100 results on '"Ruiz-Medrano J"'
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2. The role of tocilizumab in the treatment of inflammatory diseases of the eye and orbit: A useful alternative
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Ruiz-Medrano, J., Díaz-Valle, D., Cuiña, R., Gegúndez, J.A., Chhablani, J., Majumder, P.D., and Gutierrez-Bonet, R.
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- 2018
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3. Update of choroidal imaging techniques: Past, present and future
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Ruiz-Medrano, J., Flores-Moreno, I., Gutierrez-Bonet, R., Chhablani, J., and Ruiz-Moreno, J.M.
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- 2017
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4. Actualización en técnicas de imagen coroidea: pasado, presente y futuro
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Ruiz-Medrano, J., Flores-Moreno, I., Gutierrez-Bonet, R., Chhablani, J., and Ruiz-Moreno, J.M.
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- 2017
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5. Effect of pharmacological pupil dilation on measurements and iol power calculation made using the new swept-source optical coherence tomography-based optical biometer
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Arriola-Villalobos, P., Almendral-Gómez, J., Garzón, N., Ruiz-Medrano, J., Fernández-Pérez, C., Martínez-de-la-Casa, J.M., and Díaz-Valle, D.
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- 2016
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6. The outcome of fluocinolone acetonide intravitreal implant is predicted by the response to dexamethasone implant in diabetic macular oedema
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Cicinelli, M. V., Rosenblatt, A., Grosso, D., Zollet, P., Capone, L., Rabiolo, A., Lattanzio, R., Loewenstein, A., Bandello, F., Nassisi, M., Tan, A., Reynolds, R., Singh, S. R., Vaezi, K. P., Giocanti-Aurégan, A., Weinberg, T., Faes, L., Schwartz, R., Reyes, D. Y. A., Savastano, A., Touhami, S., Garcia, H. R., Pohlmann, D., Plant, A., Ventura, C. V., Chatziralli, I., Phasukkijwatana, N., Ruiz-Medrano, J., Yuan, M., Yılmaz, İ., Vogt, D., Ting, D. S. W., Mustapha, M., Mendaro, M., Cicinelli, M. V., Rosenblatt, A., Grosso, D., Zollet, P., Capone, L., Rabiolo, A., Lattanzio, R., Loewenstein, A., Bandello, F., Nassisi, M., Tan, A., Reynolds, R., Singh, S. R., Vaezi, K. P., Giocanti-Aurégan, A., Weinberg, T., Faes, L., Schwartz, R., Reyes, D. Y. A., Savastano, A., Touhami, S., Garcia, H. R., Pohlmann, D., Plant, A., Ventura, C. V., Chatziralli, I., Phasukkijwatana, N., Ruiz-Medrano, J., Yuan, M., Yılmaz, İ., Vogt, D., Ting, D. S. W., Mustapha, M., and Mendaro, M.
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Drug Implants ,Diabetic Retinopathy ,Visual Acuity ,Correction ,Article ,Dexamethasone ,Macular Edema ,Ophthalmology ,Fluocinolone Acetonide ,Intravitreal Injections ,Diabetes Mellitus ,Humans ,Steroids ,Glucocorticoids ,Retrospective Studies - Abstract
BACKGROUND/OBJECTIVES: To investigate if the visual and anatomic response to the first dexamethasone implant (DEX) predicts the 12-month clinical outcome after shifting to fluocinolone acetonide (FAc) implant in patients with diabetic macular oedema (DMO). METHODS: Retrospective cohort study including pseudophakic patients with previously treated DMO, undergone one or more DEX injections before FAc. Functional and morphologic response to DEX was defined based on the best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes after the first DEX, respectively. Steroid-response was defined as intraocular pressure (IOP) elevation ≥5 mmHg or IOP > 21 mmHg after any previous DEX exposure. Pairwise comparisons for BCVA, CMT, and IOP after FAc were performed with linear mixed models and a repeated-measure design. RESULTS: Forty-four eyes of 33 patients were included. Patients were shifted to FAc after a mean ± standard deviation of 4.6 ± 3.2 DEX injections. Overall, BCVA and CMT improved during the first 12 months after switching to FAc (p = 0.04 and p
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- 2021
7. The outcome of fluocinolone acetonide intravitreal implant is predicted by the response to dexamethasone implant in diabetic macular oedema
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Cicinelli, M.V. Rosenblatt, A. Grosso, D. Zollet, P. Capone, L. Rabiolo, A. Lattanzio, R. Loewenstein, A. Bandello, F. Nassisi, M. Tan, A. Reynolds, R. Singh, S.R. Vaezi, K.P. Giocanti-Aurégan, A. Weinberg, T. Faes, L. Schwartz, R. Reyes, D.Y.A. Savastano, A. Touhami, S. Garcia, H.R. Pohlmann, D. Plant, A. Ventura, C.V. Chatziralli, I. Phasukkijwatana, N. Ruiz-Medrano, J. Yuan, M. Yılmaz, İ. Vogt, D. Ting, D.S.W. Mustapha, M. Mendaro, M. On behalf of the International Retina Collaborative
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genetic structures ,polycyclic compounds ,sense organs ,hormones, hormone substitutes, and hormone antagonists ,eye diseases - Abstract
Background/Objectives: To investigate if the visual and anatomic response to the first dexamethasone implant (DEX) predicts the 12-month clinical outcome after shifting to fluocinolone acetonide (FAc) implant in patients with diabetic macular oedema (DMO). Methods: Retrospective cohort study including pseudophakic patients with previously treated DMO, undergone one or more DEX injections before FAc. Functional and morphologic response to DEX was defined based on the best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes after the first DEX, respectively. Steroid-response was defined as intraocular pressure (IOP) elevation ≥5 mmHg or IOP > 21 mmHg after any previous DEX exposure. Pairwise comparisons for BCVA, CMT, and IOP after FAc were performed with linear mixed models and a repeated-measure design. Results: Forty-four eyes of 33 patients were included. Patients were shifted to FAc after a mean ± standard deviation of 4.6 ± 3.2 DEX injections. Overall, BCVA and CMT improved during the first 12 months after switching to FAc (p = 0.04 and p < 0.001, respectively). Only eyes with a good morphologic response to DEX had a significant CMT reduction after FAc (p < 0.001), while no significant relationship was found between BCVA improvement after DEX and after FAc. IOP elevation occurred in 9 eyes (20%) following DEX implant. These eyes carried a 20-fold increased risk of having an IOP rise after FAc (p < 0.001), with a non-linear relationship between the IOP increase after DEX and the one after FAc. Conclusion: The response to previous DEX may anticipate the morphologic response to subsequent FAc. Eyes with steroid-induced IOP elevation after DEX are at a high risk of IOP increase after FAc. The visual response after FAc was not associated with the visual response to previous steroids, indicating that FAc may have a role also in patients refractory to DEX implant. © 2021, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.
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- 2021
8. Overcoming barriers of retinal care delivery during a pandemic-attitudes and drivers for the implementation of digital health: A global expert survey
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Faes, L. Rosenblatt, A. Schwartz, R. Touhami, S. Ventura, C.V. Chatziralli, I.P. Ruiz-Medrano, J. Vogt, D. Savastano, A. Ruiz-Garcia, H. Pohlmann, D. Loewenstein, A.
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Background/Aims The SARS-CoV-2 pandemic has imposed barriers to retinal care delivery worldwide. In this context, retinal services are exploring novel ways to ensure access to healthcare. Methods We conducted a worldwide survey among retinal specialists between March 31, 2020 and April 12, 2020. The expert survey was developed on the basis of focus group discussions involving retinal specialists and literature searches. It included 44 questions on alternative ways of care provision including digital health domains such as teleophthalmology, home monitoring or decentralised patient care. Results 214 retinal experts participated in the survey, of which 120 (56.1%) had more than 15 years of experience in ophthalmology. Most participants were clinicians (n=158, 73.9%) practising in Western Europe (n=159, 74%). In the majority of institutions, teleophthalmology, home monitoring and decentralised patient care have not been implemented before the pandemic (n=46, 21.8.1%; n=64, 29.9%; n=38, 19.1%). During the pandemic, the use of teleophthalmology and home monitoring increased significantly (n=105, p
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- 2021
9. Maculopatía en torpedo con desprendimiento seroso del epitelio pigmentario de la retina
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Arcos-Villegas, G., primary, Valor-Suarez, C., additional, Ruiz-Medrano, J., additional, Valverde-Megías, A., additional, Flores Moreno, I., additional, and Donate López, J., additional
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- 2017
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10. Expulsive total iridodialysis through microincision phacoemulsification wound
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Ruiz-Medrano, J., primary, Ávalos-Franco, N., additional, Gutierrez-Bonet, R., additional, Cifuentes-Canorea, P., additional, Gegundez-Fernandez, J.A., additional, and Diaz-Valle, D., additional
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- 2017
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11. Agreement and clinical comparison between a new swept-source optical coherence tomography-based optical biometer and an optical low-coherence reflectometry biometer
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Arriola-Villalobos, P, primary, Almendral-Gómez, J, additional, Garzón, N, additional, Ruiz-Medrano, J, additional, Fernández-Pérez, C, additional, Martínez-de-la-Casa, J M, additional, and Díaz-Valle, D, additional
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- 2016
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12. Canal de Cloquet o conducto de Stilling y espacio de Martegiani
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Santos-Bueso, E., primary, Asorey-García, A., additional, Ruiz-Medrano, J., additional, Vinuesa-Silva, J.M., additional, and García-Sánchez, J., additional
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- 2015
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13. Cloquet's canal or Stilling's duct and Martegiani's space
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Santos-Bueso, E., primary, Asorey-García, A., additional, Ruiz-Medrano, J., additional, Vinuesa-Silva, J.M., additional, and García-Sánchez, J., additional
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- 2015
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14. Linfoma orbitario tipo MALT en paciente diagnosticado de linfoma no Hodgkin
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Ruiz-Medrano, J., primary, Peralta-Díaz, L.M., additional, and Santos-Bueso, E., additional
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- 2015
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15. Orbitary MALT lymphoma in a patient diagnosed with non-Hodgkin lymphoma
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Ruiz-Medrano, J., primary, Peralta-Díaz, L.M., additional, and Santos-Bueso, E., additional
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- 2015
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16. Charles Bonnet y sus teorías
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Ruiz-Medrano, J., primary, Santos-Bueso, E., additional, and García-Sánchez, J., additional
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- 2013
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17. Retinal tubulations in geographic atrophy associated with age-related macular degeneration
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RUIZ MORENO, JM, primary, LUGO, FL, additional, RUIZ-MEDRANO, J, additional, MONTERO, JA, additional, and DONATE, J, additional
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- 2013
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18. Macular choroidal thickness profile in healthy population measured by swept‐source optical coherence tomography
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RUIZ MORENO, JM, primary, RUIZ‐MEDRANO, J, additional, FLORES‐MORENO, I, additional, PEñA‐GARCíA, P, additional, and MONTERO, JA, additional
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- 2013
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19. Choroidal thickness changes determined by SS OCT following intravitreal bevacizumab
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RUIZ MORENO, JM, primary, MONTERO, JA, additional, RUIZ‐MEDRANO, J, additional, FLORES‐MORENO, I, additional, and LUGO, F, additional
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- 2013
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20. Agreement and clinical comparison between a new swept-source optical coherence tomography-based optical biometer and an optical low-coherence reflectometry biometer
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Arriola-Villalobos, P, Almendral-Gómez, J, Garzón, N, Ruiz-Medrano, J, Fernández-Pérez, C, Martínez-de-la-Casa, J M, and Díaz-Valle, D
- Abstract
PurposeTo compare measurements taken using a swept-source optical coherence tomography-based optical biometer (IOLmaster 700) and an optical low-coherence reflectometry biometer (Lenstar 900), and to determine the clinical impacts of differences in their measurements on intraocular lens (IOL) power predictions.MethodsEighty eyes of 80 patients scheduled to undergo cataract surgery were examined with both biometers. The measurements made using each device were axial length (AL), central corneal thickness (CCT), aqueous depth (AQD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW), and pupil diameter (PD). Holladay 2 and SRK/T formulas were used to calculate IOL power. Differences in measurement between the two biometers were determined using the paired t-test. Agreement was assessed through intraclass correlation coefficients (ICC) and Bland–Altman plots.ResultsMean patient age was 76.3±6.8 years (range 59–89). Using the Lenstar, AL and PD could not be measured in 12.5 and 5.25% of eyes, respectively, while IOLMaster 700 took all measurements in all eyes. The variables CCT, AQD, LT, and MK varied significantly between the two biometers. According to ICCs, correlation between measurements made with both devices was excellent except for WTW and PD. Using the SRK/T formula, IOL power prediction based on the data from the two devices were statistically different, but differences were not clinically significant.ConclusionsNo clinically relevant differences were detected between the biometers in terms of their measurements and IOL power predictions. Using the IOLMaster 700, it was easier to obtain biometric measurements in eyes with less transparent ocular media or longer AL.
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- 2017
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21. Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN)
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Ruiz-Medrano, J. (Jorge)
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- Pathologic myopia, Staphyloma, Myopic maculopathy, Myopic traction maculopathy, Myopic choroidal neovascularization, High myopia, ATN classification system, Myopic maculopathy classification
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Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area—defined as myopic maculopathy—are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>−6 to −8 diopters) in the context of eye elongation (26–26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)—with and without retinal detachment—and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable—but erroneous—use of the terms high and pathologic myopia in genetic research
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- 2019
22. Myopic maculopathy progression: insights into posterior staphyloma and macular involvement.: Short title: Myopic maculopathy progression.
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Flores-Moreno I, Puertas M, Fernández-Jiménez M, Franco LC, Terrón-Vilalta M, Eslava B, Almazán-Alonso E, Ruiz-Medrano J, Kudsieh B, García-Zamora M, and Ruiz-Moreno JM
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Purpose: To analyze the myopic maculopathy's progression pattern., Design: Retrospective, observational case series., Methods: 824 highly myopic eyes (axial length ≥26mm) of 430 patients examined at Puerta de Hierro-Majadahonda University Hospital (Madrid, Spain) with a minimum follow-up of 2 years. All patients underwent complete ophthalmologic examination, including multimodal imaging. Progression of myopic maculopathy was assessed according to ATN classification system at baseline and throughout the follow-up, as well as associated clinical features., Results: Progression of myopic maculopathy was described in 42% of eyes over a mean follow-up of 4.10±1.28 (range: 2.00 to 6.23) years. Compared to non-progressing eyes, myopic maculopathy progression correlated with worse best-corrected visual acuity (BCVA) at follow-up (p<0.05) and greater BCVA loss (p<0.01). There were no significant differences between groups in axial length, gender, and age (p>0.05). Eyes with posterior staphyloma (PS) and, particularly, those with macular PS showed significantly greater myopic maculopathy progression (p<0.01). The likelihood of myopic maculopathy's progression was 3.94 times higher (OR: 3.94±1.22, p<0.01) in eyes with PS compared to those without PS. Atrophic progression occurred in 21.9% of eyes, with diffuse to patchy atrophy being the most common pattern (54.17%). Tractional progression was observed in 22.8% of eyes, predominantly from non-traction to inner/outer foveoschisis (40%). Neovascular progression affected 11.4% of the eyes, most of them from no-neovascular component to macular lacquer cracks (40%)., Conclusions: The study highlights significant myopic maculopathy progression over the natural course of the disease, compromising the BCVA as macular complications progress. Myopic maculopathy progression was significantly associated with PS and, especially, with those with macular involvement., Competing Interests: Declaration of competing interest No conflicting relationship exists for any author., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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23. The Importance of the Type of Posterior Staphyloma in the Development of Myopic Maculopathy.
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Ruiz-Medrano J, Puertas M, Flores-Moreno I, Almazán-Alonso E, García-Zamora M, Kudsieh B, and Ruiz-Moreno JM
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The objective of this paper was to determine how different types of posterior staphyloma (PS) may affect the appearance and degree of myopic maculopathy. A cross-sectional study was conducted, in which 467 eyes from 246 highly myopic patients [axial length (AL) ≥ 26 mm] were studied. A complete ophthalmic exploration was carried out on all patients, including imaging tests. The presence of macular PS was established as the main comparison variable between groups (macular PS vs. non-macular PS vs. non-PS). The variables analyzed included age, AL, decimal best-corrected visual acuity (BCVA), Atrophy (A)/Traction (T)/Neovascularization (N) components according to the ATN grading system, and the presence of severe pathologic myopia (PM). Out of the total, 179 eyes (38.3%) presented macular PS, 146 eyes presented non-macular PS (31.2%), and 142 eyes showed no PS (30.4%). The group without PS was significantly younger than macular PS and non-macular PS groups (53.85 vs. 66.57 vs. 65.20 years; p < 0.001 each, respectively). There were no age differences between PS groups. Eyes with macular PS (31.47 ± 2.30 mm) were significantly longer than those with non-macular PS (28.68 ± 1.78 mm, p < 0.001) and those without PS (27.47 ± 1.34 mm, p < 0.001). BCVA was significantly better in the non-PS group (0.75 ± 0.27) compared to the non-macular PS (0.56 ± 0.31) and macular PS groups (0.43 ± 0.33), with p < 0.001 each. Eyes without PS showed significantly lower A and T components (1.31 ± 0.96 and 0.30 ± 0.53, respectively) than non-macular PS (2.21 ± 0.75 and 0.71 ± 0.99, respectively, p < 0.001 each) and macular PS eyes (2.83 ± 0.64 and 1.11 ± 1.10, respectively, p < 0.001 each). The N component was lower in non-PS eyes vs. non-macular PS eyes (0.20 ± 0.59 vs. 0.47 ± 0.83, p < 0.001) and as compared to the macular PS group (0.68 ± 0.90, p < 0.01). Additionally, the N component was significantly lower in the non-macular PS group than in the macular PS one ( p < 0.05). The prevalence of severe PM was different between groups ( p < 0.001). It was higher among macular PS eyes (138/179) when compared to other groups ( p < 0.001, each), followed by the non-macular PS eyes (40/146) and being the lowest in the non-PS group (20/142). To conclude, macular PS is associated with a more advanced maculopathy, worse vision, and higher rates of severe PM.
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- 2024
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24. Anterior Scleral Thickness and Anterior Segment Biometrics Measured with Swept Source Ocular Coherence Tomography in High Myopic Eyes with and without Glaucoma: A Comparative Study.
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Kudsieh B, Vega-González R, Bryan S, Almazan-Alonso E, Puertas M, Gutiérrez-Martin L, Flores-Moreno I, Ruiz-Medrano J, Samaan M, and Ruiz-Moreno JM
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Background : To assess the anterior scleral thickness (AST), Schlemm's canal diameter (SCD), trabecular meshwork diameter (TMD) and conjunctiva tenon capsule thickness (CTT) in high myopic (HM) subjects and HM subjects with glaucoma (HMG) compared to control eyes. Methods: One hundred and twenty eyes were included, and AST at 0, 1, 2 and 3 mm from the scleral spur, SCD, TMD and CTT were measured. Results : Mean age was 64.2 ± 11.0 years, and the temporal SCD and temporal TMD were significantly longer in the HMG subjects compared to the controls (380.0 ± 62 μm vs. 316.7 ± 72 μm, p = 0.001) and (637.6 ± 113 μm vs. 512.1 ± 97 μm, p = 0.000), respectively. There were no significant differences between the HM and HMG subjects in SCD and TMD (all p > 0.025). Compared to the HM subjects, the temporal AST0 (432.5 ± 79 μm vs. 532.8 ± 99 μm, p = 0.000), temporal AST1 (383.9 ± 64 μm vs. 460.5 ± 80 μm, p = 0.000), temporal AST2 (404.0 ± 68 μm vs. 464.0 ± 88 μm, p = 0.006) and temporal AST3 (403.0 ± 80 μm vs. 458.1 ± 91 μm, p = 0.014) were significantly thinner in the HMG group. No differences were found between the CTT in the three groups (all p > 0.025). Conclusions : Our data indicate a thinner AST in HMG subjects and no differences in SCD and TMD between HM and HMG subjects., Competing Interests: The authors declare no conflicts of interest.
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- 2024
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25. Development of Acquired Peripapillary Optic Disk Pit in Pathologic Myopia.
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Puertas M, Flores-Moreno I, Ruiz-Medrano J, and Ruiz-Moreno JM
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- Humans, Vision Disorders pathology, Tomography, Optical Coherence, Optic Disk pathology, Eye Abnormalities complications, Eye Abnormalities diagnosis, Eye Abnormalities pathology, Myopia, Degenerative complications, Myopia, Degenerative diagnosis, Myopia, Degenerative pathology
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- 2024
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26. Influence of posterior staphyloma in myopic maculopathy and visual prognosis.
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Flores-Moreno I, Puertas M, Ruiz-Medrano J, Almazán-Alonso E, García-Zamora M, and Ruiz-Moreno JM
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- Humans, Female, Male, Cross-Sectional Studies, Visual Acuity, Tomography, Optical Coherence methods, Fundus Oculi, Prognosis, Vision Disorders, Retrospective Studies, Myopia, Degenerative complications, Myopia, Degenerative diagnosis, Retinal Diseases etiology, Scleral Diseases diagnosis, Macular Degeneration complications
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Background/objectives: Posterior staphyloma is a hallmark of high myopia and its presence associates to greater degrees of myopic maculopathy. Nonetheless, its development, repercussion on visual function and relationship with maculopathy components, is still unclear. The objective was to analyze the impact of posterior staphyloma on the incidence and severity of myopic maculopathy and its repercussion on visual prognosis., Subjects/methods: Cross-sectional study conducted on 473 consecutive eyes of 259 highly myopic patients examined at Puerta de Hierro-Majadahonda University Hospital (Madrid, Spain). All patients underwent complete ophthalmologic examination including best corrected visual acuity (BCVA), axial length (AL), myopic maculopathy classification according to ATN system (atrophic/traction/neovascularization), determined the presence of posterior staphyloma, pathologic myopia (PM) and severe PM. Multimodal imaging were performed including fundus photography, optical coherence tomography (OCT), OCT-angiography, fundus autofluorescence and/ or fluorescein angiography., Results: Out of the total, 70.65% were female patients (n = 173/259), mean BCVA was 0.41 ± 0.54 logMAR units and mean AL was 29.3 ± 2.6 mm (26-37.6). Posterior staphyloma was present in 69.4% of eyes. Eyes with posterior staphyloma compared to non-staphyloma were older (p < 0.05), had greater AL (p < 0.01), worse BCVA (p < 0.01) and higher stage in ATN components (p < 0.01). Moreover, compound subgroup showed worse BCVA (p < 0.01) and greater stage in each of the ATN components (p < 0.01). Staphylomas with macular involvement presented worse BCVA (p < 0.01), higher AL (p < 0.01), and greater ATN (p < 0.05). The risk of posterior staphyloma presence in eyes with PM and severe PM eyes was 89.8% and 96.7%, respectively. Posterior staphyloma was the best predictor for BCVA in myopic patients (p < 0.01)., Conclusions: Posterior staphyloma's presence determines high risk of myopic maculopathy and therefore worse visual prognosis, especially those with macular involvement. Posterior staphyloma represented the best predictor for BCVA in highly myopic patients., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)
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- 2024
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27. ASSESSMENT AND ROLE OF ARTERY-VEIN COMPLEX IN MYOPIC CHOROIDAL NEOVASCULARIZATION USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.
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Ruiz-Medrano J, Almazán-Alonso E, Puertas M, Flores-Moreno I, García-Zamora M, Kudsieh B, and Ruiz-Moreno JM
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- Humans, Middle Aged, Aged, Tomography, Optical Coherence methods, Retrospective Studies, Fluorescein Angiography methods, Chronic Disease, Fundus Oculi, Arteries, Choroidal Neovascularization diagnosis, Myopia, Myopia, Degenerative complications, Myopia, Degenerative diagnosis
- Abstract
Purpose: To analyze the presence of an artery-vein complex (AVC) underneath myopic choroidal neovascularization (mCNV) and to determine its relationship with neovascular activity., Methods: Retrospective analysis of 681 eyes from 362 patients with high myopia defined by an axial length of >26 mm using optical coherence tomography (OCT) and OCT angiography imaging. Patients with clinical diagnosis of mCNV and good quality OCT angiography images were then selected. An AVC was defined by the identification of both perforating scleral vessels and dilated choroidal veins under or in contact with the mCNV in the same case. Swept source OCT (SS-OCT) and SS-OCT angiography images (TRITON; Topcon Corporation, Tokyo, Japan) were reviewed to detect AVC in the mCNV area., Results: Fifty eyes of 49 highly myopic patients with mCNV were analyzed. Eyes with AVC were statistically older (69.95 ± 13.53 vs. 60.83 ± 10.47 years old; P < 0.01), needed less intravitreal injections/year along the follow-up period (0.80 ± 0.62 vs. 1.92 ± 0.17; P < 0.01), and showed less relapses/year (0.58 ± 0.75 vs. 0.46 ± 0.42; P < 0.05) when compared with eyes without AVC. Moreover, eyes with AVC were less likely to relapse during the first year from mCNV activation (n = 5/14 vs. n = 14/16; P < 0.01; P < 0.01). No significant differences were found regarding either axial length (30.55 ± 2.31 vs. 29.65 ± 2.24, P > 0.05) or best-corrected visual acuity (0.4 ± 0.5 vs. 0.4 ± 0.5 Logarithm of the Minimum Angle of Resolution (logMAR), P > 0.05) between groups., Conclusion: AVC complex has an influence over myopic choroidal neovascularization activity resulting in less aggressive neovascular lesions than those with perforating scleral vessels only., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)
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- 2023
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28. Analysis of Bilaterality and Symmetry of Posterior Staphyloma in High Myopia.
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Ruiz-Moreno JM, Puertas M, Flores-Moreno I, Almazán-Alonso E, García-Zamora M, and Ruiz-Medrano J
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The purpose of this study was to examine bilaterality and symmetry of posterior staphyloma (PS) in high myopic eyes. Methods: This cross-sectional and non-interventional study assessed 473 high myopic eyes [axial length (AL) ≥ 26 mm] of 259 patients. Patients underwent an ophthalmological examination including multimodal-imaging and myopic maculopathy grading according to Atrophic/Tractional/Neovascular (ATN) system, presence and subtype of PS, and severe pathologic myopia (PM). Bilaterality of PS and subtype's symmetry between eyes of the same patient was assessed. Four groups were analyzed: (1) bilateral vs. unilateral PS's eyes. Within bilateral group, symmetric vs. asymmetric subtypes according to (2) Curtin's classification, (3) Ohno-Matsui's classification, and (4) primary/compound subtypes. Results: Out of the total, 334 myopic eyes of 167 patients were included. The 92.8% ( n = 310/334) of the eyes presented PS and was bilateral in 85.6% ( n = 143/167) of the patients. Bilateral eyes showed significantly ( p < 0.01) greater AL, severe PM, A and N components vs. unilateral PS. AL-difference between both eyes was greater in unilateral PS ( p < 0.01). Among bilateral PS, the subtype was symmetric in 79 (55.2%), 84 (58.7%), and 115 (80.4%) patients according to Curtin's classification, Ohno-Matsui's classification, and primary/compound; respectively. The asymmetric group presented worse best-corrected visual acuity ( p < 0.01), higher AL ( p < 0.01), incidence of PM, and severe PM ( p < 0.05). Conclusions: PS was bilateral in most of the patients without clinical differences between both eyes, being symmetrical in more than half of bilateral cases. Patients with bilateral PS showed higher myopic maculopathy, AL, and incidence of severe PM than unilateral PS.
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- 2023
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29. Posterior Staphyloma as Determining Factor for Myopic Maculopathy.
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Ruiz-Moreno JM, Puertas M, Flores-Moreno I, Almazán-Alonso E, García-Zamora M, and Ruiz-Medrano J
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- Humans, Cross-Sectional Studies, Eye, Vision Disorders complications, Retrospective Studies, Tomography, Optical Coherence, Myopia, Degenerative complications, Myopia, Degenerative diagnosis, Myopia, Degenerative pathology, Retinal Diseases etiology, Retinal Diseases complications, Scleral Diseases diagnosis, Macular Degeneration complications
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Purpose: The aim of this study was to determine the influence of posterior staphyloma (PS) on the development of myopic maculopathy., Design: Cross-sectional study., Methods: A total of 467 highly myopic eyes (axial length [AL] ≥26 mm) of 246 patients were included. Patients underwent a complete ophthalmological examination, including multimodal imaging. Presence of PS was defined as the main variable analyzed between groups (PS vs non-PS): age, AL, best-corrected visual acuity (BCVA), atrophy/traction/neovascularization (ATN) components, and presence of severe pathologic myopia (PM). Two different cohorts were studied (age-matched and AL-matched) comparing PS vs non-PS eyes., Results: In all, 325 eyes (69.59%) presented with PS. Eyes without PS were younger and had lower AL, ATN components, and prevalence of severe PM than those with PS (P < .001). Moreover, non-PS eyes had better BCVA (P < .001). Analyzing the age-matched cohort (P = .96); mean AL, A, and T components, and severe PM were significantly higher in the PS group (P < .001), as well as the N component (P < .005), showing worse BCVA (P < .001). Regarding the AL-matched cohort (P = .93), the PS group showed worse BCVA (P < .01), older age (P < .001), A (P < .001), and T components (P < .01), and severe PM (P < .01). The risk of PS increased by 10% per year of age (odds ratio = 1.109, P < .001) and by 132% per each millimeter of growth of AL (odds ratio = 2.318, P < .001)., Conclusions: Posterior staphyloma is associated with myopic maculopathy, worse visual acuity, and higher prevalence of severe PM. AL and age, in this order, constitute the main factors associated with the onset of PS., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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30. Retinal phototoxicity after macular hole surgery in a patient under paclitaxel.
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Ruiz-Moreno JM, García-Zamora M, and Ruiz-Medrano J
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- Humans, Female, Middle Aged, Paclitaxel adverse effects, Retina, Vitrectomy adverse effects, Retrospective Studies, Tomography, Optical Coherence, Retinal Perforations diagnosis, Retinal Perforations surgery, Retinal Diseases surgery
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Background: The purpose is to report the second case, to our knowledge, of suspected paclitaxel-induced phototoxic maculopathy following pars plana vitrectomy surgery., Case Presentation: 63-year-old phakic female who underwent an uneventful phaco-vitrectomy to treat a complete macular hole, developing macular phototoxicity in the post-operatively period that could not be explained by the surgery itself and could only be attributed to a possible photosensitization induced by the previous use of paclitaxel., Conclusions: The use of paclitaxel has been widely extended as a chemotherapy drug to treat breast cancer. It works by altering the intracellular microtubular reorganization and, based on this mechanism of action, photosensitivity has been previously described. We report a case of suspected paclitaxel-induced macular phototoxicity following ocular endoillumination during vitrectomy surgery., (© 2023. The Author(s).)
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- 2023
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31. Early-switch versus late-switch in patients with diabetic macular edema: a cost-effectiveness study.
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Ruiz-Moreno JM and Ruiz-Medrano J
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- Humans, Glucocorticoids, Dexamethasone, Cost-Benefit Analysis, Vascular Endothelial Growth Factor A, Retrospective Studies, Drug Implants therapeutic use, Intravitreal Injections, Retina, Macular Edema diagnosis, Macular Edema drug therapy, Macular Edema etiology, Diabetic Retinopathy complications, Diabetic Retinopathy diagnosis, Diabetic Retinopathy drug therapy, Diabetes Mellitus drug therapy
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Background: To evaluate the cost-effectiveness of early- versus late-switch to the intravitreal-dexamethasone implant (DEX-i) in patients with diabetic macular edema (DME) who did not adequately respond to vascular endothelial growth factor inhibitors (anti-VEGF)., Methods: Retrospective analysis of a multicenter Clinical Data Registry. The registry included DME eyes who received 3 intravitreal anti-VEGF injections (early-switch) or > 3 intravitreal anti-VEGF injections (late-switch) before switching to DEX-i injections. The primary outcome was to estimate the incremental cost needed to obtain a best-corrected visual acuity (BCVA) improvement ≥ 0.1 or a central-retinal thickness CRT ≤ 250 μm., Results: The analysis included 108 eyes, 32 (29.6%) and 76 (70.4%) in the early- and late-switch groups, respectively. Early-switch strategy was associated with a cost saving of €3,057.8; 95% CI: €2,406.4-3,928.4, p < 0.0001). Regarding incremental-cost-effectiveness ratio, late-switch group was associated with an incremental cost of €25,735.2 and €13,533.2 for achieving a BCVA improvement ≥ 0.1 at month 12 and at any of the time-point measured, respectively. At month 12, 38 (35.2%) eyes achieved a BCVA improvement ≥ 0.1. At month 12, 52 (48.1) eyes had achieved a CRT ≤ 250 micron. As compared to baseline, the mean (95% CI) CRT reduction was - 163.1 (- 212.5 to - 113.7) µm and - 161.6 (- 183.8 to - 139.3) µm in the early-switch and late-switch groups, respectively, p = 0.9463., Conclusions: In DME eyes, who did not adequately respond to anti-VEGF, switching to DEX-i at early stages (after the first 3-monthly injections) was found to be more cost-effective than extending the treatment to 6-monthly injections of anti-VEGF., (© 2022. The Author(s).)
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- 2023
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32. Update on the Utility of Optical Coherence Tomography in the Analysis of the Optic Nerve Head in Highly Myopic Eyes with and without Glaucoma.
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Kudsieh B, Fernández-Vigo JI, Flores-Moreno I, Ruiz-Medrano J, Garcia-Zamora M, Samaan M, and Ruiz-Moreno JM
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Glaucoma diagnosis in highly myopic subjects by optic nerve head (ONH) imaging is challenging as it is difficult to distinguish structural defects related to glaucoma from myopia-related defects in these subjects. Optical coherence tomography (OCT) has evolved to become a routine examination at present, providing key information in the assessment of glaucoma based on the study of the ONH. However, the correct segmentation and interpretation of the ONH data employing OCT is still a challenge in highly myopic patients. High-resolution OCT images can help qualitatively and quantitatively describe the structural characteristics and anatomical changes in highly myopic subjects with and without glaucoma. The ONH and peripapillary area can be analyzed to measure the myopic atrophic-related zone, the existence of intrachoroidal cavitation, staphyloma, and ONH pits by OCT. Similarly, the lamina cribosa observed in the OCT images may reveal anatomical changes that justify visual defects. Several quantitative parameters of the ONH obtained from OCT images were proposed to predict the progression of visual defects in glaucoma subjects. Additionally, OCT images help identify factors that may negatively influence the measurement of the retinal nerve fiber layer (RNFL) and provide better analysis using new parameters, such as Bruch's Membrane Opening-Minimum Rim Width, which serves as an alternative to RNFL measurements in highly myopic subjects due to its superior diagnostic ability.
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- 2023
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33. Atrophic, Tractional, and Neovascular Grading System in a Dome-Shaped Macula and Ridge-Shaped Macula Highly Myopic Cohort.
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García-Zamora M, Flores-Moreno I, Ruiz-Medrano J, Puertas M, Almazán-Alonso E, Vega-González R, González-Buendía L, and Ruiz-Moreno JM
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- Humans, Cross-Sectional Studies, Retrospective Studies, Tomography, Optical Coherence methods, Atrophy, Myopia diagnosis, Myopia pathology, Retinal Diseases diagnosis, Macula Lutea pathology, Myopia, Degenerative complications, Myopia, Degenerative diagnosis
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Introduction: The aim of this study was to analyze the atrophic, tractional, and neovascular (ATN) components grading in highly myopic patients with dome-shaped macula (DSM) and ridge-shaped macula (RSM)., Methods: This was a cross-sectional, noninterventional study. 57 eyes of 38 different patients were included. They were classified as DSM or RSM based on the number of radial scans that showed an inward protrusion ≥50 µm in the swept-source optical coherence tomography (SS-OCT) (12 = DSM; <12 = RSM). All patients underwent a complete ophthalmological examination in addition to SS-OCT. They were graded using the ATN system for myopic maculopathy by 2 masked retina specialists that assessed the atrophic (A), tractional (T), and neovascular (N) components in order to analyze the differences between the groups. As complementary measurements, age, axial length, and best-corrected visual acuity were collected. Height and orientation of the macular bulge and the presence of Bruch's membrane defects, scleral perforating vessels, and staphyloma were recorded., Results: Out of total 57 eyes, 13 eyes (22.8%) were classified as DSM. Regarding the atrophic component (A), there were statistically significant differences between groups, with DSM group showing a greater stage of atrophy (predominantly stage A3 in 69.2% of the sample) compared to the RSM group (predominantly stage A2 in 61.3% of the sample) (p < 0.05). For the T and N components, there were no significant differences between groups. The presence of Bruch's membrane defects was more frequently seen in DSM (p < 0.05)., Conclusions: DSM group showed more Bruch's membrane defects and a greater stage of the atrophy component, based on the ATN grading system, compared with RSM group. As Bruch's membrane may have biomechanical properties in terms of strength, the defects found around the macula, added to the major atrophic component, may be a cause of a local relaxation that induce a central bulge forming the dome., (© 2023 S. Karger AG, Basel.)
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- 2023
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34. OPHTHALMOLOGIC INVOLVEMENT IN PATIENTS WITH HEREDITARY TRANSTHYRETIN AMYLOIDOSIS.
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Ruiz-Medrano J, Puertas M, Almazán-Alonso E, Fernández-Jiménez M, Flores-Moreno I, Antón CS, García-Pavía P, and Ruiz-Moreno JM
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- Humans, Plaque, Amyloid, Cross-Sectional Studies, Quality of Life, Vitreous Body, Amyloid Neuropathies, Familial complications, Amyloid Neuropathies, Familial diagnosis, Amyloid Neuropathies, Familial genetics, Orbital Diseases
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Purpose: The aim of this study was to determine the ophthalmologic involvement in patients with hereditary transthyretin amyloidosis and its correlation with the mutations described in the literature., Methods: Cross-sectional, noninterventional study. Fifty-two eyes of 26 consecutive patients diagnosed with hereditary transthyretin amyloidosis who visited the Puerta de Hierro-Majadahonda University Hospital from September 2019 to March 2022. All patients underwent complete ophthalmologic examination and multimodal imaging. Cardiologic, neurologic, digestive, and renal examinations were also recorded., Results: Eighteen eyes of the total (34.61%) showed amyloid-related ocular involvement, vitreous amyloid deposits being the most common ocular manifestation (18/52). Statistically significant differences were found for the presence of vitreous amyloid deposits ( P < 0.01), crystalline amyloid deposits ( P < 0.05), parenchymal amyloid deposits ( P < 0.01), and vascular alterations ( P < 0.01) when comparing affected and unaffected eyes. Moreover, affected eyes showed worse best-corrected visual acuity ( P < 0.01)., Conclusion: Ocular manifestations are present in a substantial number of patients with ATTR that could potentially lead to devastating consequences to patients' best-corrected visual acuity and quality of life. Therefore, it is important to emphasize the importance of multidisciplinary management and ophthalmologic assessment, follow-up and surgical treatment when necessary. To the best of our knowledge, this represents the largest series in Spain of amyloidosis' ophthalmologic involvement., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)
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- 2023
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35. Choroidal Vascularity Index versus Choroidal Thickness as Biomarkers of Acute Central Serous Chorioretinopathy.
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Ruiz-Moreno JM, Gutiérrez-Bonet R, Chandra A, Vupparaboina KK, Chhablani J, and Ruiz-Medrano J
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- Humans, Retrospective Studies, Cross-Sectional Studies, Tomography, Optical Coherence methods, Visual Acuity, Choroid, Acute Disease, Biomarkers, Central Serous Chorioretinopathy diagnosis
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Introduction: The aim of this study was to analyze the choroidal vascularity index (CVI) versus choroidal thickness (CT) as biomarkers in acute central serous chorioretinopathy (CSCR)., Methods: In this multicenter retrospective, cross-sectional, noninterventional study carried out at Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Jules-Gonin, Lausanne, Switzerland; and Pittsburg University, USA. 40 eyes from 40 patients with acute CSCR, 40 eyes from 40 patients with keratoconus (KC), and 40 eyes from 40 healthy patients were included. The variables analyzed were age, CT, CVI, and the presence of neurosensory retinal detachment. CT and the CVI were obtained from a 12-mm horizontal single-line B-scan (Triton SS-OCT, Topcon Co., Japan). Blinded measurements of the subfoveal CT were performed manually by two independent investigators. The images of the choroid were automatically binarized using a validated algorithm, and a percentage of vascularity was calculated., Results: There were no significant differences in age between the three groups (ANOVA, p = 0.092). There were statistically significant differences in CT and the CVI (ANOVA, p < 0.001). After Bonferroni correction, pairwise analysis between CSCR group against the KC group showed no significant differences in age and CT (p = 0.10 and p = 0.27, respectively). CVI was statistically greater among CSCR patients (p = 0.03)., Conclusion: CT does not meet the criteria to be considered a biomarker of acute CSCR, while CVI may prove to be a more specific and reliable biomarker. Further studies with larger sample sizes, standardized procedures, and a wider representation of all CSCR stages are necessary to confirm the validity of CVI as biomarker in this disease. Further studies with larger samples are required in order to validate the use of CVI/CT correlation as a new biomarker., (© 2023 The Author(s). Published by S. Karger AG, Basel.)
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- 2023
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36. Type one macular neovascularization in central serous chorioretinopathy: Short-term response to anti-vascular endothelial growth factor therapy.
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Lejoyeux R, Behar-Cohen F, Mantel I, Ruiz-Medrano J, Mrejen S, Tadayoni R, Gaudric A, and Bousquet E
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- Angiogenesis Inhibitors therapeutic use, Endothelial Growth Factors therapeutic use, Fluorescein Angiography, Humans, Intravitreal Injections, Neovascularization, Pathologic drug therapy, Retrospective Studies, Tomography, Optical Coherence, Central Serous Chorioretinopathy complications, Central Serous Chorioretinopathy drug therapy, Retinal Detachment drug therapy
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Purpose: The aim of this study was to assess the short-term effect of anti-vascular endothelial growth factor (VEGF) treatment on type 1 macular neovascularization (MNV) secondary to central serous chorioretinopathy (CSCR) and to identify potential predictive factors for treatment response using multimodal imaging., Methods: Retrospective, multicentre study in CSCR patients with MNV detected by OCT-angiography and treated with anti-VEGF injections. Clinical and multimodal imaging data before and after anti-VEGF injections was reviewed. Univariate and multivariate linear regression analyses were performed to evaluate associations between the change in central macular thickness (CMT) after anti-VEGF therapy and other factors., Results: Forty patients were included. One month after receiving a mean number of 2.7 anti-VEGF intravitreal injections, visual acuity increased significantly from 0.46 ± 0.3 logMAR at baseline to 0.38 ± 0.4 logMAR (p = 0.04). The CMT and foveal serous retinal detachment (SRD) decreased significantly from 330 ± 81.9 µm at baseline to 261.7 ± 63.1 µm after treatment (p < 0.001) and from 145.1 ± 98.8 µm at baseline to 52.6 ± 71.3 µm (p < 0.001), respectively. Subretinal fluid and/or intraretinal fluid were still present in 18 eyes (45%) one month after treatment. In the multivariate analysis, a higher SRD height was associated with a greater CMT change (p = 0.002) and a lower CMT change with the presence of subretinal hyperreflective material (SHRM) (p = 0.04)., Conclusion: Fluid resorption was incomplete in about half of the patients with MNV secondary to CSCR after anti-VEGF injections. Shallower SRD or the presence of SHRM were predictors of poor response to anti-VEGF., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)
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- 2022
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37. Impact of ocular dominance on circumpapillary and macular retinal nerve fibre layer thickness and ganglion cell layer thickness in a healthy pediatric population.
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Jiménez-Santos M, Cifuentes-Canorea P, Ruiz-Medrano J, Felipe-Márquez G, Valverde-Megias A, and Gomez de Liaño R
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- Child, Cross-Sectional Studies, Dominance, Ocular, Humans, Retina, Tomography, Optical Coherence methods, Nerve Fibers, Retinal Ganglion Cells
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Objective: This study was designed to evaluate potential differences in circumpapillary retinal nerve fibre layer (cpRNFL) thickness and segmented macular retinal layers between dominant and nondominant eyes on spectral-domain optical coherence tomography in a pediatric population., Design: Cross-sectional study., Participants: 89 healthy children attending a general pediatric clinic., Methods: Participants underwent sighting dominant testing and macular and cpRNFL spectral-domain optical coherence tomography. Segmented macular layer thicknesses and cpRNFL thickness were compared for individual patients based on their ocular dominance., Results: Ocular dominance occurred particularly in the right eye (64.7%). Dominant and nondominant eyes did not differ significantly in axial length or spherical equivalent refraction; axial length: 22.99 ± 1.17 mm versus 22.98 ± 1.19 mm; p = 0.51 and spherical equivalent refraction: -0.09 ± 2.68 D versus 0.32 ± 2.93 D; p = 0.41. In the comparison of the macular ganglion layer the average thickness in the 1 mm central Early Treatment Diabetic Retinopathy Study area was significantly different between the dominant and nondominant eye (16.56 ± 6.02 μm vs 17.58 ± 8.32 μm; p = 0.02). However, when compensating with Bonferroni, this difference was no longer statistically significant. There were no differences in the analyses of average global and sectorial cpRNFL thickness in dominant and nondominant eyes., Conclusion: Dominant eyes demonstrated no significantly thicker average macular retinal nerve fiber layer (mRNFL), Ganglion cell layer (GCL) thickness or cpRNFL thickness. No ocular characteristic was found to be associated with the relative dominance of an eye in eyes with low anisometropia., (Copyright © 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)
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- 2022
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38. Pathologic myopia and severe pathologic myopia: correlation with axial length.
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Flores-Moreno I, Puertas M, Almazán-Alonso E, Ruiz-Medrano J, García-Zamora M, Vega-González R, and Ruiz-Moreno JM
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- Cross-Sectional Studies, Humans, Retrospective Studies, Tomography, Optical Coherence, Visual Acuity, Myopia, Degenerative diagnosis, Retinal Diseases
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Purpose: This study had three aims: (1) correlate axial length (AL), age and best-corrected visual acuity in high myopic patients scored on the ATN grading system; (2) determine AL cut-off values to distinguish between pathologic myopia (PM) and severe PM; and (3) identify clinical differences between PM and severe PM., Methods: This is a cross-sectional, non-interventional study. All patients underwent complete ophthalmologic examination, ATN grading and multimodal imaging (colour fundus photography, swept-source OCT, fundus autofluorescence, OCT angiography and fluorescein angiography)., Results: Six hundred forty-four eyes from 345 high myopic patients were included. The eyes were graded on the ATN system and classified as PM (≥ A2) or severe PM (≥ A3, ≥ T3 and/or N2). Significant between-group (PM vs. severe PM) differences (p < 0.05) were observed on the individual ATN components (atrophic [A], tractional [T] and neovascular [N]), age, BCVA and AL. AL was also linearly correlated with the A, T and N components (r = 0.53, p < 0.01; r = 0.24, p < 0.01; r = 0.20, p < 0.01; respectively). ROC curve analysis showed the optimal AL cut-off value to distinguish between PM at 28 mm (AUC ROC curve: 0.813, specificity: 75%, sensitivity: 75%) and severe PM at 29.50 mm (AUC ROC curve: 0.760, specificity: 75%, sensitivity: 70%)., Conclusion: AL is the main variable associated with myopic maculopathy. Due to the clinical differences found between PM and severe PM, there is need to create an objective cut-off point to distinguish these two different entities being the optimal cut-off points for AL 28 mm and 29.5 mm, respectively. These objective AL cut-off values should be taken into account for determining a correct follow-up, ophthalmic management and treatment., (© 2021. The Author(s).)
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- 2022
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39. RELATIONSHIP BETWEEN MYOPIC CHOROIDAL NEOVASCULARIZATION ACTIVITY AND PERFORATING SCLERAL VESSELS IN HIGH MYOPIA.
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Ruiz-Medrano J, Almazan-Alonso E, Flores-Moreno I, Puertas M, García-Zamora M, and Ruiz-Moreno JM
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- Adolescent, Adult, Aged, Aged, 80 and over, Choroid blood supply, Choroid diagnostic imaging, Choroidal Neovascularization etiology, Cross-Sectional Studies, Female, Fundus Oculi, Humans, Male, Middle Aged, Myopia, Degenerative diagnosis, Retrospective Studies, Rupture, Spontaneous, Visual Acuity, Young Adult, Blood Vessels diagnostic imaging, Choroidal Neovascularization diagnosis, Fluorescein Angiography methods, Multimodal Imaging, Myopia, Degenerative complications, Sclera blood supply, Tomography, Optical Coherence methods
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Purpose: To study perforating scleral vessels (PSVs) in patients with high myopia using swept-source optical coherence tomography and to determine their relationship with myopic choroidal neovascularization (mCNV) and its activity., Methods: Retrospective analysis of patients with high myopia (≥-6 D or ≥26 mm of axial length) using multimodal imaging. The presence of PSVs and mCNV was assessed using swept-source optical coherence tomography images (TRITON; Topcon Corporation, Japan)., Results: Five hundred sixty-four eyes from 297 highly myopic patients were studied. One hundred fifty-five eyes (27.5%) showed signs of mCNV while PSVs were found in 500 eyes (88.6%). Perforating scleral vessels were found in 93.5% (145/155) of eyes with mCNV, and they were under or in contact with the mCNV in 80.6% (117/145). The mean number of intravitreal injections received by patients with mCNV was 4.06 ± 4.17 along 66.9 ± 4.1 months of follow-up. The number of injections per year was 1.32 ± 1.56, the mean number of relapses was 1.11 ± 1.83, and the mean number of relapses per year was 0.25 ± 0.41., Conclusion: Perforating scleral vessels are more common among highly myopic patients suffering from neovascular complications. Myopic CNV complexes that are coincident with PSVs on optical coherence tomography show higher rates of activity, needing more injections to control them and being more prone to relapses., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)
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- 2022
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40. Macular Hemorrhage Due to Age-Related Macular Degeneration or Retinal Arterial Macroaneurysm: Predictive Factors of Surgical Outcome.
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Pierre M, Mainguy A, Chatziralli I, Pakzad-Vaezi K, Ruiz-Medrano J, Bodaghi B, Loewenstein A, Ambati J, de Smet MD, Tadayoni R, and Touhami S
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Objective: The study aimed to determine the outcomes and prognostic factors of vitrectomy, subretinal injection of tissue-plasminogen activator and gas tamponade in macular hemorrhage (MaH) due to age-related macular degeneration (AMD) or retinal arterial macroaneurysm (RAM)., Methods: The study design utilized a multicentric retrospective case series design of consecutive patients undergoing surgery between 2014 and 2019., Results: A total of 65 eyes from 65 patients were included in the study. Surgery was performed after a mean period of 7.1 days. Displacement of MaH was achieved in 82% of the eyes. Mean best-corrected visual acuity (BCVA) improved from 20/500 to 20/125 at month(M)1 and M6 ( p < 0.05). At M6, BCVA worsening was associated with an older age at diagnosis ( p = 0.0002) and higher subretinal OCT elevation of MaH ( p = 0.03). The use of treat and extend (TE) (OR = 16.7, p = 0.001) and small MaH fundus size (OR = 0.64 and 0.74 for horizontal and vertical fundus size, p < 0.05) were predictive of a higher likelihood of obtaining a countable BCVA at M1. Baseline BCVA was predictive of postoperative BCVA ( p < 0.05). Retinal detachment and MaH recurrence occurred in 3% and 9.3% of cases at M6., Conclusion: MaH surgery stabilizes or improves BCVA in 85% of cases. Younger age at diagnosis, better baseline BCVA figures, smaller subretinal MaH height and use of TE regime were predictive of the best postoperative outcomes.
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- 2021
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41. Overcoming barriers of retinal care delivery during a pandemic-attitudes and drivers for the implementation of digital health: a global expert survey.
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Faes L, Rosenblatt A, Schwartz R, Touhami S, Ventura CV, Chatziralli IP, Ruiz-Medrano J, Vogt D, Savastano A, Ruiz-Garcia H, Pohlmann D, and Loewenstein A
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- Attitude, Humans, Pandemics, SARS-CoV-2, COVID-19, Delivery of Health Care methods, Ophthalmology, Telemedicine
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Background/aims: The SARS-CoV-2 pandemic has imposed barriers to retinal care delivery worldwide. In this context, retinal services are exploring novel ways to ensure access to healthcare., Methods: We conducted a worldwide survey among retinal specialists between March 31, 2020 and April 12, 2020. The expert survey was developed on the basis of focus group discussions involving retinal specialists and literature searches. It included 44 questions on alternative ways of care provision including digital health domains such as teleophthalmology, home monitoring or decentralised patient care., Results: 214 retinal experts participated in the survey, of which 120 (56.1%) had more than 15 years of experience in ophthalmology. Most participants were clinicians (n=158, 73.9%) practising in Western Europe (n=159, 74%). In the majority of institutions, teleophthalmology, home monitoring and decentralised patient care have not been implemented before the pandemic (n=46, 21.8.1%; n=64, 29.9%; n=38, 19.1%). During the pandemic, the use of teleophthalmology and home monitoring increased significantly (n=105, p<0.001; n=90, p<0.001). In the subgroup of institutions reporting no teleophthalmology service before and implementing a service during the pandemic (34/70, 48.6%), reimbursement was the sole significant parameter (OR 9.62 (95% CI 2.42 to 38.16); p<0.001)., Conclusion: Digital health is taking the centre stage tackling unpreceded challenges of retinal care delivery during the SARS-CoV-2 pandemic and may sustainably change the way we practice ophthalmology., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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42. Dome-Shaped Macula versus Ridge-Shaped Macula Eyes in High Myopia Based on the 12-line Radial Optical Coherence Tomography Scan Pattern. Differences in Clinical Features.
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García-Zamora M, Flores-Moreno I, Ruiz-Medrano J, Vega-González R, Puertas M, Almazán-Alonso E, González-Buendía L, and Ruiz-Moreno JM
- Abstract
Purpose: To study clinical features in patients with ridge-shaped macula (RSM) compared with those with dome-shaped macula (DSM) having been previously classified by the number of swept-source optical coherence tomography (SS-OCT) radial scans affected., Methods: Retrospective observational study including 49 highly myopic eyes from 31 patients who underwent SS-OCT. DSM eyes were defined as those that showed a complete round inward convexity in all their axes, presenting an inward convexity ≥50 µm in the 12-line radial OCT scans. Eyes that did not meet this criterion and had at least one flat radial scan were grouped into the RSM group, defined as a macular inward convexity in some meridians across the fovea, whereas the opposite perpendicularly oriented meridians were flat. Age, spherical equivalent, axial length (AL), and best-corrected visual acuity (BCVA) were collected. Height of the bulge, scleral and choroidal thicknesses, Bruch´s membrane defects, and presence of perforating scleral vessels were recorded., Results: Thirty-seven (75.5%) eyes were classified into the RSM group and 12 (24.5%) into the DSM group. Twenty-six (53.0%) eyes showed macular elevation only in the horizontal direction. Mean AL showed statistically significant differences (28.8 ± 2.7 vs. 30.5 ± 1.5 mm in the RMS vs. DSM group, respectively) and the presence of Bruch´s membrane defects was more frequently seen in DSM ( p < 0.001). Mean age, spherical equivalent, BCVA, height of the inward convexity, retinal foveal thickness, foveal scleral thickness, subfoveal choroidal thickness, and the presence of perforating scleral vessels did not show significant differences between groups., Conclusion: This study shows the reliability of using the 12 equal radial OCT scans as an objective method to define and differentiate DSM versus RSM. Patients with RSM showed differences in AL compared with those with DSM, being longer in DSM, and regarding the presence of Bruch´s membrane defects, being more common in DSM. This may contribute to identifying those patients that, in daily clinical practice, have a higher risk of developing complications due to their myopia.
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- 2021
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43. CORRELATION BETWEEN ATROPHY-TRACTION-NEOVASCULARIZATION GRADE FOR MYOPIC MACULOPATHY AND CLINICAL SEVERITY.
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Ruiz-Medrano J, Flores-Moreno I, Ohno-Matsui K, Cheung CMG, Silva R, and Ruiz-Moreno JM
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- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Macular Degeneration etiology, Male, Middle Aged, Myopia, Degenerative physiopathology, Reproducibility of Results, Retrospective Studies, Macular Degeneration diagnosis, Myopia, Degenerative complications, Refraction, Ocular physiology, Tomography, Optical Coherence methods, Visual Acuity
- Abstract
Purpose: To assess the reliability of the atrophy-traction-neovascularization (ATN) classification in patients with pathologic myopia (PM) and its correlation with best-corrected visual acuity (BCVA)., Methods: Cross-sectional study. Hundred highly myopic eyes with a spherical equivalent of >-6.0 diopters or axial length of >26 mm and a total ATN score of ≥3 underwent a complete ophthalmological examination, including fundus photography and swept-source optical coherence tomography. Five observers graded each eye using the ATN system. Mean A, T, and N scores were calculated and correlated with age, BCVA (in logarithm of the minimum angle of resolution), and axial length. Patients were considered to present severe PM if either A or T components were ≥3 and/or N was ≥2., Results: Hundred eyes (53 left) from 91 patients (78 women) were classified. Mean age, BCVA, and axial length values were, respectively, 65.1 ± 11.7 years (range, 36-97 years), -0.63 ± 0.62 (-3.00 to 0.00), and 29.26 ± 2.7 mm (26.01-37.66 mm). Mean ATN grades for each component were as follows: A = 2.51 ± 0.78 (0.6-4.0), T = 0.88 ± 1.14 (0.0-5.0), and N = 1.31 ± 1.40 (0.0-3.0). Weighted interobserver agreement was 98.1%, 98.7%, and 94.6%, for A, T and N, respectively. In eyes with severe PM, BCVA was significantly lower and axial length was significantly longer., Conclusion: The excellent interobserver rate in this study demonstrates that the updated ATN grading system is an accurate and reliable tool to classify patients with PM. These findings show that BCVA is more compromised in eyes with severe PM, particularly those graded ≥A3 and/or T3., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)
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- 2021
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44. Prevalence of age-related macular degeneration among optometric telemedicine users in Spain: a retrospective nationwide population-based study.
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Zapata MA, Burés A, Gallego-Pinazo R, Gutiérrez-Sánchez E, Oléñik A, Pastor S, Ruiz-Medrano J, Salinas C, Otero-Romero S, and Abraldes M
- Subjects
- Aged, Angiogenesis Inhibitors, Cross-Sectional Studies, Female, Humans, Male, Prevalence, Retrospective Studies, Risk Factors, Spain epidemiology, Vascular Endothelial Growth Factor A, Visual Acuity, Optometry, Telemedicine, Wet Macular Degeneration
- Abstract
Purpose: To evaluate the prevalence of AMD among optometric telemedicine users in Spain and to identify risk factors., Methods: Retrospective analysis of a nationwide database conducted on subjects attending to optometry centers, between January 2013 and December 2019. Fundus photographs were performed by optometrists, using non-mydriatic cameras, and evaluated by a group of 12 retina specialists., Results: Among the 119,877 subjects included, the overall prevalence of AMD was 7.6%. The prevalence of early, intermediate, and advanced AMD was 2.9%, 2.7%, and 2.0%, respectively. Of the 9129 AMD subjects, 1161 (12.7%) had geographic atrophy, and 1089 (11.9%) had neovascular AMD, either scar (4.5%) or exudative (7.4%). There was a significant association between AMD and age (per year older, adjusted odds ratio, OR 1.116; 95% CI 1.114 to 1.119, p<0.0001). Women had higher prevalence (adjusted OR 1.17; 95% CI 1.12 to 1.23, p<0.0001). Every diopter (spherical equivalent) of progress toward hyperopia was associated with a significant increase in early AMD prevalence (adjusted OR 1.02, 95 CI 1.01 to 1.04, p=0.0074). Presence of diabetes was associated with a lower AMD prevalence (p<0.0001)., Conclusions: The prevalence of AMD (any eye and any severity) was 7.6%, with a prevalence of advanced AMD of 2.0%. Older age and women were significantly associated with a higher prevalence of AMD, whereas myopia and presence of diabetes were associated with significantly lower odds of any AMD., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)
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- 2021
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45. Results of dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema patients: Early versus late switch.
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Ruiz-Medrano J, Rodríguez-Leor R, Almazán E, Lugo F, Casado-Lopez E, Arias L, and Ruiz-Moreno JM
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- Angiogenesis Inhibitors therapeutic use, Dexamethasone therapeutic use, Drug Implants therapeutic use, Glucocorticoids therapeutic use, Humans, Intravitreal Injections, Retina, Retrospective Studies, Vascular Endothelial Growth Factor A, Visual Acuity, Diabetes Mellitus drug therapy, Diabetic Retinopathy drug therapy, Macular Edema drug therapy
- Abstract
Purpose: To assess the functional and anatomical outcomes of intravitreal dexamethasone implant Ozurdex® in eyes with diabetic macular edema that did not adequately respond to vascular endothelial growth factor inhibitors., Methods: Multicenter, retrospective, and real-life case series study conducted on consecutive diabetic macular edema patients who underwent treatment with one or more dexamethasone implant injections and were followed up for a minimum of 12 months. Subjects were divided into three groups: I-naïve patients, II-previously treated eyes that received three intravitreal antivascular endothelial growth factor inhibitors injections before the study (early switch), and III-previously treated eyes that received >3 intravitreal antivascular endothelial growth factor inhibitors injections before the study (late switch). Primary endpoints were best-corrected visual acuity and central retinal thickness at month 12., Results: A total of 129 eyes (21 naïve and 108 previously treated, Group II: 32 and Group III: 76) were included. At month 12, best-corrected visual acuity significantly improved from 0.27 ± 0.23 and 0.31 ± 0.22 at baseline to 0.36 ± 0.25 and 0.37 ± 0.23 at month 12 in naïve and previously treated eyes, respectively, and p = 0.0063 and 0.0060, respectively. Central retinal thickness, in naïve and previously treated eyes, was significantly reduced from 483.0 ± 143.4 and 431.3 ± 115.5 µm, at baseline, to 278.8 ± 72.1 and 269.3 ± 66.2 µm, at month 12, respectively, and p < 0.0001 each, respectively. Best-corrected visual acuity improvement was significantly greater in both absolute and percentage values, p = 0.0393 and 0.0118, respectively, in Group II than in Group III., Conclusion: In eyes with insufficient response to antivascular endothelial growth factor inhibitors, switching to dexamethasone at the time to 3-monthly antivascular endothelial growth factor inhibitors injections provided better functional outcomes than those that received >3 antivascular endothelial growth factor inhibitors injections.
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- 2021
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46. Retinal imaging study diagnoses in COVID-19: a case report.
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Ortiz-Egea JM, Ruiz-Medrano J, and Ruiz-Moreno JM
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- Adult, Asymptomatic Infections, COVID-19 Testing methods, Diagnostic Errors prevention & control, Diagnostic Techniques, Ophthalmological, Humans, Male, Visual Acuity, COVID-19 complications, COVID-19 diagnosis, COVID-19 physiopathology, Fundus Oculi, Retina diagnostic imaging, SARS-CoV-2 isolation & purification, Scotoma diagnosis, Scotoma etiology, Tomography, Optical Coherence methods
- Abstract
Background: Hyperreflective lesions at the level of ganglion cell (GCL) and inner plexiform retinal layers (IPL) by optical coherence tomography (OCT) and cotton wool spots in the examination of the eye fundus have recently been described as findings in patients with COVID-19 infection., Case Report: We report the case of a 42-year-old healthy Caucasian male anesthetist who had treated COVID-19 patients during the previous 5 weeks and suddenly presented with a temporal relative scotoma in his left eye. Best-corrected visual acuity was 20/20 for the left eye, and no discromatopsy or afferent pupillary defect was present. Visual field test was performed, with no significant findings associated with the focal loss of sensitivity described by the patient. The anterior segment was unremarkable on slit lamp examination in both eyes. Fundus examination of the left eye showed no significant findings. A placoid, hyperreflective band at the level of the GCL and IPL was visible in OCT which spared the outer retina, at the time of diagnosis and 1 month later. An oropharyngeal swab test was performed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA), immunoglobulin G (IgG) and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) determination. Real-time reverse-transcriptase polymerase chain reaction (RT-PCR) was negative. ELISA testing and a third rapid antibody detection test performed 7 days after the onset of symptoms were positive., Conclusions: Ocular signs and symptoms in COVID-19 cases are rarely reported, but may be underestimated, especially those that affect the retina and occur in asymptomatic or paucisymptomatic cases. We present a case of COVID-19 diagnosis based on retinal ophthalmic examination.
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- 2021
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47. Evolution of Macular Bruch Membrane Defects of Patchy Chorioretinal Atrophy in Pathologic Myopia Based on a Recent Classification System.
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Ruiz-Moreno JM, Puertas M, Flores-Moreno I, Ruiz-Medrano J, Almazán-Alonso E, and Garcia-Zamora M
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- Atrophy pathology, Cross-Sectional Studies, Female, Humans, Male, Retrospective Studies, Tomography, Optical Coherence, Bruch Membrane pathology, Myopia, Degenerative complications, Myopia, Degenerative diagnosis
- Abstract
Purpose: The purpose of this study was to analyze the progression of macular Bruch membrane defects (BMD) in highly myopic patients with patchy atrophy (PA); and study its correlation with the enlargement of PA and ATN grading. Setting/Venue: Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain., Patients and Methods: This was a cross-sectional, noninterventional study. A series of 451 highly myopic eyes with spherical equivalent > -6.0 D and/or >26 mm of axial length (AL) were included. All patients underwent a complete ophthalmological examination and swept-source optical coherence tomography (SS-OCT), and were graded using the ATN system by 2 masked retina experts that assessed the atrophic (A), tractional (T), and neovascular (N) components. SS-OCT b-scans were employed to study PA and macular BMD at baseline and at a 1-year follow-up, in patients with good foveal fixation., Results: Out of total 451 eyes, 126 eyes (27.9%) had PA (53 patients; 75.4% women). Mean T and N in eyes with PA were 1.1 ± 1.3 and 0.08 ± 0.2, respectively. Sixty-eight of them had >1-year follow-up with a good foveal fixation and enough image quality. From them, BMD were found in 44 eyes (64.7%) at baseline and increased to 59 eyes (86.7%) at a 1-year follow-up. The mean great linear dimension of PA and macular BMD increased with a median of 384.5 ± 462.5 μm (IR 68.0-660.2) and 265.6 ± 418.1 μm (IR 0-331.7), respectively. At 1-year, PA and BMD sizes increase, and were statistically significant (p < 0.001). There was a positive correlation between the growth of macular BMD and the growth of PA (r = 0.490, p < 0.00). T grading correlated significantly with PA growth (p < 0.05)., Conclusions: Macular BMD increase its prevalence and its size over time in highly myopic patients with PA. There is a positive correlation between BMD and PA area growth. New studies with a larger sample size, longer follow-up, and AL elongation correlation are necessary to corroborate our findings., (© 2021 S. Karger AG, Basel.)
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- 2021
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48. CHANGES IN CHORIOCAPILLARIS, SATTLER, AND HALLER LAYER THICKNESSES IN CENTRAL SEROUS CHORIORETINOPATHY AFTER HALF-FLUENCE PHOTODYNAMIC THERAPY.
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Flores-Moreno I, Arcos-Villegas G, Sastre M, Ruiz-Medrano J, Arias-Barquet L, Duker JS, and Ruiz-Moreno JM
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- Adult, Central Serous Chorioretinopathy diagnosis, Central Serous Chorioretinopathy physiopathology, Coloring Agents administration & dosage, Female, Fluorescein Angiography, Humans, Indocyanine Green administration & dosage, Male, Middle Aged, Organ Size, Photosensitizing Agents therapeutic use, Retrospective Studies, Tomography, Optical Coherence, Verteporfin therapeutic use, Visual Acuity physiology, Central Serous Chorioretinopathy drug therapy, Choroid blood supply, Choroid pathology, Photochemotherapy
- Abstract
Purpose: To determinate the variation in thickness of the individual choroidal layers in patients with central serous chorioretinopathy treated with half-fluence photodynamic therapy., Methods: Twenty-two eyes were evaluated with spectral-domain optical coherence tomography. The images were taken before photodynamic therapy, 3 months, and 6 months after the treatment. Two investigators performed these measurements: 1) choroidal thickness (CT), 2) Haller layer thickness, defined as the most external layer containing a 100-μm vessel, and 3) choriocapillaris + Sattler layer (C&S). Nine measurements were taken in the macular region., Results: Choroidal thickness before photodynamic therapy was 471.8 µm ± 145.8. The Haller layer was 358.4 µm ± 122.6, and C&S was 114.3 µm ± 27.8. At 3-month follow-up, CT was 441.1 µm ± 150.7, Haller layer 348.8 µm ± 127.6, and C&S 92.4 µm ± 27.9. At 6-month follow-up, CT was 420.4 µm ± 118.4, Haller layer 331.8 µm ± 97.2, and C&S 89.5 µm ± 28.0. Using a multilevel mixed-effects linear regression, CT was found to be reduced at both 3 months (P < 0.03) and at 6 months (P < 0.001), Haller layer showed no significant reduction at 3 months (P = 0.483) or at 6 months (P = 0.055), and C&S showed reduction at 3 months (P < 0.001) and at 6 months (P < 0.001). Fellow nonaffected eyes showed no statistical variation at 3-month and 6-month follow-up., Conclusion: Reduction in CT in patients affected by central serous chorioretinopathy after half-fluence photodynamic therapy occurs primarily in the choriocapillaris and medium diameter vessel layers of the choroid in a short- and medium-term follow-up.
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- 2020
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49. VALIDATION OF THE RECENTLY DEVELOPED ATN CLASSIFICATION AND GRADING SYSTEM FOR MYOPIC MACULOPATHY.
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Ruiz-Medrano J, Flores-Moreno I, Ohno-Matsui K, Cheung CMG, Silva R, and Ruiz-Moreno JM
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- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Myopia, Degenerative pathology, Observer Variation, Reproducibility of Results, Retinal Diseases pathology, Retrospective Studies, Tomography, Optical Coherence, Visual Acuity, Classification methods, Diagnostic Techniques, Ophthalmological classification, Myopia, Degenerative classification, Retinal Diseases classification
- Abstract
Purpose: To validate the recently developed ATN grading system for myopic maculopathy to classify eyes with pathologic myopia., Methods: Cross-sectional study. A series of consecutive eyes diagnosed with pathologic myopia and signs of myopic maculopathy (grade ≥1 for atrophic, tractional, or neovascular components of the ATN), with a refractive error > -6.0 diopters (D), were included. All patients underwent complete ophthalmological examination including fundus photography and swept-source optical coherence tomography. Six observers graded each eye twice using the ATN system (≥15 days between assessments) based only on the aforementioned data., Results: Sixty eyes from 47 patients (61.7% female) were graded. Mean patient age was 63.2 ± 11.7 years. The mean spherical equivalent was -13.8 ± 6.5 D. Mean axial length was 28.6 ± 2.16 mm. Overall, the mean intraobserver agreement (%) for the same image was 92.0%, and the mean interobserver agreement for the second image was 77.5%. The weighted Fleiss k showed excellent correlation (k > 0.8) for the traction and neovascularization components and good correlation (0.75) for atrophy. Interobserver agreement for each of these three components was 95.2%, 98.4%, 95.0%, respectively., Conclusion: Application of the ATN resulted in high intraobserver and interobserver correlation, underscoring the reproducibility of the system.
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- 2020
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50. Automatic Quantification Software for Geographic Atrophy Associated with Age-Related Macular Degeneration: A Validation Study.
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Ruiz-Moreno JM, Ruiz-Medrano J, Lugo F, Sirvent B, and Flores-Moreno I
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Aims: To determine the accuracy and repeatability of new software to automatically quantify GA areas associated to age-related macular degeneration (AMD) by swept-source optical coherence tomography (SS-OCT). Settings and Design . Tertiary referral hospital in Spain. Cross-sectional and noninterventional. Methods and Material . Forty-six eyes from 33 AMD patients with GA, without previous choroidal neovascularization, were scanned using a SS-OCT (Topcon Corporation, Japan), including three consecutive 7 × 7 mm OCT scans. Three independent masked observers manually measured the GA area using FAF images. These measures were compared to the three automatic determinations of the GA. Lesions were classified according to their morphology and number as regular/irregular and single/multiple. Statistical Analysis Used . Intraclass correlation coefficients (ICCs) were estimated to study the agreement between the three physicians in manual measurements. ICC through a two-way mixed effects model was used for the software measures, and Lin's concordance correlation coefficient (CCC) was used to analyse the agreement between the physicians and the software., Results: The mean age was 76.3 ± 11.7 years. Eighteen cases showed regular lesions, and 30 showed single lesions. The CCC between manual and automatic measures was 0.95 for the whole sample. The CCC for the area according to the lesion type was 0.92 and 0.97; it was 0.99 for single lesions and 0.89 for multiple lesions. The ICC between the three physicians was 0.94 for the whole sample and 0.88 in multiple lesions. The ICC between the three automatic measures for the area was 0.98 for the whole sample, regular or irregular lesions, and single or multiple lesions., Conclusions: The accuracy of this new software is substantial for the area with a high degree of repeatability agreement, being very precise in single lesions., Competing Interests: Professor Ruiz-Moreno received a grant from TOPCON, and the other authors declare no conflicts of interest., (Copyright © 2020 José M. Ruiz-Moreno et al.)
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- 2020
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