A delphi study to detect deficiencies and propose actions in real life treatment of neovascular age-related macular degeneration.

Purpose. Spanish retina specialists were surveyed in order to propose actions to decrease deficiencies in real-life neovascular age macular degeneration treatment (nv-AMD). Methods. One hundred experts, members of the Spanish Vitreoretinal Society (SERV), were invited to complete an online survey of 52 statements about nv-AMD management with a modified Delphi methodology. Four rounds were performed using a 5-point Linkert scale. Recommendations were developed after analyzing the differences between the results and the SERV guidelines recommendations. Results. Eighty-seven specialists completed all the Delphi rounds. Once major potential deficiencies in real-life nv-AMD treatment were identified, 15 recommendations were developed with a high level of agreement. Consensus statements to reduce the burden of the disease included the use of treat and extend regimen and to reduce the amount of diagnostic tests during the loading phase and training technical staff to perform these tests and reduce the time between relapse detection and reinjection, as well as establishing patient referral protocols to outside general ophthalmology clinics. Conclusion. The level of agreement with the final recommendations for nv-AMD treatment among Spanish retinal specialist was high indicating that some actions could be applied in order to reduce the deficiencies in real-life nv-AMD treatment.

Amniotic membrane as single treatment in complication of exposed scleral buckle.

PURPOSE: To report a case of complicated exposed scleral buckle in which amniotic membrane was used to repair the extremely thin sclera that showed the underlying choroid. METHODS: Interventional case report. A 65-year-old man presented to our Department with severe eye pain after retinal detachment repair with scleral buckling technique 7 years ago. RESULTS: Examination of the left eye revealed extrusion of the buckle with conjunctival and scleral erosion that allowed distinguishing the choroid. The buckle was removed and successful scleral repair was achieved through the use of amniotic membrane. CONCLUSION: Amniotic membrane graft is a safe and useful scleral substitute that should be considered to cover scleral defects, in the absence of infection.

Central retinal artery occlusion in Wegener's granulomatosis: a diagnostic dilemma.

PURPOSE: To report a case of central retinal artery occlusion (CRAO) in a patient with biopsy-verified Wegener's granulomatosis (WG) with positive C-ANCA. METHODS: A 55-year-old woman presented with a 3-day history of acute painless bilateral loss of vision; she also complained of fever and weight loss. Examination showed a CRAO in the left eye and angiographically documented choroidal ischemia in both eyes. RESULTS: The possibility of systemic vasculitis was not kept in mind until further studies were carried out; methylprednisolone pulse therapy was then started. Renal biopsy disclosed focal and segmental necrotizing vasculitis of the medium-sized arteries, supporting the diagnosis of WG, and cyclophosphamide pulse therapy was administered with gradual improvement, but there was no visual recovery. CONCLUSION: CRAO as presenting manifestation of WG, in the context of retinal vasculitis, is very uncommon, but we should be aware of WG in the etiology of CRAO. This report shows the difficulty of diagnosing Wegener's granulomatosis; it requires a high index of suspicion, and we should obtain an accurate medical history and repeat serological and histopathological examinations. It emphasizes that inflammation of arteries leads to irreversible retinal infarction, and visual loss may occur.

Factores de riesgo vascular y enfermedad obstructiva microvascular de la retina / Vascular risk factors and retinal occlusive disease

Fundamento y objetivo: Nuestro objetivo fue caracterizar el perfil de factores de riesgo vascular que presentan diferentes enfermedades vasculares oclusivas de la retina, como son la trombosis venosa, la embolia arterial y la neuropatía óptica isquémica anterior (NOIA). Para eso estudiamos a los pacientes que diagnosticó el servicio de oftalmología sobre la base de criterios clínicos, funduscópicos y angiográficos. Pacientes y método: Estudio transversal de 284 sujetos con enfermedades vasculares de la retina entre 25–93 años de edad a los que se seleccionó consecutivamente en la consulta de oftalmología y que se remitieron a la consulta de medicina interna. Resultados: De 284 pacientes, el 52 % eran varones y el 48 % eran mujeres, con una edad media (DE) de 62 (12) años (intervalo: 25–93 años). La trombosis venosa retiniana era la enfermedad más frecuente, con un 66 % (intervalo de confianza [IC] del 95%: 60,4–71,5), seguida de la NOIA, con un 21% (IC del 95%: 16,1–25,8) y la embolia arterial, con un 11% (IC del 95 %: 7,29–14,7). En conjunto, presentaban alta prevalencia de antecedentes de factores de riesgo vascular, sobre todo hipertensión arterial, en un 50 % (IC del 95%: 44,0–55,9), y síndrome metabólico en un 39% (IC del 95%: 33,2–44,7). Individualmente, la trombosis venosa retiniana se asoció a hipertensión arterial con hipertrofia ventricular izquierda en el 54% (p<0,009), y fue significativa (p<0,01) en la trombosis central respecto a las trombosis de ramas. Los enfermos con embolia arterial tenían menos sobrepeso y obesidad (p<0,04), pero presentaban significativamente (p<0,001) soplos vasculares y placas aterosclerosas en carótidas, así como enfermedad vascular extraocular. La NOIA va asociado a obesidad, sobrepeso y diabetes. No existían diferencias significativas en los marcadores inflamatorios (proteína C reactiva, factor de necrosis tumoral alfa, interleucina 6 e interleucina 10) en las diversas enfermedades retinianas (AU)

Background and objective: The aim of the present study is to define the risk factors associated with different retinal occlusive diseases, such as retinal venous thrombosis, arterial emboli and ischaemic anterior optic neuritis. Patients with any of these entities entered the study. Patients and method: A cross-sectional study on 284 consecutive subjects, aged 25–93, who were initially attended at the ophthalmology unit and then sent to the internal medicine unit. Results: We included 284 patients, 52% men, 48% women, aged 62±12 years (range 25–93). Retinal vein thrombosis was observed in 66% (IC 95%: 60.4–71,5), followed by anterior ischemic optic neuropathy in 21% (IC 95%: 16, 1–25,8) and arterial embolism in 11% (IC 95 %: 7,29–14,7). Vascular risk factors were frequently recorded, especially hypertension in 50% (IC 95%: 44, 0–55,9) and metabolic syndrome in 39% (IC 95%: 33,2–44,7). Venous thrombosis showed an association with hypertension and with left ventricular hypertrophy, especially central vein thrombosis (54%, p<0.009). Among those with arterial embolism obesity was less frequently observed (p=0.04), but these patients showed significantly (p<0.001) more vascular bruits, carotideal atheromatous plaques and extraocular vascular disease. Anterior optic ischaemic neuritis was significantly associated with obesity, overweight, and diabetes. No differences were observed regarding inflammatory markers (CRP, TNF alpha, IL-6 and IL-10) among the different retinal occlusive diseases analysed. Conclusions: Occlusive retinal diseases are associated with vascular risk factors, but the association is specific for each entity (AU)

[Vascular risk factors and retinal occlusive disease]. / Factores de riesgo vascular y enfermedad obstructiva microvascular de la retina.

BACKGROUND AND OBJECTIVE: The aim of the present study is to define the risk factors associated with different retinal occlusive diseases, such as retinal venous thrombosis, arterial emboli and ischaemic anterior optic neuritis. Patients with any of these entities entered the study. PATIENTS AND METHOD: A cross-sectional study on 284 consecutive subjects, aged 25-93, who were initially attended at the ophthalmology unit and then sent to the internal medicine unit. RESULTS: We included 284 patients, 52% men, 48% women, aged 62+/-12 years (range 25-93). Retinal vein thrombosis was observed in 66% (IC 95%: 60.4-71.5), followed by anterior ischemic optic neuropathy in 21% (IC 95%: 16.1-25.8) and arterial embolism in 11% (IC 95 %: 7.29-14.7). Vascular risk factors were frequently recorded, especially hypertension in 50% (IC 95%: 44. 0-55.9) and metabolic syndrome in 39% (IC 95%: 33.2-44.7). Venous thrombosis showed an association with hypertension and with left ventricular hypertrophy, especially central vein thrombosis (54%, p<0.009). Among those with arterial embolism obesity was less frequently observed (p=0.04), but these patients showed significantly (p<0.001) more vascular bruits, carotideal atheromatous plaques and extraocular vascular disease. Anterior optic ischaemic neuritis was significantly associated with obesity, overweight, and diabetes. No differences were observed regarding inflammatory markers (CRP, TNF alpha, IL-6 and IL-10) among the different retinal occlusive diseases analysed. CONCLUSIONS: Occlusive retinal diseases are associated with vascular risk factors, but the association is specific for each entity.