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RESUMEN

La Degeneracin Macular Asociada a la Edad (DMAE) es la principal causa de ceguera legal en


personas mayores de 50 aos en el mundo desarrollado. Afecta al rea de visin central de la
retina e implica que en fases avanzadas los pacientes son incapaces de distinguir los objetos
que enfocan y su actividad habitual se ve considerablemente mermada. De los dos tipos de
DMAE que existen, la DMAE hmeda afecta a un 40% de los pacientes y es la que produce
efectos ms devastadores en un periodo de tiempo ms corto. El descubrimiento casual del
efecto de los Anti-VEGF (Vascular Endothelial Growth Factor) en las membranas neovasculares
de la DMAE hmeda, ha dado un paso muy importante para el control de la perdida brusca de
visin de estos pacientes. Este tipo de frmacos se administra exclusivamente mediante
inyeccin intravitrea. El objetivo de este Trabajo Fin de Grado es realizar un estudio
retrospectivo de los cambios de agudeza visual del ltimo antiangiognico que ha salido al
mercado, Aflibercept, cuyo nombre comercial es EYLEA. MATERIAL Y MTODOS: Se ha
realizado un estudio retrospectivo en el que se han recogido datos de 30 pacientes. Se recogi
su AV justo antes de la primera inyeccin y tras las tres inyecciones mensuales que marca el
protocolo de inyeccin intravitrea de la SERV. La medicin de la AV se realiz con el test ETDRS
(Early Treatment Diabetic Retinopathy Study) comparando datos de Mejor Agudeza Visual
Corregida (MAVC), as como de ganancia y/o prdida de letras en cada una de las 4 visitas
realizadas. Todos los pacientes seleccionados firmaron el consentimiento informado para
poder recoger sus datos de visin y mantener su confidencialidad. RESULTADOS: Los 30
pacientes tenan una media de 76.5 8.6 aos de edad, de los cuales 13 de ellos eran
hombres. Utilizando la T de Student, se comprob que no existan diferencias estadsticamente
significativas (p>0,05 en todos los casos) en la MAVC obtenida en los distintos periodos
analizados. La MAVC media previa fue de 34.5 14.5 y la final de 34.5 14.3. Adems
considerando el criterio de una variacin de 15 letras como datos de significacin clnica,
encontramos que tras la ltima inyeccin un 53.0 % de los pacientes mejoraban una media de
3.2 3.0 letras de AV (rango entre 0 y 10 letras ganadas) y un 46.7 % perdan de media 2.6
2.6 letras (rango entre 1 y 11 letras perdidas). CONCLUSIONES: Tras el tratamiento intravitreo
con Aflibercept la AV de los pacientes con DMAE hmeda permanece estable, al menos tras
tres meses de tratamiento.
ABSTRACT

Age-related Macular Degeneration (AMD) is the main causes of legal blindness in elderly
people on developed word. Affect the central area of the retina and implies that in advanced
phases the patients dont be able to perceive the objects that they focus and their daily tasks
are decreased. One of the two types of AMD is the wet AMD and affects to 40% of the
patients and is the form that produces the most devastated effects in a short time. The
appearance by chance of Anti-VEGF (Vascular Endothelial Growth Factor) has taken an
important step to control of neovascular membrane in the suddenly lost of vision in wet AMD
patients. This kind of drugs only is administered by intravitreal injection. The purpose of this
final degree project is doing a retrospective study about vision changes produces of the last
anti-VEGF, who has been commercialized, Aflibercept, commercial name is EYLEA. METHODS:
We have done a retrospective study compiling information of 30 patients. We have compiled
their visual acuity (VA) just before first injection and after three monthly injections according
to protocol of the Retina and Vitreous Spanish Society (SERV). Visual acuity was tested with
eye chart ETDRS (Early Treatment Diabetic Retinopathy) to compare Visual Acuity Average with
Best Correction (MAVC), as in the patients visual acuity plus/minus any additional letters
seen/not seen in each of four consultations. Every patient selected was willing to sign the
informed consent to compile their vision information and their confidentiality. RESULTS: 30
Patients were an average of 76.5 8.6 years old and 13 of which were men. We used Student
T, to verify that in no case the differences were statistically significant (p>0, 05 in every
patient), in the MAVC compiled and in all the periods analyzed. The average previous MAVC
was 34.5 14.5 and the MAVC final was 34.5 14.3. This results doesnt have clinical
significant, because were further of 15 letters variation who is considering statistically
significant, we found after the last injection a 53.0% of patients improved an average of 3.2
3.0 VA letters (range between 0 and 10 plus letters) and a 46.7% of patients lost an average of
2.6 2.6 VA letters (range between 1 and 11 minus letters). CONCLUSIONS: Aflibercept
treatment administered in three consecutive monthly injections does not produce significant
visual acuity changes.
Corregido por Melissa 15 de junio de 2015

ABSTRACT

Age-related Macular Degeneration (AMD) is one of the main causes of legal blindness in
elderly people in the developed word. It affects the central area of the retina and implies that,
in advanced phases, the patients arent able to perceive the objects that they are focusing on
and their ability to carry out daily tasks is dramatically reduced. One of the two types of AMD
is the wet AMD and this affects up to 40% of patients and this is the form that produces the
most devastating effects in such a short time. The discovery, by chance of the effects of the
Anti-VEGF (Vascular Endothelial Growth Factor) on the neovascular membrane was an
important step towards controlling the sudden loss of vision in wet AMD patients. This kind of
drug is only administered by an intravitreal injection. The purpose of this final degree project is
to do a retrospective study about the changes in vision that are produced by the lastest anti-
VEGF drug, which has been commercialised by Aflibercept, whose commercial name is EYLEA.
METHODS: We have made a retrospective study, in which we have compiled information from
30 patients. We have collected their visual acuity (VA) data just before their first injection and
again after each of their following three monthly injections according to protocol of the Retina
and Vitreous Spanish Society (SERV). Visual acuity was tested with the eye chart ETDRS (Early
Treatment Diabetic Retinopathy) to compare Visual Acuity Average with Best Correction
(MAVC), as well as any improvements or deteriorations in the patients visual acuity using
additional letters seen in each of our four consultations. Every patient selected was willing to
sign the informed consent allowing us to compile information about their vision and to protect
their confidentiality. RESULTS: 30 Patients were on average 76.5 8.6 years old and of which,
13 were men. We used Student T, to verify the nonexistence of any significant statistic
differences (p>0, 05 in every patient), in the MAVC obtained during the distinctive periods
analysed. The average obtained the in previous MAVC was 34.5 14.5 and the MAVC final was
34.5 14.3. These results dont have any clinical significance because there was a further 15-
letter variation which is considered statistically significant, we found that after the last
injection, 53.0% of patients improved an average of 3.2 3.0 VA letters (range between 0 and
10 letters improved) and 46.7% of patients lost an average of 2.6 2.6 VA letters (range
between 1 and 11 letters lost). CONCLUSIONS: Aflibercept treatment administered in three
consecutive monthly injections does not produce any significant visual acuity change.