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AimThe objective of this study is to report the incidence of retinopathy of prematurity (ROP) outliers that fall outside the screening guidelines of the American Academy of Ophthalmology (AAO) in our country.MethodsA retrospective review of 503 records of newborns evaluated in our institution between January 2011 and March 2017. We analyzed the data by subgroups based on gestational age (GA), birth weight (BW) and stage, focusing on the outliers that don’t meet the criteria of the screening AAO guidelines (GA ≤ 30 weeks, BW ≤ 1500 g).ResultsOf the 503 records, 352 had some degree of ROP, 91.76% being bilateral, and 26.2% require treatment. The mean GA at delivery was 30.56 ± 2.33 weeks, and the mean BW was 1287.90 ± 338.52 g. For the current AAO/AAP ROP screening, 19.9% were outliers, of which (57%) had ROP diagnosis and (38%) required treatment.ConclusionsROP diagnosis in newborns of BW > 1500 g or GA > 30 weeks is not uncommon in Mexico, and it is important to take this into account to adjust the selection criteria on each population to reach all the infants at risk.

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Purpose: To evaluate the clinical response of treatment-resistant choroidal neovascularization (CNV) to photodynamic therapy (PDT) combined with bevacizumab (BVZ) therapy. Methods: Retrospective, non-comparative evaluation of eyes diagnosed with CNV secondary to age-related macular degeneration that had no response after at least 3 intravitreal BVZ injections, who were treated with combined PDT+BVZ therapy, followed by subsequent monthly BVZ for a 6 months period. Main outcome measures were best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a 6 month follow-up period after combined therapy. Results: Eleven patients (54.5% female, mean age 62 years) were included. Using ICG angiography, lesions were classified as polypoidal choroidal vasculopathy (PCV) 54.5%, arteriolized CNV 18.2% (2), and non-differentiable 27.3% (3). BCVA (logMAR) at baseline was 0.63 (20/85), increasing to 0.32 (20/40) 6 months after treatment (p = 0.04). Mean CMT before the intervention was 469 µm, decreasing to 289 µm 6 months after treatment (p = 0.01). Conclusion: Combined PDT+BVZ therapy appears to be effective in treatment-resistant CNV, with an improvement of BCVA and CMT after a 6-month period that was not observed with BVZ monotherapy. A high incidence of PCV and arteriolized CNV was observed in this group or treatment-resistant CNV cases. Terapia fotodinámica combinada con bevacizumab intravítreo para el tratamiento de neovascularización coroidea refractaria a tratamiento con monoterapia con bevacizumab, Serie de casos.

con bevacizumab intravítreo (BVZ) en neovascularizaciones coroideas (NVC) resistentes al tratamiento. Métodos: Evaluación retrospectiva, no comparativa, de ojos con diagnóstico de NVC secundaria a degeneración macular relacionada con la edad sin respuesta clínica después de al menos 3 inyecciones intravítreas de BVZ, a los que se administró TFD+BVZ combinados y posteriormente BVZ mensual durante un periodo de 6 meses. Las variables principales de desenlace incluyeron agudeza visual corregida (AVC) y grosor macular central (GMC) durante un seguimiento de 6 meses posteriores al tratamiento combinado. Resultados: Se incluyeron once pacientes (54.5% femenino, media de edad 62 años). Utilizando angiografía con ICG, las lesiones se clasificaron como vasculopatía coroidea polipoidea (VCP) en 54.4%, NVC arteriolizada en 18.2% (2) y no diferenciable en 27.3% (3). La AVC (logMAR) en la basal fue de 0.63 (20/85), mejorando a 0.32 (20/40) después del tratamiento (p = 0.04). La media de GMC antes de la intervención fue de 469 µm, mejorando a 289 µm seis meses después del tratamiento (p = 0.01). Conclusión: La terapia combinada con TFD+BVZ parece ser efectiva en casos de NVC resistentes a tratamiento, con mejoría de la AVC y el GMC después de un periodo de 6 meses de tratamiento que no se observó con la monoterapia con BVZ. En este grupo se observó una alta incidencia de VCP y NVC arteriolizada o casos de NVC resistentes al tratamiento. La adecuada clasificación del tipo de NVC asociada a una elevada resistencia puede ser útil para el tratamiento.

To describe fundus autofluorescence (FAF) patterns in premature infants and to determine whether FAF increases gradually with increasing post-gestational age. This was a cross-sectional, observational and descriptive case series. FAF images were obtained from patients screened for Retinopathy of Prematurity. The presence of the following hypo-autofluorescence areas/structures was graded and ranked: macular pigment (foveal centre), optic nerve head, peripapillary vessels/vascular arcade (PP/VA), and equatorial vessels (EqV). Ranks were attributed to the number of structures visualized from the posterior pole towards the periphery. The rank of FAF could then be analysed by Spearman’s correlation against age. Additionally, patients were divided by age into group 1 (< 40 weeks of corrected gestational age (WCGA)) and group 2 (> 40 WCGA). Differences between groups were tested with the Mann–Whitney U test. Thirteen patients were analysed. The mean WCGA at examination was 47.85 weeks. Spearman’s correlation showed a strong positive correlation (r = 0.714) (P = 0.006) of FAF and WCGA. The Mann–Whitney U test revealed that the PP/VA and EqV were significantly more visible at > 40 WCGA than at < 40 WCGA (8.0 [P = 0.016] and 7.5 [P = 0.03], respectively). Patterns of FAF are described for the first time in premature infants. FAF increases gradually with age and centrifugally from the posterior pole towards the equator in premature infants.