Nutrition et dégénérescences maculaires liées à l'âge

The pathogenesis of age-related macular degeneration (ARMD) involves nutritional factors related to the oxidative stress. Antioxidant micronutrients, anti-free-radicals and micronutrients that protect from blue light play a role in disease prevention. These nutritional factors are closely related to environmental risk factors such as smoking and chronic blue light exposure. Although experimental and epidemiological data are concordant and coherent, the protective role of these micronutrients is not clearly established and the effective dose devoid of adverse effects remains to be determined. Besides, interventional studies on omega-3 long-chain polyunsaturated fatty acids (LCPFA) supplements constitute a significant advance in terms of primary care prevention. In practice, as primary disease prevention, omega-3 LCPFA supplements may be considered in subjects with a risk for ARMD, while a cocktail of antioxidant and blue-light-protective micronutrients should be considered for patients with grade 3 and grade 4 ARMD, or, as secondary prevention, for subjects with an uncontrolled nutritional status. Of course, such supplements are compatible with simple dietary measures. Their interest might be enhanced by an improved formulation and a dose-optimization of the supplements currently used. Further research and clinical studies remain necessary to definitely validate these formulations and consider them true drugs.     

Valoración de técnicas intraoperatorias para la prevención de la opacificación del eje visual en la cirugía de cataratas congénitas

ObjectiveTo evaluate the effectiveness of various surgical procedures in the management of posterior capsule and anterior vitreous on the prevention of visual axis opacification.Subjects, material and methodsWe retrospectively reviewed 120 eyes operated for unilateral congenital cataracts, with a median age at the time of cataract surgery of 21 months (interquartile range, 6-52 months). The eyes were divided into 3 groups: group 1 (eyes with intact posterior capsule, n = 39), group 2 (eyes with posterior continuous curvilinear capsulorhexis, n = 38), group 3 (eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, n = 43).ResultsTo determine the effect of posterior continuous curvilinear capsulorhexis on visual axis opacification we compared group 2 with group 1 (chi-square Pearson test, P =.281), therefore in this study the implementation of the posterior continuous curvilinear capsulorhexis did not show any decreases in the incidence of visual axis opacification. To study the effect of posterior continuous curvilinear capsulorhexis associated anterior vitrectomy, we compared group 3 with group 1 (chi-square Pearson test, P =.014), demonstrating that the combination of both techniques (posterior continuous curvilinear capsulorhexis and anterior vitrectomy) decreases the incidence of visual axis opacification.ConclusionPosterior continuous curvilinear capsulorhexis as a single technique did not show any decrease in the incidence of visual axis opacification. Posterior continuous curvilinear capsulorhexis together with anterior vitrectomy are required to prevent visual axis opacification and to decrease reoperation rate.