Outer retinal tubulation analysis in cases of macular

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a r c h s o c e s p o f t a l m o l . 2 0 1 3;8 8(4):160–163
161
Outer retinal tubulation analysis in cases of macular
dystrophy夽
Análisis de la tubulización de la retina externa en las distrofias
maculares
Dear Sir,
Macular dystrophies are a heterogeneous group of diseases
characterized either by retina pigment epithelium (RPE) atrophy or by the deposit of substances –mainly lipofuscin above
or below the RPE. Outer retinal tubulation (ORT) was described
recently in tomographic images as pseudo-cystic spaces surrounded by a hyper-reflective wall located in the outer retinal
layers.1,2 We have analyzed the prevalence and characteristics of ORT in spectral domain optic coherence tomography
(SD-OCT) by means of a retrospective review of 61 eyes of
32 patients diagnosed with macular dystrophy. The SD-OCT
images were assessed in order to determine the presence
and location of ORT, the integrity of the external limiting
membrane (ELM), the joint of the internal and external
photoreceptor segments (IS/OS) and the apex of the photoreceptor external segments (COST). The patients included in the
study (12 males and 20 females) were diagnosed with adult
vitelliform foveomacular dystrophy (19 eyes of 10 patients),
Stargardt disease (14 eyes of 7 patients), pattern dystrophy (12
eyes of 7 patients), retinoschisis linked to chromosome X (8
eyes of 4 patients) and cone dystrophy (8 eyes of 4 patients).
ORT was evidenced in 13 eyes (21.3%). When considering
only cases with external retina disruption, ORT was found in
Fig. 1 – (A) Color retinography of a 56-year-old patient with Stargardt disease, exhibiting significant macular atrophy area
with fleck-type lesions around it. (B) The lesions are more evident in the autofluorescence image. (C) OCT exhibits central
RPE and external retinal layer atrophy up to the external limiting membrane, producing window effect with secondary
increase of choroidal reflectiveness (black arrows). At the edge of the atrophy a rounded lesion appears with a
hyper-reflective wall corresponding to the ORT (white arrow).
夽
Please cite this article as: Dolz-Marco R, et al. Análisis de la tubulización de la retina externa en las distrofias maculares. Arch Soc Esp
Oftalmol. 2013;88:161–2.
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162
a r c h s o c e s p o f t a l m o l . 2 0 1 3;8 8(4):160–163
50% of cases with ELM disruption, and 34.2% of cases with
disruption in IS/OS, and 24.5% of cases with atrophic changes
in the external retina (Stargardt disease, retinoschisis linked
to chromosome X and cone dystrophy) (Fig. 1). ORT was not
observed in dystrophies characterized by lipofuscin deposits.
ORT appears to be a frequent finding in SD-OCT of macula
dystrophies with atrophic changes in the cytoarchitecture of
the external retina and could constitute a late event in retinal
degeneration, closely associated to ELM disruption. New studies with a higher number of patients must be carried out to
assess the usefulness of this finding in the follow-up and prognostic evaluation of these patients as well as for its possible
use in monitoring the neuroprotective effect of new therapies
in development.
R. Dolz-Marco a,∗ , R. Gallego-Pinazo a , M.D. Pinazo-Durán b,c ,
J.F. Arévalo d,e , L.A. Yannuzzi f , M. Díaz-Llopis a,c
a
Department of Ophthalmology, University and Polytechnic
Hospital La Fe, Valencia, Spain
b Opthalmology Research Unit Santiago Grisolía, University
Hospital Doctor Peset, Valencia, Spain
c Faculty of Medicine, University of Valencia, Valencia, Spain
d Retina Division, Wilmer Eye Institute, Johns Hopkins University
School of Medicine, Baltimore, MD, USA
e King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
f Vitreous Retinal Macula Consultants of New York, LuEsther T.
Mertz Retinal Research Center, Manhattan Eye, Ear and Throat
Hospital, New York, USA
references
author.
E-mail address: rosadolzmarco@gmail.com (R. Dolz-Marco).
∗ Corresponding
1. Zweifel SA, Engelbert M, Laud K, Margolis R, Spaide RF,
Freund KB. Outer retinal tubulation: a novel optical coherence
tomography finding. Arch Ophthalmol. 2009;127:
1596–602.
2. Cohen SY, Dubois L, Nghiem-Buffet S, et al. Retinal
pseudocysts in age-related geographic atrophy. Am J
Ophthalmol. 2010;150:211–7.
2173-5794/$ – see front matter
© 2012 Sociedad Española de Oftalmología. Published by
Elsevier España, S.L. All rights reserved.
Use of quality of life questionnaires for the evaluation
of patients subjected to cataract surgery夽
Uso de cuestionarios de calidad de vida para la evaluación
de pacientes sometidos a cirugía de catarata
Dear Sir,
In the past decades the use of quality of life questionnaires
as instruments based on patient reporting has increased.1
However, said questionnaires have been utilized mainly in
research while their application in ophthalmological medical
practice is largely ignored.
Conventionally, post-surgery evaluations include visual
acuity, biomicroscopy findings and the presence of new symptoms. Quality of life questionnaires provide an additional tool
to obtain an evaluation including the patient point of view
as regards functional condition of the eyesight and satisfaction. In order to obtain a comprehensive assessment of a
patient, the latter aspect is important and should be taken
into account. On the other hand, it is also important to take
into account the costs and time involved in the execution of
said questionnaires. Even so, it is the best way to assess the
therapeutic response and avoid discrepancies that could arise
between visual acuity measurement and the patients visual
impairment.2
The benefit of the above-mentioned instruments depends
on their correct application. In order to choose the most
appropriate questionnaires, it is important to know that some
instruments make a better evaluation of the quality of life
Table 1 – Main characteristics of 4 instruments for
measuring quality of life in ophthalmology.
Original
language
ADVS
Cataract type
specification
questionnaire
Catquest
NEI VFQ 25
Number of Validation
questions into Spanish
Cronbach
English
English
22
12
No
No
˛ ≥ 0.90
˛ ≥ 0.94
English
English
19
25
No
Yes
˛ ≥ 0.93
˛ ≥ 0.86
Source: Based on Lundström and Pesudovs.1
ADVS, Activities of Daily Vision Scale; NEI VFQ-25, National Eye
Institute Visual Function Questionnaire; VF-14: Visual Function-14.
夽
Please cite this article as: Luján S, et al. Uso de cuestionarios de calidad de vida para la evaluación de pacientes sometidos a cirugía
de catarata. Arch Soc Esp Oftalmol. 2013;88:162–3.