Publications by authors named "Jose M Ruiz-Moreno"

105 Publications

Retinal imaging study diagnoses in COVID-19: a case report.

J Med Case Rep 2021 Jan 15;15(1):15. Epub 2021 Jan 15.

Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain.

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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http://dx.doi.org/10.1186/s13256-020-02620-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810099PMC
January 2021

Treatment of Experimental Choroidal Neovascularization via RUNX1 Inhibition.

Am J Pathol 2021 Mar 17;191(3):418-424. Epub 2020 Dec 17.

Schepens Eye Research Institute of Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. Electronic address:

Choroidal neovascularization (CNV) is a prevalent cause of vision loss in patients with age-related macular degeneration. Runt-related transcription factor 1 (RUNX1) has been identified as an important mediator of aberrant retinal angiogenesis in proliferative diabetic retinopathy and its modulation has proven to be effective in curbing pathologic angiogenesis in experimental oxygen-induced retinopathy. However, its role in CNV remains to be elucidated. This study demonstrates RUNX1 expression in critical cell types involved in a laser-induced model of CNV in mice. Furthermore, the preclinical efficacy of Ro5-3335, a small molecule inhibitor of RUNX1, in experimental CNV is reported. RUNX1 inhibitor Ro5-3335, aflibercept-an FDA-approved vascular endothelial growth factor (VEGF) inhibitor, or a combination of both, were administered by intravitreal injection immediately after laser injury. The CNV area of choroidal flatmounts was evaluated by immunostaining with isolectin B4, and vascular permeability was analyzed by fluorescein angiography. A single intravitreal injection of Ro5-3335 significantly decreased the CNV area 7 days after laser injury, and when combined with aflibercept, reduced vascular leakage more effectively than aflibercept alone. These data suggest that RUNX1 inhibition alone or in combination with anti-VEGF drugs may be a new therapy upon further clinical validation for patients with neovascular age-related macular degeneration.
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http://dx.doi.org/10.1016/j.ajpath.2020.12.005DOI Listing
March 2021

Topical delivery of a small molecule RUNX1 transcription factor inhibitor for the treatment of proliferative vitreoretinopathy.

Sci Rep 2020 11 30;10(1):20554. Epub 2020 Nov 30.

Schepens Eye Research Institute of Massachusetts Eye and Ear and the Department of Ophthalmology at Harvard Medical School, Boston, USA.

Proliferative vitreoretinopathy (PVR) is the leading cause of retinal detachment surgery failure. Despite significant advances in vitreoretinal surgery, it still remains without an effective prophylactic or therapeutic medical treatment. After ocular injury or retinal detachment, misplaced retinal cells undergo epithelial to mesenchymal transition (EMT) to form contractile membranes within the eye. We identified Runt-related transcription factor 1 (RUNX1) as a gene highly expressed in surgically-removed human PVR specimens. RUNX1 upregulation was a hallmark of EMT in primary cultures derived from human PVR membranes (C-PVR). The inhibition of RUNX1 reduced proliferation of human C-PVR cells in vitro, and curbed growth of freshly isolated human PVR membranes in an explant assay. We formulated Ro5-3335, a lipophilic small molecule RUNX1 inhibitor, into a nanoemulsion that when administered topically curbed the progression of disease in a novel rabbit model of mild PVR developed using C-PVR cells. Mass spectrometry analysis detected 2.67 ng/mL of Ro5-3335 within the vitreous cavity after treatment. This work shows a critical role for RUNX1 in PVR and supports the feasibility of targeting RUNX1 within the eye for the treatment of an EMT-mediated condition using a topical ophthalmic agent.
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http://dx.doi.org/10.1038/s41598-020-77254-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705016PMC
November 2020

Microvascular alterations in children with optic disk drusen evaluated by optical coherence tomography angiography.

Graefes Arch Clin Exp Ophthalmol 2021 Mar 15;259(3):769-776. Epub 2020 Oct 15.

Department of Ophthalmology, University Hospital Puerta de Hierro Majadahonda, Joaquin Rodrigo 1, 28222, Madrid, Spain.

Purpose: To asses changes in vessel density (VD) in children with optic disk drusen (ODD) using swept source optical coherence tomography angiography (OCTA).

Methods: Cross-sectional study of 27 eyes with ODD compared with age-matched controls. Peripapillary and macular VD were measured in the superficial retinal capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC). The correlation between VD changes with alterations in retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and visual field (VF) was analyzed.

Results: Mean participant age was 12.5 ± 3.3 years (range, 7-18 years); 63% was females. In the patients vs. controls, median central peripapillary VD was 52.9% vs. 50.6% (p = 0.63) for SCP; 48.1% vs. 53.8% (p = 0.017) for DCP; and 17.0% vs. 28.2% (p = 0.0037) for CC, respectively. VD in the superior and nasal CC layers was significantly lower in the patients (36.3% vs. 56.2%; p < 0.001) and (60.4% vs. 70.3%, p < 0.001), respectively. No significant differences were observed for VD in the macular region. The RNFL was thinner in eyes with superficial drusen versus controls (87 vs. 111 μm; p < 0.001). No significant differences between were observed in GCL thickness (p = 0.13). Nasal SCP and nasal RNFL VD were moderately correlated (r = 0.54, p < 0.01), while mean VF deviation was strongly correlated with median SCP VD in patients with superficial drusen (r = 0.9, p = 0.03).

Conclusion: Impaired VD was observed in the peripapillary nasal CC in patients with ODD; this impairment was associated with a decreased RNFL thickness. Nasal SCP VD and RNFL thickness were moderately correlated in patients with ODD.
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http://dx.doi.org/10.1007/s00417-020-04970-8DOI Listing
March 2021

Automatic Quantification Software for Geographic Atrophy Associated with Age-Related Macular Degeneration: A Validation Study.

J Ophthalmol 2020 5;2020:8204641. Epub 2020 Aug 5.

Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.

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). . Tertiary referral hospital in Spain. Cross-sectional and noninterventional. . 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. . 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.
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http://dx.doi.org/10.1155/2020/8204641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428960PMC
August 2020

Results of dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema patients: Early versus late switch.

Eur J Ophthalmol 2020 Jun 3:1120672120929960. Epub 2020 Jun 3.

Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.

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  = 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  < 0.0001 each, respectively. Best-corrected visual acuity improvement was significantly greater in both absolute and percentage values,  = 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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http://dx.doi.org/10.1177/1120672120929960DOI Listing
June 2020

Bimonthly, treat-and-extend and as-needed ranibizumab in naïve neovascular age-related macular degeneration patients: 12-month outcomes of a randomized study.

Acta Ophthalmol 2020 Nov 19;98(7):e820-e829. Epub 2020 Mar 19.

Department of Ophthalmology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.

Purpose: To assess the noninferiority of the treat-and-extend (T&E) and fixed bimonthly regimens of 0.5 mg intravitreal ranibizumab as compared with the pro re nata (PRN) in naïve patients with neovascular age-related macular degeneration (nAMD).

Methods: Phase IV, randomized, 12-month, multicentre trial. Patients aged ≥50 years with nAMD and visual impairment [best-corrected visual acuity (BCVA) between 23 and 78 Early Treatment Diabetic Retinopathy Study (ETDRS) letters] were eligible. Patients (one eye per patient) were randomized to bimonthly, n = 103, T&E, n = 99 or PRN, n = 104. Noninferiority was established at five letters ETDRS.

Results: The mean (95% CI) difference in BCVA at 12 months was 7.2 (4.2-10.2), 6.4 (2.9-9.8), and 8.0 (51.1-11.0) in the bimonthly, T&E and PRN, respectively. The bimonthly or T&E regimens were not inferior to the PRN scheme. All regimens were associated with a significant reduction of central subfield thickness and volume. The mean (95% CI) number of injections in the bimonthly regimen (7.6, 7.5-7.7) was similar as compared with the PRN regimen (7.4, 6.7-8.0) (p = 0.159) but lower than in the T&E regimen (9.3, 8.9-9.7) (p < 0.001).

Conclusion: At 12 months, bimonthly and T&E ranibizumab were noninferior to PRN in naïve nAMD.
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http://dx.doi.org/10.1111/aos.14399DOI Listing
November 2020

VALIDATION OF THE RECENTLY DEVELOPED ATN CLASSIFICATION AND GRADING SYSTEM FOR MYOPIC MACULOPATHY.

Retina 2020 Nov;40(11):2113-2118

Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.

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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http://dx.doi.org/10.1097/IAE.0000000000002725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575023PMC
November 2020

Analysis of Choroidal Vascularity Index in Keratoconus Patients Using Swept-Source Optical Coherence Tomography-Based Binarization Techniques.

J Ophthalmol 2020 8;2020:1682463. Epub 2020 Jan 8.

Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.

Purpose: To analyse the vascular density of the choroid in a keratoconus (KC) population using swept-source optical coherence tomography (SS-OCT).

Methods: Prospective, noninterventional study that analysed 97 eyes from 52 KC patients and 145 eyes from 89 healthy controls. The sample was divided in four different age groups. Inclusion criteria were topographic diagnosis of KC using Pentacam, axial length shorter than 26 mm, good quality of the images, and no other systemic or ocular diseases. A 12 mm horizontal single-line SS-OCT b-scan was performed to create a choroidal thickness (CT) profile. Validated automated segmentation and binarization were used in order to analyse choroidal, stromal, and vascular areas.

Results: The percentage of choroidal vascularity (vascular area/total area) was 56.6% in KC patients vs. 49.4% in controls. Aged-adjusted choroidal, stromal, and vascular areas and corrected choroidal percentage of vascularity are statistically increased in KC patients when compared with healthy controls ( < 0.001). All these parameters show a decreasing trend with age. Both stromal and vascular areas were thicker in KC patients ( < 0.001).

Conclusions: Choroidal, stromal, and vascular areas and corrected choroidal percentage of vascularity are statistically increased in KC patients when compared with healthy controls. All these parameters tend to decrease with age.
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http://dx.doi.org/10.1155/2020/1682463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984744PMC
January 2020

CHANGES IN CHORIOCAPILLARIS, SATTLER, AND HALLER LAYER THICKNESSES IN CENTRAL SEROUS CHORIORETINOPATHY AFTER HALF-FLUENCE PHOTODYNAMIC THERAPY.

Retina 2020 Dec;40(12):2373-2378

Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.

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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http://dx.doi.org/10.1097/IAE.0000000000002764DOI Listing
December 2020

Normative database and determinants of macular vessel density measured by optical coherence tomography angiography.

Clin Exp Ophthalmol 2020 01 16;48(1):44-52. Epub 2019 Oct 16.

Department of Ophthalmology, Centro Internacional de Oftalmología Avanzada, Madrid, Spain.

Importance: To provide a normative vessel density (VD) database for the macula through swept-source optical coherence tomography angiography (OCTA) and to assess the main determinants of this measurement.

Background: In contrast with dye angiography, the recently introduced OCTA technique allows for the non-invasive measurement of retinal and choroidal VD metrics.

Design: Cross-sectional study.

Participants: The right eyes of 346 healthy subjects were studied. In 105 subjects both eyes were imaged.

Methods: Foveal and parafoveal macular VD measurements were obtained in the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), and in the choriocapillaris (CC) layer. Also recorded were age, sex, axial length (AL), foveal and choroidal thickness (CT).

Main Outcome Measures: Normative database and determinants of macular VD measured by OCTA.

Results: Mean participant age was 38.3 ± 20.1 years (mean ± SD) (range 5-83). Foveal VDs in the different plexuses were: SCP 22.1% ± 5.0% (7.3-35.1), DCP 19.9% ± 6.3% (6.9-51.2) and CC: 52.8% ± 4.3% (40.2-62.1). Parafoveal VDs ranged from 45.4% ± 3.7% to 51.8% ± 4.6%. Positive correlation was observed between foveal VD and foveal thickness (R = .327), as well as between parafoveal DCP VD and CT (R = .250;P ≤ .006), while correlation with age was negative in the SCP and CC (R = -.283;P < .001). No associations were detected between macular VD and sex or AL (P ≥ .05).

Conclusion And Relevance: Macular VD showed wide individual variation, was positively correlated with foveal thickness and with CT, negatively correlated with age, and showed no correlation with AL or sex.
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http://dx.doi.org/10.1111/ceo.13648DOI Listing
January 2020

Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN).

Prog Retin Eye Res 2019 03 1;69:80-115. Epub 2018 Nov 1.

Red Temática de Investigación Cooperativa en Salud: "Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; Vissum Corporation, Spain. Electronic address:

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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http://dx.doi.org/10.1016/j.preteyeres.2018.10.005DOI Listing
March 2019

Intercalary membrane as the inner wall overlying optic and chorio-retinal colobomas. Deep penetration Swept Source-OCT study.

Indian J Ophthalmol 2018 07;66(7):1027-1030

Department of Ophthalmology, Castilla La Mancha University and Puerta de Hierro Majadahonda University Hospital; Department of Retina, VISSUM Corporation, Spain.

Five eyes of four patients were studied to analyze the structure of the inner wall of optic and chorioretinal colobomas using swept-source optical coherence tomography (SS-OCT). The colobomatous cavities and their relationship with adjacent structures were examined. SS-OCT permitted the study of the colobomatous cavities in all cases. In four of those cases, a Y-shaped intercalary membrane (ICM) was identified, with an origin in the retinal nerve fiber layer (RNFL), which covered the coloboma and in one case the coloboma was in contact with the vitreous cavity. Vitreous adhesion to the internal wall of the coloboma was found in three cases. No clinical or tomographic maculopathy was observed in any patient. High-resolution deep penetration SS-OCT allows in vivo study of optic and chorioretinal colobomas, identifying the RNFL as the main component of the ICM overlying the colobomatous cavities.
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http://dx.doi.org/10.4103/ijo.IJO_892_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032745PMC
July 2018

Macular Choroidal Thickening in Keratoconus Patients: Swept-Source Optical Coherence Tomography Study.

Transl Vis Sci Technol 2018 May 7;7(3):15. Epub 2018 Jun 7.

Castilla-La Mancha University, Albacete, Spain.

Purpose: To determine the choroidal thickness (CT) profile in keratoconus (KC) patients using swept-source optical coherence tomography (SS-OCT).

Methods: This was a prospective, cross-sectional study. One hundred two eyes of 52 KC patients were studied using Pentacam and SS-OCT. The macular CT profile was created by manually measuring the distance between the retinal pigment epithelium and the choroid-sclera junction on horizontal b-scans at nine different macular locations. The results were compared to 93 eyes of 93 healthy controls.

Results: Mean age of the KC group was 34.9 ± 13.5 years and mean axial length (AL) was 24.1 ± 1.3 mm. Mean topographic KC classification (TKC) was 2.0; 39 eyes were classified as early KC (TKC <1-2), 34 eyes as moderate (TKC 2, 2-3), and 29 as advanced (TKC 3+). Mean subfoveal CT was 383.2 μm in KC patients and 280.5 μm in control group ( < 0.001). CT in KC patients was statistically thicker in all measure locations ( < 0.001). CT in KC eyes decreased with age, approaching control group at >45 years old, losing statistical significance ( = 0.37).

Conclusions: CT in KC patients is statistically thicker than in healthy population. After age 45, CT decreases approaching control group values.

Translational Relevance: This study describes changes in the CT profile of KC patients, a disease that was considered purely corneal. These choroidal changes argue that KC is a disease that likely involves several ocular structures other than the cornea, and could open new research lines related to the pathophysiology of KC.
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http://dx.doi.org/10.1167/tvst.7.3.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991807PMC
May 2018

Comparison of choroidal vessel thickness in children and adult eyes by enhanced-depth imaging optical coherence tomography imaging.

Int J Ophthalmol 2018 18;11(4):681-686. Epub 2018 Apr 18.

Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad 500034, India.

Aim: To evaluate choroidal thickness, medium choroidal vessel thickness (MCVT) and large choroidal vessel thickness (LCVT) in normal children and adult subjects.

Methods: Manual measurements of subfoveal choroidal thickness (SFCT), MCVT and LCVT at subfoveal and 750 µm nasal and temporal to fovea locations were completed on enhanced-depth imaging optical coherence tomography (EDI-OCT) scans of normal children and adult subjects.

Results: Fifty adult and fifty-seven child subjects were included in the study (including 80 adult and 103 child eyes). Mean (±SD) SFCT of adult and children eyes in the study was 309.3±95.7 µm and 279.3±50.4 µm respectively. SFCT and subfoveal MCVT in adult eyes were significantly more than children (=0.01 and ≤0.0001 respectively).

Conclusion: There is choroidal thickening with associated thickening of medium choroidal vessels in adults, suggesting that there is alteration in choroidal vasculature with ageing.
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http://dx.doi.org/10.18240/ijo.2018.04.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902377PMC
April 2018

Early and intermediate age-related macular degeneration: update and clinical review.

Clin Interv Aging 2017 3;12:1579-1587. Epub 2017 Oct 3.

Red Telemática de Investigación Cooperativa Oftared, Instituto de Salud Carlos III, Madrid, Spain.

Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in developed countries. With the aging of population, AMD will become globally an increasingly important and prevalent disease worldwide. It is a complex disease whose etiology is associated with both genetic and environmental risk factors. An extensive decline in the quality of life and progressive need of daily living assistance resulting from AMD among those most severely affected highlights the essential role of preventive strategies, particularly advising patients to quit smoking. In addition, maintaining a healthy diet, controlling other risk factors (such as hypertension, obesity, and atherosclerosis), and the use of nutritional supplements (antioxidants) are recommendable. Genetic testing may be especially important in patients with a family history of AMD. Recently, unifying criteria for the clinical classification of AMD, defining no apparent aging changes; normal aging changes; and early, intermediate, and late AMD stages, are of value in predicting AMD risk of progression and in establishing recommendations for the diagnosis, therapeutic approach, and follow-up of patients. The present review is focused on early and intermediate AMD and presents a description of the clinical characteristics and ophthalmological findings for these stages, together with algorithms for the diagnosis and management of patients, which are easily applicable in daily clinical practice.
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http://dx.doi.org/10.2147/CIA.S142685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633280PMC
April 2018

Structure versus function: correlation between outer retinal and choroidal thicknesses measured by swept-source OCT with multifocal electroretinography and visual acuity.

Int J Retina Vitreous 2017 7;3:29. Epub 2017 Aug 7.

Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona Spain.

Background: To correlate retina-choroidal anatomy as assessed via swept-source OCT (SS-OCT) with retinal function as determined by best-corrected visual acuity (BCVA) and multifocal electroretinogram (mfERG).

Methods: Thirty-three eyes from 33 patients including 16 with neovascular AMD (nvAMD) and 17 controls were included. Patients were included in the present study after a complete ophthalmologic examination, including BCVA, slit-lamp study, intraocular pressure measurement, dilated fundus examination after tropicamide instillation, SD-OCT, SS-OCT, fundus photographs and mfERG. Age, sex, BCVA, number of anti-VEGF intravitreal injections in the nvAMD group, were recollected. Outer retinal and choroidal thickness were determined at the fovea and 500 μm temporal, superior, nasal and inferior. First-order response from mfERG was collected. P1 amplitude was recorded in R1, R2 and the average of R1 + R2. The measurements recollected from the SS-OCT, mfERG and BCVA were compared.

Results: Better BCVA was found with thicker outer retina foveal thickness (r = 0.349;  = 0.047), with thicker subfoveal choroidal thickness (r = 0.443;  = 0.010), and with higher amplitude in P1 at R1 (r = 0.346;  = 0.037). Outer retina foveal thickness did not correlate with P1 amplitude at R1 (r = 0.072;  = 0.692), R2 (r = 0.265;  = 0.137) either with the average P1 amplitude at R1 + R2 (r = 0.253;  = 0.156). A thicker subfoveal choroidal thickness was related with higher amplitude in P1 at R1 (r = 0.383;  = 0.028), R2 (r = 0.409;  = 0.018) and the average of R1 + R2 (r = 0.419;  = 0.015).

Conclusions: Choroidal thickness demonstrated a positive correlation with retinal function in the sample studied, so a thicker choroid is related to a better retinal function measured with mfERG and BCVA.
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http://dx.doi.org/10.1186/s40942-017-0082-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545836PMC
August 2017

ACUTE RETINAL DAMAGE AFTER USING A TOXIC PERFLUORO-OCTANE FOR VITREO-RETINAL SURGERY.

Retina 2017 Jun;37(6):1140-1151

*Institute of Applied Ophthalmobiology (IOBA), Eye Institute, University of Valladolid, Valladolid, Spain; †University Clinic Hospital of Valladolid, Valladolid, Spain; ‡Thematic Cooperative Health Network for Research in Ophthalmology (Oftared), Carlos III Health Institute, Madrid, Spain; §Crystallography and Mineralogy Department, University of Valladolid, Valladolid, Spain; ¶Cell Biology Department, University of Valladolid, Valladolid, Spain; **Toxicology Department, University of Valladolid, Valladolid, Spain; ††Vision I+D, Valladolid, Spain; ‡‡Miguel Servet Hospital, Zaragoza, Spain; §§Donostia Hospital, San Sebastian, Spain; ¶¶Canaries University Hospital, Canarias, Spain; ***Castille-La Mancha University, Albacete, Spain; and †††Regenerative Medicine Network and Cell Therapy Center, Valladolid, Spain.

Purpose: To describe a series of retinal acute toxicity cases with severe visual loss after intraocular use of a toxic perfluoro-octane (PFO). The clinical presentation is described, and the likely causes are analyzed. New biological methods for testing safety of intraocular medical devices are proposed.

Methods: Information regarding a series of eyes suffering acute severe events after intraocular use of a toxic PFO was analyzed. Four types of spectroscopy, nuclear magnetic resonance, and chromatography were used to identify the potential PFO contaminants. Cultures of human retinal pigment epithelial cells (ARPE-19) and porcine neuroretina were used to quantify the toxicity of the suspect PFO lots.

Results: Of 117 cases of intraocular toxicity, 96 were considered clearly related to the use of PFO. Fifty-three cases had no light perception, and 97 had no measurable visual acuity. Retinal necrosis (n = 38) and vascular occlusion (n = 33) were the most characteristic findings. Two hydroxyl compounds, perfluorooctanoic acid and dodecafluoro-1-heptanol, and benzene derivatives were identified as the suspected toxic agents. While existing toxicity testing failed, we proposed new tests that demonstrated clear toxicity.

Conclusion: Protocols to determine cytotoxicity of intraocular medical devices should be revised to assure safety. Acute toxic events should be reported to health authorities and scientific media.
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http://dx.doi.org/10.1097/IAE.0000000000001680DOI Listing
June 2017

AGE-RELATED CHANGES IN CHOROIDAL VASCULAR DENSITY OF HEALTHY SUBJECTS BASED ON IMAGE BINARIZATION OF SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

Retina 2018 Mar;38(3):508-515

Smt. Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, Hyderabad, India.

Purpose: To analyze the vascular density of the choroid in a healthy population using swept-source optical coherence tomography.

Methods: A cross-sectional, noninterventional study.

Inclusion Criteria: best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, no systemic or ocular diseases, and ages ranging between 3 and 85 years. One hundred and thirty-six eyes from 136 subjects were analyzed, 86 eyes (63.2%) were from male and 50 eyes (36.8%) from female subjects. The eyes were divided into different age groups to analyze the possible age-related changes. Twelve-millimeter horizontal, fovea-centered B-scans were used. Choroidal stroma and vessel area analysis involved automated segmentation and binarization using validated algorithms.

Results: Mean age was 33.1 ± 24.5 years. Mean choroidal area was 0.5554 ± 0.1377 mm. Mean stromal area was 0.2524 ± 0.0762 mm, and mean vascular region area was 0.3029 ± 0.0893 mm. The percentage of choroidal vascularity (vascular area/total area) was 54.40 ± 8.35%. Choroid area, vascular region, and percentage of choroidal vascular density were statistically higher in the <18-year-old group versus the >18-year-old group (P < 0.001). The stromal region was not different (P = 0.46). In the same way, choroid area, vascular region, and percentage of choroidal vascular density between the 5 age groups were statistically different (P < 0.001), showing larger figures in the 0 to 10-year-old group, but not stromal region (P = 0.71). There were no gender-related differences.

Conclusion: The luminal area and the percentage of vascular/total area decrease with increasing age, while the stromal area remains stable.
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http://dx.doi.org/10.1097/IAE.0000000000001571DOI Listing
March 2018

ANALYSIS OF AGE-RELATED CHOROIDAL LAYERS THINNING IN HEALTHY EYES USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

Retina 2017 Jul;37(7):1305-1313

*Ophthalmology Unit, Clínico San Carlos University Hospital, Madrid, Spain; †Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; ‡Ophthalmology Unit, Pío del Río Hortega University Hospital, Valladolid, Spain; §New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and ¶Insituto Europeo de la Retina (IER) Baviera, Spain.

Purpose: To study the changes in the choroidal layers thickness with age in a healthy population using swept-source optical coherence tomography.

Methods: Retrospective data analysis of a subgroup of eyes from a previous single-center, prospective, cross-sectional, noninterventional study. One hundred and sixty-nine healthy eyes were evaluated using swept-source optical coherence tomography. Inclusion criteria were best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, and no systemic or ocular diseases. Two independent investigators determined the macular horizontal choroidal thickness (CT) and the Haller's layer thickness across a 9 mm line centered at the fovea. Subjects were divided into five age groups.

Results: Mean subfoveal choroidal thickness was 305.76 ± 80.59 μm (95% confidence interval: 294.85-319.33). Mean subfoveal thickness for Haller's layer was 215.47 ± 67.70 μm (95% confidence interval: 207.30-227.86) and mean subfoveal thickness for choriocapillaris plus Sattler's layer was 87.31 ± 40.40 μm (95% confidence interval: 83.38-95.65). No significant differences were found due to gender. Choroidal thickness profile was similar between groups with choroidal thickness and Haller's layer thickness decreasing with age (P = 0.002).

Conclusion: Choroidal and Haller's layer thickness profiles are similar between different age groups. Age-related choroidal thinning is mostly at the expense of Haller's layer.
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http://dx.doi.org/10.1097/IAE.0000000000001347DOI Listing
July 2017

Ranibizumab in monotherapy and combined with photodynamic therapy for retinal angiomatous proliferation.

Clin Ophthalmol 2016 17;10:861-9. Epub 2016 May 17.

Spanish Vitreoretinal Society (SERV), C/Xosé Chao Rego, Santiago de Compostela, Spain; RETICS OFTARED, Institute of Health Carlos III, C/Sinesio Delgado, Madrid, Spain; Department of Ophthalmology, Albacete University Hospital, Avenida de Almansa s/n, Albacete, Spain.

Purpose: To compare the effects of intravitreal ranibizumab in monotherapy (group A) and combined with photodynamic therapy (PDT) with verteporfin (group B) in retinal angiomatous proliferation (RAP) treatment.

Methods: This was a multicentric, prospective, randomized clinical study conducted with parallel groups. The study eye in both groups received ranibizumab on days 1, 30, and 60 (loading dose); group B received PDT additionally on day 1. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) testing and optical coherence tomography were performed monthly, and fluorescein angiography and indocyanine green angiography were performed quarterly. Retreatment criteria were leakage in fluorescein angiography or indocyanine green angiography, mean foveal thickness increase ≥100 µm, or VA decrease ≥5 letters.

Results: Twenty patients were recruited (ten patients in each group). Six eyes had previous treatment (three eyes in group A and three eyes in group B), so only 14 eyes were naïve. At 12-month follow-up, mean VA improved +1.5 letters in group A and +5.6 letters in group B (analysis of variance test; P>0.05). Two patients (20%) in both groups gained ≥15 letters (chi-square test; P>0.05). Mean changes in greatest linear dimension and in foveal thickness were not statistically significant between groups of treatment (analysis of variance test; P>0.05). Mean retreatments per patient were 1.8 (group A) and 0.9 (group B) (Mann-Whitney U-test; P>0.05). One patient died due to underlying disease not related to study medication.

Conclusion: Intravitreal ranibizumab administered in monotherapy or combined with PDT was efficacious in terms of VA stabilization in patients with RAP.
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http://dx.doi.org/10.2147/OPTH.S106092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876105PMC
June 2016

Reply.

Retina 2016 Jun;36(6):e51

*Department of Ophthalmology Castilla La Mancha University Albacete and Baviera European Retina Institute Alicante, Spain †Ophthalmology Unit Río Hortega University Hospital Valladolid and Retina Unit Oftalvist Madrid, Spain.

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http://dx.doi.org/10.1097/IAE.0000000000001079DOI Listing
June 2016

Detection of subclinical keratoconus through non-contact tonometry and the use of discriminant biomechanical functions.

J Biomech 2016 Feb 29;49(3):353-63. Epub 2015 Dec 29.

Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain.

The purpose of the present study was to develop a discriminant function departing from the biomechanical parameters provided by a non-contact tonometer (Corvis-ST, Oculus Optikgeräte, Wetzlar, Germany) to distinguish subclinical keratoconus from normal eyes. 212 eyes (120 patients) were divided in two groups: 184 healthy eyes of 92 patients aged 32.99 ± 7.85 (21-73 years) and 28 eyes of 28 patients aged 37.79 ± 14.21 (17-75 years) with subclinical keratoconus. The main outcome measures were age, sex, intraocular pressure (IOP), corneal central thickness (CCT) and other specific biomechanical parameters provided by the tonometer. Correlations between all biomechanical parameters and the rest of variables were evaluated. The biomechanical measures were corrected in IOP and CCT (since these variable are not directly related with the corneal structure and biomechanical behavior) to warrant an accurate comparison between both types of eyes. Two discriminant functions were created from the set of corrected variables. The best discriminant function created depended on three parameters: maximum Deformation Amplitude (corrected in IOP and CCT), First Applanation time (corrected in CCT) and CCT. Statistically significant differences were found between groups for this function (p=2·10(-10); Mann-Withney test). The area under the Receiving Operating Characteristic was 0.893 ± 0.028 (95% confidence interval 0.838-0.949). Sensitivity and specificity were 85.7% and 82.07% respectively. These results show that the use of biomechanical parameters provided by non-contact tonometry, previous normalization, combined with the theory of discriminant functions is a useful tool for the detection of subclinical keratoconus.
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http://dx.doi.org/10.1016/j.jbiomech.2015.12.031DOI Listing
February 2016

Reply.

Retina 2016 Jan;36(1):e4-5

*Department of Ophthalmology, Ramon y Cajal Hospital, Madrid, Spain and Vissum Madrid, Spain †Department of Ophthalmology, Ramon y Cajal Hospital, Madrid, Spain ‡Vissum Alicante, Alicante, Spain §Department of Ophthalmology, Hospital General La Mancha Centro, Ciudad Real, Spain.

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http://dx.doi.org/10.1097/IAE.0000000000000915DOI Listing
January 2016

Treatment of Exudative Age-related Macular Degeneration: Focus on Aflibercept.

Drugs Aging 2015 Oct;32(10):797-807

Department of Ophthalmology, Clinica Universidad de Navarra, Pio XII 36, 31080, Pamplona, Navarra, Spain.

A formulation of aflibercept for intravitreal injection (Eylea) is approved for the treatment of patients with exudative age-related macular degeneration (AMD). Aflibercept has a significantly higher affinity for Vascular endothelial growth factor (VEGF)-A compared with other monoclonal anti-VEGF antibodies. In addition to binding all VEGF-A isoforms, aflibercept also blocks other proangiogenic factors such as VEGF-B and placental growth factor. The VIEW 1 and 2 trials showed this drug achieves improved results in patients with exudative AMD similar to those obtained with monthly ranibizumab, using a bimonthly treatment regimen after a loading dose of three intravitreal injections, which translates to less use of healthcare resources. There is a subgroup of patients that present with persistent fluid after the loading dose that could benefit from monthly injections or personalized proactive treatment after the first year. In the second year of treatment, the Treat and Extend patterns can permit even more lengthening of the time between injections. More data are needed to confirm the optimal monitoring and retreatment dosing, to maintain long-term efficacy. Other preliminary data suggest that patients that do not respond to other anti-angiogenics and patients with special pathologies such as polypoidal choroidopathy or retinal angiomatous proliferation can improve upon switching to aflibercept. To date, the safety profile of aflibercept is excellent and is comparable to other anti-angiogenic treatments.
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http://dx.doi.org/10.1007/s40266-015-0300-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607716PMC
October 2015

En face mode of swept-source optical coherence tomography in circumscribed choroidal haemangioma.

Br J Ophthalmol 2016 Mar 23;100(3):360-4. Epub 2015 Jul 23.

Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain.

Purpose: To describe the findings in circumscribed choroidal haemangioma (CCH) using en face swept-source optical coherence tomography (SS-OCT).

Methods: En face images were obtained employing DRI-1 Atlantis OCT (Topcon, Tokyo, Japan), using a three-dimensional volumetric scan of 12×9 mm. Images were obtained from the retinal pigment epithelium to 1000 μm in depth of the tumour.

Results: Twenty-two eyes from 22 patients with the clinical diagnosis of CCH were included. In 20 eyes (90.9%), a characteristic pattern was visualised in the en face image across the vascular tumour. A multilobular pattern, similar to a honeycomb, with hyporeflective, confluent, oval or round areas corresponding with the lumen of the tumour vascular spaces, and hyper-reflective zones, which may represent the vessels walls and connective tissue of the tumour. Ten eyes (45.4%) showed a hyper-reflective halo surrounding the tumour. Seventeen tumours (77.2%) showed small diameter vessels at the inner zone and larger vessels in the outer area. Twelve patients (54.5%) had previously received treatment (photodynamic therapy, transpupillary thermotherapy, dexamethasone intravitreal implant or brachytherapy with ruthenium-106). No differences were found between treated and untreated patients in any of the measured parameters.

Conclusions: En face SS-OCT is a rapid, non-invasive, high-resolution, technology, which allows a complementary study to cross-sectional scans in CCH. A characteristic multilobular pattern, with a hyper-reflective halo surrounding the tumour, was found in en face SS-OCT images. No morphological differences were found between naïve patients and patients who received previous treatment.
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http://dx.doi.org/10.1136/bjophthalmol-2015-307099DOI Listing
March 2016

INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR CHOROIDAL NEOVASCULARIZATION SECONDARY TO PATHOLOGIC MYOPIA: SIX YEARS OUTCOME.

Retina 2015 Dec;35(12):2450-6

*Department of Ophthalmology, Castilla La Mancha University, Albacete and Baviera European Institute of Retina, Alicante, Spain; †Pío del Río Hortega University Hospital, Department of Ophthalmology, Valladolid and Oftalvist, Retina Unit, Madrid, Spain; ‡University of the Basque Country (Surgical-Clinical Institute of Ophthalmology) and San Eloy Hospital, Bilbao, Spain; §Bellvitge University Hospital, Department of Ophthalmology, Barcelona, Spain; ¶Navarra University Hospital, Department of Ophthalmology, Pamplona, Spain; **Department of Sense Organs of Faculty of Medicine of University of Porto and Department of Ophthalmology of Hospital of São João, Porto, Portugal; and ††Faculty of Medicine University of Coimbra (FMUC), Coimbra Hospital and University Centre (CHUC) and Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal.

Purpose: To report the visual outcome after 6-year follow-up in highly myopic eyes with choroidal neovascularization treated with anti-vascular endothelial growth factor drugs.

Methods: Retrospective, nonrandomized, multicenter, consecutive, and interventional case series.

Results: Seventy-eight patients were treated with intravitreal bevacizumab and 19 with ranibizumab. Mean age of the patients was 56.5 years (SD, 13.3). The average number of letters read was 56.7 (SD, 19.0) at baseline; 65.7 (SD, 18.4) at 12 months; 63.6 (SD, 20.6) at 24 months; 62.4 (SD, 21.4) at 36 months; 60.6 (SD, 22.0) at 48 months; 58.9 (SD, 22.9) at 60 months, and 58.4 (SD, 22.7) at 72 months (P < 0.01, between initial vs. 12, 24, and 36 months; P = 0.07, 0.3, and 0.5 between initial vs. 48, 60, and 72 months, respectively; Student's t-test paired data). The mean total number of intravitreal injections was 3.3 (SD, 2.3; range, 1-9).

Conclusion: Bevacizumab and ranibizumab are effective therapies and show similar clinical effects in myopic eyes with choroidal neovascularization. Visual acuity gain is maintained at a 3-year follow-up. The improvement is no longer statistically significant at Years 4, 5, and 6.
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http://dx.doi.org/10.1097/IAE.0000000000000632DOI Listing
December 2015

Morphologic features of the choroidoscleral interface in a healthy population using swept-source optical coherence tomography.

Am J Ophthalmol 2015 Sep 2;160(3):596-601.e1. Epub 2015 Jun 2.

Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; Insituto Europeo de la Retina (IER), Baviera, Spain.

Objective: To analyze the morphologic features of the choroidoscleral interface in a healthy population using swept-source optical coherence tomography (SS OCT).

Design: Retrospective data analysis of a subgroup of eyes from a previous single-center, prospective, cross-sectional, noninterventional study.

Methods: A total of 276 healthy eyes from 154 subjects were evaluated using SS OCT. Inclusion criteria were best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, and no systemic or ocular diseases. Two independent investigators analyzed the morphologic features of the choroidoscleral interface in a masked fashion, classifying the contour and shape as concave (bowl-shaped) or inflective (S-shaped contour with ≥1 inflection point).

Results: The presence of a temporal choroidoscleral interface inflection was identified in 12.8% of the eyes. The mean choroidal thickness was 372.1 ± 76.8 μm and the average distance from the inflection point to the fovea was 4427.3 ± 627.9 μm. Nine patients showed an inflective profile in both eyes. No changes in the retinal profile were found in any of these cases. The mean age of the patients with an inflective profile was 16 ± 19 years (range 4-82) vs 36 ± 25 years (range 3-95) in the group with a concave contour (P = .001). The temporal choroidal thickness at 4000 and 5000 μm from the fovea was thicker in the group with a concave contour.

Conclusions: Temporal choroidoscleral interface inflection or S-shaped profile of the choroidoscleral interface with focal thinning of the choroid can be considered a normal variation without clinical significance, especially in younger populations.
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http://dx.doi.org/10.1016/j.ajo.2015.05.027DOI Listing
September 2015

BAX and BCL-2 polymorphisms, as predictors of proliferative vitreoretinopathy development in patients suffering retinal detachment: the Retina 4 project.

Acta Ophthalmol 2015 Nov 19;93(7):e541-9. Epub 2015 May 19.

Instituto de Oftalmobiología Aplicada (IOBA-Retina Group), University of Valladolid, Valladolid, Spain.

Purpose: To compare the distribution of BCL-2 -938C>A (rs2279115) and BAX -248G>A (rs4645878) genotypes among European subjects undergoing rhegmatogenous retinal detachment (RRD) surgery in relation to the further development of proliferative vitreoretinopathy (PVR).

Methods: A case-control gene association study, as a part of Retina 4 project, was designed. rs2279115 and rs4645878 polymorphisms were analysed in 555 samples from patients with RRD (134 with PVR secondary to surgery). Proportions of genotypes and AA homozygous groups of BCL-2 and BAX polymorphisms between subsamples were analysed in two phases. Genotypic and allelic frequencies were compared in global sample and in subsamples.

Results: BAX: Differences were observed in the genotype frequencies and in AA carriers between controls and cases in the global series. The odds ratio (OR) of A carriers in the global sample was 1.7 (95% CI: 1.23-2.51). Proportions of genotypes in Spain + Portugal were significant different. The OR of A carriers from Spain and Portugal was 1.8 (95% CI: 1.11-2.95). BCL-2: No significant differences were observed in genotype frequencies. However, proportions of genotypes in Spain + Portugal were significant. A protective effect (OR: 0.6 95% CI: 0.43-0.96) was found in A carriers from Spain and Portugal.

Conclusions: Results suggest that A allele of rs4645878 could be a biomarker of high risk of developing PVR in patients undergoing RD surgery. The possible role of BCL-2 (inhibitor of necroptosis pathway) as a possible new target in PVR prophylaxis should be investigated.
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http://dx.doi.org/10.1111/aos.12718DOI Listing
November 2015

LONG-TERM OUTCOMES OF 23-GAUGE PARS PLANA VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING AND GAS TAMPONADE FOR MYOPIC TRACTION MACULOPATHY: A Prospective Study.

Retina 2015 Sep;35(9):1836-43

*Department of Ophthalmology, Hospital Universitario Ramón y Cajal, Madrid, Spain; †Vissum Madrid, Madrid, Spain; ‡Vissum Alicante, Alicante, Spain; and §Department of Ophthalmology, Hospital General La Mancha Centro, Ciudad Real, Spain.

Purpose: To investigate the long-term safety and efficacy of microincisional 23-gauge pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic traction maculopathy.

Methods: A prospective nonrandomized multicenter study was designed. Patients with myopic traction maculopathy without macular hole and retinal detachment were included in the study between January 2009 and May 2012. All patients underwent microincisional 23-gauge pars plana vitrectomy with ILM peeling and 12% C3F8 gas tamponade. In all cases, brilliant blue G staining of the ILM was performed. All patients were prospectively evaluated. The evolution of best-corrected visual acuity (BCVA) and macular thickness were recorded.

Results: Myopic traction maculopathy resolved in 28 of the 30 patients (93%) included. Mean follow-up was 33.8 ± 13 months (range, 24-60 months). Mean time of myopic traction maculopathy resolution after surgery was 2.65 ± 1.4 months. At 1 month after surgery, one patient developed a macular hole and another one a rhegmatogenous retinal detachment. After 2 years, another patient developed a retinal detachment. Statistically significant improvements in macular thickness compared with baseline were found at all follow-up visits (P < 0.001, Student's t-test). At final visit, BCVA improved significantly compared with baseline (P = 0.044, Wilcoxon's test). However, a statistically significant improvement in visual acuity was achieved only in eyes with a preoperative Snellen visual acuity ≥ 20/63 (P = 0.027). In contrast, the final BCVA of eyes with worse preoperative visual acuity (<20/63) did not improve significantly (P = 0.41, Wilcoxon's test).

Conclusion: Microincisional 23-gauge pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic traction maculopathy, with low postoperative complications. Globally, both BCVA and macular thickness improved significantly during the follow-up period. However, greater visual acuity improvements were only seen in eyes with preoperative BCVA equal to or better than 20/63 Snellen equivalent. Some concerns remain about the risk of macular hole formation after ILM peeling. Further studies are necessary to investigate this issue.
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http://dx.doi.org/10.1097/IAE.0000000000000554DOI Listing
September 2015