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Purpose: To assess the effect of clinical factors on the development and progression of atrophy and fibrosis in patients with neovascular age-related macular degeneration (nAMD) receiving long-term treatment in the real world. Methods: An ambispective 36-month multicentre study, involving 359 nAMD patients from 17 Spanish hospitals treated according to the Spanish Vitreoretinal Society guidelines, was designed. The influence of demographic and clinical factors, including the presence and location of retinal fluid, on best-corrected visual acuity (BCVA) and progression to atrophy and/or fibrosis were analysed. Results: After 36 months of follow-up and an average of 13.8 anti-VEGF intravitreal injections, the average BCVA gain was +1.5 letters, and atrophy and/or fibrosis were present in 54.8% of nAMD patients (OR = 8.54, 95% CI = 5.85-12.47, compared to baseline). Atrophy was associated with basal intraretinal fluid (IRF) (OR = 1.87, 95% CI = 1.09-3.20), whereas basal subretinal fluid (SRF) was associated with a lower rate of atrophy (OR = 0.40, 95% CI = 0.23-0.71) and its progression (OR = 0.44, 95% CI = 0.26-0.75), leading to a slow progression rate (OR = 0.34, 95% CI = 0.14-0.83). Fibrosis development and progression were related to IRF at any visit (p < 0.001). In contrast, 36-month SRF was related to a lower rate of fibrosis (OR = 0.49, 95% CI = 0.29-0.81) and its progression (OR = 0.50, 95% CI = 0.31-0.81). Conclusion: Atrophy and/or fibrosis were present in 1 of 2 nAMD patients treated for 3 years. Both, especially fibrosis, lead to vision loss. Subretinal fluid (SRF) was associated with good visual outcomes and lower rates of atrophy and fibrosis, whereas IRF yields worse visual results and a higher risk of atrophy and especially fibrosis in routine clinical practice.

Objective. The aim of this study was to assess the efficacy of anti-TNF-alpha therapy in refractory uveitis due to Behcet's disease (BD). Methods. We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load. Results. Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (S.D. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-alpha drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-alpha therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 mu m] and 35 (49 eyes) had cystoid macular oedema (OCT > 300 mu m) that improved from 420 mm (S.D. 119.5) at baseline to 271 mu m (S.D. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases. Conclusion. Anti-TNF-alpha therapy is effective and relatively safe in refractory BD uveitis.

Case Report. A 47-year-old man presented with blurred vision in the right eye. Ophthalmoscopic examination showed several placoid, pigmented lesions in the posterior pole and midperiphery of the retina of both eyes. Results. Patient referred a cutaneous malignant melanoma on the back skin removed 6 years ago. A systemic workup revealed multiple metastases in liver and spleen. After an exhaustive study we concluded that it was a dissemination of a cutaneous malignant melanoma with bilateral choroidal metastases, liver and spleen metastases. The patient obtained clinical ocular improvement after palliative chemotherapy, although he died in the following months. Pathological examination of the lesions confirmed the diagnosis of choroidal metastases from a malignant cutaneous melanoma. Conclusions. Monitoring patients who have had cutaneous malignant melanoma is very important, since melanoma metastases may occur even many years after the diagnosis of the primary tumor. Choroidal metastases from cutaneous melanoma are uncommon but we should be aware because their appearance worsens prognosis.

Caso clínico: Varón de 55 años, sin drusas ni alteraciones del epitelio pigmentario sugestivas de degeneración macular asociada a la edad (DMAE), que presentó maculopatía exudativo-hemorrágica. La angiografía con fluoresceína e indocianina verde mostraron la proliferación angiomatosa retiniana (PAR), la arteriola aferente y vénula retinianas de drenaje. La respuesta fue óptima a un único tratamiento con terapia fotodinámica. Discusión: La PAR es una lesión descrita en los últimos años en el contexto de la DMAE, cuya principal característica es la lesión neovascular formada a partir de capilares retinianos y su extensión posterior al espacio subretiniano. Nuestro paciente presentaba los hallazgos típicos de PAR sin DMAE. Case: A 55-year-old male was diagnosed with exudative-hemorrhagic maculopathy, with no signs observed of drusen or pigmentary epithelium defects suggestive of age-related macular degeneration (ARMD). Fluorescein angiography (FA) and indocyanine green choroidal angiography (ICGA) showed retinal angiomatous proliferation (RAP). Afferent arteriole and retinal drainage venule connection was also observed. Treatment with a single Photodynamic Therapy provided an optimal outcome. Discussion: RAP is a form of neovascular ARMD described in recent years; it consists of an angiomatous proliferation that originates from the retinal capillary system and extends posteriorly into the subretinal space. Our patient showed typical RAP findings without any sign of ARMD.

espanolCaso clinico: Varon de 55 anos, sin drusas ni alteraciones del epitelio pigmentario sugestivas de degeneracion macular asociada a la edad (DMAE), que presento maculopatia exudativo-hemorragica. La angiografia con fluoresceina e indocianina verde mostraron la proliferacion angiomatosa retiniana (PAR), la arteriola aferente y venula retinianas de drenaje. La respuesta fue optima a un unico tratamiento con terapia fotodinamica. Discusion: La PAR es una lesion descrita en los ultimos anos en el contexto de la DMAE, cuya principal caracteristica es la lesion neovascular formada a partir de capilares retinianos y su extension posterior al espacio subretiniano. Nuestro paciente presentaba los hallazgos tipicos de PAR sin DMAE. EnglishCase: A 55-year-old male was diagnosed with exudative-hemorrhagic maculopathy, with no signs observed of drusen or pigmentary epithelium defects suggestive of age-related macular degeneration (ARMD). Fluorescein angiography (FA) and indocyanine green choroidal angiography (ICGA) showed retinal angiomatous proliferation (RAP). Afferent arteriole and retinal drainage venule connection was also observed. Treatment with a single Photodynamic Therapy provided an optimal outcome. Discussion: RAP is a form of neovascular ARMD described in recent years; it consists of an angiomatous proliferation that originates from the retinal capillary system and extends posteriorly into the subretinal space. Our patient showed typical RAP findings without any sign of ARMD.

Casos clínicos: Se presentan 3 pacientes con desgarro de epitelio pigmentario retiniano (EPR). En dos de ellos, éste se produjo de manera espontánea, estando el tercero en relación con la fotocoagulación de una neovascularización extrafoveal. Se realizaron angiografías (AGF) y estudio con tomografia óptica de coherencia (OCT) que confirmaron el diagnóstico. Discusión: Existen pocos estudios sobre OCT en desgarro del EPR. Las principales características son: interrupción de la línea hiperreflectante del EPR, hiperreflectividad de la coroides en la zona de ausencia de EPR y doble capa de EPR donde éste está replegado. Es frecuente el desprendimiento de EPR y neurosensorial asociado. Case reports: Three cases of pigmentary epithelial tears are described in this study. One of them was related to previous extrafoveal photocoagulation, whereas the other two were idiopathic. Fluorescein angiography (FA) and optical coherence tomography (OCT) were performed to confirm the clinical diagnosis. Discussion: Few studies using OCT to assess pigmentary retinal epithelial (RPE) tears have been published in the world literature. The main findings of our study included hyper-reflectant line breaks, choroidal hyper-reflectance due to the lack of RPE and RPE double layering where it was folded. Images were frequently associated with RPE tears and neurosensorial retinal detachment.

espanolCasos clinicos: Se presentan 3 pacientes con desgarro de epitelio pigmentario retiniano (EPR). En dos de ellos, este se produjo de manera espontanea, estando el tercero en relacion con la fotocoagulacion de una neovascularizacion extrafoveal. Se realizaron angiografias (AGF) y estudio con tomografia optica de coherencia (OCT) que confirmaron el diagnostico. Discusion: Existen pocos estudios sobre OCT en desgarro del EPR. Las principales caracteristicas son: interrupcion de la linea hiperreflectante del EPR, hiperreflectividad de la coroides en la zona de ausencia de EPR y doble capa de EPR donde este esta replegado. Es frecuente el desprendimiento de EPR y neurosensorial asociado. EnglishCase reports: Three cases of pigmentary epithelial tears are described in this study. One of them was related to previous extrafoveal photocoagulation, whereas the other two were idiopathic. Fluorescein angiography (FA) and optical coherence tomography (OCT) were performed to confirm the clinical diagnosis. Discussion: Few studies using OCT to assess pigmentary retinal epithelial (RPE) tears have been published in the world literature. The main findings of our study included hyper-reflectant line breaks, choroidal hyper-reflectance due to the lack of RPE and RPE double layering where it was folded. Images were frequently associated with RPE tears and neurosensorial retinal detachment.

espanolObjetivo: Detectar la incidencia de edema macular quistico (EMQ) tras cirugia de catarata tanto clinico como subclinico, mediante «ocular coherence tomography» (OCT) y comparar dicha incidencia entre un grupo de pacientes diabeticos y otro de no diabeticos. Material y metodos: Estudio prospectivo de 260 ojos intervenidos de forma consecutiva de catarata mediante facoemulsificacion con implante de lente intraocular acrilica, desde septiembre de 2004 a marzo de 2005. Grupo A: 208 ojos de pacientes no diabeticos, grupo B: 42 ojos de pacientes diabeticos, grupo C: 10 ojos de pacientes diabeticos con edema macular y que recibieron triamcinolona intravitrea (TAIV) al finalizar la cirugia. En cada revision efectuada a los 6 dias (basal), 5 semanas y 12 semanas se realizo biomicroscopia de polo posterior y OCT. Resultados: El espesor macular en la OCT, fue significativamente superior en el grupo B que en el grupo A (241,6 versus 204,6 µm p- 43,74 µm (2 DE del valor basal del grupo A). En el grupo B, seis ojos presentaron EMQ clinicamente significativo, con disminucion de agudeza visual (14,2%), en 12 ojos detectamos aumento del espesor macular (28,5%). Las diferencias entre grupos fueron significativas (p EnglishPurpose: To determine the incidence of cystoid macular edema (CME) by means of clinical evaluation and subclinical assessment by means of ocular coherence tomography (OCT), and to compare the incidence between diabetic and non-diabetic groups of patients. Methods: Prospective study of 260 consecutive cataract surgeries operated from September 2004 to March 2005. The procedures were performed by means of phacoemulsification plus intraocular acrylic lens implantation. Group A: 208 eyes of non-diabetic patients; Group B: 42 eyes of patients with diabetes and Group C: 10 eyes of diabetic patients with macular edema that received an intravitreal injection of triamcinolone at the end of surgery. Postoperative follow-up visits were performed 6 days (basal visit), 5 weeks and 12 weeks after surgery. Each visit included posterior pole biomicroscopy and OCT. Results: Central macular thickness measured by OCT was significantly increased in group B compared with group A (241.6 versus 204.6 µm; p

Objetivo: Detectar la incidencia de edema macular quístico (EMQ) tras cirugía de catarata tanto clínico como subclínico, mediante «ocular coherence tomography» (OCT) y comparar dicha incidencia entre un grupo de pacientes diabéticos y otro de no diabéticos. Material y métodos: Estudio prospectivo de 260 ojos intervenidos de forma consecutiva de catarata mediante facoemulsificación con implante de lente intraocular acrílica, desde septiembre de 2004 a marzo de 2005. Grupo A: 208 ojos de pacientes no diabéticos, grupo B: 42 ojos de pacientes diabéticos, grupo C: 10 ojos de pacientes diabéticos con edema macular y que recibieron triamcinolona intravítrea (TAIV) al finalizar la cirugía. En cada revisión efectuada a los 6 días (basal), 5 semanas y 12 semanas se realizó biomicroscopía de polo posterior y OCT. Resultados: El espesor macular en la OCT, fue significativamente superior en el grupo B que en el grupo A (241,6 versus 204,6 µm p- 43,74 µm (2 DE del valor basal del grupo A). En el grupo B, seis ojos presentaron EMQ clínicamente significativo, con disminución de agudeza visual (14,2%), en 12 ojos detectamos aumento del espesor macular (28,5%). Las diferencias entre grupos fueron significativas (p

Objetivo: Valorar la eficacia de la terapia fotodinámica (TFD) en el tratamiento de neovascularización subretiniana (NVSR) causada por DMAE (degeneración macular asociada a la edad) y miopía. Material y método: Se estudiaron 102 pacientes con neovascularización coroidea yuxta o subfoveolar tratados con TFD en los que se valoró: Agudeza visual (AV), examen oftalmoscópico y angiografía fluoresceínica. El retratamiento se realizó cuando fue necesario cada tres meses. Resultados: La etiología de la neovascularización coroidea fue: 75,5% por DMAE y 24,5% miópica. El tiempo de seguimiento medio fue de 15,94 meses (9-33). Un 88% de las NVSR eran angiográficamente clásicas en los miopes y un 40% en las DMAE. La supervivencia de la membrana resultó significativa en función del tipo de NVSR, presentando una mejor evolución en los pacientes miopes (p=0,0018). La AV mejoró en 48% de los pacientes miopes y en 28,6% de las DMAE. No se objetivaron complicaciones severas atribuibles al tratamiento. Conclusiones: La TFD es un tratamiento moderadamente efectivo y sin complicaciones para el tratamiento de la NVSR sub/yuxta foveolar. Purpose: To evaluate the efficacy of photodynamic therapy with photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) and myopia. Methods: 102 eyes with subfoveal or yuxtafoveal CNV underwent visual acuity (VA) testing, ophthalmic examination, and fluorescein angiography. Retreatment of persistent CNV was done after three months. Results: CNV was caused by AMD in 75.5% of patients, pathologic myopia in 24.5%. Follow up ranged from 9 to 33 months (mean: 15.94 months). 88% of CNV caused by pathologic myopia was classic and 40% was in lesions caused by AMD. CNV survival was shorter in lesions caused by pathologic myopia with a significant difference (p=0.0018). VA improved in 48% of lesions caused by pathologic myopia and in 28.6% of lesions caused by AMD. We did not observe any severe complication caused by PDT. Conclusion: PDT is a moderately effective treatment without complications in treating subfoveal CNV

A case of an immunocompetent patient presenting primary systemic toxoplasma infection involving the eye (condition seen in less than 3% of primary infections). The patient showed reactivation of this primary focus two years later.Diagnosis of toxoplasm retinitis is based on a typical lesion consisting in an area of active retinitis adjacent to an inactive corioretinal scar. Differential diagnosis must consider other causes of retinal coroiditis in primary infection cases: sarcoidosis, tuberculosis, syphilis as well as viral and fungal infections. Ocular toxoplasmosis was confirmed by serum tests.

To study the effect of topical ketorolac-tromethamine in the arachidonic acid metabolism on a model of endotoxin induced uveitis (EIU) in albino rabbits.EIU was produced by intravitreal injection in the right eye with 10 ng LPS A Salmonella typhimurium endotoxin in 5ul saline solution. We used 60 animals (5 groups of 12 animals each). Control group (G-I) was injected with saline (5 ul); endotoxin group (G-II) was injected with 10 ng of ET; group III, IV and V were injected with the same amount of ET and treated with topical ketorolac-tromethamine every 6, 4 and 2 hours respectively. The animals were sacrificed 24 hours after the ET administration and we determined E2 prostaglandin and B4 leukotriene concentration in the aqueous humor.In all treated groups with ketorolac-tromethamine we observed a significant reduction (p0.05) in aqueous humor concentration of E2 prostaglandin without increase of the B4 leukotriene concentration comparing with endotoxin group.Ketorolac tromethamine produced an inhibition of ciclooxigenase metabolism of arachidonic acid without increase of lypoxygenase pathway.