María Castro-Rebollo

Effect of intravitreal ranibizumab on corneal endothelium in age-related macular degeneration.

Purpose: To determine the effect of intravitreal injection of ranibizumab on the corneal endothelium in patients with choroidal neovascularization in age-related macular degeneration. Methods: Observational prospective case series study. Fifty-two eyes of 52 consecutive patients (29 men, 23 women; age range, 61-80 years) were evaluated. All participants received monthly intravitreal injections of (0.05 mL, 0.5 mg) ranibizumab for 3 consecutive months; the follow-up period was 6 months. Central corneal specular microscopy was performed before injection and at 7 days and 6 months after the first intravitreal injection. The endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells were analyzed, and the central corneal thickness was measured. Results: There were no significant differences in the endothelial cell densities, coefficient of variation of cell sizes, and percentage of hexagonal cells values before injection and at 7 days and 6 months after the first intravitreal ranibizumab injection (P = 0.987, P = 0.822, and P = 0.918, respectively). There was also no significant difference in central corneal thickness measurements before injection and at 7 days and 6 months after the first intravitreal ranibizumab injection (P = 0.325). Conclusion: Repeated intravitreal injections of 0.5 mg of ranibizumab do not seem to cause substantial changes in the corneal endothelium at 6 months.

Intraoperative mitomycin C and corneal endothelium after pterygium surgery.

Purpose: To determine the effect of mitomycin C (MMC) on the corneal endothelium after primary pterygium surgery. Methods: This prospective, interventional, nonrandomized, observer-masked study included 46 consecutive patients (51 eyes) with primary pterygium. The bare sclera technique with 1-minute application of 0.02% MMC intraoperatively was used in all cases. The follow-up period was 3 months. Preoperative and postoperative central corneal specular microscopy was performed. The endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells were analyzed, and the corneal thickness was measured. Results: The mean endothelial cell densities preoperatively and 3 months postoperatively were 2382.35 ± 342.07 cells per square millimeter (range, 1020-3129) and 2385.02 ± 356.83 cells per square millimeter (range, 1001-3151), respectively (P = 0.96). The mean coefficients of variation of cell size preoperatively and 3 months postoperatively were 34.31 ± 5.62 (range, 22-49) and 35.29 ± 7.50 (range, 22-55), respectively (P = 0.17). The mean percentages of hexagonal cells values preoperatively and 3 months postoperatively were 52.98 ± 7.32 (range, 32-71) and 51.61 ± 8.98 (range, 32-67), respectively (P = 0.48). The mean pachymetry measurements preoperatively and 3 months postoperatively were 506.65 ± 36.87 μm (range, 411-583) and 502.08 ± 41.33 μm (range, 411-593), respectively (P = 0.99). Conclusions: One intraoperative application of 0.02% MMC for 1 minute after primary pterygium surgery does not seem to cause substantial changes in the corneal endothelium at 3 months.

Effect of topical 0.05% cyclosporine A on corneal endothelium in patients with dry eye disease.

AIM To determine the effect of topical 0.05% cyclosporine A (CsA) on corneal endothelium in patients with dry eye disease. METHODS Observational, prospective, case series study. Fifty-five eyes of 29 consecutive patients (9 males and 20 females; median age: 66.8 years, interquartile range: 61-73.2 years) with moderate-severe dry eye disease were evaluated. All patients were treated with topical 0.05% CsA ophthalmic emulsion twice a day in addition to lubricant eyedrops 5 times a day. The follow-up period was 12 months. Before treatment and at 3 and 12 months post-treatment central corneal specular microscopy was performed. The endothelial cell density (ECD), coefficient of variation of cell size (CoV), and percentage of hexagonal cells (Hex %) were analyzed. RESULTS The median ECDs pre-treatment and at 3 and 12 months post-treatment were 2 352.5/mm(2) (interquartile range, 2 178-2 548.5), 2364/mm(2) (interquartile range, 2 174.25-2 657.5), and 2366 cells/mm(2) (interquartile range, 2 174.75-2 539.75), respectively (P=0.927, one way ANOVA). The median CoVs pre-treatment and at 3 and 12 months post-treatment were 34.5 (interquartile range, 30-37), 35 (interquartile range, 30-38), and 34 (interquartile range, 30.75-38.25), respectively (P=0.7193, one way ANOVA). The median Hex % values pre-treatment and at 3 and 12 months post-treatment were 53 (interquartile range, 47-58), 54 (interquartile range, 45.75-59), and 50.5 (interquartile range, 45.75-58), respectively (P=0.824, one way ANOVA). CONCLUSION Treatment of patients with dry eye disease for 12 months with topical 0.05% CsA does not seem to cause substantial changes on corneal endothelium.

Optical coherence tomography features of sub-internal limiting membrane hemorrhage and temporary premacular cavity following Nd-YAG laser membranotomy in Valsalva retinopathy

(Fig. 1c). Although she received urokinase and hyperbaric oxygen treatment, her right BCVA remains 0.1. A 61-year-old woman developed blurred vision in the right eye after 6 months of treatment with pegylated interferon-α and ribavirin. Ophthalmologic evaluation revealed scattered or fl ame-shaped retinal hemorrhage (Fig. 2). Since she had never undergone ophthalmologic examination, information regarding her previous retinal status was unavailable. Her BCVA was 0.1 (OD), which recovered to 1.2 (OD) after treatment with urokinase and hyperbaric oxygen.

Endothelial cells analysis after intravitreal ranibizumab (Lucentis) in age-related macular degeneration treatment: a pilot study.

Ranibizumab (rhuFabV2, Lucentis; Genentech, San Francisco, California) is a humanised monoclonal antibody fragment, designed to bind all isoforms of human vascular endothelial growth factor-A (VEGF-A) by preventing the interaction of VEGF-A with its receptors VEGFR-1 (Flt-1) and VEGFR-2 (Flk-1/KDR). Although the pharmacokinetic profile of ranibizumab after intravitreal injection in humans has not been determined definitively, ranibizumab has been detected in the aqueous humour after intravitreal standard injections in a rabbit model.1 Moreover, VEGF and its receptors were expressed in the corneal endothelium.2–5 Therefore, ranibizumab in the aqueous humour after intravitreal injections may affect the function of VEGF in the corneal endothelium, being potentially cytotoxic to human corneal endothelial cells. In the present study, we analyse the effect of the …

Association between macular perfusion and photoreceptor layer status in diabetic macular edema.

Purpose: To evaluate the relationship between the photoreceptor layer status (inner segment ellipsoid band and external limiting membrane) and the foveal avascular zone size, as a result of macular perfusion, in patients with diabetic macular edema. Methods: This observational case series study included 151 eyes of 118 patients with naive diabetic macular edema. The length of the disrupted photoreceptor layer was assessed by optical coherence tomography. The foveal avascular zone diameter was measured on fluorescein angiogram. Results: No significant association was found between the foveal avascular zone size and the mean lengths of the disrupted inner segment ellipsoid band nor the external limiting membrane in patients with naive diabetic macular edema. Conclusion: Macular ischemia, which lengthens the distance from the perifoveal vessels to the center of the fovea and may disrupt the normal flow of nutrients by simple diffusion to the photoreceptor line, does not seem to influence on inner segment ellipsoid band nor external limiting membrane integrity. Future studies may evaluate the effect of choroidal vascularization on the photoreceptor layer status to enhance the knowledge about the photoreceptor layer nutrients source.

Primary cerebral lymphoma diagnosed by the ophthalmologist

CASE REPORT A 20-year-old male, HIV positive, with myodesopsias (floaters) in both eyes for two weeks. Fundus examination revealed bilateral papillary oedema with peripapilar flame-shaped haemorrhages. The neuroimaging tests showed a cerebral mass in the left parietal lobe. The biopsy confirmed the diagnosis of lymphoid neoplasm. DISCUSSION Primary lymphoma is the most common malignancy of the central nervous system (CNS) in AIDS patients, although highly active antiretroviral therapy has reduced its incidence. The ophthalmologist plays an essential role in the diagnosis of CNS neoplasm.

Subclinical thinning of macular ganglion cell layer in Leber optic neuropathy carriers: Retinal thinning in Leber carriers

Leber hereditary optic neuropathy (LHON) is a rare disease. Despite its low prevalence (1:54,000 in the Danish population), LHON is considered, after dominant optic atrophy, the second most frequently inherited neuropathy. LHON usually presents with painless acute or subacute visual loss and predominantly affects young men. Three mitochondrial DNA point mutations are responsible for a large majority of cases reported worldwide. These mutations are located at nucleotide positions 11778 (G to A), 3460 (G to A) and 14484 (T to C) respectively in the ND4, ND1 and ND6 subunit genes of complex I of the oxidative phosphorylation chain in the mitochondria. The mitochondria are organelles found in all cells of eukaryotic organisms. However, LHON affects selectively the ganglion cells of the papillomacular bundle. This specificity is poorly understood. Some authors suggest that because of their small diameter and the absence of myelin, the fibres of the papillomacular bundle require higher amounts of energy and are therefore more vulnerable to oxidative stress. Optical coherence tomography (OCT) has improved our understanding of LHON. It has been reported that the evaluation of the macular ganglion cell layer would be better correlated to visual loss in LHON than the peripapillary retinal nerve fibre layer. Ganglion cell loss is detected earlier in the macular region due to the presence of edema at the optic nerve in the acute phase. It has also been suggested that focal thinning in the macular ganglion cell layer might develop before visual loss, heralding the development of disease. However, we report the presence of focal thinning in the macular ganglion cell layer in two asymptomatic, unaffected carriers.

Focal cortical cataract due to caterpillar hair migration

The pine processionary caterpillar, Thaumetopoea pityocampa, is a forest pest and represents a human health hazard, since its hairs may affect the eyes, skin and respiratory tract. Caterpillar hairs are sophisticated biological weapons. They have a harpoon-shaped design and express at least 300 proteins. Some of these proteins have enzymatic activities, which combined with the harpoon shape of the hair allows them to migrate through animal tissues, causing severe damage along the way. This is a case report in which a caterpillar hair migrated into the anterior chamber and produced a focal cortical cataract.

Eficacia de bevacizumab tópico en queratopatía lipoidea bilateral primaria

CASE REPORT A 75-year-old man with bilateral idiopathic lipid keratopathy underwent a penetrating keratoplasty in the left eye. One month later, there was deep corneal neovascularisation extending across the bed and the graft-host interface, with a whitish opacity surrounding the vessels. Topical bevacizumab (25mg/mL) was administered 4 times daily for 2 months with partial regression of corneal neovascularization. DISCUSSION Topical bevacizumab may be useful in preventing a recurrence of lipid deposition after penetrating keratoplasty in patients with bilateral primary lipid keratopathy, although its long-term efficacy needs to be assessed.