Evaluation of a follow-up protocol for patients on chloroquine and hydroxychloroquine treatment.

OBJECTIVE: To review the problems found after a new follow-up protocol for patients on chloroquine and hydroxychloroquine treatment. METHOD: Retrospective study was conducted between May 2012 and January 2013 on the clinical files, retinographies, fundus auto-fluorescence (FAF) images, and central-10 degree visual fields (VF) of patients who were referred to the Ophthalmology Department as they had started treatment with hydroxychloroquine. RESULTS: One hundred twenty-six patients were included; 94.4% were referred from the Rheumatology Department and 5.6% from Dermatology. Mean age was 59.7 years, and 73.8% were women. All of them were on hydroxychloroquine treatment, and 300mg was the most frequent daily dose. Rheumatoid arthritis was the most common diagnosis (40.5%), followed by systemic lupus erythematosus (15.9%). The mean Snellen visual acuity was 0.76, and 26 patients had lens opacities. The VF were normal in 97 patients, 8 had mild to moderate defects with no definite pattern, and in 9 the results were unreliable. Of the 51 patients older than 65years, 16 (31.4%) had altered or unreliable VF. The FAF was normal in 104 patients (82.5%), and abnormal, but consistent with ophthalmoscopic features, in 12 patients (pathological myopia, age related changes, early, middle or late age-related macular degeneration). CONCLUSIONS: Visual fields as a reference test for the diagnosis of AP toxicity are not quite reliable for patients over 65. Therefore, the FAF is recommended as primary test, perhaps combined with another objective test, such as SD-OCT instead of VF.

[Training and clinical activity of Spanish retinologists: a preliminary approach. Retina 2 project. Descriptive analysis]. / Formación y actividad clínica de los retinólogos en España: un primer acercamiento. Proyecto retina 2. Análisis descriptivo.

PURPOSE: To create a database of Spanish ophthalmologists mainly dedicated to retinal pathology care, describing their training period characteristics and their daily activity (clinical and surgical). METHODS: A postal questionnaire was sent to 504 possible retinologists identified through the information supplied by the Spanish Ophthalmological Society and the Spanish Vitreous-Retina Society, with a minimum of 3 retinologists per Autonomous Region. RESULTS: 267 (52.9% of the sample population) responses were collected and processed. Most of the respondents had started their residency after 1980 (82.4%). Ninety-four percent had received specific training in retinal pathology, mostly during the residency period (82.1%) and from more experienced colleagues (62.9%). Official fellowships were held in a minority of cases (around 12%). Twelve percent of retinologists performed retinal surgery only, 14.6% performed anterior segment surgery, and 60.7% performed both types of surgery. CONCLUSIONS: Despite not having taken into consideration non-response bias, this study provides the first reported data on the professional profile of Spanish retinologists.

Efficacy of intravitreal and periocular triamcinolone associated with photodynamic therapy for treatment of retinal angiomatous proliferation.

AIMS: To compare the relative efficacy of photodynamic therapy (PDT), PDT associated with intravitreal triamcinolone (PDT-IT) and PDT associated with periocular triamcinolone (PDT-PT) for treatment of retinal angiomatous proliferation (RAP) stage III. METHODS: Retrospective, interventional, non-randomised multicentric study. The files, optical coherence tomography scans, indocyanine green and fluorescein angiograms of patients with RAP stage III who had been referred to a regional centre for PDT were retrospectively examined. Final visual acuity and chorioretinal atrophy were considered to be the main outcome indicators. The need to re-treat and recurrences were also considered. RESULTS: Forty-two eyes were treated by PDT as monotherapy, 18 eyes by PDT-PT, and 19 eyes by PDT-IT. The mean (SD) age in each group was 79.1 (5.2), 77.0 (5.9) and 80.2 (5.1) years, respectively. The mean (SD) initial best corrected visual acuity (BCVA) was 0.17 (0.19), 0.21 (0.20) and 0.20 (0.18), respectively. Mean BCVA was 0.14 (0.19), 0.17 (0.15) and 0.17 (0.23), respectively, at 6 months (p = 0.27, 0.33 and 0.21, respectively) and 0.12 (0.18), 0.10 (0.10) and 0.17 (0.26), respectively, at 12 months (p = 0.12, 0.05 and 0.60, respectively, comparing vision at 6 months and 12 months with baseline; Student t test for paired data). Retinal pigment epithelium rips appeared in three eyes in group 1, in one eye in group 2, and in two eyes in group 3. CONCLUSION: Combined PDT-IT may offer better results than PDT monotherapy or PDT-PT in patients with RAP stage III.

Non-complicated retinal detachment management: variations in 4 years. Retina 1 project; report 1.

AIMS: To assess variations in the characteristics and management of two series of non-complicated rhegmatogenous retinal detachments (RD) carried out 4 years apart in Spain. METHODS: Prospective, multicentric, non-randomised comparative study. 339 consecutive cases of RD treated in five hospitals were included. Group 1 (G1) (n = 186) included cases operated on from 1999 to 2001; group 2 (G2) (n = 153) included cases from 2004 to 2006. 83 variables related to preoperative characteristics of RD, surgical management and postoperative evolution were recorded. Surgeons were allowed to treat patients following their personal criteria. Differences in preoperative characteristics, rate of vitrectomy and anatomical outcome were studied. Quantitative variables were compared by Mann-Whitney U test and qualitative variables by standard contingency tables. Multivariate analysis was carried out by logistic regression analysis. RESULTS: G1 showed a significantly longer delay in performing surgery, since the first symptoms appeared (G1: 29 (SD 50) days; G2: 22 (55); p<0.001) and more RD without visible retinal break than G2 (G1: 17.4%; G2: 9.2%; p = 0.028). In G2, cases with multiple retinal breaks (G1: 31.6%; G2: 44.6%) were more frequent (p = 0.022). No significant differences in other preoperative variables were observed. Vitrectomy was performed in 30.1% in G1 and in 78.4% in G2 as a primary surgical approach (p<0.001). Regardless of the characteristics of the RD, the rate of vitrectomy was higher in G2. The reattachment rate was over 94% in both groups (p = 0.833). Pseudophakic RD showed better anatomical outcomes in G2 (G1: 83.9%; G2: 96.4%; p = 0.028). CONCLUSION: There is an increasing tendency to treat RD with primary vitrectomy, which is related to neither a higher complexity of cases nor better anatomical results.

[Teletherapy ocular complications. A clinical case]. / Complicaciones oculares tras teleterapia. Caso clínico.

CLINICAL CASE: An 82-year-old pseudophakic male patient developed several ocular complications after teletherapy for cavum carcinoma. Three years after receiving the radiotherapy, he presented with a right optic neuritis with some posterior improvement. Five years later he developed an ischemic retinopathy and a severe dry eye syndrome. DISCUSSION: Ocular complications due to radiotherapy used to treat nasopharyngeal carcinomas are not as common as those caused by epiescleral radiotherapy for choroidal melanoma, but must be taken into account due to their special severity. We present a single case of a patient who suffered several subsequent ocular complications after such radiotherapy.