INTRODUCTION AND OBJECTIVES: Photic maculopathy is a retinal condition caused by exposure to intense light sources, resulting in varying degrees of visual impairment. Optical coherence tomography angiography (OCT-A) offe...INTRODUCTION AND OBJECTIVES: Photic maculopathy is a retinal condition caused by exposure to intense light sources, resulting in varying degrees of visual impairment. Optical coherence tomography angiography (OCT-A) offers high-resolution, non-invasive imaging of the retinal microvasculature, facilitating detailed assessment of vascular alterations linked to this pathology. This study aims to characterize the OCT-A features of photic maculopathy and to emphasize the utility of OCT-A in evaluating retinal damage and microvascular changes. MATERIALS AND METHODS: This retrospective descriptive study included patients diagnosed with PM between September 2021 and September 2023. Inclusion required a history of intense or prolonged light exposure temporally related to visual symptoms, characteristic fundus and clinical findings, and multimodal imaging confirming focal outer retinal damage at the fovea. Patients with alternative diagnoses, poor-quality imaging, or incomplete records were excluded. Clinical evaluation included structural optical coherence tomography (OCT), OCT-A, fluorescein angiography, and visual function tests. Demographic and ophthalmic data were collected, and a literature review was conducted to support interpretation. RESULTS: Eight eyes from six patients were analyzed: two bilateral cases of solar maculopathy, one unilateral welder's maculopathy, and three unilateral laser-induced maculopathies. All patients presented with reduced visual acuity. Fundus examination revealed a yellowish foveal lesion in seven eyes and retinal pigment epithelium changes in one. OCT showed consistent disruption of the outer retinal layers. OCT-A demonstrated an irregular foveal avascular zone in six eyes and reduced vessel density in the superficial capillary plexus in four eyes. CONCLUSIONS: OCT-A plays a critical role in detecting structural retinal damage and associated microvascular alterations, offering key insights into the underlying pathophysiology. This study emphasizes the added value of OCT-A in assessing retinal integrity and vascular changes, which may enhance diagnostic accuracy and guide the clinical management of photic maculopathy.
BACKGROUND AND OBJECTIVE: Telemedicine allows for shorter diagnostic times and is cost-effective. One of the most widely used instant messaging applications in our field is WhatsApp™. We analyze the use of this applicati...BACKGROUND AND OBJECTIVE: Telemedicine allows for shorter diagnostic times and is cost-effective. One of the most widely used instant messaging applications in our field is WhatsApp™. We analyze the use of this application in our specialty, to determine whether it is useful for everyday use in our clinical practice. MATERIAL AND METHODS: All teleconsultations from 2024 carried out through this application to the same mobile phone were collected. The origin, the reason for consultation and the most frequent diagnoses, as well as the characteristics of the applicants, were analyzed. RESULTS: Of the 206 teleconsultations, 65% became from the patient himself. The average age of the applicants was 42.66, with 38% being men. 81% were seeking a diagnosis, whose most frequent pathologies were conjunctivitis and ametropias. WhatsApp™ allows for fast and effective communication, although they are young patients due to a probable digital divide. In our experience, it has allowed us to avoid face-to-face consultations (77%) and, more importantly, to bring forward some potentially serious ones quickly. CONCLUSIONS: It is a cost-effective, fast tool that adds advantages to our daily clinical practice.
BACKGROUND AND OBJECTIVE: The changes of ocular biometric parameters with age have significant clinical implications for intraocular lens (IOL) power calculation and surgical planning. However, few large-sample studies h...BACKGROUND AND OBJECTIVE: The changes of ocular biometric parameters with age have significant clinical implications for intraocular lens (IOL) power calculation and surgical planning. However, few large-sample studies have analyzed this variability in Mediterranean populations with cataract. The objective of the present study is to analyze the biometric characteristics of a large sample with a complete age representation MATERIAL AND METHODS: Retrospective observational study including 5,716 eyes. Axial length (AL), corneal radii (R1 and R2), anterior chamber depth (ACD), central corneal thickness (CCT), white-to-white diameter (WTW), and lens thickness (LT) were analyzed. Linear and polynomial regression models were applied to assess their relationship with age. Adjustments for sex were performed using multiple regression. RESULTS: AL and ACD decreased significantly with age (p < 0.001), while LT increased exponentially from the sixth decade onwards (p < 0.001). No relevant changes were observed in CCT or WTW. Males presented greater AL, ACD, and WTW than females (p < 0.001). Variability increased in older age groups. CONCLUSIONS: This study provides detailed and population-specific reference values for the Mediterranean population with cataract. Identifying morphometric patterns associated with ocular aging enables optimized IOL calculation and risk anticipation in elderly patients.
BACKGROUND AND OBJECTIVE: Levator aponeurosis advancement is a technique used to treat aponeurotic ptosis, which can be performed via anterior (transcutaneous) or posterior (transconjunctival) approach, each with specifi...BACKGROUND AND OBJECTIVE: Levator aponeurosis advancement is a technique used to treat aponeurotic ptosis, which can be performed via anterior (transcutaneous) or posterior (transconjunctival) approach, each with specific advantages. This study aims to evaluate and compare pre- and postoperative eyelid aperture outcomes for both techniques and analyze the rate of over- and undercorrections, contributing to a better understanding of their efficacy and limitations. MATERIALS AND METHODS: We conducted a retrospective study on 62 eyelids with aponeurotic ptosis and good levator function. A total of 32 anterior and 30 posterior approaches were performed, assessing marginal reflex distance 1 (MRD1), eyelid aperture (EA), and their pre- and postoperative variations, along with the rate of over- and undercorrections relative to ideal values. RESULTS: MRD1: Preoperative values for the anterior approach were 1.59 ± 1.08 mm, and 0.85 ± 1.00 mm for the posterior approach. Improvements were 2.08 ± 1.59 mm for the anterior approach and 2.13 ± 1.32 mm for the posterior one (p > 0.05). EA: Improvements were 2.03 ± 2.15 mm for the anterior approach and 2.50 ± 1.66 mm for the posterior one (p > 0.05). Ideal MRD1 correction (4 mm) was achieved in 31.3% of anterior cases vs 20.0% of posterior cases (p ≈ 0.05). Ideal EA correction (10 mm) was achieved in 18.8% of anterior cases vs 3.3% of posterior cases (p < 0.05). CONCLUSIONS: Both approaches are effective, but the anterior approach demonstrates higher rates of ideal corrections and fewer undercorrections. The posterior approach was used in lower preoperative MRD1 cases, which may have influenced the results. Selection should be based on the patient's specific characteristics and needs.
Although keratoplasties are key surgical procedures for treating corneal diseases, they may present late complications such as retrocorneal membranes. We present an unusual case following a penetrating keratoplasty (PKP)...Although keratoplasties are key surgical procedures for treating corneal diseases, they may present late complications such as retrocorneal membranes. We present an unusual case following a penetrating keratoplasty (PKP) in a patient with a history of DMEK. This is the case of an 85-year-old woman with a past medical history of DMEK and 2 PKPs due to previous graft failures, who developed a retrocorneal membrane 6 months after the last PKP. A membranectomy was performed. Histological analysis confirmed the presence of retained Descemet's membrane and decreased endothelial cell density. Visual acuity remained stable (0.4-0.63) with no signs of edema. No recurrence was observed. Late retention of Descemet's membrane may result from incomplete descemetorhexis, among other causes. Although asymptomatic, it may require surgery. Close postoperative follow-up is essential.
We document the clinical ocular presentation of methylmalonic acidemia (MMA) with a mutase defect, specifically the MUT N219Y variant, in a 27-year-old female who presented with sudden bilateral visual acuity deteriorati...We document the clinical ocular presentation of methylmalonic acidemia (MMA) with a mutase defect, specifically the MUT N219Y variant, in a 27-year-old female who presented with sudden bilateral visual acuity deterioration. The ophthalmologic workup included visual acuity testing, biomicroscopic and fundus examinations, macular spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence, multicolor imaging, retinal nerve fiber layer analysis, kinetic and static visual field testing, and head magnetic resonance imaging. The patient demonstrated bilateral visual acuity loss, more severe in the left eye. SD-OCT of the macula and optic nerve appeared normal, yet static visual field testing showed elevated central threshold values bilaterally, and kinetic testing revealed bilateral constriction. MRI of the head revealed bilateral focal signal abnormalities of the optic nerves, with left-sided predominance. This case represents the first detailed ophthalmologic description in a patient with MMA carrying the MUT N219Y variant.
This study explores the interconnections between various publications and authors, identifies distinct research domains concerning light's role in myopia control, and pinpoints the most referenced study within citation n...This study explores the interconnections between various publications and authors, identifies distinct research domains concerning light's role in myopia control, and pinpoints the most referenced study within citation networks. A systematic literature search was conducted in the Web of Science database using the keywords "(Myopia OR 'Refractive error') AND (Control OR Treatment OR Therapy OR Management) AND (Light OR Ultraviolet OR Solar OR Outdoors)" covering the period from 1990 to December 2024. Citation Network Explorer, VOSviewer, and CiteSpace were used to analyze the publications. A total of 1,468 publications and 5,473 citation networks were identified, with the highest publication volume in 2023 (153 papers). The most cited article, by He et al. in JAMA 2015, focused on the effect of outdoor time on myopia development among children, receiving 588 citations. The analysis clustered the findings into five key research areas: dopamine's role, outdoor exposure time, red light therapy, scleral cross-linking efficacy, and intrastromal cross-linking benefits. Overall, the citation network provides a comprehensive assessment of significant studies on sunlight and monochromatic light in myopia prevention and management, emphasizing the importance of preventing axial eye growth.
OBJECTIVE: The main objective of this study is to develop a tool capable of synthesizing images of the ganglion cell layer (GCL) that simulate glaucoma progression using generative antagonistic networks (GANs). MATERIAL...OBJECTIVE: The main objective of this study is to develop a tool capable of synthesizing images of the ganglion cell layer (GCL) that simulate glaucoma progression using generative antagonistic networks (GANs). MATERIAL AND METHODS: The dataset includes 406 GCL images of 76 eyes with glaucoma and progression, recorded by a spectral domain optical coherence tomograph (OCT). The Pix2Pix model, a conditional antagonistic generative network, was used to transform the current GCL images into images representing glaucoma progression. A total of 70% of the samples were used for training and 30% for model testing. The structural similarity coefficient was used to analyze the similarity between the real and generated images, and finally, an expert's opinion was used to assess the originality of the generated images. RESULTS: The synthesized images successfully replicate glaucoma lesion patterns, with good generalizability and reproducibility. The results show a mean structural similarity between 0.76 and 0.78 in the different tests. The test with the expert obtained an accuracy of 57% in distinguishing between real and generated images. CONCLUSIONS: The system developed can generate synthetic images of the GCL with a high similarity to the real ones, demonstrating the effectiveness of the model in synthesizing images that represent the evolution of glaucoma.
Although vitamin A deficiency is a rare cause of nyctalopia, its detection is crucial since vitamin A supplementation can improve vision. This is the case of a 69-year-old woman with progressive night blindness, a past m...Although vitamin A deficiency is a rare cause of nyctalopia, its detection is crucial since vitamin A supplementation can improve vision. This is the case of a 69-year-old woman with progressive night blindness, a past medical history of intestinal surgery, and low vitamin A levels. After vitamin A treatment, her visual acuity improved, along with an increase in macular thickness. Vitamin A is essential for photoreceptor function, and its deficiency is associated with conditions such as xerophthalmia and keratopathy. OCT proved useful in monitoring treatment response. It is important to suspect hypovitaminosis A in patients with risk factors such as bariatric surgery or malabsorption, as its correction can enhance both retinal structure and visual function.
This is the case of a necrotizing retinitis associated with occlusive retinal vasculitis due to cytomegalovirus (CMV) in an immunocompetent patient with complex diagnosis and management, but with resolution after the sta...This is the case of a necrotizing retinitis associated with occlusive retinal vasculitis due to cytomegalovirus (CMV) in an immunocompetent patient with complex diagnosis and management, but with resolution after the start of appropriate antiviral therapy, with subsequent control of intraocular inflammation and visual recovery. CMV was confirmed as the pathogen using the polymerase chain reaction (PCR) assay of aqueous humor samples.
This work aims to present a novel technique for obtaining grafts for Descemet Membrane Endothelial Keratoplasty (DMEK) safely and efficiently, thanks to its fast learning curve and reduced risk of graft tears. The techni...This work aims to present a novel technique for obtaining grafts for Descemet Membrane Endothelial Keratoplasty (DMEK) safely and efficiently, thanks to its fast learning curve and reduced risk of graft tears. The technique involves the peripheral dissection of the endothelium starting with a superficial incision made using a 30-Gauge needle, 1 mm inside Schwalbe's line across 360º of the corneal periphery. Trypan Blue is then applied to visualize the dissection boundary, and a DMEK Sinskey hook is used to lift 1 mm of the peripheral graft along the entire circumference. The technique continues with the separation of Descemet's membrane from the stroma, as is commonly performed. This technique reduces costs by employing a standard needle and achieves low failure rates compared to other techniques.
INTRODUCTION AND OBJECTIVES: The aim of this study was to assess the precision of a web-based tool in measuring color vision in ophthalmic patients, comparing it to the traditional in-clinic evaluation using the Ishihara...INTRODUCTION AND OBJECTIVES: The aim of this study was to assess the precision of a web-based tool in measuring color vision in ophthalmic patients, comparing it to the traditional in-clinic evaluation using the Ishihara test, the most used test in clinical context. MATERIALS AND METHODS: We conducted a prospective validation comparing the Eyecare Colour Vision Test® to the standard Ishihara test, with patients undergoing both tests sequentially. Patients wore their standard spectacles as needed for both tests. Inclusion criteria involved individuals above 18 years with visual acuity equal to or better than + 1 logMAR (20/200) in each eye. Visual acuity measurements were converted from Snellen to LogMAR, and statistical analyses included Bland-Altman and descriptive statistics. RESULTS: The study, encompassing 330 patients, compared Eyecare Color Vision Test® to conventional Ishihara test, the score for correct responses by the Eyecare Color Vision Test® was 4073 as compared to 4081 by Ishihara standard test- a concordance rate of 87,88%. Sensitivity of 96.43% (CI 95%, 81.65% to 99.91%), and specificity of 99.34% (CI 95%, 97.63% to 99.92%) for the diagnosis of color vision deficiency. CONCLUSION: The Eyecare Color Vision Test® demonstrates accuracy and reliability, with the potential to facilitate remote CVD diagnosis.
Nivolumab and ipilimumab are immune checkpoint inhibitors widely used for the treatment of metastatic melanoma. They can cause various adverse effects in a significant percentage of treated patients, including uveitis. S...Nivolumab and ipilimumab are immune checkpoint inhibitors widely used for the treatment of metastatic melanoma. They can cause various adverse effects in a significant percentage of treated patients, including uveitis. Symptoms include decreased visual acuity, pain, redness, and photophobia, which typically resolve with appropriate anti-inflammatory therapy. The aim of this work is to report a case of uveitis in a patient on ipilimumab and nivolumab for the treatment of metastatic melanoma, as well as the response to therapy with difluprednate.
Congenital simple hamartoma of the retinal pigment epithelium is a rare, benign retinal lesion, rarely seen bilaterally. This case shows a 46-year-old man initially misdiagnosed with macular dystrophy, whose vision progr...Congenital simple hamartoma of the retinal pigment epithelium is a rare, benign retinal lesion, rarely seen bilaterally. This case shows a 46-year-old man initially misdiagnosed with macular dystrophy, whose vision progressively declined over several years due to concomitant cataracts. Multimodal imaging, including OCT, was key in differentiating from more serious conditions such as choroidal melanoma. With no growth or secondary complications, the lesion remains under regular monitoring. This case underscores the importance of imaging in distinguishing CSHRPE from other chorioretinal disorders.