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Age-related macular degeneration (AMD) is a leading cause of severe vision loss in older individuals in developed countries. Despite advances in our understanding of AMD, its pathophysiology remains poorly understood. Matrix metalloproteinases (MMPs) have been proposed to play a role in AMD development. In this study, we aimed to characterize MMP-13 in AMD. We used retinal pigment epithelial cells, a murine model of laser-induced choroidal neovascularization, and plasma samples from patients with neovascular AMD to conduct our study. Our results show that MMP13 expression significantly increased under oxidative stress conditions in cultured retinal pigment epithelial cells. In the murine model, MMP13 was overexpressed in both retinal pigment epithelial cells and endothelial cells during choroidal neovascularization. Additionally, the total MMP13 levels in the plasma of patients with neovascular AMD were significantly lower than those in the control group. This suggests a reduced diffusion from the tissues or release from circulating cells in the bloodstream, given that the number and function of monocytes have been reported to be deficient in patients with AMD. Although more studies are needed to elucidate the role of MMP13 in AMD, it could be a promising therapeutic target for treating AMD.

Age-related macular degeneration (AMD) is currently the main cause of severe visual loss among older adults in developed countries. The pathophysiology has not been clarified, but oxidative stress is believed to play a major role. Matrix metalloproteinases (MMP) may play a prominent role in several steps of the pathophysiology of AMD, especially in its neovascular form; therefore, there is of great interest in understanding their role in choroidal neovascularisation. This study aimed to elucidate the role of MMP10 in the development of choroidal neovascularisation (CNV). We have demonstrated that MMP10 was expressed by retinal pigment epithelium cells and endothelial cells of the neovascular membrane, in cell culture, mouse and human retina. MMP10 expression and activity increased under oxidative stress conditions in ARPE-19 cells. MMP10-/- mice developed smaller laser-induced areas of CNV. Furthermore, to exclude a systemic MMP10 imbalance in these patients, plasma MMP10 concentrations were assessed in an age- and sex-matched sample of 52 control patients and 52 patients with neovascular AMD and no significant differences were found between the groups, demonstrating that MMP10 induction is a local phenomenon. Our findings suggest that MMP10 participates in the development of choroidal neovascularisation and promotes MMP10 as a possible new therapeutic target.

Age-related macular degeneration (AMD) is a leading cause of severe vision loss in older individuals in developed countries. Despite advances in our understanding of AMD, its pathophysiology remains poorly understood. Matrix metalloproteinases (MMPs) have been proposed to play a role in AMD development. In this study, we aimed to characterize MMP-13 in AMD. We used retinal pigment epithelial cells, a murine model of laser-induced choroidal neovascularization, and plasma samples from patients with neovascular AMD to conduct our study. Our results show that MMP13 expression significantly increased under oxidative stress conditions in cultured retinal pigment epithelial cells. In the murine model, MMP13 was overexpressed in both retinal pigment epithelial cells and endothelial cells during choroidal neovascularization. Additionally, the total MMP13 levels in the plasma of patients with neovascular AMD were significantly lower than those in the control group. This suggests a reduced diffusion from the tissues or release from circulating cells in the bloodstream, given that the number and function of monocytes have been reported to be deficient in patients with AMD. Although more studies are needed to elucidate the role of MMP13 in AMD, it could be a promising therapeutic target for treating AMD. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration (AMD) is currently the main cause of severe visual loss among older adults in developed countries. The pathophysiology has not been clarified, but oxidative stress is believed to play a major role. Matrix metalloproteinases (MMP) may play a prominent role in several steps of the pathophysiology of AMD, especially in its neovascular form; therefore, there is of great interest in understanding their role in choroidal neovascularisation. This study aimed to elucidate the role of MMP10 in the development of choroidal neovascularisation (CNV). We have demonstrated that MMP10 was expressed by retinal pigment epithelium cells and endothelial cells of the neovascular membrane, in cell culture, mouse and human retina. MMP10 expression and activity increased under oxidative stress conditions in ARPE-19 cells. MMP10-/- mice developed smaller laser-induced areas of CNV. Furthermore, to exclude a systemic MMP10 imbalance in these patients, plasma MMP10 concentrations were assessed in an age- and sex-matched sample of 52 control patients and 52 patients with neovascular AMD and no significant differences were found between the groups, demonstrating that MMP10 induction is a local phenomenon. Our findings suggest that MMP10 participates in the development of choroidal neovascularisation and promotes MMP10 as a possible new therapeutic target. [ABSTRACT FROM AUTHOR]

Introduction/Background: Hallervorden-Spatz syndrome is an autosomal recessive neurodegenerative disorder with brain iron accumulation. The classical form has a progressive early onset in infancy that results in the presence of extrapyramidal symptoms and retinitis pigmentosa (RP). The clinical symptoms and signs in RP include nyctalopia and peripheral visual field reduction. Cystoid macular oedema (CMO) can occasionally occur in RP. Pathogenesis of CMO remains unclear and no gold-standard treatments or protocols have established yet. Methods: Case report. Patient monitored with OCT imaging and treated with topic brinzolamide 10 mg/ml and topical nepafenac 1 mg/ml. Results: A 10 year-old female, diagnosed with Hallervorden- Spatz disease, was derived to the Ophthalmology service from Paediatrics with a progressive vision loss. During exploration, bestcorrected visual acuity (BCVA) was 0.2 in both eyes. Macular OCT was performed and a bilateral CMO was found. Bone spicule pigmentation was observed in periphery without further pathological findings. She was diagnosed with RP. Topic brinzolamide was prescribed and there was vision improvement with bilateral reduction of the CMO. Two months later, BCVA deteriorated although CMO diminished; treatment with brinzolamide was maintained and a topical non-steroidal anti-inflammatory (nepafenac) was added. After three months of double therapy, her BCVA was 0.9 in both eyes and the CMO had considerably reduced. Two months later, the CMO was prominent again and her BCVA had decreased again. Due to the evolution with topical treatment, the patient was finally derived to a children's referral hospital where she can be treated more aggressively (intravitreal and/or subtenon triamcinolone acetonide injection, intravitreal dexamethasone implant or intravitreal anti-VEGF injection). Conclusions: There is no specific treatment to arrest or reverse the photoreceptor degeneration, but complications can be managed in diverse ways. Since a protocol to treat CMO in RP is lacking, a gradually aggressive treatment steps should be followed. Acknowledgements: To Ana Montoliu Antón, Francisco Ramos Martí, Soledad Peña, María Redón Soriano and especially Luis León Ibáñez. [ABSTRACT FROM AUTHOR]

Introduction/Background: Spontaneous closure of idiopathic macular holes (MH) has been documented with imaging techniques, but the pathogenesis of the formation and the closure remains unclear although there are some hypotheses. The aim of our case report, monitored with OCT imaging, is to add further support to one of these hypotheses: the closure by a retinal tissue bridge over the MH, and to stress the importance of a short period of observation. Methods: Observational case report. OCT imaging was used to monitor the formation and resolution of a case of an idiopathic stage III macular hole. Results: A 77 year-old woman with an ocular history of a retinal detachment in the right eye 20 years ago with a poor outcome and a mild diabetic retinopathy, came to the emergency room with blurred vision of 3 days of evolution in the left eye. During exploration, the best-corrected visual acuity (BCVA) was 0.5 LOGMAR in the left eye. On OCT, a lamellar hole and a subclinical posterior vitreous detachment were diagnosed and follow-up visits were programmed. Six months later, BCVA was 0.2 and a full-thickness MH was diagnosed; surgery was proposed, but the patient denied. Ten months after the initial examination, the BCVA was 0.6 and the full-thickness MH was covered by a retinal bridge. Five months later, there was a complete resolution of the MH with normal foveal contour that stabilised in the following months and remains unchanged until now. Conclusions: Observation of MH during the first months is advised, especially when the diameter is small. We also want to draw attention to the potential mechanism through which a MH with no vitreomacular traction can resolve. It has been proposed the implication of Müller cells in forming a bridge of retinal tissue, but further investigations need to be done in this direction. Acknowledgements: To Elena Sorlí Clemente, Francisco Ramos Martí, and especially Ana Montoliu Antón and Soledad Peña. [ABSTRACT FROM AUTHOR]

Introduction: Urinary lithiasis involves a major source of morbidity and economic costs. The aim of this study was to evaluate the adherence to the European Association of Urology Guidelines on Urolithiasis with regard to treatment among Spanish urologists. Methods: A total of 723 patients were included in a prospective study between May 1, 2014, and July 31, 2014. The study involved 8 hospitals responsible of urolithiasis in a geographical area of Spain (Comunidad Valenciana) with approximately 4,500,000 inhabitants. Data were collected about the demographic characteristics of the patients, the characteristics of the stones, and the indicated treatment, in order to analyze the adherence to the clinical guidelines. A 90% threshold was used in concordance with the indications in the guidelines. Results: Adherence to guidelines was poor in chemolysis, distal and ureteral calculi, and >2 cm renal calculi. Adherence was high in <2 cm renal calculi. Conclusions: In our study, the overall adherence to the clinical guidelines regarding the therapeutic indication for urinary lithiasis has been low. In the case of both renal and ureteral stones, the adherence in small lithiasis has been greater, compared with larger ones. In our survey, a trend has been observed in favor of endoscopic procedures even in large lithiasis. [ABSTRACT FROM AUTHOR]

Background: The present study was aimed at determining the prophylactic efficacy of American cranberry (AC) extract (Cysticlean®) in women with recurrent symptomatic postcoital urinary tract infections (PCUTI), non-consumer of AC extract in the past 3 months before inclusion, and to determine changes in their quality of life (QoL). Methods: This was a single center, observational, prospective study in a total of 20 women (mean age 35.2 years; 50.0% were married). Patients were followed up for 3 and 6 months during treatment. Results: The number of PCUTIs in the previous 3 months prior to start the treatment with Cysticlean® was 2.8±1.3 and it was reduced to 0.2±0.5 at Month 6 (P<0.0001), which represent a 93% improvement. At baseline, the mean score on the VAS scale (range from 0 to 100) for assessing the QoL was 62.4±19.1, increasing to 78.2±12.4 at Month 6 (P=0.0002), which represents a 20% improvement. All patients had an infection with positive urine culture at baseline, after 6 months there were only 3 symptomatic infections (P<0.001). The most common bacterium was Escherichia coli. Conclusions: Prophylaxis with American cranberry extract (Cysticlean®) could be an alternative to classical therapies with antibiotics. Further studies are needed to confirm results obtained in this pilot study. [ABSTRACT FROM AUTHOR]

Background: It is a priority to achieve smoking cessation in diabetic smokers, given that this is a group of patients with elevated cardiovascular risk. Furthermore, tobacco has a multiplying effect on micro and macro vascular complications. Smoking abstinence rates increase as the intensity of the intervention, length of the intervention and number and diversity of contacts with the healthcare professional during the intervention increases. However, there are few published studies about smoking cessation in diabetics in primary care, a level of healthcare that plays an essential role in these patients. Therefore, the aim of the present study is to evaluate the effectiveness of an intensive smoking cessation intervention in diabetic patients in primary care. Methods/Design: Cluster randomized trial, controlled and multicentric. Randomization unit: Primary Care Team. Study population: 546 diabetic smokers older than 14 years of age whose disease is controlled by one of the primary care teams in the study. Outcome Measures: Continuous tobacco abstinence (a person who has not smoked for at least six months and with a CO level of less than 6 ppm measured by a cooximeter) , evolution in the Prochaska and DiClemente's Transtheoretical Model of Change, number of cigarettes/day, length of the visit. Point of assessment: one- year post- inclusion in the study. Intervention: Brief motivational interview for diabetic smokers at the pre-contemplation and contemplation stage, intensive motivational interview with pharmacotherapy for diabetic smokers in the preparation-action stage and reinforcing intevention in the maintenance stage. Statistical Analysis: A descriptive analysis of all variables will be done, as well as a multilevel logistic regression and a Poisson regression. All analyses will be done with an intention to treatment basis and will be fitted for potential confounding factors and variables of clinical importance. Statistical packages: SPSS15, STATA10 y HLM6. Discussion: The present study will try to describe the profile of a diabetic smoker who receives the most benefit from an intensive intervention in primary care. The results will be useful for primary care professionals in their usual clinical practice. [ABSTRACT FROM AUTHOR]

Introduction/Background: Traumatic macular holes are a complication of blunt ocular trauma occurring in 1.4% of closed globe injuries. Compared to idiopathic macular holes they commonly present in younger patients and are associated with poorer visual acuity. Spontaneous closure is frequently observed with rates of 44% cited. However, the number of reported cases reflects the low incidence of traumatic macular holes and therefore the recommended observation period for spontaneous closure ranges significantly. There is a clinical need to determine an optimal observation period as recent evidence shows inferior outcomes in delayed intervention due to prolonged observation periods. Methods: A review of current literature was performed. Articles included in the review were those that presented cases or case series of spontaneous closure of traumatic macular hole with documented time to closure. Cases were assessed for age, gender, changes in visual acuity from initial presentation to final follow up visit and time to closure. 25 articles were included with a total of 57 eyes. Results: Of the 56 patients (1 had bilateral TMH), 49 were aged 30 or younger with 28 patients aged 18 or younger. 39 were male, 5 were female (gender was not specified for 12). Majority of patients (47) achieved closure by 4 months. In 54 of the eyes there was an improvement in the VA from initial presentation (1 report did not record final VA and 2 showed no improvement). Conclusions: While further research into this area is required, our recommendation at present would be to observe for a period of 4 months to assess if there is evidence of spontaneous closure before surgical intervention is undertaken, particularly in young patients where spontaneous closure is regularly observed. While surgical intervention has a high rate of success (83%), the chance of spontaneous closure is significant enough that observation remains a viable management option. Acknowledgements: None. [ABSTRACT FROM AUTHOR]

Introduction/Background: Retinopathy of prematurity (ROP) is a vasoproliferative disease that affects the premature infants. Various algorithms have been developed to try to recognize the risk of developing severe ROP, such as the WINROP algorithm (weight, insulin-like growth factor I: IGF-1, neonatal ROP). The construction of the latter is based on the relationship between poor weight progression and low levels of IGF-1 in the first weeks of life, in infants with severe ROP. Purpose: Evaluate whether weight gain in the first six weeks after birth, in premature infants with ROP, influences the development of severe ROP. Methods: Retrospective study with review the processes of premature infants with gestational age <32 weeks and with very low birth weight, born in our hospital in January 2005 to 2015 and diagnosed with ROP. The weight was recorded weekly in infants and weight gain was analyzed at 2, 4 and 6 weeks. Results: 150 eyes were included, of which 38 had severe ROP requiring treatment and 112 had ROP with spontaneous regression of retinopathy. Birth weight was significantly lower in premature infants who developed severe ROP (p = 0.008). Weight gain in the 2nd, 4th and 6th weeks was not significantly different be tween the two groups (p = 0.057, p = 0.201, p = 0.169, respectively), and there is even a greater weight gain in premature infants with severe ROP in the 2nd and 4th weeks. Conclusions: Unlike other studies, in our study there were no significant differences in weight gain in the first weeks of life among premature infants with severe ROP and that spontaneously regressed. WINROP algorithm for severe ROP, already validated for the Swedish and American population, may not fit perfectly to the Portuguese population, having been found the same in Brazilian and Mexican populations. This may be due to similar characteristics among these populations. Acknowledgements: The authors declare that there is no conflict of interests. [ABSTRACT FROM AUTHOR]

Introduction/Background: Cuticular drusen (or basal laminar drusen) is a rare retinal disorder that typically manifests between age 35 and 70. Genetic factors play a prominent role in its development. Occasionally, cuticular drusen may be complicated by choroidal neovascularisation (CNV) that can result in severe visual loss. Methods: A case report of a 31-year-old man with CNV secondary to cuticular drusen. Results: On first ophthalmologic examination, the patient presented with metamorphopsia and acute visual loss in the left eye (OS). His best corrected visual acuity (BCVA) was 20/20 in the right eye (OD) and 20/200 in OS. Fundus examination showed multiple small yellow-white subretinal deposits in both eyes (OU), consistent with basal laminar drusen and demonstrated a grey subfoveal lesion in OS. On SD-OCT, basal laminar drusen appeared as a 'sawtooth' elevation of the RPE OU and subfoveal lesion in OS demonstrated a moderately hypereflective mass above the RPE with neurosensory retina elevation and macular thickening. Fluorescein angiography showed a 'stars-in-the-sky' appearance OU and presented a hyperfluorescence of the subfoveal lesion on early phases, with leakage on late phases corresponding to subfoveal classic CNV OS. The patient was treated with 3 monthly intravitreal ranibizumab injections. The 2 years follow-up showed no recurrence of CNV. On the latter examination his BCVA OS was 20/20. Conclusions: Clinical progression of patients with cuticular drusen can be very variable. They can remain asymptomatic for a long period or may develop variable visual loss. Choroidal neovascularisation is the main complication of cuticular drusen occurring in 10-31% of cases. We describe here a case report of a young patient with cuticular drusen complicated by NVC who was successfully treated with intravitreal ranibizumab injections, resulting in good clinical and structural response, with markedly improved vision, that has remained stable for 2 years. Acknowledgements: Author's acknowledgements go to the involved patient for his cooperation. [ABSTRACT FROM AUTHOR]

Introduction/Background: Coats' Disease is a rare disease which is usually seen in young males (male 3:1 female) presenting with complaints of unilateral vision loss, leukocoria or strabismus. Coats' Disease presents unilaterally in 80% of patients. Biomicroscopically, retinal telangiectasis and exudative retinal detachment is seen. The presence of retinal calcification is also described and is a more rare finding in Coats' Disease. A differential diagnosis with retinoblastoma is mandatory. Methods: Case report: male patient with Coats' disease presenting with calcification. Differencial diagnosis with retinoblastoma is debated. Results: A 9-year-old boy first presented for evaluation of visual impairment in his left eye since the previous 6 months. Past medical and family history were unremarkable. Visual acuity was 20/20 in the right eye (RE) and no light perception in the left eye (LE). There was an afferent pupillary defect in LE. Slit lamp examination of the anterior segments was unremarkable. Ophthalmoscopy of the right eye was normal. The left fundus revealed an exudative retinal detachment extending from 11 o'clock to 8 o'clock involving the macula, with massive lipid exudation throughout the retina. Multiple telangiectatic vessels were found within hemorragic zones. Orbital-CT scan was performed for differential diagnosis with retinoblastoma and showed a unique and small spot of calcification, located on the posterior contour of the left eyeball next to the optic nerve. No mass or other intraorbital changes were founded. An ophthalmic ultrasound excluded retinoblastoma. A diagnosis of Coats' disease in advanced stage was made. Conclusions: Coats' disease is a rare disease that requires an early diagnosis in order to prevent its devastating complications. Calcification is not a pathognomonic finding for retinoblastoma and can be a confusional factor in the differential diagnosis. As show in our case a careful examination can help to distinguish between a late stage of Coats' disease and a life-threatening disease such as retinoblastoma. Acknowledgements: The authors have no finantial interests to declare. [ABSTRACT FROM AUTHOR]