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OBJETIVO: Evaluar mediante tomografía de coherencia óptica (OCT) las variaciones de espesor macular producidas a lo largo del tiempo en ojos pseudoafáquicos implantados con una lente intraocular (LIO) transparente en comparación con sus respectivos ojos contralarerales implantados con LIO amarilla. MÉTODOS: El espesor macular de 36 ojos de 18 sujetos fue evaluado mediante OCT. Los sujetos presentaban edades superiores a 65 años y habían sido intervenidos de cataratas en ambos ojos en 2 cirugías independientes. La principal característica de los individuos es que llevaban implantada una LIO con diferente absorción en cada ojo: transparente (absorbente de la radiación ultravioleta) y amarilla (con filtro adicional absorbente de las radiaciones violeta-azul del espectro visible). El espesor macular se evaluó en 2 sesiones separadas en el tiempo por un intervalo de tiempo de 5 años, mediante el sistema Stratus-OCT (protocolo fast macular thickness). Se analizaron estadísticamente las diferencias en la evolución del espesor macular entre ojos con diferente tipo de LIO. RESULTADOS: Tras 5 años de seguimiento, se observó que los ojos implantados con LIO transparente manifestaban una reducción del espesor macular estadísticamente significativa, superior a la esperada por el aumento de la edad. Sin embargo, los ojos implantados con LIOs amarillas mantuvieron su espesor macular estable. La disminución del espesor macular promedio en ojos implantados con LIO transparente fue de 5 ± 8 μm (p = 0,02) y la reducción del espesor foveal fue de 10 ± 17 μm (p = 0,02). CONCLUSIONES: Los cambios de espesor macular producidos en ojos implantados con una LIO amarilla difieren de los cambios manifestados en ojos con LIO transparente. Estas observaciones apuntan a un posible efecto protector de las LIOs amarillas contra los efectos dañinos de la luz en sujetos pseudoafáquicos. Sin embargo, estudios con un mayor tamaño muestral y mayor tiempo de seguimiento son necesarios para confirmar que la protección inducida por este tipo de LIO es clínicamente significativa

OBJECTIVE: To study the use of optical coherence tomography (OCT), for measuring the macular thickness variations produced over time in elderly pseudophakic subjects implanted with a clear intraocular lens (IOL) in one eye, and a yellow IOL in the other eye. METHODS: Macular thickness measurements were obtained in the 36 eyes of 18 subjects over 65 years, with cataracts surgically removed from both eyes and implanted with different absorbance (clear and yellow) IOLs in 2 separate surgeries. Stratus-OCT was used to determine the macular thickness in 2 sessions with 5 years of difference. RESULTS: After 5 years of follow-up, the eyes implanted with clear IOLs revealed a significant decrease in macular thickness. However, in eyes implanted with yellow IOLs the macular thickness remained stable. The mean overall decrease in macular thickness in eyes implanted with clear IOLs was 5 ± 8 μm (P=0.02), and foveal thickness reduction was 10 ± 17 μm (P=0.02). CONCLUSIONS: The macular thickness changes produced in eyes implanted with a yellow IOL differ from those with a clear IOL. These observation point to a possible protective effect of yellow IOL against the harmful effects of light in elderly pseudophakic subjects. However, studies with a longer follow-up are still needed to confirm that the protection provided by this IOL model is clinically significant

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OBJECTIVE: To study the use of optical coherence tomography (OCT), for measuring the macular thickness variations produced over time in elderly pseudophakic subjects implanted with a clear intraocular lens (IOL) in one eye, and a yellow IOL in the other eye. METHODS: Macular thickness measurements were obtained in the 36 eyes of 18 subjects over 65 years, with cataracts surgically removed from both eyes and implanted with different absorbance (clear and yellow) IOLs in 2 separate surgeries. Stratus-OCT was used to determine the macular thickness in 2 sessions with 5 years of difference. RESULTS: After 5 years of follow-up, the eyes implanted with clear IOLs revealed a significant decrease in macular thickness. However, in eyes implanted with yellow IOLs the macular thickness remained stable. The mean overall decrease in macular thickness in eyes implanted with clear IOLs was 5 ± 8 µm (P=.02), and foveal thickness reduction was 10 ± 17 µm (P=.02). CONCLUSIONS: The macular thickness changes produced in eyes implanted with a yellow IOL differ from those with a clear IOL. These observation point to a possible protective effect of yellow IOL against the harmful effects of light in elderly pseudophakic subjects. However, studies with a longer follow-up are still needed to confirm that the protection provided by this IOL model is clinically significant.

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Caso clínico: Se presentan las características clínicas y funcionales de un paciente de 30 años con siderosis bulbi de tres años de evolución, y el tratamiento mediante facoemulsificación y vitrectomía para la eliminación de los restos metálicos. Discusión: A pesar de que la mayoría de los cuerpos extraños intraoculares (CEIO) tienen un efecto deletéreo inmediato, en casos de cuerpos pequeños, localizados y con poca afectación visual, es posible su observación. Sin embargo, con el tiempo, el hierro se deposita en el epitelio pigmentado de la retina, produciendo cambios a nivel macular y periférico responsables de pérdida progresiva de visión. La cirugía de extracción del CEIO puede frenar la progresión de esta dolencia(AU)

Case report: The clinical and functional characteristics of a 30 years-old patient with three years-evolution siderosis bulbi are described in this paper, as well as the treatment using phacoemulsification and vitrectomy for the elimination of the metallic remains. Discussion: In spite of the fact that the majority of the intraocular foreign bodies (IOFB) have a dangerous immediate effect, in cases of small, local bodies and with little visual deterioration, observation is possible. Nevertheless, with time, the iron settles on the pigmented epithelium of the retina, producing changes at macula and peripheral level, which are responsible for the gradual loss of vision. The surgical removal of the IOFB can stop the progression of this pathology(AU)

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CASE REPORT: The clinical and functional characteristics of a 30 years-old patient with three years-evolution siderosis bulbi are described in this paper, as well as the treatment using phacoemulsification and vitrectomy for the elimination of the metallic remains. DISCUSSION: In spite of the fact that the majority of the intraocular foreign bodies (IOFB) have a dangerous immediate effect, in cases of small, local bodies and with little visual deterioration, observation is possible. Nevertheless, with time, the iron settles on the pigmented epithelium of the retina, producing changes at macula and peripheral level, which are responsible for the gradual loss of vision. The surgical removal of the IOFB can stop the progression of this pathology.

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OBJECTIVE: Age related macular degeneration (ARMD) in its neovascular form is a serious disease which produces legal blindness in many patients with poor prognosis if left untreated. We intend to establish a clinical guide with the different therapeutic options that exist nowadays, which may help the ophthalmologists in their clinical practice. METHODS: A group of medical retina experts selected by SERV have evaluated the results of different published studies with the drugs currently available, obtaining an evidence-based consensus. Some recommendations have been established for diagnosis, treatment and monitoring of patients with neovascular ARMD. RESULTS: The intravitreal injection of ranibizumab at a dosage of 0.5 mg produces significant improvement of visual acuity in subfoveal lesions, according to data obtained from studies with the highest level of evidence. It should be considered as a first choice drug. The use of bevacizumab, a drug with not approved indication for intraocular use, nor for the treatment of neovascular ARMD can reach a result which is closer to the ones obtained with ranibizumab than to those obtained with photodynamic therapy (PDT) and pegaptanib. The use of intravitreal pegaptanib sodium in intravitreal injection at a dosage of 0.3 mg as a treatment for subfoveal lesions can obtain similar results to the TFD, but with a wider range of injuries. CONCLUSION: The results of the evidence-based studies are a good guide for the treatment of this disease.

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Objetivo: La Degeneración Macular Asociada a laEdad (DMAE) en su forma húmeda supone unagrave enfermedad que condiciona ceguera legal enmuchos pacientes y con mal pronóstico si no es tratada.Pretendemos establecer una guía de actuaciónclínica con las diferentes opciones terapeúticas queexisten en el momento actual, que puedan ayudar aloftalmólogo en su práctica clínica.Métodos: Un grupo de expertos en retina médicaseleccionados por la SERV han evaluado los resultadosde los diferentes estudios publicados con losfármacos actualmente disponibles, llegando a un consenso basado en la evidencia. Se han establecidounas recomendaciones para el diagnóstico, tratamientoy seguimiento de los enfermos con DMAEhúmeda.Resultados: La inyección intravítrea de ranibizumaba la dosis de 0,5 mg permite obtener mejoríassignificativas de la agudeza visual en lesiones subfoveales,según los datos obtenidos de estudios conmáximo nivel de evidencia. Debe ser consideradocomo el fármaco de primera elección. El empleo debevacizumab, fármaco sin indicación aprobada parauso intraocular, ni para el tratamiento de la DMAEhúmeda, puede aportar un beneficio más próximo alos resultados obtenidos con el ranibizumab que alos obtenidos con la terapia fotodinámica (TFD) yel pegaptanib. El uso de pegaptanib sódico eninyección intravítrea a la dosis de 0,3 mg como tratamientode lesiones subfoveales permite obtenerresultados parecidos a la TFD, pero en un abanicomás amplio de lesionesConclusiones: Los resultados de los estudios basadosen la evidencia constituyen una buena guía deactuación en el tratamiento de esta enfermedad(AU)

Objective: Age related macular degeneration(ARMD) in its neovascular form is a serious diseasewhich produces legal blindness in many patientswith poor prognosis if left untreated. We intend toestablish a clinical guide with the different therapeuticoptions that exist nowadays, which may helpthe ophthalmologists in their clinical practice.Methods: A group of medical retina experts selectedby SERV have evaluated the results of differentpublished studies with the drugs currently available,obtaining an evidence-based consensus. Somerecommendations have been established for diagnosis, treatment and monitoring of patients with neovascularARMD.Results: The intravitreal injection of ranibizumabat a dosage of 0.5 mg produces significant improvementof visual acuity in subfoveal lesions, accordingto data obtained from studies with the highestlevel of evidence. It should be considered as a firstchoice drug. The use of bevacizumab, a drug withnot approved indication for intraocular use, nor forthe treatment of neovascular ARMD can reach aresult which is closer to the ones obtained with ranibizumabthan to those obtained with photodynamictherapy (PDT) and pegaptanib. The use of intravitrealpegaptanib sodium in intravitreal injection at adosage of 0.3 mg as a treatment for subfoveallesions can obtain similar results to the TFD, butwith a wider range of injuries.Conclusion: The results of the evidence-based studiesare a good guide for the treatment of this disease(AU)

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