Publications (9)19.17 Total impact
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Article: Optical Coherence Tomography Assessment of Apparent Foveal Swelling in Patients with Foveal Sparing Secondary to Geographic Atrophy.
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ABSTRACT: OBJECTIVE: To determine whether foveal swelling exists in patients with foveal sparing and geographic atrophy (GA) secondary to dry age-related macular degeneration (AMD) and to establish the contribution of different foveal layers to this condition by use of spectral-domain optical coherence tomography (SD-OCT). DESIGN: Prospective comparative case series. PARTICIPANTS: We assessed patients from a longitudinal study with foveal sparing and GA secondary to AMD. Of an initial sample of 108 patients, 13 eyes of 10 patients complied with the inclusion criteria to study eyes in which apparent swelling would not be questionable. We used a control group of 13 healthy patients to compare the outcome measurements. METHODS: We acquired high-resolution SD-OCT horizontal and oblique B-scans centered at the umbo. Two retinal specialists (J.M., F.T.) independently classified the SD-OCT images. MAIN OUTCOME MEASURES: Difference in foveal center thickness, apparent outer nuclear layer (ONL) thickness, ONL thickness without Henle's fiber layer (HFL), sub-ONL thickness, and retinal thickness at 1000 μm and 3500 μm from the foveal center. RESULTS: The thickness at the foveal center was similar between patients with apparent foveal swelling (cases) and controls without AMD (226 vs. 227 μm; P = 0.56), but the apparent ONL was thicker in cases than in controls (125 vs. 114 μm; P = 0.02). However, when HFL was excluded from the measurements, there was little difference in the results (74 vs. 73 μm; P = 0.82). CONCLUSIONS: We found neither foveal nor ONL swelling in this study. We observed HFL thickening in foveal sparing secondary to GA, which might be related to swelling of the axons of the photoreceptors, or Müller's cells. We also observed thinning of the retina below the external limiting membrane. The clinical significance of these findings should be addressed by longitudinal studies and may have specific therapeutic implications. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.Ophthalmology 01/2013; · 5.45 Impact Factor -
Article: FUSION regimen: ranibizumab in treatment-naïve patients with exudative age-related macular degeneration and relatively good baseline visual acuity.
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ABSTRACT: BACKGROUND: To investigate the safety and efficacy of a combined fixed-interval and pro re nata regimen of ranibizumab (FUSION regimen) for treatment of exudative age-related macular degeneration in patients with good visual acuity at baseline. To establish whether similar efficacy to monthly regimens can be achieved with fewer injections, even in patients with good visual acuity. METHODS: This was a prospective, open-label, consecutive interventional case series in treatment-naïve patients with exudative age-related macular degeneration. The FUSION regimen consists of three phases: 1) a loading phase of two or three injections, depending on presence or absence of choroidal neovascularization activity at first follow-up, 2) administration of one injection on disappearance of exudation, and 3) subsequent administration of two separate injections at intervals 2 months apart, and then an injection every 3 months. Endpoints included visual acuity, presence of fluid, adverse events and number of injections administered. RESULTS: Seventeen eyes of 17 Caucasian patients were included. Mean patient age was 76 years, and 15 patients were female. Mean baseline visual acuity was 67.5 letters (median 67), with Snellen equivalent 20/50++, ranged between 45 (20/125) and 83 (20/20--). At 3 months, mean change in best-corrected visual acuity (BCVA) was +2.3 letters (median +9) compared with baseline (p = 0.3). At 6 months, mean change in BCVA was +4.2 letters (median +9) compared with baseline (p = 0.02). At 12 months, one patient had discontinued the study. Mean change in BCVA was 5.6 (median +10) compared with baseline (p = 0.04). No patient lost ≥15 letters, and 14 patients (87.5%) lost <5 letters. The mean number of injections was 6.9. One patient experienced a retinal pigment epithelium tear; no other complications were observed. CONCLUSIONS: The FUSION regimen for ranibizumab has the potential to maintain visual gains achieved during the loading phase, as reported in studies with monthly injections, even in eyes with a relatively good visual acuity at baseline. These 12-month results warrant validation in a larger, randomized controlled trial.Albrecht von Graæes Archiv für Ophthalmologie 04/2012; · 2.17 Impact Factor -
Article: Hyporeflective wedge-shaped band in geographic atrophy secondary to age-related macular degeneration: an underreported finding.
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ABSTRACT: To describe and interpret the frequently observed spectral-domain optical coherence tomography (SD-OCT) finding of a marked hyporeflective wedge-shaped structure at the boundaries of the areas of atrophy. A prospective, longitudinal follow-up study. Consecutive patients (n = 71) 50 years of age and older with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) were examined between January 2010 and June 2011. Patients were evaluated with the use of imaging techniques that included 35° fundus photography, infrared, fundus autofluorescence (FAF), and SD-OCT. Visualization of the fundus with FAF was done simultaneously with OCT. Two acquisition protocols were followed: a macular cube for coverage (19 horizontal B-scans centered on the fovea) and high-resolution horizontal B-scan for qualitative foveal detail. Estimation of the prevalence of a hyporeflective wedge-shaped band among patients with GA. A marked hyporeflective wedge-shaped structure, with its base on Bruch's membrane and its apex pointing toward the inner limit of the outer plexiform layer (OPL) adjacent to the margin between the atrophied area and the preserved retina, was observed in 72.9% of eyes (70/96; 95% confidence interval, 63.9-82.0). This hyporeflective band appeared to be within the OPL. Using eccentric SD-OCT acquisition, the boundaries between the outer nuclear layer (ONL) and Henle's fiber layer (HFL) were well defined, showing that the ONL ends before the margin of atrophy of the retinal pigment epithelium (RPE). A narrow hyperreflective band separated the margin of the ONL and RPE from the hyporeflective band, already within the atrophic area. A hyporeflective wedge-shaped structure appears frequently within the boundaries of the OPL in patients with GA secondary to AMD, corresponding to an increase in the width of the HFL, presumably because of axonal swelling or interaxonal edema. This finding may improve the interpretation of SD-OCT images of the outer layers, may help in understanding better the interactions between photoreceptor cells and the RPE, and may help in the development of monitoring techniques and therapies for GA secondary to AMD.Ophthalmology 03/2012; 119(7):1412-9. · 5.45 Impact Factor -
Article: Intra and interobserver agreement in the classification of fundus autofluorescence patterns in geographic atrophy secondary to age-related macular degeneration.
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ABSTRACT: To describe the intra and interobserver agreement in the evaluation of fundus autofluorescence patterns in geographic atrophy secondary to age-related macular degeneration. A consecutive series of patients with geographic atrophy and fundus autofluorescence images of a minimum acceptable quality for grading were included. Four observers with experience in the evaluation of autofluorescence images independently classified the randomly presented series of images on two occasions, at least 1 month apart from each other (intraobserver analysis). The second determination of each observer was used for evaluation of interobserver agreement. The kappa statistic and 95% confidence intervals, together with percentages of agreement, were used to analyze the results. The final sample included 69 eyes of 49 patients. Intraobserver agreement ranged from substantial to almost perfect (kappa between 0.51 and 0.83), while interobserver results ranged from poor to substantial (corresponding to kappa between 0.30 and 0.62). The use of more simple classifications improved reproducibility. Although intraobserver reproducibility was high, interobserver agreement was variable. Clear descriptions and a uniform set of criteria to classify these patients are needed if fundus autofluorescence imaging is used to evaluate patients with geographic atrophy.Albrecht von Graæes Archiv für Ophthalmologie 10/2011; 250(4):485-90. · 2.17 Impact Factor -
Article: Update on geographic atrophy in age-related macular degeneration.
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ABSTRACT: Age-related macular degeneration (AMD) is the main cause of legal blindness in older patients in developed countries, and geographic atrophy (GA) represents the advanced form of dry AMD. Although it accounts for one third of the cases of late AMD and is responsible for 20% of the cases of severe visual loss due to the disorder. GA currently lacks effective treatment, whereas antiangiogenic therapies have been shown to be successful in managing choroidal neovascularization, the other form of late AMD. Recent advances in GA epidemiology, etiology, genetics, and imaging techniques have renewed the interest in this entity, which is a cause of progressive visual loss even in treated patients with neovascular AMD. This knowledge has triggered many clinical trials targeting different molecules shown to be associated with the disease, and it is hoped that this research will translate into effective drugs for GA in the near future.Optometry and vision science: official publication of the American Academy of Optometry 04/2011; 88(7):881-9. · 1.53 Impact Factor -
Article: A review of ranibizumab clinical trial data in exudative age-related macular degeneration and how to translate it into daily practice.
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ABSTRACT: The results of randomized controlled clinical trials of ranibizumab for the treatment of age-related macular degeneration established a new standard of care with the prospect of improved vision in many patients. Subsequent trials have explored different strategies to increase response rates and reduce treatment frequency. This review analyzes the key clinical trial data for ranibizumab on the basis of which the author proposes a new treatment regimen with the aim of rationalizing treatment frequency without compromising improvements in vision--the FUSION regimen. This consists of an initiation phase followed by pro re nata (PRN) retreatment combined with fixed injections after a period of disease inactivity of 2-4 months (depending on the time elapsed since the last injection). A randomized clinical trial is recommended for comparing monthly, PRN and the FUSION regimens.Ophthalmologica 10/2010; 225(2):112-9. · 1.42 Impact Factor -
Article: As-needed treatment with ranibizumab 0.5 mg in patients with neovascular age-related macular degeneration.
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ABSTRACT: To describe the results obtained in patients with neovascular age-related macular degeneration treated with ranibizumab 0.5 mg on an as-needed basis from the start after 1 year of follow-up. Retrospective, consecutive interventional case series of patients with all angiographic types of neovascular age-related macular degeneration (mean baseline size, 3.4 disk areas) in a tertiary retinal center (Institut de la Màcula i la Retina; Barcelona, Spain). Main outcome was mean vision change; secondary outcomes were center retinal thickness change, number of injections, adverse events, and independent covariates associated with a good response. Mean visual acuity change was an increase of 1.3 letters (95% confidence interval -2.7 to +5.3), and difference between angiographic patterns did not reach statistical significance (p=0.30). A decrease in retinal thickness of 44.6 µm was identified (p<0.001), with a median of 3 injections. Absence of baseline arterial hypertension, lower visual acuity, and lesions located outside the fovea were associated with a better response to therapy. As-needed treatment from the start achieved stabilization of visual acuity and a moderate decrease of retinal thickness with a low number of injections, but did not achieve the same efficacy as regular monthly injections.European journal of ophthalmology 09/2010; 21(3):282-9. · 0.96 Impact Factor -
Article: Ranibizumab in the treatment of choroidal neovascularization on the border of an inferior staphyloma associated with tilted disc syndrome.
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ABSTRACT: To describe a case of choroidal neovascularization (CNV) on the border of an inferior staphyloma associated with tilted disc syndrome treated with intravitreal ranibizumab. Observational case report. A patient with CNV on the border of an inferior staphyloma associated with tilted disc syndrome was imaged using fluorescein angiography, autofluorescence and spectral domain optical coherence tomography, and treated with intravitreal injections of ranibizumab. The patient received 3 ranibizumab injections during the 9-month follow-up. The visual acuity improved from 20/40 to 20/32 and the foveal thickness reduced from 470 microns to 248 microns. The angiograms showed resolution of leakage associated with CNV. There were no adverse events. Intravitreal ranibizumab is an efficacious and safe treatment in the management of choroidal neovascularization on the border of an inferior staphyloma associated with tilted disc syndrome.Clinical Ophthalmology 01/2010; 4:227-31. -
Article: Transconjunctival sutureless vitrectomy with tissue plasminogen activator, gas and intravitreal bevacizumab in the management of predominantly hemorrhagic age-related macular degeneration.
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ABSTRACT: To determine the efficacy and safety of treating predominantly hemorrhagic age-related macular degeneration (AMD) with transconjunctival sutureless vitrectomy (TSV), tissue plasminogen activator (tPA), sulphur hexafluoride (SF6), and intravitreal bevacizumab. Retrospective study, consecutive case series. Patients with acute hemorrhagic AMD treated with 25- or 23-gauge TSV, subretinal or intravitreal tPA, fluid-air-SF6 exchange and intravitreal injection of bevacizumab. All operations were performed within the first 5 days after the start of symptoms, which consisted of visual acuity (VA) loss and central scotoma. Fifteen eyes from 15 patients were included. The patients' mean age was 79.6 years, and the mean follow-up was 11.8 months. Five patients (33%) were receiving oral anticoagulant treatment. At baseline, the mean VA (logMAR values) was 1.5 (20/640 Snellen equivalent). At the last follow-up visit, the mean VA was 1.1 (20/250) (P < 0.0001; paired t-test). The submacular hemorrhage was successfully displaced in all the cases. Complications consisted of three cases of vitreous hemorrhage and a tear or the retinal pigment epithelium. Twelve cases (80%) did not require further treatment during the follow-up period. A surgical approach with 25- or 23-gauge TSV, tPA, SF6 and intravitreal bevacizumab is an efficacious and safe procedure in patients with hemorrhagic AMD. Early treatment is advisable for obtaining the optimal outcome.Clinical Ophthalmology 01/2010; 4:67-72.
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Institutions
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2010–2013
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Centro Medico Teknon
Barcelona, Catalonia, Spain -
Hospital Universitari de Bellvitge
- Department of Ophthalmology
L'Hospitalet de Llobregat, Catalonia, Spain
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