BACKGROUND AND OBJECTIVES: To evaluate intraocular pressure (IOP) and the number of hypotensive medications in patients with mild-to-moderate appositional primary angle-closure glaucoma (PACG) after phacoemulsification s...BACKGROUND AND OBJECTIVES: To evaluate intraocular pressure (IOP) and the number of hypotensive medications in patients with mild-to-moderate appositional primary angle-closure glaucoma (PACG) after phacoemulsification surgery (phaco-only group) versus phacoemulsification combined with the implantation of two iStent® W inject trabecular stents (Glaukos Corporation, CA, USA) (phaco-iStent group). MATERIALS AND METHODS: A retrospective cohort study including 28 eyes from 28 patients with appositional PACG, divided into two groups (phaco-only and phaco-iStent). The number of medications and IOP values were recorded, at baseline, as well as, at one month, six months, and twelve months postoperatively. RESULTS: Baseline and one-month postoperative mean IOP were similar in both groups (P > .05). The phaco-iStent group exhibited significantly lower IOP at six and twelve months postoperatively compared to the phaco-only group (P = .024 at six months and P = .018 at twelve months). The number of active agents was significantly lower at twelve months in the phaco-iStent group (P = ,01). CONCLUSIONS: There is greater efficacy in lowering intraocular pressure over time in patients with appositional PACG if phacoemulsification is accompanied by trabecular surgery. This could be useful in patients in whom we suspect that lowering IOP with phacoemulsification alone will not be sufficient to control the disease.
A case is presented of a 77-year-old woman with recurrent cystoid macular edema treated with intravitreal dexamethasone implants (Ozurdex®), who developed an acute and severe intraocular inflammatory reaction after the l...A case is presented of a 77-year-old woman with recurrent cystoid macular edema treated with intravitreal dexamethasone implants (Ozurdex®), who developed an acute and severe intraocular inflammatory reaction after the last administration. Clinical and imaging findings, together with negative microbiological cultures and favorable evolution under conservative medical treatment, were consistent with sterile endophthalmitis or implant-induced panuveitis. The implant showed an abnormal appearance-swollen and surrounded by vitreous condensations-suggesting possible structural alterations of the device or inadvertent contamination during injection, which could have triggered an immunologic or irritative reaction, among other mechanisms described in the literature. This case highlights the importance of recognizing atypical presentations of intraocular inflammation following Ozurdex®, differentiating them from infectious processes, and reporting such events to pharmacovigilance systems, given that this is an exceptional reaction with very few cases reported in the literature.
Miller Fisher syndrome (MFS) is an uncommon variant of Guillain-Barré syndrome characterized by the triad of ophthalmoplegia, ataxia, and areflexia. Diagnosis can be particularly challenging when the clinical presentatio...Miller Fisher syndrome (MFS) is an uncommon variant of Guillain-Barré syndrome characterized by the triad of ophthalmoplegia, ataxia, and areflexia. Diagnosis can be particularly challenging when the clinical presentation is incomplete or atypical, especially in early stages. We report the case of a 54-year-old woman who presented to the emergency department with blurred vision and nonspecific dizziness, without diplopia or other relevant neurological findings. Hospital discharge was initially considered. However, ophthalmologic examination revealed severe bilateral ophthalmoplegia with supranuclear involvement and convergence impairment, in the absence of pupillary abnormalities. These findings prompted hospital admission and neurological evaluation, which confirmed the diagnosis of MFS. Treatment with intravenous immunoglobulins led to complete recovery. This case represents an atypical form of MFS, lacking all three classical components at onset and showing no positive findings on serologic or neuroimaging studies. The initial clinical suspicion raised by the ophthalmology team was essential to prevent premature discharge and allowed early diagnosis and treatment. This report underscores the importance of thorough ocular examination in patients with nonspecific visual symptoms and highlights the key role of ophthalmologists in the early recognition of rare neurological disorders with ocular manifestations.
Age-related macular degeneration (AMD) is a multifactorial disease influenced by genetic and environmental factors, yet its pathogenesis remains incompletely understood. DNA methylation, increasingly recognized as a dise...Age-related macular degeneration (AMD) is a multifactorial disease influenced by genetic and environmental factors, yet its pathogenesis remains incompletely understood. DNA methylation, increasingly recognized as a disease indicator, has been linked to AMD and may represent a promising biomarker or therapeutic target. This systematic review, conducted according to PRISMA 2020 guidelines, analyzed 13 studies addressing DNA methylation in AMD populations (2012-2025). Results revealed that 25% reported hypermethylation, 8% hypomethylation, and 41% both patterns, while 15% found no significant differences. Notably, one study described downregulation of DNA methyltransferases in advanced stages compared with early or intermediate AMD. Despite the limited evidence, findings support the relevance of methylation in AMD prognosis and therapy. Further research with robust methodologies is essential to clarify the role of epigenetic mechanisms in disease progression and to explore their potential for guiding targeted therapeutic strategies.
Hernández-Barahona Palma J, Cabanás Jiménez M, Rodríguez de la Rúa Franch E
… +8 more, García de la Vega Sosa M, García Rescalvo MA, Balonga Balonga D, García Mateo J, Hidalgo Vega Á, Martín Lorenzo T, Maravilla-Herrera P, Pachón-Castro M
Primary open-angle glaucoma (POAG), with a prevalence of 2.6% in people over 40, is the most common form of glaucoma and can cause blindness in up to 9% of cases. The new therapeutic paradigm prioritizes early surgery to...Primary open-angle glaucoma (POAG), with a prevalence of 2.6% in people over 40, is the most common form of glaucoma and can cause blindness in up to 9% of cases. The new therapeutic paradigm prioritizes early surgery to preserve vision and quality of life. The objectives of this study were to analyze the diagnosis, treatment, and management of POAG in Andalusia, evaluate the incorporation of innovation, and propose improvements. A review of scientific literature and official databases was conducted, supplemented by a multidisciplinary panel of experts. The results show a high rate of underdiagnosis due to asymptomatic nature, lack of screening, and scarce resources, as well as limitations in adopting an early surgical approach due to waiting lists and restricted capacity. It is concluded that early diagnosis and treatment are key to slowing progression, preventing visual impairment, and reducing the socioeconomic burden.
There are few topical analgesic alternatives to treat refractory painful blind eye. We present a case series treated with topical sevoflurane. After approval from our Institutional Review Board, clinical and pharmacologi...There are few topical analgesic alternatives to treat refractory painful blind eye. We present a case series treated with topical sevoflurane. After approval from our Institutional Review Board, clinical and pharmacological information was collected from the charts of all our 11 patients with refractory painful blind eye treated with sevoflurane. The first in-hospital application of sevoflurane (dose < 0.5 mL) caused a rapid and intense analgesic effect in 10 patients, who were given a bottle of sevoflurane-filled eye drops to self-administer. Four patients discontinued treatment weeks later due to lack of effectiveness or rebound pain. Pain is still successfully controlled in the remaining six patients after several months. Well-tolerated itching was the most frequent unwanted effect (three cases). Topical ocular sevoflurane emerges as an easy to apply alternative for refractory painful blind eye, warranting further investigation to better depict its clinical profile.
Almorín-Fernández-Vigo I, Sánchez-Guillén I, Fernández-Vigo JI
… +5 more, Martín-Polo AB, De-Pablo-Gómez-de-Liaño L, Gómez-de-Liaño R, Macarro-Merino A, Fernández-Vigo JA
INTRODUCTION AND OBJECTIVES: To measure the repeatability of static cyclotorsion registry by the WaveLight EX500 excimer laser platform and its reliability in terms of the percentage of errors during different phases of...INTRODUCTION AND OBJECTIVES: To measure the repeatability of static cyclotorsion registry by the WaveLight EX500 excimer laser platform and its reliability in terms of the percentage of errors during different phases of the surgery. MATERIAL AND METHODS: Experimental, prospective, descriptive study. Candidates for LASIK surgery were evaluated with a Placido-based topographer for iris registration. Once in the operating room and after placing the blepharostat (phase 1), 3 consecutive cyclotorsion measurement attempts were performed using the excimer laser. Valid measurements or the number of errors were noted. Then, after the flap creation (phase 2) and after the flap lifting (phase 3) the first valid cyclotorsion measurement up to a maximum of three attempts was noted. The number and percentage of errors in every phase were calculated. The intraclass correlation coefficient (ICC) for absolute agreement was also calculated. RESULTS: 135 eyes of 80 subjects were included. Three consecutive measurement errors were found in 2.9%, 20.7%, and 23% of the eyes in phases 1, 2, and 3, respectively. In Phase 1, the mean range of the 3 measurements was 0,7 ° with a maximum difference of 3.5 °. The ICC between the 3 measurements was 0.960. The maximum difference between the measurements of Phases 1, 2, and 3 was calculated as 5.5 °. Twenty percent of patients with a valid measurement in Phases 1 or 2 were unable to achieve a valid measurement in Phase 3. CONCLUSIONS: Static cyclotorsion measurements are highly repeatable. Registry errors are more likely to occur after flap lifting.
BACKGROUND AND OBJECTIVE: The Covid-19 pandemic in 2020 created the need to provide medical care remotely. Although it was not implemented according to standards defined by scientific communities, it served as a first co...BACKGROUND AND OBJECTIVE: The Covid-19 pandemic in 2020 created the need to provide medical care remotely. Although it was not implemented according to standards defined by scientific communities, it served as a first contact with virtual consultations. MATERIAL AND METHODS: This paper presents the results of a survey conducted among attendees of the "Glaucoma Home" session held during the XVII Congress of the Spanish Glaucoma Society (SEG) in March 2023 in Madrid. RESULTS: Ninety-four ophthalmologists responded. Among those already using virtual glaucoma consultations, 65.4% rated them as good in terms of efficiency, safety, and patient acceptance; only 15.4% rated them poorly. In contrast, among those not practicing it, only 5.6% rated it positively, while over 75% rated it between low and very low. Sixty-six ophthalmologists do not conduct virtual glaucoma visits, mainly due to lack of personnel or appropriate space. Of these, 47% plan to implement it. Among those currently practicing telemedicine, 27% started within the last year, 62% between one and three years ago, and 10% more than three years ago. Only 3.4% have been practicing for over five years. The main candidates for telemedicine are patients with ocular hypertension or stable glaucoma. Most tests are performed in hospitals, mainly by optometrists (50%) and nursing staff (25%), and are evaluated by ophthalmologists (89.5%). CONCLUSION: The pandemic boosted the use of telemedicine in glaucoma, with a positive evaluation from those who have implemented it.
Phakic intraocular lenses (pIOLs) offer an effective option for correcting high myopia in patients unsuitable for laser refractive surgery. We report a case of unintended upside-down implantation of a toric Implantable C...Phakic intraocular lenses (pIOLs) offer an effective option for correcting high myopia in patients unsuitable for laser refractive surgery. We report a case of unintended upside-down implantation of a toric Implantable Collamer Lens (ICL), identified four months postoperatively. A 32-year-old male with corneal ectasia presented with left eye pain and bilateral dysphotopsia after bilateral ICL implantation performed elsewhere. Clinical evaluation revealed an inverted ICL in the right eye and toric axis misalignment in the left eye. Surgical management involved intraocular reinversion of the right ICL and axis realignment in the left eye. No postoperative complications occurred, and visual acuity remained stable. This case highlights the importance of early recognition of ICL malposition and demonstrates intraocular reinversion as a safe, effective alternative to explantation. Various diagnostic methods for confirming ICL inversion and the favorable refractive outcomes after corrective surgery are also discussed.
Recurrent pterygium presents a significant challenge in ophthalmic surgery due to its high rate of recurrence and associated complications. We describe a case of a 70-year-old male with a third recurrence of pterygium in...Recurrent pterygium presents a significant challenge in ophthalmic surgery due to its high rate of recurrence and associated complications. We describe a case of a 70-year-old male with a third recurrence of pterygium in the right eye, complicated by symblepharon and inferior fornix shortening. Surgical intervention included pterygium excision, corneal scraping, peripheral lamellar keratoplasty (PLK), and fornix reconstruction with an oral mucosal graft. An amniotic membrane transplant was used as an adjunct. Postoperatively, the patient showed progressive improvement in corneal transparency and visual acuity. This case highlights the role of PLK in recurrent pterygium with corneal involvement and fornix reconstruction.
PURPOSE: To investigate whether ocular dominance is associated with measurable differences in interocular biometric parameters using swept-source optical coherence tomography (SS-OCT). MATERIALS AND METHODS: This cross-s...PURPOSE: To investigate whether ocular dominance is associated with measurable differences in interocular biometric parameters using swept-source optical coherence tomography (SS-OCT). MATERIALS AND METHODS: This cross-sectional observational study included 227 phakic adults who underwent SS-OCT biometry (IOLMaster 700, Carl Zeiss Meditec). Dominant and non-dominant eyes were identified using the hole-in-the-card test. Axial length (AL), anterior chamber depth (ACD), crystalline lens thickness (LT), keratometry in flat (K1) and steep (K2) meridians, white-to-white (WTW) distance, and Chang-Waring chord distance (CWC-D) and angle (CWC-A) were compared as paired data. Statistical analyses included paired-sample t-test or Wilcoxon signed-rank test for group comparisons, and Spearman correlation for associations between biometric variables. A p-value <0.05 was considered significant. RESULTS: Among 227 participants (mean age 48.7 ± 16.2 years), 68.2% demonstrated right-eye dominance. No statistically significant interocular differences were observed in AL, ACD, LT, K1, K2, WTW, or chord μ (all p > 0.05). Correlation analysis showed that chord μ was negatively correlated with AL, ACD, and WTW, and positively correlated with LT and spherical equivalent in both eyes. CONCLUSIONS: In subjects with low anisometropia (<2 D) and comparable visual acuity between eyes, ocular dominance was not associated with biometric asymmetry measured by SS-OCT. These findings suggest that ocular dominance represents a primarily functional rather than anatomical preference.
INTRODUCTION AND OBJECTIVES: To assess differences in visual performance after implantation of two extended depth-of-focus simultaneous vision intraocular lenses (IOLs) with different optical designs. PATIENTS AND METHOD...INTRODUCTION AND OBJECTIVES: To assess differences in visual performance after implantation of two extended depth-of-focus simultaneous vision intraocular lenses (IOLs) with different optical designs. PATIENTS AND METHODS: A randomised prospective comparative interventional study in patients requiring cataract surgery for both eyes. Patients were divided into two groups: one given biconvex IOLs (Tecnis Eyhance™, Johnson & Johnson Vision Care, Inc, Jacksonville, FL, USA) and the other inverted meniscus IOLs (ArtIOLs®25, Voptica, Murcia, Spain). One month after the surgical intervention in the second eye, the binocular distance-corrected visual acuity was measured at far, intermediate (66 cm), and near (40 cm) distances. Additionally, binocular distance-corrected defocus curves were obtained. Potential correlations of intermediate visual acuity (VA) with corneal spherical aberration (Z°) and pupil size were explored. The Catquest-9SF questionnaire was administered to all patients to assess their vision-related quality of life after IOL implantation. RESULTS: Overall, 30 patients (60 eyes) were assessed. Binocular distance corrected intermediate visual acuities of 0.20 logMAR (0.10;0.30) (p = 0.445), were achieved in both groups. The binocular distance corrected near visual acuity was 0.3 logMAR (0.25; 0,40) in the Tecnis Eyhance™ group and 0.4 logMAR (0.30;0.50) in the ArtIOLs®25 group (p = 0.050). Intermediate visual acuity was weakly correlated with corneal spherical aberration and pupil size. The Catquest-9SF score was close to 1 in both groups, but better in the Eyhance group, and the difference was statistically significant (p = 0.035). CONCLUSIONS: Both the Tecnis Eyhance™ and ArtIOLs®25 IOLs achieved a binocular distance-corrected intermediate VA of 0.2 logMAR, without compromising distance VA. No differences were observed between the two groups in the outcomes experienced by patients in their daily lives related to their vision problems after cataract surgery.
We describe a case of the recently described MEWDS like retinopathy in a patient with active PEHCR and history of bilateral non-arteritic ischaemic optic neuropathy (NAION). This patient was an 83-year-old man with a kno...We describe a case of the recently described MEWDS like retinopathy in a patient with active PEHCR and history of bilateral non-arteritic ischaemic optic neuropathy (NAION). This patient was an 83-year-old man with a known history of PEHCR not requiring treatment and sequential NAION. He presented to the emergency eye services complaining of left eye (LE) reduced vision. Cystoid macular oedema (EMC) was noted. There were multiple hyper-autofluorescent dots within the macula which corresponded to subretinal hyper-reflective deposits on optical coherence tomography (OCT). The patient was observed with partial resolution of deposits and complete resolution of EMC noted 4 months following his initial presentation.
Kaposi's sarcoma (KS) is a malignant vascular neoplasm associated with human herpesvirus type 8 (HHV-8) infection. Conjunctival involvement is very rare and is considered part of classic KS. We present the case of a 57-y...Kaposi's sarcoma (KS) is a malignant vascular neoplasm associated with human herpesvirus type 8 (HHV-8) infection. Conjunctival involvement is very rare and is considered part of classic KS. We present the case of a 57-year-old female patient with skin lesions diagnosed as classic KS not associated with HIV or immunosuppression, who later developed a conjunctival lesion. This lesion was treated with superficial radiotherapy in a single fraction using a low-energy X-ray device, resulting in good clinical outcomes and no signs of conjunctival recurrence after 5 years of follow-up. Single-fraction radiotherapy is an effective treatment for local control of the lesion and prevention of recurrence.
Oculodentodigital dysplasia (ODDD) is a rare genetic disorder caused by mutations in the GJA1 gene, which encodes connexin 43 (Cx43). The condition presents with a broad phenotypic spectrum including ocular, dental, cran...Oculodentodigital dysplasia (ODDD) is a rare genetic disorder caused by mutations in the GJA1 gene, which encodes connexin 43 (Cx43). The condition presents with a broad phenotypic spectrum including ocular, dental, craniofacial, neurological, and skeletal abnormalities. We report the case of a 24-year-old female patient with genetically confirmed ODDD, carrying the c.226C > T (p.Arg76Cys) variant in the GJA1 gene, who presented with compatible clinical signs. Ophthalmologic evaluation revealed epicanthal folds, microcorneas, nystagmus, hyperprolate corneal profiles, and corneal topography consistent with incipient keratoconus, which may be attributed to functional alterations of Cx43. Close ophthalmologic follow-up is recommended in patients with ODDD to detect treatable visual complications that may significantly impact quality of life.
BACKGROUND AND OBJECTIVE: Ophthalmology in Spain has a high proportion of young specialists. This study describes the professional and training situation after residency, as well as young ophthalmologists' perceptions of...BACKGROUND AND OBJECTIVE: Ophthalmology in Spain has a high proportion of young specialists. This study describes the professional and training situation after residency, as well as young ophthalmologists' perceptions of the Spanish Society of Ophthalmology (SEO). MATERIALS AND METHODS: A cross-sectional descriptive study was conducted using an online survey of residents and attendings with ≤4 years of experience. Demographic, professional, training data, and opinions about the SEO were collected. RESULTS: A total of 81 ophthalmologists participated. Among attendings, 88.6% found immediate employment, mostly through temporary and short-term contracts; 27.3% experienced periods of unemployment. The 54.5% pursued subspecialization, mainly in retina and oculoplastics. Nearly half work exclusively in the public sector (47.7%), while 45.5% combine public and private practice. Satisfaction with residency training was high (70.4%) but decreased post-residency (56.9%). Fewer than half perceived their job situation as stable, and 38.6% had considered emigration. Main demands included higher salaries, reduced bureaucratic workload, and more public employment opportunities. SEO membership was low, with limited perceived benefits. Training in contact lenses was insufficient, while interest in artificial intelligence was high. CONCLUSIONS: Young ophthalmologists face professional instability after residency, although they highly value their residency training. Measures to enhance job stability, improve deficient training areas, and strengthen the SEO's role in continuous education and professional advocacy are needed.
Cavero-Roig L, Salvador-Valle A, Ferrero-Rosanas A
… +5 more, Mompart-Martínez R, Graff-Salinas H, Sorrentino-Navarro A, ÓFarrell-Molteni M, Romanic-Bubalo N
BACKGROUND AND OBJECTIVE: Peripheral defocus lenses (PDLs) have emerged as an effective therapeutic strategy to slow the progression of childhood and adolescent myopia. However, achieving optimal centration in pediatric...BACKGROUND AND OBJECTIVE: Peripheral defocus lenses (PDLs) have emerged as an effective therapeutic strategy to slow the progression of childhood and adolescent myopia. However, achieving optimal centration in pediatric patients can be challenging, and individual facial and postural characteristics must be carefully considered to ensure appropiate fitting. The primary objective of this study was to quantify PDL decentration as an undesirable effect during myopia management in children and adolescents undergoing concurrent atropine treatment. MATERIALS AND METHODS: The distance between the pupil center and the optical center of the lens was measured in millimeters using a conventional millimeter ruler in primary gaze. Five PDL models were evaluated across the study cohort. RESULTS: A total of 69 participants were included (mean age: 12.5 years; range 7-17). The mean spherical equivalent was -2.9 D (range: -0.25 to -8.50). Mean axial length was 24.59 mm (range: 22.96-27.02), and mean pupil diameter was 5.55 mm (range: 4-7.21). Mean decentration values were: inferior 2.26 mm; superior 0.13 mm; nasal 0.36 mm, and temporal 0.47 mm. Decentrations > 1 mm were observed in 76% of patients, > 2 mm in 50.7%, and > 3 mm in 33.3%. CONCLUSIONS: In this cohort, PDL decentration exceeding 3 mm occurred in approximately one-third of pediatric myopic patients. These findings underscore the need for individualized frame selection and meticulous fitting to ensure accurate optical centration relative to the pupillary axis.
INTRODUCTION: Virtual clinics represent an innovative approach to the management of chronic diseases, particularly in ophthalmology, by optimizing resource allocation and alleviating the burden on traditional face-to-fac...INTRODUCTION: Virtual clinics represent an innovative approach to the management of chronic diseases, particularly in ophthalmology, by optimizing resource allocation and alleviating the burden on traditional face-to-face (F2F) services. Despite their growing implementation, there is a lack of comprehensive studies assessing their efficiency. This study aims to compare the cost-effectiveness of the Virtual Retina Clinic (VRC) with F2F clinics in the follow-up of stable retinal diseases. MATERIAL AND METHODS: A cost-minimization analysis (AMC) was conducted by measuring resource utilization of patients in conventional F2F visits in 2019, and through the VRC in 2020. Our previous study on the VRC effectiveness demonstrated the equivalence of the results of the VRC and F2F approaches, as required for AMC, and a VRC sensitivity of 100% for detecting progression. The unit costs were obtained from the hospital´s accounting system. Furthermore, indirect costs related to labor productivity losses in patients and their companions were analyzed. RESULTS: No significant differences were found between the total direct direct costs of the VRC and conventional clinics in the follow-up of 481 patients with stable retinal diseases. The differences detected were that VRC staff costs were significantly lower (54.5% vs. 76.8% for F2F clinics) while its equipment costs were higher (32.8% vs. 10%). Overall, including the costs of productivity losses, the VRC is significantly less expensive than in-person care as it more than halves indirect costs. CONCLUSION: This first study analyzing the costs of a VRC versus fully F2F clinics found that it is not more expensive for the follow-up of stable retinal diseases. Additionally, taking into account indirect costs, the VRC is less expensive, and once the equipment has been acquired, its costs are lower than those of conventional clinics.