Acute and chronic optic nerve head biomechanics and intraocular pressure changes in patients receiving multiple intravitreal injections of anti-VEGF.

PURPOSE: To evaluate acute and chronic changes in optic nerve head (ONH) structures and intraocular pressure (IOP) in patients receiving intravitreal injections (IVIs) of anti-VEGF. METHODS: Twenty-nine eyes receiving IVIs for the first time were studied. IOP, retinal nerve fiber layer (RNFL) thickness, and ONH structures were evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology. Structures were measured before and 5 min after each one of the three monthly injections of a loading dose treatment. In 13 eyes (44.8%) with more than six IVIs, another evaluation pre and immediately postinjection was performed after 1 year. RESULTS: A significant acute and transient IOP increase (all p ≤ 0.001), Bruch's membrane opening (BMO) enlargement (p ≤ 0.001), cup widening (p < 0.05) and deepening (p ≤ 0.001), and prelaminar tissue thinning (p ≤ 0.001) were observed 5 min after each injection. Compared with baseline values, a significant BMO expansion (p = 0.001) and RNFL thinning (p < 0.001) were observed in the third month. In eyes with more than six IVIs, similar immediate postinjection changes, including IOP increase (p = 0.001), prelaminar tissue thinning (p = 0.007), and cup deepening (p = 0.012) were observed at 1 year, while BMO expansion was not significant (p = 0.556). Compared with baseline preinjection values, a significant BMO expansion (p = 0.003), prelaminar tissue thinning (p = 0.011), and cup deepening (p = 0.006) in the inferior region of the ONH occurred. No change in IOP was observed at the end of follow-up. CONCLUSIONS: Repeated IVIs could lead to irreversible changes in ONH structures. Large-scale, prospective studies are required to determine the long-term effects of anti-VEGF treatments in ONH tissues.

Resonancia magnética de mama: cambios en la imagen del cáncer tratado con neoadyuvancia. Correlación con subtipos moleculares / Breast MR imaging changes after neoadjuvant chemotherapy: correlation with molecular subtypes

Objetivo. La RM es la técnica de imagen que mejor valora la respuesta a la quimioterapia neoadyuvante en el cáncer de mama localmente avanzado. Los objetivos son: primero, cuantificar la respuesta en los subtipos moleculares; segundo, describir las variaciones morfológicas y dinámicas, y tercero, valorar si el fenotipo molecular se modifica tras la quimioterapia. Material y métodos. Estudio retrospectivo de 75 carcinomas, en 69 pacientes con quimioterapia neoadyuvante. Se realizó RM pre y post-tratamiento. La respuesta se clasificó en: respuesta completa; respuesta parcial mayor; respuesta parcial menor y sin respuesta, cuantificando cada una en cada subtipo molecular (luminal A, luminal B, Herb2+ y triple negativo). Los cambios morfológicos fueron: reducción concéntrica, fragmentación, realce ductal y necrosis. Los cambios dinámicos afectaron al pico de intensidad máxima y al realce post-inicial. Resultados. En los 4 subtipos moleculares se observaron los 4 tipos de respuesta. El triple negativo tuvo 84,6% de buenas respuestas, seguido del luminal B (76,9%), luminal A (75,6%), y Herb 2+ (69,2%). El cambio morfológico que predominó fue la reducción concéntrica en el 75% y el dinámico fue la disminución del pico de intensidad máxima, < 100%, en el 64,2%, con predominio de curvas tipo I y II en el 85,7%. Conclusiones. El subtipo triple negativo es el que mejor respondió a la quimioterapia neoadyuvante. Los cambios más frecuentes fueron la reducción concéntrica y la disminución del pico de intensidad máxima con menos curvas de lavado. El cambio del fenotipo molecular fue del 12,2%, entre la muestra al diagnóstico y el estudio final (AU)

Objective. MRI is the imaging technique that is best suited to evaluating the response to neoadjuvant chemotherapy for locally advanced breast cancer. We aimed to a) quantify the response in the molecular subtypes, b) describe the morphological and dynamic variation, and c) determine whether the molecular phenotype changes after chemotherapy. Material and methods. This is a retrospective study of 75 carcinomas in 69 patients who underwent MRI both before and after neoadjuvant chemotherapy. The response to treatment was classified as a) complete response, b) major partial response, c) minor partial response, or d) no response. We quantified the response in each molecular subtype (Luminal A, Luminal B, Her2+, and triple negative). The morphological changes were classified as a) concentric reduction, b) fragmentation, c) ductal enhancement, or d) necrosis. The dynamic changes affected the maximum intensity peak and the post-initial enhancement. Results. In the 4 molecular subtypes, the 4 types of response were seen. The response was good in 84.6% of the triple negative subtype, in 76.9% of the Luminal B subtype, in 75.6% of the Luminal A subtype, and in 69.2% of the Her2+ subtype. The predominant morphological change was concentric reduction (75%). The predominant dynamic change was a decrease in the maximum intensity peak (<100% in 64.2%), and type I or II curves were seen in 85.7%. Conclusions. The triple negative subtype responded best to neoadjuvant chemotherapy. The most common changes were concentric reduction and a decrease in the maximum intensity peak, with fewer washout curves. We observed a change in the molecular phenotype between the specimen at diagnosis and the final study in 12.2% of cases (AU)

Breast MR imaging changes after neoadjuvant chemotherapy: correlation with molecular subtypes.

OBJECTIVE: MRI is the imaging technique that is best suited to evaluating the response to neoadjuvant chemotherapy for locally advanced breast cancer. We aimed to a) quantify the response in the molecular subtypes, b) describe the morphological and dynamic variation, and c) determine whether the molecular phenotype changes after chemotherapy. MATERIAL AND METHODS: This is a retrospective study of 75 carcinomas in 69 patients who underwent MRI both before and after neoadjuvant chemotherapy. The response to treatment was classified as a) complete response, b) major partial response, c) minor partial response, or d) no response. We quantified the response in each molecular subtype (Luminal A, Luminal B, Her2+, and triple negative). The morphological changes were classified as a) concentric reduction, b) fragmentation, c) ductal enhancement, or d) necrosis. The dynamic changes affected the maximum intensity peak and the post-initial enhancement. RESULTS: In the 4 molecular subtypes, the 4 types of response were seen. The response was good in 84.6% of the triple negative subtype, in 76.9% of the Luminal B subtype, in 75.6% of the Luminal A subtype, and in 69.2% of the Her2+ subtype. The predominant morphological change was concentric reduction (75%). The predominant dynamic change was a decrease in the maximum intensity peak (<100% in 64.2%), and type I or II curves were seen in 85.7%. CONCLUSIONS: The triple negative subtype responded best to neoadjuvant chemotherapy. The most common changes were concentric reduction and a decrease in the maximum intensity peak, with fewer washout curves. We observed a change in the molecular phenotype between the specimen at diagnosis and the final study in 12.2% of cases.

[Influence of axial length in refractive outcome after cataract surgery]. / Influencia de la longitud axial en el resultado refractivo tras cirugía de catarata.

PURPOSE: To analyse the influence of axial length (AL) and age on refractive outcome after cataract surgery in terms of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and subjective refraction. METHODS: A retrospective review of 171 consecutive cases of uncomplicated cataract surgery was done. The refractive outcome was analysed (UCVA, BCVA and postoperative retraction) according AL before surgery (AL < 22 mm, between 22 and 25 mm and AL > 25 mm) and age (< 40, between 40-60 years and > 60 years). RESULTS: After surgery mean UCVA was 0.6 ± 0.33 Diopters (D) and mean BCVA was 0.93 ± 0.23 D. Mean refractive outcome was 0.89 ± 0.78 D. There were no significant differences in post-operative UCVA, BCVA and refraction between the three age groups. There were statistically significant differences (p = 0.004) in UCVA between the three AL groups. The group with AL between 22 and 25 mm had better UCVA. Mean refractive outcome was -0.95 ± 1.91 D in the group with AL < 22 mm, -0.36 ± 0.88 D in the group with AL between 22 and 25 mm and 0.23 ± 1.15 D in the group with AL > 25 mm. CONCLUSIONS: AL influences refractive outcome and UCVA after cataract surgery. Eyes with AL < 22 mm have a worse refractive outcome.

[Correction of secondary anisometropia after retinal detachment and LASIK surgery]. / Corrección de anisometropía secundaria tras cirugía de desprendimiento de retina y LASIK.

CASE REPORT: A male with cylindrical anisometropia secondary to retinal detachment (RD) surgery in the right eye (OD) was referred for contact lens (CL) fitting. His refraction was OD -1.25 -2.75 x 60 degrees VA 1.0 and OS +0.25 VA 1.2. He was complaining of diplopia with spectacles. Seven years prior to the RD surgery, he had undergone LASIK without complications. The diplopia was eliminated after a CL was fitted according to his corneal topography. DISCUSSION: RD surgery can cause anisometropic refractive changes. In patients with diplopia and asthenopia, spectacles are not well tolerated. CL fitting according to post-LASIK corneal geometry succeeded in refractive correction with less anisometropic symptoms.