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BACKGROUND: Complex intracranial aneurysms (CIAs) comprise a subset of lesions with defiant vascular architecture, difficult access, and prior treatment. Surgical management of CIAs is often challenging and demands an assessment on a case-by-case basis. The generational evolution of bypass surgery has offered a long-standing potential for effective cerebral revascularization. Herein, we aim to illustrate a single-center experience treating CIAs. METHODS: The authors conducted a retrospective analysis of clinical records of patients treated with cerebral revascularization techniques at Hospital Nacional Dos de Mayo, Lima, Peru, during 2018-2022. Relevant data were collected, including patient history, aneurysm features on imaging, preoperative complications, the intraoperative course, aneurysm occlusion rates, bypass patency, neurological function, and postoperative complications. RESULTS: Seventeen patients (70.59% female; median age: 53 years) with 17 CIAs (64.7% saccular; 76.5% ruptured) were included. The most common clinical presentation included loss of consciousness (70.6%) and headaches (58.8%). Microsurgical treatment included first-, second-, and third-generation bypass. In 47.1% of cases, an anastomosis between the superficial temporal artery and the M3 segment was predominantly used, followed by an A3-A3 bypass (29.4%), a superficial temporal artery-M2 bypass (17.6%), and an external carotid artery to M2 bypass (5.9%). The intraoperative aneurysm rupture rate was 11.8%. Postoperative complications included ischemia (40%), cerebrospinal fluid fistulas (26.7%), and pneumonia (20%). At hospital discharge, the median Glasgow Coma Scale score was 14 (range: 10-15). At the 6-month follow-up, 82.4% of patients had a modified Rankin Scale score ≤2, bypass patency was present in all cases, and the morbidity rate was 17.6%. CONCLUSIONS: CIAs represent a spectrum of defiant vascular lesions with a poor natural history. Bypass surgery offers the potential for definitive treatment. Our case series illustrated the predominant role of cerebral revascularization of CIAs with a critical case-by-case approach to provide optimal outcomes in a limited-resource setting.

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Introducción: Durante la anterior contingencia sanitariaocasionada por el COVID-19, se presenció una amplia difu-sión de supuestos tratamientos para esta y otras enfermeda-des. Esto dio pie al empleo de suplementos alimenticios (SA)como una posible alternativa para la prevención de esta en-fermedad. El consumo de SA confiere un riesgo en aquellaspoblaciones donde la prevalencia de uso es elevada. Tal es elcaso de la comunidad deportiva, donde su consumo es unaactividad frecuente debido a sus efectos en el rendimiento de-portivo y composición corporal. Objetivo: Conocer la prevalencia del consumo de SA endeportistas mexicanos durante el COVID-19 e identificaraquellos que lo emplearon con la finalidad de prevenir la in-fección. Asimismo, explorar la asociación de consumo con lasvariables sexo, edad y ocupación. Materiales y métodos: Se llevó a cabo un estudio des-criptivo transversal correlacional en una muestra no probabi-lística por conveniencia compuesta por 351 deportistas de laregión noroeste de México. Se aplicó una encuesta a travésde la plataforma Google Forms que incluía preguntas relacio-nadas con la frecuencia de consumo de SA además de varia-bles sociodemográficas. Resultados: El 22,5% de los participantes estaba consu-miendo algún tipo de SA durante el confinamiento y 67,1%sostuvo la creencia de que el consumo de estos suplementoscontribuyó a la prevención del COVID-19. Se encontró unaasociación entre consumo y creencia (χ2(2) = 26,256, p < 0,05;Phi = 0,274). El uso de SA fue recomendado principalmentepor nutriólogos (39,2%), entrenadores (21,5%) y médicos(20,3%). Conclusiones: El consumo de SA fue relativamente bajocomparado con otras poblaciones. Sin embargo, la mayoríade los consumidores refirió que los SA contribuyen a la pre-vención del contagio por COVID-19. Gran parte de los consu-midores de SA acudió a un profesional de la salud para su re-comendación.(AU)

Introduction: During the previous health contingencycaused by COVID-19, there was a widespread disseminationof alleged treatments for this and other diseases. This led tothe use of dietary supplements (DS) as a possible alternativefor the prevention of this disease. DS consumption poses arisk in populations where the prevalence of use is high. Suchis the case in the sports community, where its consumption isa common activity due to its effects on sports performanceand body composition.Objective: To determine the prevalence of DS consump-tion in Mexican athletes during COVID-19 and identify thosewho used them to prevent infection. Additionally, to explorethe association between consumption and the variables ofgender, age, and occupation.Materials and Methods: A descriptive cross-sectional cor-relational study was conducted in a non-probabilistic conven-ience sample composed of 351 athletes from the northwest re-gion of Mexico. A survey was administered through the GoogleForms platform that included questions related to the frequencyof DS consumption as well as sociodemographic variables. Results: 22.5% of the participants were consuming sometype of DS during the lockdown, and 67.1% believed that theconsumption of these supplements contributed to the pre-vention of COVID-19. An association between consumptionand belief was found (χ2(2) = 26.256, p < 0.05; Phi = 0.274).The use of DS was primarily recommended by nutritionists(39.2%), coaches (21.5%), and physicians (20.3%). Conclusions: DS consumption was relatively low com-pared to other populations. However, the majority of DS con-sumers reported that DS contributed to the prevention ofCOVID-19 infection. A significant proportion of DS consumerssought recommendations from healthcare professionals.(AU)

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PURPOSE: Persistent macular hole (PMH) is a challenge for retina surgeons. There are limited surgical techniques described achieving PMH closure. For more than a decade, techniques with blood derivatives have been described without optimal outcomes. The aim of this article is to report the usefulness of the plasma rich in growth factors (PRGF) as a new way to improve PMH closure. METHODS: This is an observational study. Two patients with PMH were chosen at the FOSCAL Internacional, Floridablanca, Colombia. For each patient, a complete ophthalmological examination before and after treatment was performed. It included best-corrected visual acuity and fundus examination. Features of swept-source optical coherence tomographic angiography (Topcon) at baseline and after treatment were included. Preoperative evaluation included the following: previous vitreoretinal surgery for macular hole, macular hole measurement and classification, and dissociated optic nerve fiber layer in en-face map, confirming a prior internal limiting membrane peeling. Plasma rich in growth factors-Endoret technology is characterized by moderate platelet concentration and absence of leukocytes, which requires calcium chloride for platelet activation. It is obtained from each patient's blood sample, submitted to a series of processes to acquire a three-dimensional fibrin scaffold, rich in hundreds of proteins, which seems to have therapeutic potential. This PRGF membrane is placed into the macular hole with forceps through a pars plana vitrectomy after complete air-fluid exchange. Supernatant was placed on the macula and left it for 2 minutes. It is then aspirated, and gas or silicone oil was left as a tamponade. RESULTS: Follow-up period was of 12 months for each patient. Complete macular hole closure was achieved in both cases. Best-corrected visual acuity changed from 20/200 preoperatively to 20/100 postoperatively in Patient #1 and from 20/1,500 to 20/100 in Patient #2. CONCLUSION: Plasma rich in growth factors has been primarily investigated for ocular surface diseases. This is a pilot study using this technology for PMH treatment. The use of PRGF may be an effective and safe surgical technique with satisfactory anatomical and functional results for PMH. Because of its own biomaterials and proteins, PRGF not only allows anatomical closure but also seems to stimulate tissue regeneration.

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BACKGROUND: Timely detection of early microvascular changes in patients with prediabetes could help reduce the likelihood of progression of diabetes-related retinal complications. AIM: To determine early microvascular changes in patients with prediabetes using optical coherence tomography angiography (OCT-A). METHODS: In this single-center retrospective case-control study, macular OCT-A images of superficial capillary plexus (SCP) and deep capillary plexus (DCP) were analyzed in non-diabetic controls, and prediabetic and diabetic subjects. A quantitative analysis was performed using ImageJ software of the foveal avascular zone (FAZ) area, acircularity index (AI), perfusion density (PD), and vascular length density (VLD). RESULTS: A total of 94 eyes of 53 patients were included in this study. The global mean age was 57.7 years, 39.6% men and 60.4% women. In SCP, the mean PD was 0.283 ± 0.15, 0.186 ± 0.720, and 0.186 ± 0.07 in non-diabetic controls, and prediabetic and diabetic groups, respectively. The mean VLD was 8.728 ± 3.425 in non-diabetic controls, 6.147 ± 1.399 in prediabetic group, and 6.292 ± 1.997 in patients with diabetes. The comparison of prediabetic patients and controls shows statistical differences between PD and VLD in both plexus SCP (p = 0.002 and p = 0.001, respectively) and DCP (p = 0.005 and p = 0.002, respectively). The mean area of FAZ in patients with diabetes and normal individuals was 0.281 and 0.196 mm2, respectively (p < 0.001). AI was higher in the control group (0.87 ± 0.14) and prediabetic group (0.80 ± 0.17) compared to diabetic patients (0.64 ± 0.19). There were no differences in FAZ area and AI between prediabetic and non-diabetic controls. CONCLUSION: PD and VLD demonstrated to be early microvascular changes in prediabetic patients evaluated by OCT-A. No alterations of FAZ were evidenced in this group.

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BACKGROUND: Swept source optical coherence tomography angiography (SS-OCT-A) choroidal vasculography (CVG) is an imaging method which allows the evaluation of deep choroid details, being a promising too in choroidal pathologies as polypoidal choroidal vasculopathy (PCV). RESEARCH DESIGN AND METHODS: Cross-sectional study performed at FOSCAL International Clinic in Colombia. CVG features in patients with PCV were evaluated using SS-OCT CVG. RESULTS: Twenty-two eyes of 21 patients were included. The mean age was 72.7 ± 6.5 years old (range: 48.6-95.4 years old). Twelve (57.1%) patients were male. The mean number of polyps detected by SS-OCT-A CVG before treatment with anti-VEGF therapy was 2.04 ± 1.18, which decreased after treatment to 1.18 ± 0.71. This result was statistically significant (p < 0.05). All polypoidal lesions detected by B-scan were visualized using CVG. Polyp circularity and surrounding reflectivity indicated activity of disease. CONCLUSION: En face SS-OCT-A CVG is an alternative tool to evaluate choroidal structure at different depths without a contrast dye, providing information for the diagnosis and follow-up of patients with PCV. This imaging modality do not pretend to replace gold standard tests in PCV as ICGA, but rather provides choroidal imaging features of PCV, when ICGA is not available.

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BACKGROUND AND OBJECTIVE: Neovascularization is a sight-threatening, uncommon complication of posterior uveitis that often goes undetected until persistent clinical findings appear, or in light of treatment failure. This could be attributed to the relative similarity of activity signs in inflammatory neovascular membranes (NVM) and active posterior uveitis. The purpose of the present study is to recognize imaging features that distinguish uveitic neovascularization from active uveitis using swept-source optical coherence tomography angiography (SS-OCTA). PATIENTS AND METHODS: Cross-sectional study. Patients with posterior uveitis with visual acuity (VA) decrease and at least one of the following findings were assessed by SS-OCTA: retinal thickening, subretinal or intraretinal fluid, and retinal hyperreflective areas. The change of VA and imaging features after treatment with anti-vascular endothelial growth factor (VEGF) therapy were analyzed in cases with inflammatory NVM. RESULTS: Forty-five eyes of 40 patients were evaluated. Twenty-four eyes (53.3%) showed signs of activity, of which eight (33.3%) presented inflammatory NVM. Imaging features that differentiate inflammatory neovascularization from active posterior uveitis included: vitreous cellularity (P = .003), outer retinal infiltration (P = .08), choroidal thickness (P = .003), posterior shadowing (P = .013), subretinal fluid (P = .04), and neovascular network (P ≤ .001). According to NVM characteristics by OCTA, multiple anastomoses and peripheral arcades were visualized at baseline in 85.7% of cases. Mean pre-operative best-corrected VA of inflammatory NVM was 20/150 (logMAR: 0.88 ± 0.60) with significant improvement to 20/40 (logMAR: 0.32 ± 0.22) after anti-VEGF treatment (P = .027). CONCLUSIONS: SS-OCTA achieves the distinction of inflammatory NVM from active posterior uveitis through specific imaging features. Inflammatory neovascularization presents a suitable response after anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:129-137.].

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BACKGROUND AND OBJECTIVES: To describe the imaging characteristics of polypoidal choroidal vasculopathy (PCV) in optical coherence tomography angiography (OCTA) and demonstrate its use as diagnostic method for this pathology in a Latin American population. PATIENTS AND METHODS: A case series. RESULTS: Fourteen eyes were evaluated. At baseline, the most frequent morphology was the "oval" type (76.9%), obtaining a reduction of 53.8% after treatment. The intrinsic finding of the polyps was hyporeflective content prior to treatment (80.8%), which reduced after treatment (7.7%) (P = .016). CONCLUSIONS: OCTA is a useful imaging tool for detecting findings that can guide the diagnosis of PCV without contrast medium. Likewise, it provides signs that can suggest the behavior of the lesion prior to and after treatment, enriching the understanding of the pathology and therefore aiming to an efficient therapy. To the best of the authors' knowledge, this is the first study in a Latin American population. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:748-756.].

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En los últimos años hemos asistido al renacimiento del juego en nuestra sociedad, tanto en su modalidad presencial como en la on-line. Las nuevas formas de juego han provocado la apertura de este sector a aquellos que en las formas tradicionales del juego no tenían tales facilidades de acceso como son los menores. El Estado se encuentra ante una serie de problemas coyunturales y relacionados con el juego en menores, a los que, si no se les da una rápida solución, terminarán convirtiéndose en un problema estructural de nuestra sociedad. Esto ha provocado que un tema que se había tenido por solucionado durante décadas pase a formar parte de la agenda política de nuestro país. La prohibición está presente en la legislación; ahora bien, la solución la encontraremos en la gestión

Over the past few years our society has experienced a revival of gambling in its different versions, online and personally attended. The new forms of gambling have meant that this sector has been opened up to those whose access in its traditional forms was restricted, for instance, children. The State faces several problems relating to gambling in younger people, problems which could become structural issues in our society if they are not quickly coped with. This has resulted in an issue that was considered for decades to have been settled becoming a concern in our country. Prohibition is present in legislation, but the solution will be found in management

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Objetivo: Describir el caso de un paciente joven con antecedente de miopía bilateral y degeneración en Lattice en el ojo izquierdo (OI), que desarrolló un desprendimiento de retina bilateral después de realizar una actividad de alto riesgo tipo bungee jumping. Diseño: Reporte de caso. Metodología: Reporte de caso retrospectivo mediante la recopilación de datos clínicos, estudios imagenológicos y valoraciones postoperatorias. Resultado: Recuperación de la agudeza visual posterior a tres procedimientos quirúrgicos de 20/400 en ojo derecho (OD) y de 20/30 en OI en el paciente con antecedente de desprendimiento de retina bilateral. Conclusión: El desprendimiento de retina traumático secundario a actividades de alto riesgo donde está implicado el movimiento de latigazo es poco común, sin embargo, la identificación temprana de patologías como la miopía y degeneración en lattice, en personas que van a realizar deportes extremos, debe considerarse. También es importante que las compañías que promocionan este tipo de actividades conozcan esta patología, ya que a pesar de ser infrecuente, puede llegar a desarrollarse.

Purpose: To describe the case of a young patient with a history of bilateral pathologic myopia and lattice degeneration in the left eye who developed bilateral retinal detachment after making a bungee jumping activity. Design: Case report. Methods: A descriptive, case report study type was performed by collecting clinical data, imaging studies and postoperative evaluations. Result: Subsequent recovery of visual acuity after three surgical procedures of 20/400 in right eye and 20/30 in the left eye in the case report patient with a history of bilateral retinal detachment. Conclusion: Traumatic retinal detachment secondary to high-risk activities where is involved the whipping motion is uncommon, however, early identifi cation of diseases as myopia and lattice degeneration in people who practice this extreme sports should be identifi ed. It is also important that companies promoting such activities acquire knowledge about it, taking into account, that despite it is a rare disease, it may develop.

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Objetivo: presentar el caso de un paciente joven con neovascularización coroidea idiopática, con importante compromiso visual unilateral y que con la inyección intravítrea de aflibercept mensual, por tres meses, recuperó completamente la agudeza visual. Diseño: reporte de caso. Método: se realizó un estudio descriptivo tipo reporte de caso, mediante la recopilación de datos clínicos, estudios imagenológicos y valoraciones postoperatorias. Resultados: mejoría significativa de agudeza visual en paciente con neovascularización coroidea idiopática en ojo izquierdo posterior a tres inyecciones intravítreas de aflibercept mensual. El paciente mejoró de 20/400 a 20/20 al completar el esquema terapéutico. Conclusiones: el esquema de antiangiogénico resultó ser útil para el tratamiento de neovascularización coroidea idiopática en un paciente joven, logrando una recuperación visual y anatómica completa.

Objective: to present the case of a young patient with idiopathic choroidal neovascularization, with significant unilateral visual impairment. He fully recovered visual acuity by appliyng monthly intravitreal aflibercept, for three months. Design: case report. Method: a descriptive, case report study type was performed by collecting clinical data, imaging studies and postoperative evaluations. Results: Significant visual acuity improvement was obtained in the present patient with idiopathic choroidal neovascularization after three monthly intravitreal injections of aflibercept. The patient improved from 20/400 to 20/20 when treatment was completed. Conclusions: antiangiogenic schemev could be useful for the treatment of idiopathic choroidal neovascularization, achieving a complete visual and anatomical recovery.

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