Publications by authors named "Juan Donate-Lopez"

22 Publications

  • Page 1 of 1

Goldmann-Favre/Enhanced S Cone Syndrome, 30 years mysdiagnosed as gyrate atrophy.

Am J Ophthalmol Case Rep 2021 Mar 4;21:101028. Epub 2021 Feb 4.

Department of Ophthalmology, Hospital Clínico San Carlos, Madrid, Spain.

Purpose: Case report of a Goldmann-Favre/Enhanced S Cone syndrome (GFS/ESCS) misdiagnosed for 30 years.

Observations: Clinical case, the patient had been experiencing with poor nocturnal visual acuity since childhood. The fundus examination showed extensive areas of peripheral chorioretinal atrophy with posterior demarcation borders, and a clinical diagnosis of gyrate atrophy was established, although normal levels of ornithine should have made this diagnosis doubtful. 30 years later it was reassessed with electrophysiologic and genetic studies and diagnosed as Goldman-Favre/Enhanced S Cone Syndrome (GFS/ESCS).

Conclusions And Importance: High phenotypic variability of GFS/ESCS makes it difficult to distinguish clinically from diseases such as retinitis pigmentosa, congenital retinoschisis, and gyrate atrophy. Electrophysiology and genetic studies aid in diagnosis. GFS/ESCS is a clinical diagnosis and should be suspected before molecular test. We present a novel mutation for this disease.
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http://dx.doi.org/10.1016/j.ajoc.2021.101028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876538PMC
March 2021

Reduced retinal vessel density in COVID-19 patients and elevated D-dimer levels during the acute phase of the infection.

Med Clin (Barc) 2021 Jan 28. Epub 2021 Jan 28.

Profesor y jefe de servicio de Oftalmología, Hospital Clínico San Carlos; Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain.

Purpose: To describe macular vessel density and perfusion in COVID-19 patients using coherence tomography angiography (OCTA) and to investigate whether there is a correlation between retinal vascular abnormalities and clinical and laboratory parameters.

Methods: Cross-sectional analysis conducted at the Hospital Clinico San Carlos in Madrid, Spain. Patients with laboratory-confirmed COVID-19 that were attended in the Emergency Department (ED) from March 23 to March 29, 2020 were included. Fundus examination and OCTA were performed 4 weeks after being attended in ED. Macular OCTA parameters were analyzed and correlated with clinical (severity and hypoxemia- oxygen saturation<92%) and laboratory parameters during hospital stay (D-Dimer-DD, lactate dehydrogenase-LDH and C-reactive protein-CRP).

Results: 80 patients were included, mean age 55(SD9) years old; 46.3% male. We reported macular vessel density and perfusion measurements in COVID-19 patients. Those patients with D-Dimer≥500ng/ml during SARS-CoV-2 infection had a decrease of central vessel density (mean difference 2.2; 95%CI 0.4-3.9) and perfusion density (mean difference 4.9; 95%CI 0.9-8.9) after the acute phase of COVID-19. These variations of vessel density and perfusion density were not documented in patients with LDH≥500U/L, CRP≥10mg/L and hypoxemia.

Conclusions: COVID-19 patients showed short-term retinal vasculature abnormalities which may be related to a prothrombotic state associated with SARS-CoV-2 infection. Since the retinal microvasculature shares many morphological and physiological properties with the vasculature of other vital organs, further research is needed to establish whether patients with increased D-Dimer levels require more careful assessment and follow-up after COVID-19.
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http://dx.doi.org/10.1016/j.medcli.2020.12.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843095PMC
January 2021

Bilateral retinal vein occlusion and diabetic retinopathy after COVID-19.

Acta Ophthalmol 2020 Dec 23. Epub 2020 Dec 23.

Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.

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http://dx.doi.org/10.1111/aos.14718DOI Listing
December 2020

Retinal findings in COVID-19 patients with diabetes mellitus.

Diabetes Res Clin Pract 2020 10 29;168:108395. Epub 2020 Aug 29.

Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IsISSC), IIORC, Universidad Complutense, Spain.

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http://dx.doi.org/10.1016/j.diabres.2020.108395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455526PMC
October 2020

Evaluation of retinotoxicity of COVID-19 treatment: Hydroxychloroquine and lopinavir/ritonavir.

J Med Virol 2021 02 28;93(2):644-646. Epub 2020 Sep 28.

Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IsISSC), IIORC, Universidad Complutense, Madrid, Spain.

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http://dx.doi.org/10.1002/jmv.26420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436687PMC
February 2021

Optic nerve analysis in COVID-19 patients.

J Med Virol 2021 01 19;93(1):190-191. Epub 2020 Jul 19.

Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IsISSC), IIORC, Universidad Complutense, Madrid, Spain.

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http://dx.doi.org/10.1002/jmv.26290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404849PMC
January 2021

Atypical perifoveal exudative vascular anomalous complex (PEVAC) with multifocal and bilateral presentation.

Am J Ophthalmol Case Rep 2020 Jun 21;18:100717. Epub 2020 Apr 21.

Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.

Purpose: To report an unusual case of multifocal and bilateral perifoveal exudative vascular anomalous complex (PEVAC) lesions in an otherwise healthy patient.

Observations: A 62-year-old male with complaints of long-term progressive blurred vision in both eyes. There was no history of diabetes, arterial hypertension or inflammatory disease. Best-corrected visual acuity was 75 and 80 letters in his right eye (OD) and left eye (OS) respectively. Fundus examination showed three perifoveal isolated large aneurysmal lesions in his OD and an additional one in his OS, associated with smaller microaneurysms, haemorrhages and intraretinal exudation. On optical coherence tomography PEVAC appeared as a round lesions with a hyperreflective wall and lumen containing variably reflective material, typically surrounded by intraretinal fluid. Dye-based angiography demonstrated three and one well-defined large hyperfluorescent aneurysmal lesions in his OD and OS respectively, with no leakage. The optical coherence tomography angiography images showed flow signal within the intraretinal aneurysmal lesions. No anomalous flow signal in the outer retina and choriocapillaris was present. After one bilateral anti-vascular endothelial growth factor intravitreal injection no anatomical or functional improvement was observed, and no changes in the lesions or visual acuity were observed at 6 months follow-up.

Conclusions And Importance: We describe an atypical case of PEVAC, an uncommon and poorly known macular disorder, with bilateral presentation and multifocal lesions in one eye. To our knowledge, this is the first reported case of bilateral PEVAC lesions. Hence, PEVAC should be included in the differential diagnosis of bilateral perifoveal aneurysmal lesions with macular edema.
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http://dx.doi.org/10.1016/j.ajoc.2020.100717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184128PMC
June 2020

Dexamethasone intravitreal implant in cystoid macular edema secondary to paclitaxel therapy.

Am J Ophthalmol Case Rep 2020 Jun 7;18:100653. Epub 2020 Mar 7.

Ophthalmology Department, Hospital Clinico San Carlos, Madrid, Spain.

Purpose: To report the first case of cystoid macular edema (CME) induced by nabpaclitaxel treated with intravitreal dexamethasone implant.

Observations: A 67 year-old man diagnosed with unresectable pancreatic cancer presented with decreased vision in both eyes while receiving nab-paclitaxel. He was diagnosed with CME and intravitreal dexamethasone implants were administered in both eyes. Central retinal thickness (CRT) of both eye decreased 1 month after the implant but CME persisted. 2 months after Ozurdex implant nabpaclitaxel was discontinued, improving central macular thickness and the CME significantly in both eyes.

Conclusion And Importance: Cessation of nab-paclitaxel could lead to resolution of CME more than intravitreal dexamethasone implant, although intravitreal dexamethasone implant achieved some reduction in central macular thickness.
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http://dx.doi.org/10.1016/j.ajoc.2020.100653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068047PMC
June 2020

Susac's syndrome: an update.

Br J Ophthalmol 2020 09 6;104(9):1190-1195. Epub 2020 Feb 6.

Asociados de Macula Vitreo y Retina de Costa Rica, San Jose, Costa Rica

Susac's syndrome (SS) is a relatively rare cause of multiple recurrent branch retinal arterial occlusions (BRAO). SS is frequently misdiagnosed and probably underdiagnosed. Ophthalmic manifestations may be the sole presenting sign of SS. Comprehensive literature review The typical triad of encephalopathy, sensorineural hearing loss and multiple recurrent BRAO is seldom seen at presentation in SS. The characteristic ophthalmological feature in SS is the presence of recurrent multiple BRAO in the absence of intraocular inflammation. Yellow to yellow-white, non-refractile or refractile retinal arterial wall plaques (Gass plaques) found at midarteriolar segments not associated to bifurcations are commonly found in SS. Because of its ability to capture more peripheral retinal area, ultrawide field fluorescein angiography (FA) has definite advantages over conventional FA and its use should be encouraged in patients suspected of having SS. Optical coherence tomography (OCT), particularly spectral domain OCT complements FA. Patients with BRAO and hearing loss that do not develop encephalopathy during the initial 2 years will most likely not develop encephalopathy. However, these patients will be prone to recurrent BRAO and hearing loss. Imunosuppression is the cornerstone of treatment but the best regimen still needs to be defined. A minority of patients with SS present with the typical triad. A high index of suspicion is needed to make the diagnosis promptly. Early diagnosis and treatment are important to delay disease progression and prevent blindness, deafness and dementia.
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http://dx.doi.org/10.1136/bjophthalmol-2019-315597DOI Listing
September 2020

Evaluation of leakage resistance improvement in transconjunctival sutureless vitrectomy sclerotomies closed with adhesives. an experimental study.

Eye (Lond) 2020 07 4;34(7):1229-1234. Epub 2019 Nov 4.

Ophthalmology Department, Hospital Universitario "Príncipe de Asturias". Alcalá de Henares, Madrid, Spain.

Background: The purpose of this paper is to study the utility of adhesives (artificial-cyanoacrylate and biological-fibrin glue) for improving transconjunctival sutureless vitrectomy (TSV) sclerotomy closure competency.

Methods: Experimental and observer-masked study in which after performing TSV in cadaveric pig eyes, different adhesives were tested on sclerotomy entrances in order to determine if they improved closure competency in face of progressive intraocular pressure increase. In 76 eyes cyanoacrylate-treated sclerotomies were compared with sclerotomies in which no additional manoeuvre to aid closing was performed; in 76 eyes fibrin glue with no manoeuvre; and in the last 76 eyes, cyanoacrylate-treated sclerotomies were compared with fibrin glue-treated sclerotomies.

Results: A total of 228 eyes had a 23-gauge TSV performed. Both cyanoacrylate and fibrin glue treated sclerotomies achieved higher mean opening pressures when compared with nontreated sclerotomies in the same eye (p < 0.002). When cyanoacrylate was compared with biological adhesive in the same eye, no statistically significant differences were obtained (p = 0.216).

Discussions: This experimental study provides support for the possible role of adhesives in improving TSV sclerotomy closure competency in clinical practice.
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http://dx.doi.org/10.1038/s41433-019-0651-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314807PMC
July 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

Indocyanine green angiography findings in patients with neovascular age-related macular degeneration refractory to ranibizumab switched to aflibercept.

Int Ophthalmol 2019 Nov 14;39(11):2441-2448. Epub 2019 Feb 14.

Department of Preventive Medicine, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.

Purpose: To describe indocyanine green angiography (ICGA) and visual acuity (VA) results in patients with neovascular age-related macular degeneration (nAMD) refractory to ranibizumab switched to aflibercept.

Methods: This study is a prospective interventional case series. Thirty-two eyes of 32 patients with nAMD showing a poor response after at least 24 months of ranibizumab were switched to aflibercept. Twenty eyes had type I choroidal neovascularization (CNV group), and 12 eyes had polypoidal choroidal vasculopathy (PCV group). After an initial loading dose of three monthly aflibercept injections, treatment was continued on a treat-and-extend basis. ICGA was performed just before the first aflibercept injection (baseline) and 12 and 24 months later. The variables recorded were: closure of polyps and lesion area, VA, number of aflibercept injections, dry macula, and pigment epithelium detachment.

Results: The following means were recorded in the CNV and PCV groups, respectively: number of ranibizumab injections 20.4 ± 11.2 and 22.4 ± 12.9 (p = 0.740); baseline VA (before aflibercept) 73.2 ± 9.1 and 70.3 ± 13.7 letters (p = 0.654); and final VA 73.0 ± 7.6 and 69.3 ± 15.6 letters (p = 0.509). VA remained stable (p = 0.761 and 0.964) after 15.5 ± 3 and 15.1 ± 3.5 aflibercept injections (p = 0.244). At 24 months, dry macula was noted in 40 to 50% of the eyes (p = 0.620). Complete resolution of polyps was observed in 58% at 12 months and 92% at 24 months.

Conclusions: In patients with nAMD refractory to ranibizumab, aflibercept was effective at maintaining VA and closing numerous polyps. In half of the patients, dry macula was observed at 24 months.
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http://dx.doi.org/10.1007/s10792-019-01082-zDOI Listing
November 2019

Systemic Effects of Repeated Intraocular Dexamethasone Intravitreal Implant in Diabetic Patients: A Retrospective Study.

Diabetes Ther 2017 Oct 16;8(5):1087-1096. Epub 2017 Sep 16.

Retina Service, Ophthalmology Department, Clínico San Carlos University Hospital, Madrid, Spain.

Introduction: The objective of this study is to evaluate the influence of repeated intraocular dexamethasone implant (Ozurdex) injections on metabolic control in type 2 diabetic patients.

Methods: Retrospective study of 165 type 2 diabetic patients starting Ozurdex treatment who received no less than three consecutive injections. Glycated hemoglobin (HbA1c), serum creatinine, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TGs) were evaluated during 15 months of follow-up after Ozurdex treatment onset.

Results: Fifty-seven patients met inclusion criteria. Mean baseline values for HbA1c, creatinine, total cholesterol, HDL cholesterol, and TGs before treatment (7.1%, 1.3, 176.7, 51.1, and 125.6 mg/dl, respectively) were similar to mean values after Ozurdex onset (Wilcoxon test p values were 0.68, 0.41, 0.06, 0.87, and 0.33, respectively) and remained stable during the follow-up period. Mean LDL cholesterol levels increased slightly after Ozurdex treatment onset (90.1 vs 88.2 mg/dl, p = 0.04) but after 15 months of follow-up they had returned to baseline values. Transient increase in LDL cholesterol was remarkable in the group of 24 bilaterally treated patients (96.8 vs 88.4 mg/dl, p = 0.03). A third of these patients increased their baseline LDL values by more than 20%. Even with continuous injections of Ozurdex, LDL cholesterol levels also declined back to baseline by month 15.

Conclusion: Ozurdex injections had no influence on HbA1c or renal function. Lipid profile changes were mild and transient. However, a significant temporary increase has been found in LDL cholesterol levels in patients receiving simultaneous bilateral injections. Lipid levels should be monitored in patients starting with bilateral Ozurdex injections especially in those with recent history of acute myocardial infarction.
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http://dx.doi.org/10.1007/s13300-017-0307-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630562PMC
October 2017

ARMS2 A69S polymorphism is associated with the number of ranibizumab injections needed for exudative age-related macular degeneration in a pro re nata regimen during 4 years of follow-up.

Graefes Arch Clin Exp Ophthalmol 2017 Nov 25;255(11):2091-2098. Epub 2017 Jul 25.

Retina Service, Ophthalmology Department, San Carlos Clinical Hospital, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), c/ Profesor Martin Lagos s/n, 28040, Madrid, Spain.

Purpose: To investigate whether single-nucleotide polymorphisms (SNPs) known to be strongly associated with the development of age-related macular degeneration (AMD) have an influence on recurrence rate of choroidal neovascularization (CNV) activity during 4-year ranibizumab treatment for exudative AMD.

Methods: This prospective study included 103 treatment-naïve patients (103 eyes) that received initially a loading dose of 3 monthly ranibizumab injections and thereafter, were treated according to an as-needed regimen for a 4-year follow-up period. Baseline values, visual outcome, and recurrence rate were examined. CFH Y402H and ARMS2 A69S polymorphisms were determined and their association with lesion recurrence and visual outcome was analyzed using a one-way analysis of variance (ANOVA) with post hoc comparison tested by Fisher's LSD method. Multivariate linear regression analysis was then used to identify factors associated with recurrence rate.

Results: The cumulative total mean number of ranibizumab injections at the end of each year of the follow-up was 5.3 ± 1.8, 9.2 ± 2.9, 12.6 ± 4.6, and 15.7 ± 6.1. There was great inter-patient variability. Nineteen eyes (18.5%) did not experience recurrence during the first year, and five (4.8%) still displayed inactive CNV after 4 years of follow-up. No significant association was found between the number of injections and mean best corrected visual acuity (BCVA) change or final BCVA at the end of the study period. Genotypes had no influence on baseline characteristics or visual outcome but a significant association was found between the A69S polymorphism and the number of injections needed by the patients. Homozygous for the T risk allele required more retreatments over the 48-month follow-up.

Conclusions: The ARMS2 A69S polymorphism was associated with CNV recurrence rate in our patient cohort. Prediction of a greater risk of recurrence could help to design more appropriate follow-up treatment strategies for patients with neovascular AMD.
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http://dx.doi.org/10.1007/s00417-017-3748-0DOI Listing
November 2017

Interferon-associated retinopathy in a patient with metastatic melanoma.

Arq Bras Oftalmol 2014 Oct;77(5):321-323

Department of Ophthalmology, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, España.

We present the unusual case of a 35 year-old woman with stage IV melanoma and widespread metastases, who was undergoing treatment with interferon alpha-2b and who presented with interferon-associated retinopathy. The patient, who had been taking interferon treatment for three months, complained of a sudden loss of visual acuity in the left eye. An ocular examination revealed multiple cotton wool spots along the retina and macular involvement. Interferon treatment was suspended. Although rare, retinopathy represents a potentially serious adverse effect of interferon treatment. Although normally patients are asymptomatic, complications derived of its use may arise, which can lead to significant visual impairment. We therefore suggest that before initiating treatment with this drug, patients should be informed of its potential ocular risks, and that regular eye examinations are conducted along with the treatment.
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http://dx.doi.org/10.5935/0004-2749.20140080DOI Listing
October 2014

Age-Related Macular Degeneration: Clinical Findings following Treatment with Antiangiogenic Drugs.

J Ophthalmol 2014 16;2014:346360. Epub 2014 Feb 16.

Bayer HealthCare, Avenida Baix Llobregat 3-5, Sant Joan Despí, 08970 Barcelona, Spain.

Purpose. To survey the management of patients with neovascular age-related macular degeneration (nvAMD) in Spain. Methods. An observational retrospective multicenter study was conducted. The variables analyzed were sociodemographic characteristics, foveal and macular thickness, visual acuity (VA), type of treatment, number of injections, and the initial administration of a loading dose of an antiangiogenic drug. Results. 208 patients were followed up during 23.4 months in average. During the first and second years, patients received a mean of 4.5 ± 1.8 and 1.6 ± 2.1 injections of antiangiogenic drugs, and 5.4 ± 2.8 and 3.6 ± 2.2 follow-up visits were performed, respectively. The highest improvement in VA was observed at 3 months of follow-up, followed by a decrease in the response that stabilized above baseline values until the end of the study. Patients who received an initial loading dose presented greater VA gains than those without. Conclusions. Our results suggest the need for a more standardized approach in the management and diagnosis of nvAMD receiving VEGF inhibitors. To achieve the visual outcomes reported in pivotal trials, an early diagnosis, proactive approach (more treating than follow-up visits), and a close monitoring might be the key to successfully manage nvAMD.
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http://dx.doi.org/10.1155/2014/346360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945152PMC
April 2014

Retinal nerve fiber layer thickness changes in patients with age-related macular degeneration treated with intravitreal ranibizumab.

Invest Ophthalmol Vis Sci 2012 Sep 14;53(10):6214-8. Epub 2012 Sep 14.

Servicio de Oftalmologia, Hospital Clinico San Carlos, Departamento de Oftalmologia, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain.

Purpose: To assess the effects of intravitreal ranibizumab therapy on intraocular pressure (IOP) and retinal nerve fiber (RNFL) thickness.

Methods: Forty-nine eyes of 49 patients with neovascular age-related macular degeneration (AMD) treated with intravitreal ranibizumab injections and 27 fellow eyes not requiring treatment were followed for 1 year. RNFL thickness, as measured by Fourier domain optical coherence tomography, and IOP were determined pre- and postinjection.

Results: After 12 months, the mean number of injections received was 4.8 ± 1.6. The incidence of IOP elevations (>5 mm Hg over baseline) observed at the time of injection was 0.4%. Baseline RNFL thickness was 105.7 ± 12.2 μm in the treatment group compared with 101.8 ± 11.6 μm in the control group (P = 0.176). At the end of follow-up, significant RNFL thinning was noted in the treatment group (100.2 ± 11.0 μm, P < 0.001), whereas no differences were found in the control group (100.5 ± 10.8 μm, P = 0.477).

Conclusions: Intravitreal ranibizumab injections used to treat AMD caused a significant change in RNFL thickness after 12 months of follow-up.
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http://dx.doi.org/10.1167/iovs.12-9875DOI Listing
September 2012

Ranibizumab in retinal angiomatous proliferation (RAP): influence of RAP stage on visual outcome.

Eur J Ophthalmol 2011 Nov-Dec;21(6):783-8

Ophthalmology Department, Hospital Clinico San Carlos, Madrid, Spain.

Purpose: To evaluate the influence of retinal angiomatous proliferation (RAP) stage on visual and anatomic outcome after ranibizumab (Lucentis®).

Methods: This was a prospective study on consecutively diagnosed RAP eyes at the Hospital Clínico San Carlos, Madrid. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) are performed monthly. Indocyanine green angiography (ICG) and fluorescein angiography (FA) are performed at baseline and every 3 months thereafter. A starting dose of a monthly ranibizumab injection in the first 3 months is followed by retreatment in case of intraretinal edema, subretinal fluid, or pigment epithelium detachment (PED) in OCT, increased leakage in FA, or a hot spot in ICG.

Results: A total of 53 eyes from 49 patients were included. The mean change in BCVA at 12 months was +7.3, +0.83, and -2.1 letters in stages IIA (21 cases), II B (18 cases), and III (14 cases), respectively. After adjusting the change in BCVA according to baseline BCVA, ß coefficient was -6.012 letters (p=0.025) in stage IIB and -9.762 letters (p=0.003) in stage III vs stage IIA. Four cases had a retinal pigment epithelium tear after injection of ranibizumab.

Conclusions: Patients in stage II without PED have a better visual and anatomic evolution than patients in stage II with PED and stage III.
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http://dx.doi.org/10.5301/EJO.2011.6526DOI Listing
March 2012

Early neovascular bridging of choroidal neovascularization after ranibizumab treatment.

Graefes Arch Clin Exp Ophthalmol 2009 Oct 21;247(10):1427-30. Epub 2009 Jul 21.

Hospital Clínico Universitario San Carlos, Calle Profesor Martín Lagos s/n, Madrid, Spain.

Background: To report three cases of early choroidal neovascularization (CNV) bridging after ranibizumab treatment.

Methods: Three patients with two separated foci of CNV secondary to age-related macular degeneration (ARMD), pathologic myopia and multifocal choroiditis were treated with monthly injections of ranibizumab por a period of 3 months.

Results: All three cases showed early coalescence across the fovea of the two neovascular foci, already 1 month after the first ranibizumab injection. Best-corrected visual acuity (BCVA) decreased in the three cases more than 20 letters due to early foveal involvement.

Conclusions: Two different foci of CNV show a great tendency to decrease patients' vision because of neovascular bridging with foveal implication.
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http://dx.doi.org/10.1007/s00417-009-1143-1DOI Listing
October 2009