BackgroundAge-related macular degeneration (AMD) is the leading cause of blindness in the western world. As a consequence of AMD, patients develop structural damage that comprises the fovea and subsequently present loss of central vision, low visual acuity and unstable fixation. Contrary to what happens with anti-angiogenic treatment in neovascular AMD, there is currently no definitive treatment to reverse geographic atrophy progression. The aim of this study was to determine the effectiveness of the visual rehabilitation treatment via microperimetry in patients with geographic atrophy.MethodsLongitudinal and prospective study, 18 patients with areas of geographic atrophy in their eye of better visual acuity were included. Macular integrity assessment (Maia) microperimeter (CentreVue, Padova, Italy) was used to diagnose retinal fixation and sensitivity in these patients. Based on these data and using the training module available in the equipment, the patients underwent visual rehabilitation sessions intended to allow the patient to establish the best possible fixation in the best area of retinal sensitivity. To determine the training effectiveness, the following variables were compared before and after: visual acuity in LogMAR scale with ETDRS charts, reading speed with Minnesota Low-Vision Reading Test (MN Read), average sensitivity threshold in microperimetry; P1 and 95% Bivariate Contour Ellipse Area (BCEA) values were used for fixation stability measurement.ResultsMean age was 77 years old (65–92). Visual acuity of the trained eye was on average 0.7 versus 0.6 LogMAR (p = 0.006) before and one week after training. Reading speed, using both eyes, was 47 words per minute (wpm) before training and 69 wpm after training (p = 0.04). Average retinal sensitivity was 14.1 versus 14.6 db (p = 0.4). Fixation stability improved with P1 values of 45% versus 51% (p = 0.05) and 95% BCEA values of 43 versus 25 (p = 0.02) before and after training, respectively.ConclusionsVisual training via microperimetry in patients with age-related macular degeneration is effective in improving fixation stability, reading speed, and visual acuity, measured one week after training is completed.

Caso clínico: Se trata de un paciente masculino de 19 años con paresia bilateral del músculo recto externo secundario a un traumatismo craneoencefálico. Durante su tratamiento se produjo una inyección intraocular inadvertida de toxina botulínica, ocasionando un desgarro retiniano y desprendimiento de retina localizado. Ambas lesiones fueron delimitadas con láser, observándose una resolución espontánea del desprendimiento sin presentar deterioro visual durante el seguimiento. Discusión: A pesar de que la toxina botulínica intraocular no genera toxicidad a nivel retiniano, la inyección intraocular inadvertida debe ser vigilada de manera estrecha para evitar complicaciones secundarias a la perforación.

Introduction: The purpose was to assess the level of agreement and reproducibility between fluorescein angiography (FA) and optical coherence tomography angiography (OCTA), throughout the evaluation of the foveal avascular zone (FAZ) to diagnose diabetic macular ischemia (DMI). Methods: In this ambispective, observational, cross-sectional research, 41 patients underwent traditional FA and OCTA to obtain the level of agreement and reproducibility between them, using an intraclass correlation coefficient (ICC) in mixed models. Two raters independently graded the area of the FAZ using the ImageJ software and the Early Treatment Diabetic Retinopathy Study protocols. Spearman and rank-biserial correlational analysis were used to calculate the strength of linear relationship between the area of the retinal vessels, the thickness of subfoveal retinal and choroid layers, the presence of neovascularization, and the visual acuity. A classification, based on the radius of the FAZ, was proposed and used to categorize the severity of DMI into five different grades. Result: From 52 evaluated eyes, the level of agreement between the OCTA and FA among the raters had an ICC of 0.99 and 0.907 (p<.001), respectively. Furthermore, the reproducibility analysis had an ICC of 0.85 (p<.001). In the correlation analysis, the enlargement of the FAZ was associated with a decrease in the outer retinal layers (r=-0.458, p<0.001), the photoreceptor layer (r=-0.32, p=0.021), their outer segments (r=-0.32, p=0.021) and the subfoveal choroidal thickness (r=-0.483, p<0.001). A reduction of the vascular area was observed in higher grades of diabetic retinopathy (r= -0.395, p=0.38). Additionally, meager choroidal thickness was found in grater grades of DMI (r=-0.461, p=0.014). Conclusion: Compelling evidence of a high level of agreement and reproducibility between OCTA and FA was obtained to diagnose diabetic macular ischemia. Moreover, it is suggested that the increase in macular ischemia leads to the thinning of the photoreceptor, outer retinal and choroid layers.