decrease for both plexus, Superficial CD (p = 0,01) and Deep CD (p = 0,01), being more involved the superficial plexus. The lower the capillary density in both plexus, the worse BCVA, Superficial CD (r - 0,27, p = 0,03) and Deep CD (r - 0,29, p = 0,02). Media FAZ pre-treatment was 0,30 mm2 (IQR 0,23), with enlargement to 0,37 mm2 (IQR 0,32) (p = 0,01) post-treatment. Preservation of External Limiting Membrane/ Ellipsoid Zone (ELM/EZ) was seen in 60% of subjects (n = 37). The majority had grade 3 macular ischemia. Variables that best explain visual results were, baseline visual acuity (p = 0,01), pre-treatment CRT (p = 0,02) and pretreatment foveal superficial CD (p = 0,02). CONCLUSIONS: Variables that best explain final vision after anti-VEGF were baseline visual acuity, CRT and foveal superficial CD.

Results of Follow-up in Pediatric Keratoconus Treated With Intracorneal Ring Segments Implantation Alone or in Combination With Corneal Cross-linking.

PURPOSE: To report visual and topographic outcomes of pediatric keratoconus with intracorneal ring segments (ICRS) implantation alone or in combination with accelerated corneal cross-linking (A-CXL). METHODS: A descriptive, retrospective observational study was performed. Medical records of patients younger than 18 years at Fundación Oftalmológica Nacional in Bogotá, Colombia, were reviewed. Demographic data, follow-up time, preoperative and postoperative uncorrected (UCVA) and best corrected (BCVA) visual acuity, manifest refraction, and tomography were evaluated. SPSS software (version 22.0; SPSS, Inc) was used for analysis. RESULTS: Twenty-six eyes of 19 patients with a mean age of 16.5 ± 1.8 years were analyzed, and 16 were boys (84.2%). Median follow-up time was 39.6 months (inter-quartile range [IQR] = 30). Fifteen patients (78.9%) had a history of allergic conjunctivitis. Sixteen eyes (61.5%) received ICRS implantation with A-CXL and 10 eyes (38.4%) received ICRS implantation only. Global results (including ICRS implantation with A-CXL and ICRS implantation only) were: (1) median UCVA of 0.90 logarithm of the minimum angle of resolution (logMAR) (IQR = 0.85) preoperatively improved to 0.54 logMAR (IQR = 0.70) postoperatively; (2) median BCVA of 0.43 logMAR (IQR = 0.39) preoperatively improved to 0.30 logMAR (IQR = 0.26) postoperatively; and (3) median spherical equivalent of -5.37 diopters (D) (IQR = -5.28) preoperatively improved to -4.12 D (IQR = -3.57) postoperatively. There was a reduction in half of the sphere and cylinder. The median maximum keratometry was 54.40 D (IQR = 7.4) preoperatively and 49.80 D (IQR = 5.3) postoperatively. The median asphericity was -1.18 (IQR = 0.70) preoperatively and changed to -0.75 (IQR = 0.68) postoperatively. No patient presented with complications before or after surgery. CONCLUSIONS: ICRS implantation only or in combination with A-CXL induced visual and topographic improvement in patients with keratoconus, which was maintained throughout the follow-up time. It seems to be a safe procedure to delay or avoid corneal transplantation in the pediatric population. [J Pediatr Ophthalmol Strabismus. 2022;59(2):118-127.].

Characteristics of Pediatric Glaucoma in a Latin American Reference Center.

AIM: To describe the clinical and epidemiological characteristics of children with pediatric glaucoma (PG) treated in an ophthalmologic national reference center. MATERIALS AND METHODS: A retrospective study of patients diagnosed with PG in a national ophthalmologic reference center was made, between 2005 and 2015. Clinical findings, type of treatment, and the follow-up were evaluated. RESULTS: A total of 89 patients (145 eyes) were included. The median age of diagnosis was 2.0 years. The most frequent type of glaucoma was primary PG with 67.4% of affected patients, primary congenital glaucoma (PCG) being more frequent (69 eyes) than juvenile open-angle glaucoma (JOAG 36 eyes). Secondary PG accounted for 32.6% of the cases (40 eyes). At least one surgical procedure was needed in 56.6% of all studied eyes, and 10.7% of eyes had more than two surgical procedures. Even more, eyes with PCG had surgery in 88.4% of cases. On the contrary, eyes with JOAG did not require surgery. In the last assessment, the distribution of cases according visual acuity did not show differences. However, it is important to note that patients with secondary PG maintained a good vision only in 17.9% of cases. CONCLUSION: Pediatric glaucoma is a heterogeneous group of diseases, and due to its low incidence, descriptive reports of large cohorts are not available. This study has a well-detailed report of PG characteristics in a national reference center. The frequency of JOAG in the present study was significantly higher than that reported in other studies. Also, clinical characteristics of all glaucoma described have some differences from data published. CLINICAL SIGNIFICANCE: There are few studies that describe characteristics of PG. This study is an important tool to analyze the characteristics of PG in an effort to better know the disease. HOW TO CITE THIS ARTICLE: Saavedra C, Rios HA, Belalcazar S, et al. Characteristics of Pediatric Glaucoma in a Latin American Reference Center. J Curr Glaucoma Pract 2020;14(1):10-15.

Lens changes in cardiovascular catheterization laboratories staff / Cambios en el cristalino en personal de laboratorio de cateterismo cardiovascular

Abstract Objective: To determine the association between occupational ionizing radiation exposure in the cardiovascular catheterization laboratories staff and development of lens changes. Methods: A cross-sectional study was made. Participants were recruited at the XIII Colombian Conference of Interventional Cardiology and SOLACI conferences in Bogotá - Colombia 2017. Informed consent was obtained from all study participants. Demographics and clinical data were collected. Associated lens changes were determined according to the ionizing radiation exposure status. Results: A total of 89 subjects (178 eyes) participated in the study. In general, the mean age was 40 years old, ranging from 19 to 78 years old. Distribution according gender was 55.3% male and 44.7% female. 31 subjects (62 eyes) were deemed to have not occupational exposure to radiation and 58 subjects (116 eyes) with a history of occupational radiation exposure. Exposed eyes had twice risk for present subcapsular posterior lens opacity compared to non-exposed eyes. The subjects with older age and physician role were associated to the presence of lens opacity, with a p value 0.001 in both cases. Likewise, exposed subjects with any lens opacity had a high mean occupational lifetime, with a p 0.001. Conclusions: This study confirms a statistically significant increase in radiation-associated subcapsular lens changes in the eyes of interventional cardiology staff compared to unexposed controls.

Resumen Objetivo: Determinar la asociación entre la exposición a radiación ionizante en el personal de las salas de cateterismo cardiovascular y el desarrollo de cambios en el cristalino. Métodos: Se hizo un estudio transversal. Los participantes fueron reclutados en el XIII Congreso Colombiano de Cardiología Intervencionista y las Conferencias SOLACI en Bogotá - Colombia 2017. Se obtuvo el consentimiento informado de todos los participantes. Se recolectaron datos demográficos y clínicos. Se determinó la asociación entre los cambios en el cristalino y la exposición a la radiación ionizante. Resultados: Un total de 89 sujetos (178 ojos) participaron en el estudio. En general, la edad promedio fue de 40 años, con edades comprendidas entre los 19 años y 78 años. La distribución según el género fue del 55,3% en hombres y el 44,7% en mujeres. Se consideró que 31 sujetos (62 ojos) no tenían exposición ocupacional a la radiación y 58 sujetos (116 ojos) presentaban exposición ocupacional a esta. Los ojos expuestos tenían dos veces el riesgo de presentar opacidad subcapsular posterior del cristalino en comparación con los ojos no expuestos. Los sujetos de mayor edad y con rol de médico se asociaron a la presencia de opacidad del cristalino, con un valor p de 0.001 en ambos casos. Del mismo modo, los sujetos expuestos con cualquier opacidad del cristalino tenían una vida laboral más larga, con una p 0.001. Conclusiones: Este estudio confirma un aumento estadísticamente significativo en la presencia de cambios en el cristalino en el personal de las salas de cateterismo cardiovascular en comparación con los controles no expuestos.

Genetic association with intravitreal ranibizumab response for neovascular age-related macular degeneration in Hispanic population.

BACKGROUND/PURPOSE: Age-related macular degeneration (AMD) is the leading cause of visual impairment in patients over 55 years. Currently, the most common therapies for neovascular AMD (nAMD) are intravitreal antiangiogenics. Studies suggest that genetic factors influence on antiangiogenics therapy outcomes. The purpose of this work was to establish the association between complement factor H (CFH) (Y402H), age-related maculopathy susceptibility 2 (ARMS2) (A69S), and high-temperature requirement factor A1 (HTRA1) (rs11200638) polymorphisms and the response to treatment with ranibizumab in patients with nAMD. METHODS: A cross-sectional study with 61 eyes with nAMD treated with ranibizumab was performed. Association between polymorphisms from CFH, ARMS2, and HTRA1 with the response to treatment was established. RESULTS: The mean age of patients was 76.6 (51-91) years. Only 37.7% of patients had a functional response and 26.2% had an anatomic response. TT polymorphism Y402H from CFH gene was associated with an increased likelihood of functional response to treatment. Otherwise, there was not a statistically significant association between anatomic and functional response to gene polymorphisms rs11200638 from HTRA1 and rs10490924 from ARMS 2. CONCLUSIONS: This study suggests that the response to intravitreal antiangiogenic therapy with ranibizumab was not associated to main polymorphisms from genes HTRA1 and ARMS2. However, it was found that the response to treatment differed according to CFH genotype, suggesting that further investigations are needed to establish if patients with the CC and TC genotype may need to be monitored more closely for disease recurrence than the TT genotype.