Infectious uveitis is an inflammation of the uveal tract, corresponding to the middle layer of the eye, triggered by a response against an infectious agent. This condition is classified into anterior, intermediate, poste...Infectious uveitis is an inflammation of the uveal tract, corresponding to the middle layer of the eye, triggered by a response against an infectious agent. This condition is classified into anterior, intermediate, posterior and panuveitis. The most frequent infectious agents in anterior uveitis are viruses, mainly Herpes simplex virus, although it can also be caused by other pathogens such as Bartonella spp., Mycobacterium tuberculosis and Fusarium spp. In intermediate uveitis, syphilis plays a predominant role, while in posterior uveitis various microorganisms are involved, among them Toxoplasma gondii, Cytomegalovirus, Plasmodium spp. and Candida spp. In certain cases, as in ocular toxoplasmosis, severe inflammation may involve the entire uvea, resulting in panuveitis. Clinical manifestations of uveitis include ocular pain, redness, myodesopsias, blurred vision, and even loss of vision. Direct identification of the causative agent is complex, and the diagnostic performance of available tests varies significantly. For example, polymerase chain reaction (PCR) on ocular specimens for Herpes simplex virus has a sensitivity of 91.3% and specificity of 98.8%, while for toxoplasmosis the sensitivity is 43.1% and specificity 98.5%. Another challenge in infectious uveitis is treatment, as systemic antimicrobials generally have a low penetration into ocular tissue, mostly less than 5%, mainly due to the blood-retinal and blood-aqueous barriers. The efficacy of the molecules in ocular tissue is favored by low protein binding and high liposolubility. This review addresses the most frequent clinical manifestations of bacterial, viral, parasitic and fungal etiologies of infectious uveitis, as well as the diagnostic performance of available tests. In addition, emphasis is placed on the different therapeutic approaches depending on the etiology.
Congenital microcoria (MCOR) is a rare ocular anomaly characterized by pupil smaller than 2 mm with no response to mydriatic agents. It can present in two forms: autosomal recessive associated with Pierson syndrome and a...Congenital microcoria (MCOR) is a rare ocular anomaly characterized by pupil smaller than 2 mm with no response to mydriatic agents. It can present in two forms: autosomal recessive associated with Pierson syndrome and autosomal dominant isolated (associated with a high incidence of myopia and glaucoma). Studies have identified deletions in the 13q32.1 region of chromosome 13 that include the GPR180 gene, involved in smooth muscle cell growth, as the underlying cause. We describe 3 members of a family with deletion of the GPR180 gene on chromosome 13. In all, IOP was normal and gonioscopy showed iridocorneal angle dysgenesis with prominent ciliary processes. MCOR is due to poor development of the iris dilator muscle of genetic cause. Early diagnosis and continuous follow-up for possible complications such as amblyopia, progressive myopia and juvenile glaucoma is essential.
Adverse events due to unsafe healthcare practices constitute a serious global problem. The World Health Organization (WHO) has recognized healthcare insecurity as a public health issue and has undertaken various initiati...Adverse events due to unsafe healthcare practices constitute a serious global problem. The World Health Organization (WHO) has recognized healthcare insecurity as a public health issue and has undertaken various initiatives to safeguard patient safety. The Surgical Safety Checklist (SSC) is one of the tools implemented that has proven to be most effective in reducing morbidity and mortality associated with surgeries. Its impact is tied to implementation policies. Although the SSC is universal, the WHO has encouraged adaptations for different specialties. The purpose of our work is to present the SSC used in our hospital for major and minor ophthalmic surgery. Regarding cataract surgery, it is noteworthy to consider special ocular conditions and the correct choice of intraocular lens.
OBJECTIVE: To determine the correlation of Optical Coherence Tomography (OCT) biomarkers in diabetic macular edema with the level of albuminuria in patients with chronic kidney disease. DESIGN: This is a retrospective, o...OBJECTIVE: To determine the correlation of Optical Coherence Tomography (OCT) biomarkers in diabetic macular edema with the level of albuminuria in patients with chronic kidney disease. DESIGN: This is a retrospective, observational, cross- sectional, and analytical study. PARTICIPANTS: All patients over 18 years of age with diabetic macular edema who attended the retina department of the Ophthalmology service and met the inclusion criteria between March 2021 and August 2022. METHODS: Data collection was carried out by reviewing the records of patients diagnosed with diabetic macular edema. Patients were divided based on 3 categories of albuminuria. The OCT images of the affected eye were collected and analyzed, and the corresponding subdivision was made depending on the presence of biomarkers of poor visual prognosis. RESULTS: Chi-square goodness-of-fit tests were performed to analyze whether the proportion of biomarkers for each category of albuminuria was related to each level of albuminuria. A direct correlation was found between the lack of integrity of the outer retina layers and the severity of albuminuria. CONCLUSIONS: OCT can be a valuable tool for the detection of kidney damage when considering the relationship of some biomarkers with the presence of albuminuria, especially the disruption of the outer retina layers, which can be an OCT biomarker of advanced kidney disease.
The association between retinal angiomatous proliferation (RAP) or type 3 choroidal neovascular membrane (CNV) and pachychoroidopathy has been rarely described. Its occurrence would be a consequence of ischemia resulting...The association between retinal angiomatous proliferation (RAP) or type 3 choroidal neovascular membrane (CNV) and pachychoroidopathy has been rarely described. Its occurrence would be a consequence of ischemia resulting from loss of the choriocapillaris secondary to compression of the pachyvessels. We report a case of retinal angiomatous proliferation in the context of pachychoroidopathy.
PURPOSE: Diabetic retinopathy (DR) is the most common ocular complication of diabetes. Screening programmes using fundus examination with retinal imaging are a useful tool for early diagnosis of DR and an improved diseas...PURPOSE: Diabetic retinopathy (DR) is the most common ocular complication of diabetes. Screening programmes using fundus examination with retinal imaging are a useful tool for early diagnosis of DR and an improved disease prognosis. The purpose of this study is to analyse the number of patients attended in the DR screening programme of the Castilla y León health system and to estimate DR prevalence and severity. METHODS: An observational study of patients previously registered as diabetic who participated in the screening programme between 2018 and 2028 was conducted. Patients were classified according to their diagnosis in non-evaluable test, non-evaluable patient, no DR, DR (mild, moderate, severe, proliferative, and suspected diabetic macular oedema) and other pathologies. RESULTS: The total number of consultations in the program up to the present date has been 31,901, increasing from 3,934 in 2018 to 9,508 in 2023. The estimated prevalence of DR is 15.41%. 1.58% of patients were referred to their reference hospitals due to DR or other pathologies requiring urgent treatment. The remaining patients were managed by the program. CONCLUSIONS: The prevalence of DR appears to be slightly lower than that reported in other published series, but no significant differences were observed between different program years, overall assessment, or different forms of DR or suspected diabetic macular oedema.
OBJECTIVE: The main objective is to determine if there are differences in visual function and retinal structure in patients with bipolar disorder compared to healthy subjects. MATERIAL AND METHODS: Cross-sectional observ...OBJECTIVE: The main objective is to determine if there are differences in visual function and retinal structure in patients with bipolar disorder compared to healthy subjects. MATERIAL AND METHODS: Cross-sectional observational study of cases and controls, adjusted for age and sex. A total of 43 controls (86 eyes) and 82 cases (163 eyes) were included. Visual function was assessed by measuring best corrected visual acuity (BCVA) using high contrast and low contrast visual charts. Optical coherence tomography (OCT) model modelo DRI OCT Triton-Swept Source (Topcon, Tokyo, Japón) was used for retinal structural analysis. RESULTS: BCVA with high contrast, as well as with reduced contrast at 2.5% and 1.25%, showed significant differences (p < 0.05) between both groups, being the mean of each variable lower in the case group. OCT analysis also showed significant differences in the mean thickness of the nerve fiber layer (RNFL) and ganglion cell layer (GCL) between the two groups, with the mean of each variable lower in the case group (p-value = 0.007 in both). No significant differences were observed in the mean thickness of these retinal layers between type I and type II bipolar patients (p-value = 0.556 and 0.871 respectively). CONCLUSIONS: there are significant differences in visual function and in the mean thickness of retinal layers between bipolar patients and healthy controls.
Phthiriasis palpebrarum is defined as the involvement of the eyelids by the Phthirus pubis parasite. It is a pathology considered as a sexually transmitted disease, whose treatment can be challenging in some situations....Phthiriasis palpebrarum is defined as the involvement of the eyelids by the Phthirus pubis parasite. It is a pathology considered as a sexually transmitted disease, whose treatment can be challenging in some situations. We present the case of a 4-year-old patient with eyelashes severely affected by this parasite, who cooperated poorly for mechanical removal. Given this situation, we decided to prescribe a single dose of topical permethrin 5% and several applications of vaseline, repeating this treatment a week later, which led to the complete resolution of the condition. This case introduces topical permethrin 5% as an effective, safe and widely available option for the treatment of this pathology, especially for pediatric patients or those who do not cooperate adequately for mechanical removal of the parasites.
Pigment epithelial detachments (PEDs) form a heterogeneous group of lesions of diverse prognosis and treatment that have in common the pathologic elevation of the retinal pigment epithelium plane and its detachment from...Pigment epithelial detachments (PEDs) form a heterogeneous group of lesions of diverse prognosis and treatment that have in common the pathologic elevation of the retinal pigment epithelium plane and its detachment from the underlying layers. Although PEDs are a common finding in age-related macular degeneration, especially in its exudative forms, the diagnostic characterization and prognostic estimation of these lesions is a clinical challenge that necessarily requires a multimodal imaging approach. This review presents the clinical characteristics of the different groups of PED, their diagnostic imaging profile, as well as their natural history.
BACKGROUND AND OBJECTIVE: Glaucoma, a leading cause of preventable blindness, significantly impacts patients' quality of life (QoL). The GQL-15 (1999) assesses functional disability due to glaucoma through 15 items acros...BACKGROUND AND OBJECTIVE: Glaucoma, a leading cause of preventable blindness, significantly impacts patients' quality of life (QoL). The GQL-15 (1999) assesses functional disability due to glaucoma through 15 items across 4 domains. However, it has not been validated in Spanish. This study aimed to validate and update the GQL-15 for Spanish-speaking individuals. METHODS: We conducted a cross-sectional study with individuals diagnosed with glaucoma at 2 ophthalmological referral centers in Cali-Colombia. Researchers translated the GQL-15 into Spanish and modified it by replacing the 'reading newspaper' item with 'reading on a cellphone/mobile/smartphone' to modernize the questionnaire (GQL-15 m). The GQL-15 m was tested for validity and reliability using Cronbach's alpha (α) coefficient, exploratory factor analysis, and criterion validity. Reproducibility was assessed through a 2-week test-retest analysis. RESULTS: A total of 157 out of 468 eligible patients with glaucoma participated in the survey (33% response rate). The mean age was 67 ± 12 years (64%, women). The GQL-15 m showed a mean total score of 29.3 ± 7.31, suggesting good QoL. Internal consistency was high for both the GQL-15 (α = 0.97) and GQL-15 m (α = 0.96). Criterion validity was supported by significant correlations between the GQL-15 m scores and the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ 25), World Health Organization Quality of Life-BREF (WHOQoL-BREF), Glaucoma Symptom Scale (GSS), Glaucoma Utility Index (GUI), and visual acuity. Reproducibility was high, with an intraclass correlation coefficient (ICC) of 0.89. CONCLUSIONS: The GQL-15 m is a reliable and valid instrument for assessing QoL in Spanish-speaking individuals with glaucoma and has potential for broader application across various cultural contexts.
PURPOSE: To evaluate the performance of ChatGPT in solving clinical scenarios in ophthalmology, specifically questions from the specialty exams for Resident Medical Interns (MIR). DESIGN: Cross-sectional design for evalu...PURPOSE: To evaluate the performance of ChatGPT in solving clinical scenarios in ophthalmology, specifically questions from the specialty exams for Resident Medical Interns (MIR). DESIGN: Cross-sectional design for evaluating a diagnostic tool. METHOD: Ophthalmology questions from the MIR exams from the 2010-2023 sessions were collected. The performance of ChatGPT in successfully answering the questions was calculated. The results were also compared with those obtained by ophthalmology professionals. Additionally, sensitivity, specificity, and positive and negative probability coefficients were calculated. RESULTS: A total of 54 questions were collected, with those from the subspecialty "Retina" being the most frequent. ChatGPT's overall score was 90.2%, with a sensitivity of 92.59% and a specificity of 96.8%. The average concordance with the evaluators' answers was 86.41%. The agreement between the evaluators was 79.62%. CONCLUSIONS: ChatGPT-4 is a useful tool for solving clinical scenarios and theoretical questions in ophthalmology. Proper use of the tool, supervised by professionals, can help optimize the care processes for ophthalmology patients.
We present the case of a 52-year-old man with a stable ophthalmological follow-up for the last 10 years. Clinically asymptomatic, except for floaters in both eyes. In the fundus, bilateral peripheral retinoschisis was ob...We present the case of a 52-year-old man with a stable ophthalmological follow-up for the last 10 years. Clinically asymptomatic, except for floaters in both eyes. In the fundus, bilateral peripheral retinoschisis was observed without associated macular schisis. The electroretinogram (ERG) is electronegative and shows a genetic confirmation of the pathogenic variant c.461A > G; p.(Gln154Arg) of the RS1 gene compatible with the diagnosis of juvenile X-linked retinoschisis (RSLX). The foveal architecture in Optical Coherence Tomography (OCT) presents "inverted roof fovea" not previously described, having found two similar cases in the literature. In males in whom we find the sign of "inverted roof fovea", we should check the fundus, and if we find peripheral retinoschisis, we recommend insisting on the family history, and increase its study with an ERG and molecular genetic analysis, ruling out RSLX.
Peripapillary Intrachoroidal Cavitation (PICC) can be appeared as an orangish lesion located at the outer lower edge of the myopic cone and confined to the intrachoroidal space. It is more common in patients with high my...Peripapillary Intrachoroidal Cavitation (PICC) can be appeared as an orangish lesion located at the outer lower edge of the myopic cone and confined to the intrachoroidal space. It is more common in patients with high myopia, older age, and greater axial length. The most accepted pathophysiological mechanism involves traction over a vulnerable sclera tissue at the myopic cone. PICC may present with visual field defects like mild glaucomatous neuropathy. Differential diagnosis with other choroidal pathologies is essential, and OCT-HD shows distinctive features in PICC. Additionally, OCT-A plays a crucial role in the diagnosis. We present 3 patients with PICC from our center, all of whom share advanced age, increased axial length, and myopia. All cases exhibit characteristic imaging alterations and visual field defects likely associated with the pathology.
PURPOSE: To assess the perception and knowledge that Spanish ophthalmologists have of overdiagnosis (OD) and overtreatment (OT) in the field of glaucoma. METHODS: An anonymous, 26-item online survey was submitted to memb...PURPOSE: To assess the perception and knowledge that Spanish ophthalmologists have of overdiagnosis (OD) and overtreatment (OT) in the field of glaucoma. METHODS: An anonymous, 26-item online survey was submitted to members of the Spanish Glaucoma Society and the Spanish Ophthalmology Society. RESULTS: Approximately 55% out of the 195 respondents were aware of the current definition of OD/OT. Only 13 (6.7%) believe OD/OT is not a clinically significant problem. There were no significant differences in terms of demographics, type of practice and treatment preferences between ophthalmologists who considered OD/OT important and those who considered OD/OT unimportant, except for a higher proportion of PhDs among the "not clinically relevant" group. No differences were found either across groups considering clinical findings/real-world scenarios. "Peace of mind" was considered a principal driver of OD/OT by both groups. Moderate OHT was considered the most common clinical scenario for OD/OT, which was estimated to affect 20% of medically treated patients and only 5% of those undergoing surgical procedures. CONCLUSIONS: Spanish ophthalmologists reported being aware of the importance of OD and OT. However, only half were aware of the current definition of OD and OT. Most participants believe a White Paper should be produced to reduce the prevalence of OD/OT. The low participation rate and the non-response bias may limit the generalization of the results.
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect almost every organ. This article describes a middle-aged woman, previously diagnosed with untreated SLE, who during a severe SLE flare simultane...Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect almost every organ. This article describes a middle-aged woman, previously diagnosed with untreated SLE, who during a severe SLE flare simultaneously presented with a superior nasal artery occlusion in the right eye and a central retinal artery occlusion (CRAO) in the left eye. Severe ocular complications, such as CRAO, can occur during an acute flare of the disease in previously asymptomatic SLE.