Age-relatedmaculardegeneration (AMD) is a leading cause of irreversible blindness among people above 60 years old in industrialized countries (Jager et al., 2008; Wong et al., 2014). It is estimated to have a prevalence of ∼ 18% in the population aged 65-74 years (Klein et al., 1992), and the general consensus states that, as the population grows and ages, the incidence of the disease will increase (Buschini et al., 2015). AMD is a heterogeneous disease, presenting several signs such as accumulation of debris and deposits both below (drusen) and above ( pseudodrusen) the retinal pigment epithelium (RPE), thickening of Bruch ’ s membrane (BrM), hyper or hypopigmentation of the RPE, choroidal neovascularisation (CNV) and loss of photoreceptors (PRs) (Bhutto and Lutty, 2012; Jager et al., 2008). Clinically, AMD has been classified in two forms: non-exudative AMD (the more prevalent form of the disease) and exudative or neovascular AMD (NVAMD). Although the two forms might not necessarily be mutually exclusive, the hallmark of NVAMD is CNV, whereas non- exudative AMD is characterized by a delimited central area of RPE atrophy and PR loss, which in advanced stages is called geographic atrophy (GA) (Bhutto and Lutty, 2012; Jager et al., 2008; van Lookeren Campagne et al., 2014). Currently, there is no approved or effective treatment to prevent the onset and progression of GA. Several environmental aspects, such as old age, female sex, cigarette smoking, diet and Caucasian race, have been identified as risk factors for AMD (Buschini et al., 2015; Danis et al., 2015; van Lookeren Campagne et al., 2014; Zarbin, 2004). In addition, oxidative stress, inflammation, RPE senescence and choroid blood flow changes are involved in AMD development and progression (Buschini et al., 2015; Danis et al., 2015; van Lookeren Campagne et al., 2014; Zarbin, 2004). However, the exact pathogenic mechanisms and their temporal sequence are still elusive. AMD is difficult to study because of its late onset, complex genetics and the influence of environmental factors. Unravelling which are the most critical mechanisms in AMD pathogenesis is unlikely to be achieved in studies limited to the clinically observable changes in human retinas. Far more detailed and invasive studies are needed, preferably in a readily available animal model. Over the last decade, there have been an increasing number of reports describing rodent models (mostly mice), which show some characteristics compatible with human AMD (Fletcher et al., 2014; Pennesi et al., 2012; Ramkumar et al., 2010). The majority of these models result from the manipulation of mouse genes involved in inflammation ( CFH , CCL2 , CCR2 , CX3CR1 ) and oxidative stress ( SOD1 and SOD2 ), as well as genes related to metabolic pathways ( CTSD , CP and APOE ), among others (Fletcher et al., 2014; Pennesi et al., 2012; Ramkumar
Age-relatedmaculardegeneration (AMD) is the leading cause of blindness among the elderly in the Western world [1–3]. Currently, there is no cure for the disease; however, intravitreal antivascular endothelial growth factor (anti- VEGF) agents have significantly improved visual outcomes in patients with neovascular age-relatedmaculardegeneration (nAMD) [4–7]. These new therapeutic approaches have been shown to prevent and in some cases reverse visual damage caused by nAMD in clinical trials. Early diagnosis is obvi- ously essential in order to take action as promptly as possible to obtain the best result from therapy . Therefore, primary care physicians who suspect nAMD should directly refer their patients to an ophthalmologist . It is advisable to establish a referral protocol based on signs and symptoms in order to maximize efficiency and utilization of health resources.
Age-relatedmaculardegeneration (AMD) is the most com- mon cause of blindness in the Western world, and given its chronic and progressive course altogether with the fact that AMD may require lifelong observation and therapy, it has become a major socioeconomic issue as the proportion of the aged population is increasing exponentially . The beneficial effects of intravitreal injections of ranibizumab (Lucentis, Genentech, Inc., South San Francisco, CA, and Novartis, Basel, Switzerland) and aflibercept in the treatment of neovas- cular AMD (nv-AMD) have been widely evidenced showing significant improvements in visual acuity and quality of life [2, 3]. The standard of care for nv-AMD was established on basis of the results obtained in the pivotal randomized clinical trials with fixed monthly injections of ranibizumab , albeit a significant burden for patients, physicians, and health ser- vices. Retinal specialists developed further modifications to this monthly regime. For instance, an individualized dosing strategy through a monthly follow-up with the decision to treat based on optical coherence tomography (OCT) findings and visual acuity changes arose as a potential alternative. Sev- eral reports have shown that intravitreal antiVEGF therapy with ranibizumab or with bevacizumab is effective in mainta- ining or improving visual acuity on this “as-needed” basis, so called pro re nata (PRN) strategy; [4–6] furthermore, ranibi- zumab administered on an as-needed basis was a more cost- effective strategy compared to fixed monthly treatments with respect to cost per QALY gained .
Purpose. To survey the management of patients with neovascular age-relatedmaculardegeneration (nvAMD) in Spain. Methods. An observational retrospective multicenter study was conducted. The variables analyzed were sociodemographic characteristics, foveal and macular thickness, visual acuity (VA), type of treatment, number of injections, and the initial administration of a loading dose of an antiangiogenic drug. Results. 208 patients were followed up during 23.4 months in average. During the first and second years, patients received a mean of 4.5±1.8 and 1.6±2.1 injections of antiangiogenic drugs, and 5.4±2.8 and 3.6±2.2 follow-up visits were performed, respectively. The highest improvement in VA was observed at 3 months of follow-up, followed by a decrease in the response that stabilized above baseline values until the end of the study. Patients who received an initial loading dose presented greater VA gains than those without. Conclusions. Our results suggest the need for a more standardized approach in the management and diagnosis of nvAMD receiving VEGF inhibitors. To achieve the visual outcomes reported in pivotal trials, an early diagnosis, proactive approach (more treating than follow-up visits), and a close monitoring might be the key to successfully manage nvAMD.
Que el trabajo titulado " CHOROIDAL THICKNESS IN NON-NEOVASCULAR VERSUS NEOVASCULAR AGE-RELATEDMACULARDEGENERATION: A FELLOW EYE COMPARATIVE STUDY " ( GROSOR COROIDEO EN LA DEGENERACION MACULAR ASOCIADA A LA EDAD: UN ESTUDIO TRASVERSAL ) ha sido realizada bajo mi dirección por Don ANDREA GOVETTO en e Departamento de Cirugía, Ciencias Médicas y Sociales de la Universidad de Alcalá en colaboracion con la Universidad de California en Los Angeles UCLA (EEUU) y la Universidad Vita-Salute San Raffaele de Milan (ITALIA), y que dicho trabajo reúne los requisitos científicos de originalidad y rigor metodológio suficientes para ser presentado como Tesis Doctoral ante el tribunal que corresponda.
La idea de comparar los resultados encontrados en los ensayos clínicos (que presentan criterios de inclusión y exclusión de pacientes muy estrictos, controles médicos continuos y exhaustivos y tratamientos sin tiempo de demora) con los de la práctica clínica habitual no es nueva, existen estudios realizados de manera retrospectiva por diferentes centros de oftalmología en diferentes partes del mundo, los cuales no siempre encuentran resultados semejantes a los ensayos clínicos realizados; el “Ranibizumab treatment for neovascular age-relatedmaculardegeneration: from randomized trials to clinical practice” (15) fue realizado en Australia y obtiene resultados semejantes a los ensayos clínicos, pero es realizado por un grupo de oftalmólogos en su práctica habitual que son dependientes de la empresa farmacéutica. Sin embargo, el “Effectiveness of intravitreal ranibizumab for the treatment of neovascular age-relatedmaculardegeneration in a Canadian retina practice: a retrospective review” (16) por una parte no obtiene buenos resultados por alta tasa de abandono del tratamiento por el paciente (seguimiento 1 año), y por otra parte, encuentra que pacientes con AV inicial menor a 1.30 LogMAR (0.05 decimal) mantienen o decrecen poco su AV, mientras que los de AV inicial mayor o igual a 1.30 si mejoran con el tiempo. Otro estudio fue realizado por Britta Heimes, et al (17). Que no encuentra mejoras visuales a largo plazo, aunque si llega a encontrar que la visión se estabiliza a los 2 años con tratamiento y destaca la dificultad para seguir los criterios de reinyección (5 letras ETDRS o 100 micras de grosor macular foveolar).
Screening for retinal diseases, in particular diabetic retinopathy (DR) and age-relatedmaculardegeneration (AMD), is one of the most common and successful application of early diagnosis of eye diseases until now. DR is an eye disorder that affects the retinal vasculature and gradually develops in patients with diabetes. Visual problems derived from DR provoke dark spots in the vision associated with the areas of the retina affected. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million in 2030 (Zheng, He, and Congdon 2012). DR is the leading cause of vision loss in middle-aged and elderly people globally (Ting, Cheung, and Wong 2016). According to WHO it is estimated that 4.8% of the number of cases of blindness worldwide are caused by DR (Resnikoff et al. 2004). Among the people affected by diabetes the cumulative incidence of DR increase with time; for the population with 25 years suffering Type 1 diabetes the rate reach 97% (Klein et al. 2008). Due to the increasing number of people with diabetes worldwide (estimated in 415 million in 2015 and in 642 million in 2040 (Ogurtsova et al. 2017)) the prevalence rate of DR is estimated to increase rapidly in the near future (Saaddine et al. 2008). AMD accounts for 8.7% of all blindness worldwide and is the most common cause of blindness in developed countries especially in people older than 60 years old (W. L. Wong et al. 2014). AMD affects the central vision preventing patients to perform detailed activities. The project number of people with AMD in 2020 is 196 million increasing to 288 million in 2040 (W. L. Wong et al. 2014).
Forty-four (28 boys and 16 girls) out of 241 children (18.2%) who suffered IH CA (22 cases) or OOH CA (22 cases) received at least one electric shock. The mean age of the patients was 78.2 ± 66.7 months (range, 1 month–16 years) and the mean weight was 24.8 ± 19.0 kg (range, 3–70 kg). Patients' characteristics are summarized in Table 1. CA was identified by health professionals in 38 patients (86.4%) and by paramedics in six cases (13.6%). Twenty-five patients (56.8%) were monitored when they suffered the CA episode, 20 patients (45.5%) were on mechanical ventilation, and 16 patients (36.4%) were treated with vasoactive drugs at the time of CA. The time elapsed from CA to CPR was less than four minutes in 29 patients (65.8%), was 4–20 minutes in five patients (11.4%), and was longer than 20 minutes in three cases (6.8%). The time from arrest to resuscitation was unknown in seven instances.
414 36. Shukla D, Behera UC, Chakraborty S, Mahalakshmi R, Prasad NM. Serous macular detachment as a predictor of resolution of macular edema with intravitreal triamcinolone injection. Ophthalmic Surg Lasers Imaging. 2009;40(2):115-9. 37. Benson WB. A Randomized Trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion. Evidence-Based Ophthalmol. 2010;11(1):22-3.
32 En los ojos con antecedente de uveítis e inflamación activa dentro de 3 meses antes de la cirugía aumenta el riesgo de EMC en comparación con los ojos sin inflamación (RR, 6.19; P =0.04). El EMC se asoció significativamente con la visión más pobre (P =0.001). En este estudio se concluye que los ojos con antecedente de uveítis bien controlada pueden obtener resultados similares a los obtenidos en los ojos sin este antecedente, después de una cirugía de catarata (hasta 3 meses). El uso de los corticosteroides orales peri operatoria y control de uveítis durante más de 3 meses antes de la cirugía parecen disminuir el riesgo de EMC postoperatorio en los ojos con uveítis en este estudio. En este estudio al igual que en el nuestro se observa que se presenta cambios en la morfología macular, siendo de mayor frecuencia y duración en pacientes con antecedentes de uveítis.
Background: Sustained growth in longevity raises questions as to why some individuals report a good quality of life in older ages, while others seem to suffer more markedly the effects of natural deterioration. Health-related quality of life (HRQL) is mediated by several easily measurable factors, including socio-demographics, morbidity, functional status and lifestyles. This study seeks to further our knowledge of these factors in order to outline a profile of the population at greater risk of poor ageing, and to identify those attributes that might be modified during younger stages of the life course. Methods: We use nationally representative data for Catalonia (Spain) to explain the HRQL of the population aged 80-plus. Cross-sectional data from 2011 to 2016 were provided by an official face-to-face survey. HRQL was measured using EQ-VAS – the EuroQol-5D visual analogue scale – which summarizes current self-perceived health. Multivariate linear regression was used to identify variables influencing the EQ-VAS score.
La tomografía óptica coherente es una herramienta útil en la evaluación de los pacientes operados de desprendimiento de retina regmatógeno mediante retinopexia neumática. Puede ser más sensible en la evaluación del área macular posoperatoria que el examen físico oftalmológico, ya que muestra elementos de la microestructura macular relacionados con la recuperación de la agudeza visual en estos casos, que incluyen no solo la presencia de alteraciones como el desprendimiento subfoveal o la membrana epirretineana, sino también aspectos de la reorganización de la capa de fotorreceptores tales como la presencia de la línea correspondiente a la interdigitación epitelio pigmentario de la retina-segmentos externos de los fotorreceptores a nivel macular.
A descriptive and retrospective study in 109 patients with macular diseases, assisted in the Ophthalmological Center of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from September, 2011 to July, 2012, to whom 4 mg of triamcinolone intravitreal (via pars plana) were administered in unique dose, in order to describe the complications presented after the treatment. Female sex (64.3%), the age group 65-84 years (49.5%) and maculardegeneration associated with age (wet) as ophthalmological history (76.1%) prevailed in the case material. Among the most frequent complications there were: secondary ocular hypertension (13.7%) and cataract (11.9%).
results: We studied 118 eyes (mean ± SD: 59.9 ± 8.3 years). Seventy one eyes had nonproliferative retinopathy (60.1%), 94 eyes (79.7%) had focal macular edema, and 24 eyes (20.3%) showed diffuse edema. Edema severity was mild in 27 eyes (22.9%, 95% CI 15.3-30.5), moderate in 23 (19.5%, 95% CI 12.3-26.6) and severe in 68 (57.6% 95% CI 48.7-66.5). Conclusions: Standardization of the International Clinical Scale using OCT showed that the most common severity level of macular edema was severe; the minimum expected proportion of eyes with high risk of visual loss secondary to severe edema approached 50%. Opportune detection needs reinforcement because more than half of these eyes require immediate treatment.
gest that the decreasing mortality rate observed for the country likely accurately reflects the changing patterns of mortality due to cirrhosis. The analysis within the major regions, on the other hand, should be interpreted with a grain of salt. The better data quality in the South and Southeast regions suggests the observed decreasing trends might be real while the important increase in cirrhosis-re- lated mortality rates in the North and Northeast might be true or an artifact due to a better quality of data registration in these regions in the more recent years. In a sensitive analysis, we reported similar trends on cirrhosis-related mortality in Brazil and its regions when ill-defined deaths were proportionally redistributed according to the defined causes (i.e. cirrhosis and other causes) by age (Table 4).
funcionales producidas por el edema macular quístico posterior a la cirugía de agujero macular idiopático estadio 3, y que luego de un cierre exitoso anatómico y funcional de este comenzó con edema macular quístico recurrente, sin reapertura del agujero macular; respondió al uso de esteroides locales recomendable en estos casos y logró mejorar los resultados visuales iniciales posquirúrgicos.
Aging is a very complex biological and physiological process. Aging results from genetic, epigenetic, and environmental events interacting throughout life. One corollary of aging is that it is the most important risk factor for age-related chronic diseases, including cardiovascular diseases, cancer, neurodegenerative diseases, and diabetes. It was shown that the most common underlying physiopathological process of all these diseases is inflammation. It was also stated that aging is accompanied by changes in the immune sys- tem called immunosenescence, characterized by mul- tiple alterations in the phenotypes and functions of the innate and adaptive immune cells. One important characteristic of this immunosenescence is a low- grade inflammation called inflammaging. There is overwhelming evidence that this inflammaging con- tributes, if not being the origin of, most age-related chronic diseases. The etiology of this inflammaging is still largely unknown, but certainly the disequilibrium between the relatively functioning innate and the more altered adaptive immune system is a contribut- ing factor. The presence of the senescence-associat- ed secretory phenotype is another contributor, and finally, the presence of endogenous damaged macro- molecules and cells as well as the leakage of the gut microbiota also participate. Certainly inflammaging is not the only cause of these age-related chronic dis- eases, but it may represent a sort of common path- way. These chronic diseases shorten the lifespan and also the healthspan. Recently, new efforts of gerosci- ence aimed to more deeply uncover the biological aging process as observed in animal models to apply to humans, and to find pathway targets for slowing down the aging process, leading to a more healthy and functional lifespan by delaying the emergence of these chronic age-related diseases. Among the inter- ventions, those targeting the immunosenescence by thymic replacement, effective vaccine against CMV, targeted anti-inflammatory interventions, or those