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El edema macular pseudofáquico (EMP) es una complicación en la cirugía de catarata. Existen diversos factores que aumentan el riesgo de desarrollar EMP tales como la uveítis, membranas epirretinianas y diabetes mellitus. Se ha demostrado ampliamente que un mayor porcentaje de pacientes diabéticos desarrolla EMP tras someterse a cirugía de catarata frente a los pacientes no diabéticos. El EM es la principal causa de pérdida de agudeza visual en estos pacientes. Existen dos tipos de EM en paciente diabético: 1) El EMP tras cirugía de catarata en pacientes diabéticos. 2) El Edema macular diabético (EMD)que se genera por las alteraciones intrínsecas vasculares que el paciente diabético tiene. Un tratamiento preventivo podría mejorar los resultados de los pacientes diabéticos tras someterse a cirugía de catarata, con los correspondientes beneficios para la calidad de vida del paciente y su repercusión en los costes sanitarios asociados a esta patología. Existen 4 AINEs aprobados por la FDA (Food and Drugs Administration) para el manejo de la inflamación tras la cirugía de catarata: bromfenaco, dicloflenaco, ketorolaco y nepafenaco. Aunque prácticamente todos los AINEs se han venido usando en prevención en pacientes intervenidos quirúrgicamente de catarata, nepafenaco es el único aprobado por la EMA (European Medicines Agency) para esta indicación, y lo ha demostrado en pacientes con retinopatía diabética. El objetivo del presente trabajo es revisar la literatura publicada al respecto y destacarla importancia de una estrategia de prevención de edema macular en pacientes diabéticos sometidos a cirugía de catarata (AU)

Pseudophakic macular edema (PME) is a common complication of cataract surgery. There are several factors that increase the risk of developing PME such as uveitis, epiretinal membranes and diabetes mellitus. There is ample evidence that a higher percentage of diabetic patients develop PME after undergoing cataract surgery compared to patients without diabetes.Macular edema is the main cause of loss of visual acuity in these patients. There are two types of ME in diabetic patients: 1) PME after cataract surgery in diabetic patients. 2) Diabetic Macular Edema (DME) that is generated by intrinsic vascular alterations present in diabetic patients. A preventive treatment could improve outcomes of diabetic patients undergoing cataract surgery, with corresponding benefits to the quality of life and their impact on health care costs associated with this pathology. There are 4 NSAIDs approved by the FDA (Food and Drugs Administration) for the management of inflammation after cataract surgery: bromfenac, dicloflenac, ketorolac and nepafenaco. Although practically all NSAIDs are been used for the prevention in patients with cataract surgery, nepafenac is the only one approved by the EMA (European Medicines Agency) for this indication, and it has demonstrated its effects in patients with diabetic retinopathy. The aim of this paper is to review the published literature and highlight the importance of a macular edema prevention strategy in diabetic patients undergoing cataract surgery (AU)

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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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AIMS: To compare anatomical and functional outcomes for 546 phakic and pseudophakic primary rhegmatogenous retinal detachments (RDs) treated by pars plana vitrectomy or scleral buckling. METHODS: Prospective, non-randomised, interventional study in 15 centres in Spain and Portugal, with data from RDs consecutively treated from January 2005 to May 2007. Cases with preoperative proliferative vitreoretinopathy grade C-1 or higher and perforating trauma were excluded. Minimum follow-up was 3 months. Twenty-seven pre-, intra- and post-surgical variables for each patient were analysed. Multivariate analysis was carried out by logistic regression analysis with stepwise selection of variables. RESULTS: Data from 546 patients were analysed. Global anatomical success was 94.7%. Logistic regression analysis showed that only the development of postoperative proliferative vitreoretinopathy was associated with a poor anatomical outcome. The poorest functional results were associated with macular involvement, extension of RD, previous RD surgery, time of evolution of RD, and age of patient. Hierarchical log-linear analysis showed no effect of the lens status (phakic versus pseudophakic) on the functional results. However, pars plana vitrectomy was most often performed in pseudophakic eyes and resulted in a worse final visual acuity (p<0.001). CONCLUSIONS: No differences in anatomical success between phakic and pseudophakic eyes were found in this series. Pars plana vitrectomy was most often performed in pseudophakic eyes and had a greater probability of a worse final visual acuity than scleral buckling.

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BACKGROUND: Seroprevalence studies in Spain have shown that a high number of the population has been in contact with Toxocara canis although no cases of ocular involvement by this helminth have been described. The clinical and age of presentation makes differential diagnosis with retinoblastoma necessary, which is at time difficult, although essential since the treatment and prognosis are very different. METHODS: One case of ocular toxocariosis and the diagnostic keys based on the following are described: ophthalmologic exploration, imaging techniques (ECHO, TC, NMR), aqueous humor cytology, LDH quotient of aqueous/serum humor, and determination of specific anti-Toxocara antibodies by ELISA in serum and aqueous humor. CONCLUSIONS: Correct differential diagnosis between ocular toxocariosis and retinoblastoma is required.

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