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Objective: To evaluate the impact of subfoveal choroidal thickness (SFCT) and other clinical biomarkers in intravitreal anti-vascular endothelial growth factor response in treatment-naive Caucasian patients diagnosed with polypoidal choroidal vasculopathy (PCV/AT1)., Design: Cross-sectional study., Participants: Treatment-naive patients diagnosed with PCV/AT1 recruited in a single centre from January 2013 to December 2020., Methods: Eligibility was determined in treatment-naive PCV patients who received a loading dose of 3 injections of 0.5 mg ranibizumab. A diagnosis of PCV/AT1 was made based on the diagnostic criteria in the efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with sumptomatic macular polypoidal choroidal vasculopathy study. Choroidal thickness was manually measured by enhanced depth imaging technology in Spectralis spectral domain optical coherence tomography., Results: Eighty-three eyes of 83 patients were included in this study, 47 patients diagnosed with PCV/AT1 with a good response to 3 intravitreal injections of ranibizumab and 36 with a poor response. The receiver operating characteristic curve of treatment effect against the SFCT revealed that the area under the curve was 0.85 (range, 0.74-0.96). Based on the Youden index, the optimal SFCT cut-off point for predicting a poor response to anti-vascular endothelial growth factor is 257 µm. In the multivariate analysis, the SFCT remained statistically significant (odds ratio 1.02 [range, 1.01-1.04]; P = 0.008). The combined effect of treatment effect against clinical biomarkers produced an area under the curve of 0.90 (range, 0.82-0.98)., Conclusion: SFCT is a risk factor for a poor response to the 3 loading injections of ranibizumab in treatment-naive PCV/AT1 Caucasian patients. A cut-off point of 257 µm could be a valuable parameter for defining the population at risk for an inadequate response to ranibizumab., (Copyright © 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the perception of barriers in healthcare and the impact of intravitreal injections in patients with neovascular age-related macular degeneration (nAMD)., Methods: Cross-sectional study including 108 patients with nAMD in treatment with intravitreal injections. The patients answered a questionnaire with 26 questions (score from 1 to 5) divided in three sections: 1) the disease and its treatment with injections, 2) healthcare barriers and 3) new technologies., Results: The mean age was 80.4 ± 7.0 years and visual acuity (VA) was 75.2 ± 12.4 letters. The main barriers in healthcare were long waiting times (72%), followed by other comorbidities (10%). Some 63% of patients have to wait between 3 and 5 h to attend their clinical visit. Significant anxiety due to the injections (2.8 ± 1.3) was observed, being present in 71% of the cases the day before. A great fear of blindness and losing independence was observed (4.4 ± 0.9 and 4.3 ± 1.1), with no differences in relation to VA, age or sex (p ≥ 0.135). Moreover, 28% of the patients reported that it was quite or very difficult for them to attend the clinical visit, with 69% of the total showing great interest in having a diagnostic device at home., Conclusion: The nAMD and its treatment represent a significant burden on patients, among whom there is a great fear of blindness and of losing their independence, the main barrier being the long waiting time for the clinical visit., (Copyright © 2021 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To assess the vision-related quality of life and the depression and anxiety rates in patients with neovascular Age-Related Macular Degeneration (nAMD)., Methods: A cross-sectional study of patients with nAMD treated with intravitreal injections was performed. The patients completed two validated questionnaires: the Visual Functioning Questionnaire (VFQ-25, score from 0 to 100), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Age, gender and visual acuity (VA) in the Early Treatment Diabetic Retinopathy Study (ETDRS) scale was registered., Results: Fifty-five patients with nAMD participated with a mean age of 80.9 ± 6.6 years-old (range 67-93) and a mean VA in the best eye of 73.5 ± 12.7 letters (range 44-95). The global VFQ-25 mean score was 57.4 ± 21.9 being 38.9 ± 13.2 for the general vision and 42.0 ± 19.5 for the general health. VA in the best eye was associated with the global score of the VFQ-25 scale (R = 0.608; P < .001), but no correlation was observed with general health (P = .936). In the HADS scale, 26.9% and 25.5% of patients had symptoms of depression and anxiety respectively. A negative correlation was found between the HADS and VFQ-25 scales for the general vision score (R = -0.438)., Conclusion: This study elucidates the impact of vision impairment and the visual functioning in nAMD, describing an important rate of depression and anxiety symptoms., (Copyright © 2020 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

We present an uncommon case of a unilateral congenital retinal macrovessel documented with retinography, perimetry, fluorescein angiography and macular optical coherence tomography. In the case presented the macrovessel crossed the horizontal meridian, between macula and optic disk. A literature review has been performed on congenital retinal macrovessels, possible structural and visual alterations they may cause and their association with other pathologies., (Copyright © 2020 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To compare two different initial dosing regimens of intravitreal ranibizumab used to treat myopic choroidal neovascularization., Methods: A total of 61 eyes of 56 patients were treated: 26 eyes received a single injection followed by treatment pro re nata (1+ PRN), while 35 eyes first received 3 consecutive monthly injections (3+ PRN)., Results: The mean follow-up was 53 ± 16 months. The visual acuities were 51.9 ± 16.2 letters with 3+ PRN and 53 ± 22.4 letters with 1+ PRN at baseline (p = 0.824); 69.5 ± 12.3 and 69 ± 15.1 letters, respectively, at 12 months; and 67.1 ± 16.2 and 66.4 ± 19.7 letters, respectively, at the end of follow-up (p = 0.877). Mean survival until first retreatment after the loading dose was 36.9 ± 6.1 months with 3+ PRN and 19.2 ± 5.4 months with 1+ PRN (p < 0.001)., Conclusions: Both dosing regimens led to similar visual outcomes. For eyes given a single injection in the first quarter, retreatment was needed appreciably earlier., (© 2017 S. Karger AG, Basel.)

Case Report: A 50-year-old patient was seen during a regular follow up. The main complaint was decreased near-sight vision. Biomicroscopy showed a vascular malformation on the temporal sector of the iris in the left eye, diagnosed as an arteriovenous malformation. A second case of similar features is also presented., Discussion: The vascular malformations of the iris may be asymptomatic and go unnoticed or cause recurrent spontaneous hyphemas. Treatment must be individualised and may range from observation to photocoagulation with laser, or even surgery., (Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To compare brimonidine/timolol fixed combination (BrTFC; Combigan *) with dorzolamide/timolol fixed combination (DTFC; Cosopt dagger) in terms of ability to lower intraocular pressure (IOP) in primary open-angle glaucoma (POAG)., Methods: This was a prospective, randomized, double-masked, crossover study. After 6 weeks of therapy with timolol maleate 0.5% twice daily, patients were randomized to BrTFC twice daily or DTFC twice daily for 6 weeks, before being crossed over to the other treatment arm for a further 6 weeks. At all follow-up visits, IOP was measured at 09.00 (pre-instillation) 12.00 and 16.00. The primary outcome measure was change in mean diurnal IOP from baseline at 6 weeks. The secondary outcome was percentage of patients with IOP <18 mmHg at 6 weeks. Data were analyzed from all patients who completed the study., Results: Twenty-five patients were randomized and 20 completed the study. Mean diurnal IOP (mean +/- standard deviation [SD]) was 20.28 +/- 2.03 mmHg at timolol-treated baseline. After 6 weeks, mean diurnal IOP was 16.28 +/- 2.07 mmHg following BrTFC and 17.23 +/- 2.29 mmHg following DTFC (difference: 0.95 mmHg, 95% CI 0.10-1.80, p = 0.03). Mean IOP at 09.00 was 20.95 +/- 2.31 mmHg at baseline. This was reduced to 15.85 +/- 2.56 mmHg following BrTFC and 17.55 +/- 2.67 mmHg following DTFC (difference: 1.70, 95% CI 0.80-2.60, p = 0.001). For the 12.00 and 16.00 timepoints, the mean changes from baseline in the two arms were comparable. Percentages of patients achieving a target IOP of <18 mmHg were 85% following BrTFC and 60% following DTFC (p = NS [not significant]). No treatment-related adverse events were reported with either therapy. Key limitations include the small size of the study population and the 6-week duration of treatment periods, which prevents drawing conclusions regarding long-term therapy., Conclusion: Reductions from baseline in mean diurnal IOP and morning IOP were greater with BrTFC than with DTFC.

Clinic Case: A 25 year old patient with high myopia diagnosed of metachronic choroidal neovascularisation in both eyes secondary to punctate inner choroidopathy leading to visual impairment and metamorphopsia. First eye was treated with four injections of ranibizumab after photodynamic therapy and the second eye only with charge dose of ranibizumab, reaching inactivity with good final visual acuity in both eyes., Discussion: Ranibizumab is useful in the treatment of this illness. Prospective studies are needed to investigate the usefulness of a combination with adjuvant therapies such as photodynamic therapy.

Purpose: To study the clinical characteristics of a cohort of Spanish patients diagnosed with Behcet disease and who also presented ocular inflammation., Methods: Thirty cases of Behçet disease were studied retrospectively. The authors studied age distribution, distribution by sex, clinical course, laterality, type of uveitis, secondary glaucoma, corneal involvement, hypopyon, iris-lens synechiae, secondary cataract, cystoid macular edema (CME), and papillitis (optic neuritis)., Results: Fourteen of the patients were men and 16 were women (ratio 0.875:1). The mean age of the patients was 35.24 years (+/-10.917; 21-61 years). In 23 patients, the disease course was recurrent. In 9 patients, the disease manifested unilaterally. In 5 patients showing unilateral onset, the contralateral eye became affected. In 2 of the 30 patients, uveitis exclusively affected the anterior segment. In 8 patients, uveitis was solely posterior. There was one case of intermediate uveitis. The remaining 19 patients showed panuveitis. Three had focal chorioretinitis. One had diffuse chorioretinitis. Fifteen showed signs of diffuse vasculitis. Eight patients showed focal vasculitis., Conclusions: Women were slightly more affected than men, although the authors found no significant correlation between sex and the clinical variables examined. Apart from one unexpected case of intermediate uveitis, the observations are similar to those reported for other patient series.

Aims: This prospective, open label, non-comparative, observational case series evaluates 6-month results of Pegaptanib Sodium (Macugen) and Photodynamic Therapy (PDT) in predominantly classic juxtafoveal choroidal neovascularisation (CNV) in age-related macular degeneration (AMD) in seven eyes of seven patients., Results: Best corrected visual acuity (BCVA) diminished with a mean of five letters. Initial area of CNV increased significantly from 1.4 mm2 to 2.7 mm2. There was a significant increase in the greatest linear dimension (GLD) from 1280.3 microm to 2065.7 microm at the 24-week follow-up., Conclusion: Predominantly classic juxtafoveal CNVs are highly aggressive lesions that demonstrate poor response despite combined therapy using PDT and Macugen.

Objective: To determine the efficacy of Photodynamic Therapy (PDT) in chronic Central Serous Chorioretinopathy (CSC)., Methods: Patients diagnosed with chronic CSC, with clinical evidence of activity and treated with Photodynamic Therapy, are included in this report. All were assessed by a complete ophthalmological examination, including assessment of the best corrected visual acuity (BCVA) using an ETDRS chart, fluorescein and indocyanine angiography and optical coherence tomography (OCT). The main objective of the study was to determine the mean visual acuity change., Results: 11 eyes of 11 patients were included in the study, which had a mean follow-up period of 11 months. The mean BCVA increased from 20/76 to 20/64. 35% of eyes improved their BCVA by 2 lines or more, 45% remained stable and 18% lost 2 lines or more. Choroidal hyperpermeability was reduced in every case. Neurosensorial retinal detachment decreased in 80% of cases. Only one eye received a second PDT treatment due to choroidal neovascularization. An increase of atrophy over the Retinal Pigment Epithelium (RPE) was observed in another patient., Conclusions: PDT can reduce the clinical signs of activity, such as choroidal hyperpermeability or neurosensorial retinal detachment, in patients affected by chronic CSC. However, the increase in visual acuity is variable, probably due to the extent of RPE damage.

Objective: To evaluate the efficacy and safety of photodynamic therapy in choroidal neovascularization associated with angioid streaks., Methods: We performed a retrospective study of eleven eyes (eight patients) with subfoveal, juxtafoveal or extrafoveal neovascularization, which received at least one session of photodynamic therapy. Treatment efficacy was evaluated by visual acuity (VA) testing, color photography and fluorescein angiography. The mean follow-up was 13.2 months., Results: Ten eyes presented subfoveal neovascularization, one eye presented juxtafoveal and another eye extrafoveal neovascularization. VA was unchanged in two patients, increased in one patient, and decreased in eight patients following photodynamic therapy. Nine eyes presented conversion to a fibrotic disciform lesion, whereas leakage persisted in two eyes after one session of photodynamic therapy. Recurrence of choroidal neovascularization appeared in three eyes., Conclusions: Photodynamic therapy in choroidal neovascularization related to angioid streaks does not appear to alter the course of this disease, but it does slow its progression.

Purpose: To report a case of herpetic optic neuritis associated with herpetic keratitis., Methods: A 65 year old woman presented with oedema in the nasal sector of his right papilla. Blood biochemistry, a haemogram, erythrocyte sedimentation rate and C-reactive protein were all normal. The patient was diagnosed as having a non-arteritic anterior ischaemic optic neuropathy. One week later slit lamp examination showed diffuse stromal corneal oedema and a dendritic lesion in the nasal zone of the corneal epithelium., Results: Serology for varicela-zoster virus was positive. Treatment was started with valacyclovir given orally and topical acyclovir ointment. A week later, the optic disc swelling and corneal lesions had resolved., Conclusions: The precise mechanism through which the papilla and cornea were successively affected in our patient is unclear but the sensitive innervation of both these structures is provided by the nasal branch of the nasociliary nerve and the spread of herpes via this nerve could affect both sites.

Case Report: We present the case of a 65-year-old man who was seen in the casualty department complaining of bilateral visual loss. His past medical history was unremarkable except for chronic lymphocytic leukaemia diagnosed two years previously: he was no longer receiving treatment for this disorder. His visual acuity was 20/200 in the right eye and 20/63 in the left eye and he had a bilateral papilledema. Computed tomography and magnetic resonance imaging of the brain and orbit were performed and showed an infiltrative mass in the orbit with extension to the ethmoid bone and both optic nerves. Biopsy of the mass was compatible with chronic lymphocytic leukaemia., Discussion: Leukaemic infiltration of the optic nerve and central nervous system is a rare complication of chronic lymphocytic leukaemia, although it is common in the acute forms of this disease. Optic nerve infiltration is the most important ophthalmologic manifestation of leukaemia because it threatens vision and it is treatable.

Case Report: We describe the case of a patient suffering from acute visual loss soon after watching a solar eclipse. Optical coherence tomography was the main diagnostic tool used., Discussion: Solar retinopathy is now an unusual cause of visual loss, although there are still some cases diagnosed, especially after viewing solar eclipses. Optical coherence tomography is suitable for detecting permanent retinal injuries related to solar exposure, with the outer retinal layers being typically affected.

Purpose: Optic nerve drusen needs to be included in the differential diagnosis of pseudopapilledema. As the identification of this entity by funduscopy may be difficult, ultrasonography has thus become the gold standard for its diagnosis. Severe optic nerve drusen has been correlated with a reduction of the nerve fiber layer measured by optic coherence tomography and with the presence of serious visual field defects. To demonstrate the relationship between extensive optic nerve drusen and visual field defects., Method: A prospective observational study of the visual fields of a series of 5 patients with severe optic nerve drusen diagnosed by ultrasonography., Results: Visual field defects of widely differing severity, from inferior nasal quadrant to severe hemivisual field defects, were described in each patient studied., Conclusions: Visual field defects of diverse severity are common in patients with deep optic nerve drusen. For that reason ultrasonography and/or optical coherence tomography is highly recommended where such visual field defects exist.

Case Report: We describe a patient who was bitten on his right upper eyelid by a common canine tick. The tick was impregnated with gasoline prior to being removed., Discussion: Tick bites are uncommon in ophthalmologic practice. They occur more frequently in rural areas, especially in spring and summer. Correct identification of the problem and treatment is essential. The tick needs to be completely removed in order to avoid the embedding of different parts of the insect. Zoonoses, such as rickettsiosis, arbovirus and paralysis due to ticks must be ruled out.

Case Report: We present the case of a patient diagnosed with amaurosis of the right eye secondary to a right frontal contusion. The energy of the impact was projected from the orbital ceiling to the minor wing of the sphenoid bone. This bone was fractured, thus reducing the optic canal diameter and damaging the optic nerve., Discussion: In our case, we describe a mixed mechanism of injury, that is to say, a frontal contusion indirectly transmitted to the optic canal and a direct lesion of the optic nerve secondary to the movement of the minor wing of the sphenoid bone into the optic canal.

Case Report: We report the case of a patient with Multiple Myeloma Ig G Kappa stage IIIA and hepatic infiltration, who presented with ocular infiltration. The initial sign was a rapidly growing sub-conjunctival mass that caused ophthalmoplegia and increased intraocular pressure secondary to progressive infiltration of the orbit., Discussion: Multiple Myeloma is a malignant tumor of plasma cells that can affect the eye and orbit, not only as an infiltration secondary to the disease but also primary as an isolated tissue proliferation (extramedullary plasmacytoma). Chemotherapy is the usual treatment given. Radiotherapy with or without excisional surgery is the first option for plasmacytomas.