INTRODUCTION AND OBJECTIVES: Despite correct alignment during surgery, postoperative lens rotation remains one of the main complications for toric lenses. This study aimed to evaluate the rotational stability in patients...INTRODUCTION AND OBJECTIVES: Despite correct alignment during surgery, postoperative lens rotation remains one of the main complications for toric lenses. This study aimed to evaluate the rotational stability in patients who underwent enVista Toric MX60T intraocular lens implantation and its relationship with the capsulorhexis morphology and preoperative ocular biometrics. MATERIALS AND METHODS: 59 eyes of 59 patients with cataract and regular corneal astigmatism, who underwent uncomplicated phacoemulsification with enVista Toric MX60T intraocular lens implantation. Pre-op ocular biometrics were evaluated with the IOLMaster 700. 24 h post-surgery, perimeter, area, horizontal and vertical diameter, and circularity index of the capsulorhexis were taken with the ImageJ program through clinical photographs under pupillary dilation. OPD-Scan III was performed post-op at 24 h and at 1 month to quantify lens rotation. RESULTS: At 1 month post-op, the mean refractive cylinder was of 0.1 ± 0.61 diopters, and the mean lens rotation was of 5.00 ± 3.93 degrees. 52 % of lenses rotated 5° or less. Post-surgical uncorrected visual acuity was 20/30 or better in 64 % of eyes. Logistic regression showed a weak association regarding anterior chamber depth and IOL rotation at 24 h, however, this was not maintained at the 1 month visit. The rest of the parameters showed no correlation regarding lens rotation at any of the time periods. CONCLUSIONS: The magnitude of rotation of the enVista Toric MX60T intraocular lens is not related to the capsulorhexis morphology or preoperative ocular biometrics. Further research is needed to assess variables that may affect lens rotation, to improve post-surgical visual and refractive outcomes.
BACKGROUND AND OBJECTIVE: To evaluate the efficacy of micropulse transscleral diode laser cyclophotocoagulation as a bridge therapy prior to angle surgery in pediatric glaucoma caused by angle dysgenesis in the context o...BACKGROUND AND OBJECTIVE: To evaluate the efficacy of micropulse transscleral diode laser cyclophotocoagulation as a bridge therapy prior to angle surgery in pediatric glaucoma caused by angle dysgenesis in the context of Sturge-Weber Syndrome. The objective was to temporarily control intraocular pressure, thereby achieving the corneal transparency required for subsequent angle surgery. MATERIALS AND METHODS: Three Sturge-Weber syndrome patients under one year old, with glaucoma caused by angle dysgenesis and corneal opacity, were treated with micropulse transscleral diode laser cyclophotocoagulation to improve corneal transparency before surgery. Two patients subsequently underwent trabeculotomy, while the third patient, who had a previous trabeculotomy, underwent a MIGS OMNI procedure. RESULTS: Micropulse transscleral diode laser cyclophotocoagulation temporarily lowered IOP values, improving corneal transparency and allowing the performance of subsequent surgical interventions. CONCLUSION: The combination of micropulse transscleral diode laser cyclophotocoagulation as a bridge therapy followed by angle surgery, for example trabeculotomy or MIGS OMNI, represents a promising strategy for managing congenital glaucoma in pediatric patients with angle dysgenesis, particularly in the context of phakomatoses like Sturge-Weber Syndrome.
BACKGROUND AND PURPOSE: To describe the results of isolated Harada-Ito or Fells modification surgery in the treatment of diplopia, torticollis and excyclotorsion secondary to superior oblique paresis (SOP). MATERIAL AND...BACKGROUND AND PURPOSE: To describe the results of isolated Harada-Ito or Fells modification surgery in the treatment of diplopia, torticollis and excyclotorsion secondary to superior oblique paresis (SOP). MATERIAL AND METHODS: Retrospective workup of subjects operated on since 2015-November 2024. The age, sex, etiology of SOP, preoperative and immediate and late postoperative excyclotorsion, pre- and postoperative vertical deviation and torticollis, as well as type of suture (resorbable or not) were collected. The time of evolution of the SOP and follow-up from surgery to data collection were recorded. The resolution or improvement of diplopia, excyclotorsion and torticollis were considered a good outcome. RESULTS: Eight cases were operated on (4 women). In six, the left eye, bilateral (1). The etiology of the SOP was neoplasia (2), trauma (1), ischemic (3), infectious (1), idiopathic (1). All had subjective excyclotorsion (between 5º-15º) that disappeared at the end of follow-up. The mean torsion correction was 7.87º ± 2.47º, with resorbable suture 7º ± 2.44º and non-resorbable 8.75 º ± 2.5º. Torticollis was observed before surgery in all 8 patients, which resolved after surgery except in one case. Preoperative vertical deviation ranged from a minimum of 2 pd to a maximum of 8 pd, resolving in seven cases. The preoperative diplopia resolved in 4 of the 8 cases and improved in the rest. CONCLUSIONS: Harada-Ito surgery and Fells modification resolved or improved diplopia, symptomatic excyclotorsion and torticollis in patients diagnosed with SOP. Non-resorbable suture had a greater effect on extortion correction (not statistically significant) at the end of follow-up.
Carotid-ophthalmic aneurysms, though comprising only 4% of cerebral aneurysms, can lead to progressive visual deterioration by compressing the visual pathways, and early intervention is essential to prevent permanent vis...Carotid-ophthalmic aneurysms, though comprising only 4% of cerebral aneurysms, can lead to progressive visual deterioration by compressing the visual pathways, and early intervention is essential to prevent permanent vision loss. When suspected, urgent angiographic imaging should be requested. This report highlights an uncommon but treatable cause of progressive visual impairment due to optic nerve compression by a carotid aneurysm.
BACKGROUND AND OBJECTIVES: Glaucoma is the leading cause of irreversible blindness worldwide and early diagnosis is essential to preserve the visual health of the population. The objective of this study is to estimate th...BACKGROUND AND OBJECTIVES: Glaucoma is the leading cause of irreversible blindness worldwide and early diagnosis is essential to preserve the visual health of the population. The objective of this study is to estimate the diagnostic value of macular superficial vascular density in the detection of early changes in primary open-angle glaucoma. MATERIALS AND METHODS: Observational, analytical, and cross-sectional study in 222 eyes (215 participants) and three study groups: negative control (111 healthy subjects), mild glaucoma (55 patients), and positive control (56 patients). CIRRUS™ 5000 technology (version 11.0) was used. To make both eyes equivalent, transposition was performed on the vertical axis in the left eye. The apparent macular vascular density (6 × 6 mm) was obtained by image processing in sectors of interest using the Python algorithm. Areas under the curve with negative control groups and mild glaucoma were calculated. RESULTS: Both groups were similar in age, sex, systemic diseases and ocular biometry. Vascular densities showed low diagnostic capacity (AUC = 0.56-0.65). The apparent macular vascular densities in outer rings 240-300° and 205-245° (respectively AUC = 0.90 and 0.89) showed better diagnostic capacity (p < 0.05) than neuroretinal ring area, minimum ganglion cell thickness (AUC = 0.82; both) and retinal nerve fiber layer thickness (AUC = 0.79). CONCLUSIONS: Superficial macular vascular density in areas of anatomical interest for glaucomatous damage is the best parameter of optical coherence tomography for the detection of early changes in primary open-angle glaucoma.
We report the case of a 56-year-old male patient with mixed infectious keratitis who developed a 5 × 5 mm corneal ulcer with irregular borders and positive fluorescein staining. After topical and systemic treatment, the...We report the case of a 56-year-old male patient with mixed infectious keratitis who developed a 5 × 5 mm corneal ulcer with irregular borders and positive fluorescein staining. After topical and systemic treatment, the infectious process resolved. Topical losartan was then initiated to reduce residual fibrosis and support visual rehabilitation. During follow-up, a progressive improvement in visual acuity and a reduction in corneal leucoma were observed. This case highlights the potential of losartan as a therapeutic alternative for managing corneal opacities secondary to inflammatory or infectious processes. Its antifibrotic effect is associated with its ability to penetrate the corneal stroma, modulate fibroblast activity, and inhibit scar tissue formation. In the absence of specific treatments for corneal fibrosis, losartan represents a promising option with relevant clinical implications for preventing vision loss and improving patients' quality of life.
SMACH (Stellate Multiform Amelanotic Choroidopathy) is a rare entity that should be considered for differential diagnosis of choroidal lesions with subretinal fluid, particularly in young patients. We present the case of...SMACH (Stellate Multiform Amelanotic Choroidopathy) is a rare entity that should be considered for differential diagnosis of choroidal lesions with subretinal fluid, particularly in young patients. We present the case of a 15-year-old male with a yellow-orange choroidal lesion in the right eye, initially misinterpreted as an infection process due to the presence of a cutaneous erythema and environmental exposure. Multimodal imaging - including OCT, en-face OCT, and ICG - was essential in identifying the hallmark features of SMACH: dendriform projections, choroidal hyperreflectivity in absence of pachyvessels or deep vascular alteration, and a stellate hypofluorescent pattern. The self-limited nature of the subretinal fluid and the absence of inflammatory signs supported the diagnosis. Recognizing SMACH avoided unnecessary treatments such as anti-VEGF therapy or corticosteroids. This is Spain's first case, it underscores the importance of early diagnosis through multimodal imaging to prevent overtreatment and to improve both visual and emotional outcomes for the patient.
Rojas-Arellanes CO, de la Rosa-Jaime E, Monteon-Aspeitia X
… +7 more, Campos-Nuñez AP, Hernández-Ramírez VT, Flores-Heranandez I, Rodriguez-Ortega HA, Guzmán-Díaz JM, González-Ojeda A, Fuentes-Orozco C
BACKGROUND AND OBJECTIVE: Although uncommon, ocular neoplasms represent a significant cause of visual morbidity and, in some cases, mortality. In advanced stages, management may require mutilating procedures such as enuc...BACKGROUND AND OBJECTIVE: Although uncommon, ocular neoplasms represent a significant cause of visual morbidity and, in some cases, mortality. In advanced stages, management may require mutilating procedures such as enucleation or exenteration. Clinical, epidemiological, and histopathological characterization of these cases improves diagnostic suspicion and guides therapeutic decision-making. The objective of this study was to analyze the epidemiological, clinical, and histopathological profile of patients who underwent enucleation or evisceration due to suspected ocular neoplasia at a tertiary care hospital in Mexico. MATERIALS AND METHODS: Observational, descriptive, cross-sectional, and retrospective study. Patients with suspected ocular neoplasms who underwent enucleation or exenteration were included. Clinical, demographic, and histopathological variables were collected. Descriptive statistical analysis was performed. RESULTS: A total of 43 patients were included; 31 (72.1%) underwent enucleation and 12 (27.9%) underwent exenteration. The right eye was affected in 58.1% of cases. The mean age was 2 ± 2 years in the pediatric group (n = 21) and 63.4 years in the adult group (n = 22). The most frequent histopathological diagnosis was retinoblastoma (48.8%), followed by melanoma (23.3%) and squamous cell carcinoma (9.3%). Clinical and histopathological diagnostic concordance was observed in 90.7% of cases. The optic nerve was the most commonly infiltrated structure in retinoblastoma, while scleral infiltration predominated in melanoma. CONCLUSION: The age distribution and tumor types observed are consistent with those reported in the international literature. The high clinicopathological concordance highlights the importance of clinical judgment in managing these entities. Histopathological analysis is essential for prognostication and the development of early diagnostic strategies.
This case highlights the significance of ocular manifestations in systemic diseases and their diagnostic implications. The patient is a male of African descent who presented to the emergency department with a sudden, pai...This case highlights the significance of ocular manifestations in systemic diseases and their diagnostic implications. The patient is a male of African descent who presented to the emergency department with a sudden, painless decrease in visual acuity in the right eye (OD). He also reported a possible history of congenital anemia that had never been previously diagnosed or managed. Fundoscopic examination revealed a grade ++ vitreous hemorrhage in the right eye, along with areas of peripheral neovascularization located between zones M11-M8 and M2-M3, associated with both temporal and nasal retinal neovascularization, as well as temporal peripheral traction in the left eye (OS). These findings were suggestive of "sea fan" retinopathy, likely related to sickle cell anemia. This diagnostic impression was confirmed by the Internal Medicine and Hematology departments, who based on paraclinical findings initiated hydroxyurea treatment.
Orbital fractures are a common cause of facial trauma and may lead to significant functional impairments. Titanium mesh implants are frequently used in orbital reconstruction; however, complications can arise if improper...Orbital fractures are a common cause of facial trauma and may lead to significant functional impairments. Titanium mesh implants are frequently used in orbital reconstruction; however, complications can arise if improperly placed. We report the case of a 40-year-old woman who sustained cranioencephalic trauma in a traffic accident, resulting in fractures of the orbital floor and medial wall. She underwent early maxillofacial surgery without prior ophthalmologic evaluation, and a titanium mesh was implanted. Postoperatively, she developed sudden vision loss. A second surgery replaced the implant with smaller plates, but no improvement occurred. Imaging revealed persistent compression of the optic nerve and extraocular muscles. Surgical removal of the implants and orbital decompression, along with corticosteroid therapy, led to gradual visual recovery, reaching 20/40 best-corrected acuity and restoration of the central visual field. This case underscores the need for timely diagnosis and multidisciplinary management in orbital trauma to prevent permanent visual sequelae.
BACKGROUND AND OBJECTIVE: Obstructive sleep apnea (OSA) is common in the general population and is associated with major cardiovascular consequences and impaired quality of life. The absence of light perception in patien...BACKGROUND AND OBJECTIVE: Obstructive sleep apnea (OSA) is common in the general population and is associated with major cardiovascular consequences and impaired quality of life. The absence of light perception in patients with total bilateral blindness (TBB) promotes circadian desynchronization, which may increase the risk of OSA. The aim of this study was to assess the prevalence of OSA and other sleep-disordered breathing conditions in patients with TBB. PATIENTS AND METHODS: This was a prospective observational study conducted over a 10-year period, including 19 patients with TBB of various etiologies. Clinical interviews, validated questionnaires (STOP-BANG, ESS), and in-laboratory overnight polysomnography were performed. RESULTS: Moderate to severe OSA was present in 63.2% (12/19) of patients, with a predominance among males. Significant alterations in sleep architecture were observed, along with a high frequency of circadian desynchronization (non-24-h sleep-wake disorder). CONCLUSIONS: Patients with TBB show a significantly higher prevalence of OSA compared with the general population, probably related to circadian desynchronization secondary to the absence of light perception. These findings support the need for systematic screening for sleep-disordered breathing in this population, given its impact on quality of life and cardiovascular risk.
BACKGROUND AND OBJECTIVE: Plasmacytomas are localized collections of monoclonal plasma cells. PATIENT AND METHOD: This is a 48-year-old female patient of mixed race, with no significant medical history, with a soft, pain...BACKGROUND AND OBJECTIVE: Plasmacytomas are localized collections of monoclonal plasma cells. PATIENT AND METHOD: This is a 48-year-old female patient of mixed race, with no significant medical history, with a soft, painless tumor adhered to the sclera, in the bulbar conjunctiva and inferior temporal fornix. The method used was the presentation of a clinical case. RESULTS: The tumor was excised with pathological analysis and immunohistochemical study confirming the diagnosis of conjunctival plasmacytoma. Postoperative follow-up was uneventful. CONCLUSIONS: Extraosseous plasma cell tumors located in the eye are rare and difficult to diagnose because they present a wide range of clinical differentiation.
To present a case of a 20-year-old female who underwent a novel surgical technique for post-traumatic aphakia, aniridia, and astigmatism. Prior to surgery, the artificial iris (AI) (Customflex Artificial Iris, HumanOptic...To present a case of a 20-year-old female who underwent a novel surgical technique for post-traumatic aphakia, aniridia, and astigmatism. Prior to surgery, the artificial iris (AI) (Customflex Artificial Iris, HumanOptics) was sutured to a toric intraocular lens (IOL) (Carlevale, Soleko), folded, and then implanted in the sulcus through a small corneal incision. The procedure was complication-free and resulted in favorable functional and cosmetic outcomes. The Carlevale IOL provides stable support for the AI, effectively addressing post-traumatic aphakia, aniridia, and astigmatism. This technique ensures excellent centration, six-point fixation in the sulcus, and improved visual and aesthetic results.
INTRODUCTION AND OBJECTIVES: Congenital cataract (CC) is a pediatric eye condition that causes low vision and blindness. Despite the possible surgical treatment to avoid disability, it produces a fifth of the world's bli...INTRODUCTION AND OBJECTIVES: Congenital cataract (CC) is a pediatric eye condition that causes low vision and blindness. Despite the possible surgical treatment to avoid disability, it produces a fifth of the world's blind children. Visual Evoked Cortical Potentials (VEP) is an essential procedure for clinical practice to evaluate the visual pathway and cortex; however, there are no reports of VEP in CC cases. OBJECTIVE: To explore visual function in CC cases treated by surgical removal and lens implantation older than four months of age and their effect on their postoperative development. MATERIALS AND METHODS: Prospective longitudinal study of 53 CC cases. VEP were done under standard techniques, exploring mono and binocular responses, obtaining waves N1, P1 y N2, and the amplitude of P1. The possible impact on child development was evaluated using Gesell scales. RESULTS: All CC cases, except 6 with associated morbidities, had VEP responses. Before 12 months, they had moderate delays but followed the expected ontogenic reductions during postoperative periods. CC cases with more significant initial alteration obtained higher development quotients. CONCLUSIONS: CC cases had VEP responses and had postoperative reductions according to age. Their preoperative developmental delays improved on postoperative period. VEP is useful for assessing the effect of surgery on child development. Although cases were diagnosed and treated late, considering the positive impact in cases younger than 12 months demonstrated that the recovery critical period window is remarkably more extended than the accepted on academic reports. These findings could modify the surgical criterion for treating CC cases, especially in less developed countries.
A rare case of ciliary body melanoma (CBM) with subconjunctival extension following prior trabeculectomy is presented. The 66-year-old female patient experienced recurrent ocular discomfort and subconjunctival pigmentati...A rare case of ciliary body melanoma (CBM) with subconjunctival extension following prior trabeculectomy is presented. The 66-year-old female patient experienced recurrent ocular discomfort and subconjunctival pigmentation in the left eye. Clinical evaluation identified a pigmented subconjunctival mass, secondary glaucoma, and evidence of previous filtration surgery. Imaging and histopathology confirmed CBM with extraocular extension, and the patient subsequently underwent enucleation; the postoperative recovery was uneventful. This case underscores the importance of considering intraocular tumors such as CBM in patients presenting with unilateral secondary glaucoma, especially prior to filtration surgery. Surgical manipulation in undiagnosed CBM may facilitate tumor dissemination beyond the eye, emphasizing the necessity of comprehensive preoperative evaluation.