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Purpose: The COVID-19 pandemic affected medical practice worldwide due to interventions to prevent spreading. Its effect on ophthalmology practices in Latin America has not yet been explored. We aimed to assess the perceptions about the pandemic from countries' ophthalmological national and subspecialty retina societies affiliated to the Pan-American Association of Ophthalmology (PAAO). Patients and Methods: A survey-based study of leaders of national ophthalmological and retinal societies was conducted. The survey was sent by email to 30 societies, from which 20 responded (12 countries, 66.6% response rate). It included closed- and open-ended questions about (1) operational capacity and precautions, (2) telemedicine and virtual care, (3) procedures, and (4) post-pandemic considerations. Results: There was a marked decline in ophthalmology patient visits (80-95%) and elective surgeries (90%) during 2020 compared to before the pandemic. Precautions like temperature checks, mask usage, and social distancing were widely implemented while personal protective equipment (PPE) availability varied. Telemedicine use was limited due to lack of experience with it. Reopening plans focused on maintaining precautions and gradually resuming activities. Economic and security concerns were raised, and adherence to guidelines was emphasized. Respondents acknowledged the need to adapt to a "new normal". Long duration drugs, fewer imaging studies, and shorter wait times were preferred; however, availability of long duration drugs was limited. Conclusion: The pandemic impacted ophthalmology in Latin America, with reduced patient visits, procedures, and surgeries. Delayed treatment and complications were likely the result of the pandemic.
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PURPOSE: To assess the risk for capsular rupture during routine phacoemulsification in patients with a history of anti-VEGF injections and other possible risk modifiers such as treatment patterns, type of anti-VEGF agent, and experience of the surgeon, among others. METHODS: This study reviewed the medical records of 11,129 patients from 7 different hospitals in 5 countries. The study included 939 patients that underwent routine phacoemulsification and had a history of anti-VEGF therapy. We excluded patients with known risk factors for capsular rupture, as well as patients with a history of other retinal procedures. The study extracted data regarding general demographics, the number of previous injections, type of anti-VEGF agent, details of cataract surgery, and anti-VEGF treatment patterns. RESULTS: Overall prevalence of posterior capsular rupture: 7.45% (95% CI: 5.9-9.32%). The mean number of injections per patient was 3.37 ± 2.8. More than 50% of the patients received their last anti-VEGF injection within three months before cataract surgery. The complication rate during intravitreal injections was 1.07%. In the univariate analysis, the experience of the cataract surgeon (inexperience surgeons; OR: 2.93) and the history of prior anti-VEGF therapy (OR: 1.77) were significant risk indicators for PCR (p < 0.05). However, after controlling for age in the multivariate analysis, the trend did not reach a statistical significance. CONCLUSION: The risk for capsular rupture is higher in patients with a history of intravitreal anti-VEGF injections.
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Age-related macular degeneration (AMD) is considered one of the main causes of severe vision loss in older adults. The neovascular form (nAMD) is an advanced stage, which is responsible for the most severe vision loss. Vascular endothelial growth factor (VEGF) is at present the main factor that leads to the development of a neovascular membrane and the increased leakage from the membrane to the retina. At present, anti-VEGF therapy is the only treatment that achieves vision gains in many patients and halts progression in most of them. VEGF blockade can be achieved with several molecules and various treatment regimens, which have been studied with excellent results. Unfortunately, real-world data has shown to be far less efficacious than clinical trials. This gap between clinical trials and real-world results is an unmet medical need that supports the necessity of new treatment modalities for nAMD. Of the various treatments being studied, anti-VEGFs of higher efficacy and longer durability are those more advanced in their development. Brolucizumab and abicipar pegol are 2 new anti-VEGF drugs that had positive results in phase 2 studies and are being tested in phase 3 trials at present. Other promising therapies are antiangiopoietin 2 molecules, which are in phase 2 development. At earlier stages of development but with promising results are squalamine, anti-VEGF-C and -D, and gene therapy. The future will give retina specialists a broad armamentarium with which patients may achieve high visual gains for the long term with a low treatment burden.
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Inhibidores de la Angiogénesis/uso terapéutico , Degeneración Macular/tratamiento farmacológico , Anticuerpos Monoclonales/uso terapéutico , Neovascularización Coroidal/tratamiento farmacológico , Ensayos Clínicos como Asunto , Terapia Genética/métodos , Humanos , Factor de Crecimiento Derivado de Plaquetas/uso terapéutico , Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
This paper demonstrates multiple benefits of intravitreal bevacizumab (IVB) on diabetic retinopathy (DR) including diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) at 24 months of followup. This is a retrospective multicenter interventional comparative case series of intravitreal injections of 1.25 or 2.5 mg of bevacizumab for DME, PDR without tractional retinal detachment (TRD), and patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 or 2.5 mg of bevacizumab before vitrectomy for the management of PDR. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse DME. Therefore, in the future this new therapy could complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to panretina photocoagulation so that more selective therapy may be applied. Finally, TRD in PDR may occur or progress after IVB used as an adjuvant to vitrectomy. Surgery should be performed 4 days after IVB. Most patients had poorly controlled diabetes mellitus associated with elevated HbA1c, insulin administration, PDR refractory to panretinal photocoagulation, and longer time between IVB and vitrectomy.
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PURPOSE: The purpose of this study was to compare the injection burden, central macular thickness (CMT), and change in best-corrected visual acuity after injecting 1.25 mg or 2.5 mg bevacizumab as needed in patients with primary macular edema secondary to central retinal vein occlusion. METHODS: This is an interventional, retrospective, comparative multicenter study of 86 eyes with macular edema secondary to central retinal vein occlusion that were treated primarily with intravitreal bevacizumab (44 eyes, 1.25 mg; 42 eyes, 2.5 mg). The main outcome measures were the CMT and the change of best-corrected visual acuity at 24 months. RESULTS: All patients completed at least 24 months of follow-up. The mean number of injections per eye were 7.2 for the 1.25-mg dose group and 8.1 for the 2.5-mg dose group (P = 0.4492). At 24 months, in the 1.25-mg dose group, the logarithm of the minimal angle of resolution best-corrected visual acuity improved from baseline 0.35 +/- 0.57 units (P < 0.0001) versus 0.27 +/- 0.68 units for the 2.5-mg dose group (P < 0.0001). These differences were not statistically significant between both dose groups. In the 1.25-mg dose group, 25 (56.8%) eyes gained >or=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity and 6 (13.6%) lost >or=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. In the 2.5-mg dose group, 24 (57.1 %) eyes improved >or=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity and 7 (16.7%) lost >or=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. The CMT in the 1.25-mg dose group improved from 635 +/- 324 microm to 264 +/- 160 microm (P < 0.0001) versus 528 +/- microm to 293 +/- 137 microm in the 2.5-mg dose group (P < 0.0001). There was no statistically significant difference between both dose groups with regard to the CMT reduction. CONCLUSION: Intravitreal bevacizumab at doses up to 2.5 mg seems to be effective in improving visual acuity and reducing CMT in macular edema secondary to central retinal vein occlusion. There were no statistically significant differences between the two dose groups with regard to the number of injections, CMT, and change in visual acuity.
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Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Edema Macular/tratamiento farmacológico , Oclusión de la Vena Retiniana/tratamiento farmacológico , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Anciano , Anticuerpos Monoclonales Humanizados , Bevacizumab , Femenino , Estudios de Seguimiento , Humanos , Inyecciones , Edema Macular/etiología , Edema Macular/fisiopatología , Masculino , Persona de Mediana Edad , Retina/patología , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/fisiopatología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Agudeza Visual/fisiología , Cuerpo VítreoRESUMEN
Diabetic retinopathy (DR) remains the major threat to sight in the working age population. Diabetic macular edema (DME) is a manifestation of DR that produces loss of central vision. Proliferative diabetic retinopathy (PDR) is a major cause of visual loss in diabetic patients. In PDR, the growth of new vessels is thought to occur as a result of vascular endothelial growth factor (VEGF) release into the vitreous cavity as a response to ischemia. Furthermore, VEGF increases vessel permeability leading to deposition of proteins in the interstitium that facilitate the process of angiogenesis and macular edema. This review demonstrates multiple benefits of intravitreal bevacizumab (IVB) on DR including DME and PDR at 24 months of follow up. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse diabetic macular edema. Therefore, in the future this new therapy could replace or complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to pan-retina photocoagulation so that more selective therapy may be applied. In addition, we report a series of patients in which tractional retinal detachment developed or progressed after adjuvant preoperative IVB in severe PDR.
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Anticuerpos Monoclonales/administración & dosificación , Retinopatía Diabética/tratamiento farmacológico , Adulto , Anciano , Inhibidores de la Angiogénesis/administración & dosificación , Animales , Anticuerpos Monoclonales Humanizados , Bevacizumab , Proliferación Celular/efectos de los fármacos , Retinopatía Diabética/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intravítreas , Edema Macular/diagnóstico , Edema Macular/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Tomografía de Coherencia ÓpticaRESUMEN
PURPOSE: To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (IVB) (Avastin; Genentech Inc., San Francisco, CA) (1.25 or 2.5 mg) in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Retrospective, multicenter, interventional, comparative case series. PARTICIPANTS: We reviewed the clinical records of 180 consecutive patients (207 eyes) with subfoveal CNV secondary to AMD at 9 centers from 8 countries. METHODS: Patients were treated with at least 1 injection of IVB 1.25 mg (124 eyes [59.9%]) or 2.5 mg (83 eyes [40.1%]). Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and 1-, 3-, 6-, 12-, and 24-month visits. MAIN OUTCOME MEASURES: Changes in BCVA and OCT. RESULTS: The mean age of our patients was 74.3±7.5 years. The mean number of IVB injections per eye was 5.1 (range, 1-24 injections). In the 1.25 mg group, baseline BCVA improved from 20/235 (logarithm of the minimum angle of resolution [logMAR] 1.07) to 20/172 (logMAR 0.92) at 24 months (P<0.0001). Similar BCVA changes were observed in the 2.5 mg group. At baseline, the mean central macular thickness (CMT) by OCT in the 1.25 mg group was 308.4±127.52 µm, which was reduced to 269.35±97.92 µm, 262.1±94.81 µm, 264.03±97.06 µm, 245.91±89.52 µm, and 249.27±89.14 µm at 1, 3, 6, 12, and 24 months, respectively (P<0.0001). Similar changes were observed in the 2.5 mg group. In the 2.5 mg group, systemic complications included 2 new cases (2.6%) of arterial hypertension, 1 case (1.3%) of stroke, and 1 case (1.3%) of death. CONCLUSIONS: Primary IVB at a dose of 1.25 or 2.5 mg seems to provide stability or improvement in BCVA, OCT, and FA in subfoveal CNV secondary to AMD at 24 months. Our results show no significant difference regarding BCVA with IVB at doses of 1.25 or 2.5 mg.
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Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Neovascularización Coroidal/tratamiento farmacológico , Degeneración Macular/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados , Bevacizumab , Neovascularización Coroidal/etiología , Neovascularización Coroidal/fisiopatología , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fóvea Central , Humanos , Inyecciones , Degeneración Macular/complicaciones , Degeneración Macular/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Tomografía de Coherencia Óptica , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiología , Cuerpo VítreoRESUMEN
PURPOSE: The purpose of this study was to compare the injection burden, central macular thickness (CMT), and change in best-corrected visual acuity (BCVA) after injecting 1.25 mg or 2.5 mg of bevacizumab as needed in patients with primary macular edema secondary to branch retinal vein occlusion. METHODS: An interventional, retrospective, comparative multicenter study was conducted of 63 eyes with macular edema secondary to branch retinal vein occlusion that were treated primarily with intravitreal bevacizumab (38 eyes, 1.25 mg; 25 eyes, 2.5 mg). The main outcome measures were the CMT and the change of BCVA at 24 months. RESULTS: All patients completed at least 24 months of follow-up. The mean number of injections per eye was 3.6 in the 1.25-mg group and 4.3 in the 2.5-mg group (P = 0.4770). At 24 months, in the 1.25-mg group, the logarithm of the minimum angle of resolution BCVA improved from baseline 0.38 +/- 0.63 (P < 0.0001) units to 0.64 +/- 0.6 units for the 2.5-mg group (P < 0.0001). In the 1.25-mg group, 26 (68%) eyes gained > or =3 of Early Treatment of Diabetic Retinopathy Study visual acuity and 2 (5%) eyes lost > or =3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. In the 2.5-mg group, 18 (72%) eyes improved > or =3 of Early Treatment of Diabetic Retinopathy Study visual acuity, and none of the eyes lost > or =3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. The CMT in the 1.25-mg group improved from 453 +/- 140 microm to 244 +/- 125 microm (P < 0.0001) versus 444 +/- 175 microm to 234 +/- 80 microm in the 2.5-mg group (P < 0.0001). There were no cases of endophthalmitis. No systemic adverse events were reported. CONCLUSION: Intravitreal bevacizumab at doses up to 2.5 mg seems to be effective in improving BCVA and reducing CMT in macular edema secondary to branch retinal vein occlusion. No statistically significant differences were found between the two dose groups with regard to the number of injections, CMT, and change in BCVA.
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Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Edema Macular/tratamiento farmacológico , Oclusión de la Vena Retiniana/tratamiento farmacológico , Anciano , Anticuerpos Monoclonales Humanizados , Bevacizumab , Femenino , Humanos , Inyecciones , Edema Macular/diagnóstico , Edema Macular/etiología , Masculino , Persona de Mediana Edad , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/diagnóstico , Estudios Retrospectivos , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/efectos de los fármacos , Cuerpo VítreoRESUMEN
PURPOSE: To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin; Genentech, Inc., San Francisco, CA; 1.25 or 2.5 mg) in patients with diffuse diabetic macular edema (DDME). In addition, a comparison of the 2 different doses of intravitreal bevacizumab (IVB) used is presented. DESIGN: Retrospective, multicenter, interventional, comparative case series. PARTICIPANTS: The clinical records of 115 consecutive patients (139 eyes) with DDME at 11 centers from 8 countries were reviewed. METHODS: Patients were treated with at least 1 intravitreal injection of 1.25 or 2.5 mg of bevacizumab. All patients were followed up for 24 months. Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at the baseline, 1-, 3-, 6-, 12-, and 24-month visits. MAIN OUTCOME MEASURES: Changes in BCVA and OCT results. RESULTS: The mean age of the patients was 59.4+/-11.1 years. The mean number of IVB injections per eye was 5.8 (range, 1-15 injections). In the 1.25-mg group at 1 month, BCVA improved from 20/150 (0.88 logarithm of the minimum angle of resolution [logMAR] units) to 20/107, 0.76 logMAR units (P<0.0001). The mean BCVA at 24 months was 20/75 (0.57 logMAR units; P<0.0001). Similar BCVA changes were observed in the 2.5-mg group: at 1 month, BCVA improved from 20/168 (0.92 logMAR units) to 20/118 (0.78 logMAR units; P = 0.02). The mean BCVA at 24 months was 20/114 (0.76 logMAR units; P<0.0001). In the 1.25-mg group, the mean central macular thickness (CMT) decreased from 466.5+/-145.2 microm at baseline to 332.2+/-129.6 microm at 1 month and 286.6+/-81.5 microm at 24 months (P<0.0001). Similar results were obtained in the 2.5-mg group. CONCLUSIONS: Primary IVB at doses of 1.25 to 2.5 mg seem to provide stability or improvement in BCVA, OCT, and FA in DDME at 24 months. The results show no evident difference between IVB at doses of 1.25 or 2.5 mg.
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Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Retinopatía Diabética/tratamiento farmacológico , Edema Macular/tratamiento farmacológico , Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Bevacizumab , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Inyecciones , Mácula Lútea/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiología , Cuerpo VítreoRESUMEN
Los autores presentan el tratamiento del desprendimiento de retina en casos no complicados por medio de la inyección de Hexafluoruro de Azufre (SF6) intraocular. Describen la técnica por ellos empleada, las indicaciones y contraindicaciones del método, las complicaciones inmediatas y tardías y los resultados obtenidos. Estos, a pesar de consistir en 19 casos tratados, permiten por el éxito anatómico y funcional logrado, considerar a este método, por lo sencillo, poco traumático y de muy bajo costo, como sumamente útil de mucho futuro
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Adulto , Humanos , Masculino , Femenino , Gases/uso terapéutico , Desprendimiento de Retina/terapia , Gases/administración & dosificaciónRESUMEN
Los autores hacen mención de la etiología y formas de infección de la Necrosis Retinal Masiva y Aguda por el virus del Herpes. Asimismo la clasifican de acuerdo a la sintomatología y a la afección de los diferentes tejidos intraoculares en cinco subgrupos o formas clínicas bien diferenciadas. Teniendo en cuenta el estado clínico y las forma angiofluoresceinográficas proponen un esquema terapéutico basado en antivirósicos, corticoides e inmunodepresores
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Adolescente , Adulto , Humanos , Femenino , Necrosis/etiología , Enfermedades de la Retina/etiología , Simplexvirus , Angiografía con Fluoresceína , Coriorretinitis , Retina/patología , UveítisRESUMEN
Los autores presentan el tratamiento del desprendimiento de retina en casos no complicados por medio de la inyección de Hexafluoruro de Azufre (SF6) intraocular. Describen la técnica por ellos empleada, las indicaciones y contraindicaciones del método, las complicaciones inmediatas y tardías y los resultados obtenidos. Estos, a pesar de consistir en 19 casos tratados, permiten por el éxito anatómico y funcional logrado, considerar a este método, por lo sencillo, poco traumático y de muy bajo costo, como sumamente útil de mucho futuro (AU)
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Adulto , Humanos , Masculino , Femenino , Desprendimiento de Retina/terapia , Gases/uso terapéutico , Gases/administración & dosificaciónRESUMEN
Los autores hacen mención de la etiología y formas de infección de la Necrosis Retinal Masiva y Aguda por el virus del Herpes. Asimismo la clasifican de acuerdo a la sintomatología y a la afección de los diferentes tejidos intraoculares en cinco subgrupos o formas clínicas bien diferenciadas. Teniendo en cuenta el estado clínico y las forma angiofluoresceinográficas proponen un esquema terapéutico basado en antivirósicos, corticoides e inmunodepresores (AU)
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Adolescente , Adulto , Humanos , Femenino , Simplexvirus , Enfermedades de la Retina/etiología , Necrosis/etiología , Coriorretinitis , Uveítis , Angiografía con Fluoresceína , Retina/patologíaRESUMEN
Los autores presentan su experiencia en el diagnóstico y tratamiento de los macroaneurismas de las arterias retinales. Comentan sus casos clínicos (12 ojos en 11 pacientes) analizando estadísticamente su ubicación, las enfermedades generales asociadas: hipertensión arterial, arterioesclerosis y diabetes y la sintomatología clínica más frecuente. Dividen sus casos en tres grupos bien diferenciados: los M.A. compensados; los agudos descompensados y los crónicos descompensados y en cada uno de ellos describen su cuadro oftalmoscópico, ecográfico y angiofluoresceinográfico, señalando su evolución y su tratamiento
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Humanos , Aneurisma , Fotocoagulación , Arteria RetinianaRESUMEN
Los autores presentan su experiencia en el diagnóstico y tratamiento de los macroaneurismas de las arterias retinales. Comentan sus casos clínicos (12 ojos en 11 pacientes) analizando estadísticamente su ubicación, las enfermedades generales asociadas: hipertensión arterial, arterioesclerosis y diabetes y la sintomatología clínica más frecuente. Dividen sus casos en tres grupos bien diferenciados: los M.A. compensados; los agudos descompensados y los crónicos descompensados y en cada uno de ellos describen su cuadro oftalmoscópico, ecográfico y angiofluoresceinográfico, señalando su evolución y su tratamiento (AU)