Non-arteritic anterior ischemic optic neuropathy (NA-AION) is considered the most frequent type of acute optic neuropathy. A 61-year-old woman presented with a NA-AION in her right eye within 24 h ...following an airplane flight. One year later, after driving for 10 days with a daily accumulated altitude of 1500 m, she developed a NA-AION in her left eye. Systemic disorders were investigated, and cerebral small vessel disease was observed via cranial computed tomography. An inadequate response to hypoxia, in a patient with individual susceptibility, could lead to reduced blood supply to the optic nerve head, which could represent an underlying cause of NA-AION.
Aims/Purpose: To present a case report of a 64‐year‐old man with dislocation of a dexamethasone anterior chamber (AC) implant, who underwent secondary implantation with the Canabrava technique.
...Methods: A male patient underwent surgery for a secondary implant in the left eye using the Canabrava technique.
Post‐operatively, cystic macular oedema was observed on optical coherence tomography (OCT). After 15 days, with no anatomical improvement despite treatment with Nevanac eye drops, a dose of intravitreal injection with Ozurdex® was prescribed. A few days later, the patient came to the emergency department and reported seeing a foreign body in the treated eye. On biomicroscopic examination, an Ozurdex® insert was found in the AC. When the patient was questioned again, he stated that he had been in the praying position the previous days. A new macular OCT was performed, showing resolution of the foveal oedema. Dilation of the LAA with phenylephrine was performed with cephalic manoeuvres in the supine decubitus position, achieving the repositioning of the dexamethasone implant in the vitreous chamber. Finally, an OCT of the anterior pole shows that the secondary implant is normally positioned without complications.
Results: After initial treatment with Ozurdex® intravitreal implant, total resolution of the post‐operative cystic macular oedema is achieved, even with dislocation to the anterior chamber. After outpatient management of the dislocation of the implant, we were able to relocate it to the vitreous chamber without the need for surgical management of the patient.
Conclusions: In the clinical case, it is demonstrated that the anti‐inflammatory effect of Ozurdex® remains active despite dislocation of the implant to the anterior chamber. Likewise, a good ambulatory technique in the supine position with directed cephalic manoeuvres may be sufficient to reposition the implant without the need for surgery.
Purpose: We describe a case of Fish‐Eye Disease (FED) in which the clinical features and visual function were investigated using anterior‐segment optical coherence tomography (AS‐OCT).
Methods: A ...38‐year‐old Spanish man with a known history of dyslipidemia came to our Hospital referring mild blurred vision and whitening of both eyes. Visual acuity was 1.00 (decimal). Slit‐lamp examination showed bilateral, peripheral yellowish‐white corneal opacities, causing corneal clouding. An AS‐OCT was then performed, showing homogeneously hyper‐reflective corneal stroma. On systemic examination, the patient had low plasma high‐density lipoprotein cholesterol levels.
Results: Both slit‐lamp examination and AS‐OCT imaging revealed a corneal opacification compatible with FED, a clinical feature secondary to a lecithin‐cholesterol acyltransferase (LCAT) deficiency. The patient was sent to genetic counselling to study the mutation, which was later found to be positive for LCAT gene.
Conclusions: Although it is not a common genetic disorder, FED should be included in the differential diagnosis of corneal clouding. The findings from this case suggest that a complete eye examination, both with slit‐lamp and AS‐OCT, can be useful for an early FED diagnosis despite good visual acuity.
Purpose
To describe corneal changes after birth trauma from forceps delivery, using anterior segment optical coherence tomography (AS‐OCT), in order to reduce the risk of potential anisometropic ...amblyopia.
Methods
A 73‐year‐old female patient came to the ocular surface section consulting for dry eye disease symptoms. At the slit lamp examination, a vertical endothelial stria was observed in the right eye. After an exhaustive anamnesis, the patient referred having a traumatic birth in which forceps had been used.
Results
An AS‐OCT was performed, showing a vertical rupture in the Descemet membrane secondary to traumatic birth with forceps.
Conclusions
Descemet’s membrane rupture can cause corneal oedema which usually clears over time, but those ruptures often persist. The residual corneal changes can result in anisometropia and the main cause of vision loss after such injury is anisometropic amblyopia. The AS‐OCT is a useful diagnostic tool to detect these alterations at early stages.
Bibliography
Sarma P, Borgohain M, Tayab S, Sangma CA. Descemet's membrane rupture secondary to forceps‐induced birth injury. Indian J Ophthalmol. 2020;68(10):2253. https://doi.org/10.4103/ijo.IJO_149_20
Alobaidy R, Srinivasan S. Forceps‐induced birth injury to the cornea. BMJ Case Rep. 2014;2014:bcr2013201786. Published 2014 Apr 9. https://doi.org/10.1136/bcr‐2013‐201786
Purpose
To describe the importance of applying an urgent protocol in cases of lens subluxation into the anterior chamber (AC) in order to diminish the risk of corneal decompensation.
Methods
A ...60‐year‐old man with a history of ocular trauma in his youth and pseudoexfoliation syndrome, presented pupillary block in the right eye 2 months after an accidental fall without ocular involvement. Visual acuity was 0.05 (decimal) and intraocular pressure was 55 mmHg. Slit lamp examination and anterior segment Optical Coherence Tomography showed a lens subluxation towards AC (lower portion) with endothelial contact and corneal edema. In funduscopy, an inferior giant tear with associated retinal detachment was observed.
Results
After treating ocular hypertension with hypotensive agents, Pars Plana Vitrectomy 25 Gauge + Lensectomy + Endolaser + SF6 Tamponading gas were performed, leaving the patient in aphakia for subsequent intraocular lens implantation surgery. Two months later, a substantial loss of endothelial cell count was observed (777 cells right eye VS 2223 cells left eye).
Conclusions
In this type of pathology, it is imperative to take immediate pharmacological, postural and surgical measures to reduce contact between the lens and the cornea, in order to minimize endothelial damage and improve the visual prognosis of these patients.
Bibliography
Ke G, Zhou E, Zhu K, Wei Y, Wang Z, Jia Y, Wang S, Gu Y. Retinal break associated with traumatic lens dislocation or subluxation requiring vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2020 Mar;258(3):693–697. doi: 10.1007/s00417‐019‐04530‐9. Epub 2019 Nov 28. PMID: 31781882.
Salehi‐Had H, Turalba A. Management of traumatic crystalline lens subluxation and dislocation. Int Ophthalmol Clin. 2010 Winter;50(1):167–79. doi: 10.1097/IIO.0b013e3181c567de. PMID: 20057305.
Circumscribed choroidal hemangioma (CCH) is a rare congenital ocular tumor type that is usually benign and asymptomatic. CCH has only been reported once previously in the literature in association ...with a visceral neoplasm. Here, we present a newly described association between CCH and hepatic hemangioma (HH). We report the case of a 57-year-old woman diagnosed with asymptomatic HHs who presented with a 2- to 3-month history of central scotoma and blurred vision in her left eye. Assessment identified an orange-red elevated lesion with a central serous retinal detachment and subretinal edema. Complementary tests suggested a CCH. To our knowledge, CCH has only been reported once previously in association with a visceral neoplasm, making this newly described association between CCH and HH of clinical relevance. Ophthalmologists should be aware of the possible association between CCH and other visceral tumors as this association offers an opportunity for the early detection of this pathology.
To assess the cost-effectiveness of the delayed-release device of dexamethasone compared with aflibercept in the treatment of patients with naïve diabetic macular edema (DME) from a societal ...perspective in the healthcare sector Zaragoza III in Spain.
A Markov model with five states defined by visual acuity (VA) in the better-seeing eye (Snellen scale) and an additional death state were constructed. Two cohorts of patients were distributed along the VA states and treated during a year with either dexamethasone or aflibercept. One-year follow-up on each group was performed. Medical costs related to the DME treatment and follow-up, medical costs related to the DME comorbidities, and non-medical-related costs were taken into account. Costs (2020 €), health outcomes (Quality-Adjusted Life Years-QALYs), both discounted at a 3.5% annual rate, and incremental cost-effectiveness ratios (ICER: €/QALY) were determined for a lifetime horizon in the base case analysis.
Patients treated with dexamethasone were €77,349 more costly and provided 2.667 additional QALYs (€29,002/QALY) than those treated with aflibercept. The variable efficiency per patient was calculated dividing the improvement in quality of life (on the VFQ-25 scale) by the cost of the treatment. With the obtained results it can be concluded that the efficiency of treating the patients with dexamethasone is significantly superior than the efficiency of treating them with aflibercept.
The cost per QALY gained with the delayed-release device of dexamethasone compared with the one obtained by aflibercept in the naïve DME population is just below the €30,000 threshold, below which, new drugs are sometimes regarded as cost-effective strategies in Spain. In this model, the key variables with greater impact on the cost-effectiveness results were the selected time horizon, the chosen extrapolation method and the number of aflibercept and dexamethasone injections.
Purpose
To assess the effect of fluid status at baseline (BL) and at the end of the loading phase (LP) of three different ranibizumab regimens: treat‐and‐extend (T&E), fixed bimonthly (FBM) ...injections and pro re nata (PRN), in patients with neovascular age‐related macular degeneration (nAMD).
Design
Post hoc analysis of the In‐Eye study (phase IV clinical trial).
Methods
Patients were randomized 1:1:1 to the three study arms and were treated accordingly. The presence and type of fluid, intraretinal fluid (IRF) or subretinal fluid (SRF) and the anatomical and visual outcomes were analysed.
Main outcome measures
Best‐corrected visual acuity (BCVA), the mean change from baseline BCVA (BL BCVA), and the proportion of eyes gaining more than 15 letters or losing more than five letters were analysed. Morphological characteristics including the subtype of choroidal neovascular membrane and the development of atrophy and fibrosis were also evaluated.
Results
Patients with SRF at LP had better visual outcomes than patients with IRF. The persistence of SRF did not affect the mean change from BL BCVA among the three treatment regimens. However, in patients with IRF mean change from BL BCVA was significantly lower in the FBM group. The presence of IRF at BL and at the end of the loading phase was associated with the development of fibrosis at the end of the study; this result was contrary to that observed for patients with SRF.
Conclusions
While SRF is compatible with good visual and anatomical outcomes, IRF leads to worse results in patients with nAMD; our results suggest that patients with IRF have better outcomes when individualized treatment regimens are used (PRN or T&E) in contrast with a FBM regimen.
Purpose
To assess the noninferiority of the treat‐and‐extend (T&E) and fixed bimonthly regimens of 0.5 mg intravitreal ranibizumab as compared with the pro re nata (PRN) in naïve patients with ...neovascular age‐related macular degeneration (nAMD).
Methods
Phase IV, randomized, 12‐month, multicentre trial. Patients aged ≥50 years with nAMD and visual impairment best‐corrected visual acuity (BCVA) between 23 and 78 Early Treatment Diabetic Retinopathy Study (ETDRS) letters were eligible. Patients (one eye per patient) were randomized to bimonthly, n = 103, T&E, n = 99 or PRN, n = 104. Noninferiority was established at five letters ETDRS.
Results
The mean (95% CI) difference in BCVA at 12 months was 7.2 (4.2–10.2), 6.4 (2.9–9.8), and 8.0 (51.1–11.0) in the bimonthly, T&E and PRN, respectively. The bimonthly or T&E regimens were not inferior to the PRN scheme. All regimens were associated with a significant reduction of central subfield thickness and volume. The mean (95% CI) number of injections in the bimonthly regimen (7.6, 7.5–7.7) was similar as compared with the PRN regimen (7.4, 6.7–8.0) (p = 0.159) but lower than in the T&E regimen (9.3, 8.9–9.7) (p < 0.001).
Conclusion
At 12 months, bimonthly and T&E ranibizumab were noninferior to PRN in naïve nAMD.
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